Charles: What does President Obama need to do to win over greater public support, particularly from the elderly?

Barbara Stanton: While AARP hasn't endorsed any of the bills, it is critical — especially based on an important poll released jointly with AARP, AMA, and the ANA — that any solution ensures that people can see the health professional they want, when they want — particularly for people on Medicare. The poll I'm referring to shows that about half of people more than 50 years old are concerned that there won't be enough nurses or doctors to provide care in the future, and two-thirds of those polled are either very or somewhat concerned that the current system limits their ability to see the doctor of their choice.

Marv Paularena: Do you see any indication of tort reform coming any time soon?

Barbara Stanton: AARP believes that as part of health care reform, we must improve the way the health care system treats doctors — doctors who treat Medicare patients must be paid fairly and we must stop valuing doctors for how many patients they treat and start rewarding them for providing good care.

We recognize that doctors are being driven out of business in some parts of the country — especially the Neighbor Islands — because their practice costs are too high, including malpractice liability insurance. However, malpractice premiums are just one small part of the growing cost of health care. The Senate Finance bill was just announced and I haven't seen it yet, but none of the other proposals by Congress address tort reform.

Al Beeman: Would a compromise state-level single-payer option be OK? I am afraid it would mean that my health insurance would not be very portable. Also that you would not get the same level of savings as a national single-payer option.

Barbara Stanton: AARP is fighting for health care reform that will guarantee all Americans a choice of dependable, affordable health insurance plans and preserve their choice of doctors.

If we were starting from scratch, a single-payer approach built using Medicare — a program that's currently providing health security for 44 million people — as a model could be something to consider. The fact is, we're starting from a long history of employer-based coverage.

Regarding portability, we need to make sure that if you or your spouse loses his or her job or has to change jobs, you will have the peace of mind that comes in knowing you have affordable health care choices.

Mary: Why are people concerned about a public option when we already have Medicare and it seems to work so well?

Barbara Stanton: Since 1965 Medicare has provided our nation's seniors with much-needed health care. But Medicare needs to be strengthened and improved and health care reform will do that. For people in Medicare, health care reform is about protecting your choice of doctor, keeping your premiums fair, holding down your health care and prescription drug costs, eliminating waste, fraud and abuse, and improving the care you receive.

Among our highest priorities is the need to close the Part D coverage gap, or "doughnut hole," where beneficiaries are responsible for all of their prescription drug costs and their premiums. In Hawai'i, the share of Part D enrollees caught in the doughnut hole reached 36 percent, or 33,000 people, in 2007. This is the highest percentage in the country.

Whether accomplished through a choice of affordable private plans, a public option, or an alternative mechanism like a cooperative, the real issue is how to ensure affordable, quality health coverage for all Americans.

Ruby Silva: How would 50-plus people who have been laid off or had work hours cut back get health insurance?

Barbara Stanton: This is exactly why health care reform is needed.

One of AARP's top priorities for reform is to end discrimination by insurance companies that deny people coverage because of pre-existing conditions or use age to price people age 50-64 out of affordable, quality health insurance.

This is a critical issue in Hawai'i, where nearly 11 percent of residents age 50-64 were uninsured —and that was before the current economic recession. With the layoffs Hawai'i has experienced over the last 18 months, things have gotten even more difficult for people in this age group.

This group is especially vulnerable now if they lose their employer-sponsored insurance because it tends to take longer for older workers to find comparable employment. Plus, COBRA costs are prohibitively high for many people. Health care reform will ensure that insurance companies can't charge older Americans unaffordable premiums or deny coverage because of their age and health circumstances.

Barbara Dinoff: What's AARP's response to the charge that our members of Congress avoided tough questions on health reform during the August recess?

Barbara Stanton: We held town hall meetings last week with Congressman (Neil) Abercrombie and Congresswoman (Mazie) Hirono, and there were tough questions and vigorous discussion at both of them. About 2,500 AARP members participated in a telephone town hall meeting we sponsored with both members of Congress on Sept. 1, and another 70 people attended a town hall meeting the following day with Congresswoman Hirono. These meetings gave us an opportunity to focus on the facts of health reform, detail AARP's priorities and address people's questions. We understand that other forums were held as well before other groups.

Kyle: It would seem to me that Hawai'i residents have excellent health care. Why mess with what we have? Do you feel this is truly a move for reform, or a political agenda?

Barbara Stanton: The problems of health care are serious and need to be addressed. If health care legislation is not passed this year, family premiums for employer-sponsored insurance will nearly double between now and 2016. The full cost will rise from an average of about $13,000 this year to more than $24,000 in 2016.

In terms of Medicare, if nothing is done, because of the flawed system for paying physicians, Medicare is scheduled to reduce doctors' payments by 21 percent beginning Jan. 1, 2010.

Tina: I think health care reform is necessary. I'm just wondering how or who will end up paying for everyone having health insurance.

Barbara Stanton: We're all paying now for the wastefulness in the current system. Far too many people have no viable options, particularly on our Neighbor Islands. Too many people who are uninsured use the emergency rooms instead of utilizing preventative measures.

AARP believes in responsible fiscal policy, and we recognize that any final health care reform package should reduce the skyrocketing cost of health care, which in turn should reduce the federal deficit. If we are not willing to do this now, we will be facing in the coming years an even worse problem.