Not unlike the heated conversation that’s been happening around the nation, there was quite a bit of debate generated in response to a health care reform story posted earlier today.

The story was a question-and-answer about the potential local impacts that proposed health care legislation could have with Congressman John Dingell, D-Dearborn.

I emailed Dingell with some questions I’d received both on our Web site and in my email inbox. Here is a look at your questions and his replies from the email exchange.

Q: “Why isn’t tort reform being considered to reduce costs?”

A: “Tort reform and medical malpractice are issues that many care about. President Obama even brought it up during his speech to the American Medical Association earlier this summer. The Energy and Commerce Committee passed an amendment offered by Congressman Bart Gordon of Tennessee dealing with medical malpractice reform. The Gordon Amendment establishes a voluntary state grant program that allows states to institute either "certificate of merit" and/or "early offer" medical malpractice programs in lieu of traditional medical malpractice litigation. States would be able to design their own certificate of merit/early offer programs.”

Q: “Why aren’t changes in legislation that would use market forces, such as allowing insurers to sell across state lines and increasing competition in premiums, being considered?”

A: “The purpose of the new Health Exchange is to use market forces to increase competition in the health insurance industry. This new marketplace will force insurers to compete on the basis of price and quality. Individuals will be able to clearly shop among a wide range of options to find the best fit for themselves and their families.

In this new market, insurers will no longer be able to game the system by denying coverage to people with pre-existing conditions, charging the sick and elderly exorbitantly high premiums, or canceling a person’s policy when he or she finds out they are sick. Insurance companies are making money by denying coverage, not good service.”

Q: “Won’t any “efficiencies” or “cost savings” actually come out of hospital/health care providers pocketbooks or ultimately harm care? I’ve also heard much concern regarding long waits for health service due to rationing and comparisons to problems in Canada’s health care system? Can you address those concerns?”

A: “There is rationing now. There will be no rationing under this bill. The costs savings and efficiencies will not harm care. In fact, these measures to reduce waste will actually incentivize higher quality care.

For example, hospitals will have a financial incentive to reduce unnecessary readmissions that drive up the cost of the entire system. A patient’s multiple doctors will be encouraged to talk to each other and work together in Accountable Care Organizations and Medical Homes to make sure that care is comprehensive and not duplicative. Additional cost savings come from cracking down on waste, fraud and abuse, which add no value whatsoever to a patients care, but greatly increase the costs of health care for all of us. The health care bill places a higher priority on preventive care.

It eliminates cost-sharing for preventive care to underscore the importance of preventive health services in making America healthier and lowering the growth of health care costs over time. The overall goal of achieving near universal health care coverage will also significantly reduce health care costs. When individuals have regular access to health care providers they avoid routine emergency room care, which adds $1,000 a year to each American family’s health care bills.

This health care bill is in no way based on the Canadian health care system. Instead, we have offered a uniquely American solution that builds on the employer-sponsored, and the private insurance industry. Health care reform will not lead to long lines and rationing. None of the proposals would stand in between an individual and his or her doctor. I believe those patient and doctor decisions are sacred, and will make sure they stay that way. Again, I would like to point out that we already have rationed care in this country. Care is rationed for those 47 million people who have no insurance, and the millions more who have insurance but find the costs of health care spiraling out of control. Care is rationed due to high costs, and if we fail to act, more and more people will have to forgo necessary health care.”

Q: “I received several emails that reflect much disbelief about the claim that 92 percent of people won’t face a tax increase because of this legislation. Can you address that concern?”

A: “The nonpartisan Joint Committee on Taxation has estimated that the health care surcharge would only apply to the top 1.2% of all households in the United States. The health care surcharge would have no effect on 98.8% of all households in the United States. The health care surcharge only applies to income earned in excess of $350,000.

If the health reforms included in the bill achieve projected cost savings, families making between $350,000 and $1,000,000 will need to contribute less than 1% of their annual income to help provide access to affordable health care for all Americans.

• A family making $350,000 would not owe any surcharge at all.

• A family making $400,000 would contribute $500 to help provide access to affordable health care for all Americans - 0.13% of their annual income.

• A family making $500,000 would contribute $1,500 to help provide access to affordable health care for all Americans - 0.3% of their annual income.

• A family making $1,000,000 would contribute $9,000 to help provide access to affordable health care for all Americans - 0.9% of their annual income.

Q: “Would you yourself be willing to forego your current health plan for the one your are proposing?”

A: “Members of Congress will be treated exactly the same as every one else under this bill. Nothing in the legislation exempts the Federal Employee Health Benefits plan (the plan members of Congress and staff enroll in) from the reforms.

By the end of 2018, all employer-sponsored health insurance plans will have to meet at least the same basic minimum standards of coverage as those insurance plans as offered through the exchange. These minimum standards include coverage for preventative care, inpatient and outpatient hospital services, maternity care, and mental health services, among others. The FEHB will also have to follow these rules.

People who work for medium and large employers will not be able to purchase insurance through the new National Health Exchange in the immediate years. When the time comes that these individuals can buy into the Exchange, I plan to do exactly what every other American will do, and that is exercise my choice. It is my belief that the policies offered will be very high quality and so, I just may purchase through the Exchange. “

Q: “What do you think of the number of people who are showing up to the town hall meetings and very loudly protesting this legislation? How does this reflect what you are also hearing from constituents in your office?”

A: “This is a major piece of legislation and deserves a lot of input from the American public. We are hearing from a lot of people who are concerned about health care reform will effect themselves and their families.

It is completely fair for them to ask questions and raise their concerns and I pledge to continue listening and answering them. I would be remiss, however, I didn’t mention that we are also getting a lot of calls and visitors who support this bill.”

Tina Reed can be reached at tinareed@annarbor.com or follow her on Twitter @treedinaa.