Health Care Town Hall Meeting: Reflections

Make no mistake about it: The primary objection conservatives have to health care reform is the inclusion of a public option. Oh, they make noises about other parts of the proposals and continue to erroneously believe that the path to true reform lies through revoking the right to jury trials in the singular instance of malpractice suits (and yet, they trust juries to hand out the death penalty. Go figure). But conservatives at the town hall meeting saved most of their invective for the possibility of a public option.

A public option simply means the alternative of purchasing health insurance through a government entity. Premiums alone -- and not tax dollars -- would finance the entity. Experts in health care reform believe it necessary not because of the large amounts of people who would choose it -- according to Jay Inslee, the CBO estimates about 3% of Americans would choose the public option -- but to control costs and to provide a competitive alternative to private insurance So why all the ruckus? As Inslee himself said, suppose that it is more than 3%? All that means is that people want it, that they're making the choice of participating in a public option.

As near I can decipher the hoots and jeers, the objections come down to these:

• taxpayer money will eventually be needed to finance a public option, regardless of what anyone says now;
• a public option is the camel's nose in the tent, the camel being socialized medicine along the lines of the Canada, Great Britain, or (shudder) France. Sure we start off with a small public option. But like all government programs, it will grow until it subsumes the entire health care system.

To which I say, if only. We'll have single-payer health care in this country when the political will and momentum exists for it, i.e., when politicians believe that not supporting it will cost them their jobs. Right now, we don't have that. I might argue that the quickest path to single payer is to continue doing nothing: Let the problem fester until radical surgery becomes the only option. However, the human costs of that are too high, so I'll support reform with a public option. Reform without a public option makes a mockery of the word, anyway.

So take the conservative argument as it is: That a public option is the first step to single-payer. So what? If that's what the people of the United States and their elected representatives want, that's what we should have. If conservatives want to avoid all of this supposed catastrophe, all they have to do is become a majority party again. They seem to think that the best way to do that is to Just Say No, in a preferably loud and profane manner. Which leads me to think that they are full of sour grapes and pissed off because they lost and are out of power. Worse (for them), they don't even have a ball to take home.

What Democrats have to realize is that the game is theirs, that it would be nice if the other side played but in the end it doesn't make any difference because the Democrats have already won. So, let's act like it. We don't need Republicans to pass a public option, and it's clear that they won't support any reform that comes from outside of their agenda, whether or not it includes a public option. Quit courting them and get on with what needs to be done...

Just my little piece of the world argues that the public option is far from dead...

If you lived in New Orleans, this weekend you could lose your inhibitions at the Southern Decadence Festival, dance the day away at the Creole Zydeco Festival, chow down at the Louisiana Shrimp & Petroleum Festival, and party green at Project 30-90 (the intersection of sound + sustainability)...

Moments in time: Pablo Picasso poses with a new painting...

(Thanks to Collin Kelley.)

Health Care Town Hall Meeting: Q & A

Anyone who wanted to ask a question put their name into a box. Since more people wanted to ask questions than there was time to ask them -- this part of the meeting lasted for an hour -- an Inslee staff member drew names at random. I'm presenting the questions here in the order asked.

Q: Are there death panels?

A: If you want to talk with your physician about end-of-life issues, you can.

Some yelling and cursing greeted this response, but Inslee didn't back off.

Q: Are you willing to support a bill without a public option?

A: Without saying yes or no, Inslee stated that a public option was "fundamental to reform."

This amplified an earlier statement to the effect that if we were going to require insurance, a public alternative to the "tender mercies of the insurance companies" "makes sense." Inslee added that the public would be financed by premiums and not taxpayer contributions.

Q: If this is such a good program, will you be on it?

A: Members of Congress will be subject to the same rights and liabilities as anyone else.

Q: Do the self-employed get help from this bill?

A: Self-employed people are eligible for tax credits and -- if living at under 400% of the poverty line -- are entitled to a sliding scale.

Presumably, the sliding scale applies to the public option.

Q: (This question was actually a series of questions that recapitulated the standard right-wing talk points about health care. Inslee chose to address issues of privacy and tort reform.)

A: He's read the Ways and Means bill (putting a cap on shouts of "read the bill" once and for all), and the assertion that the federal government will have access to people's bank accounts is "not accurate."

He added that if you are low income and if you apply for a subsidy, the government can look at your tax return -- which it already has -- to verify that you are eligible.

Regarding tort reform, "there is nothing in the bill that would change the judicial system of the United States."

Inslee pointed out that medical damages are traditionally a matter of state jurisdiction and that states that have tried tort reform have found it ineffective. He went on to state his personal philosophical objection to removing medical malpractice suits from the jury system: He thinks a jury is better positioned than the state to determine damages on a case-by-case basis.

Note: Tort reform has proven an ineffective means of bringing down medical costs for a good reason: Malpractice damages compromise an infinitesimally low portion of total costs.

Q: How does a national data base for best practices protect the sanctity of the doctor-patient relationship?

A: The Ways & Means bill does not change privacy laws.

Inslee added that members of the committee have worked diligently to ensure this.

Snark Remark: Where was all of this conservative concern for privacy when Bush was tapping phones?

Q: Isn't a 1000-page bill too hard to manage? It "sorta feels" like a legal quagmire?

A: "We've done some pretty bold things in this country" and can handle this.

Q: Why should we trust government figures?

A: They're going by the CBO.

He understands the apprehension, given the false states that the Bush Administration made about the Iraq war. The jeers at the mention of Bush's name fell into two camps: The majority who routinely boo anything having to do with the man, and the minority who felt his name was unfairly injected into the debate. Bush remains a polarizing figure, and always will be.

Note: I find it odd that the same people who blamed Bill Clinton for everything that went wrong during the eight years of the Bush Administration now expect President Obama to have complete accountability for the hash Bush made of the economy after less than eight months in office. Does this mean that Bush was responsible for 9/11?

Q: Will a bill pass?

A: Inslee believes that the House and Senate will pass a bill that the president can sign. He is optimistic that it will include a public option.

If this meeting was representative, conservative opposition to health care reform coalesces around the public option, which they see as leading inevitably to socialized medicine. I'll address that further in my next blog entry. Meanwhile...

Why Boston backed Teddy Kennedy...

Just A Song: Death don't have no mercy in this land...

Second line to save Charity Hospital:

Health Care Town Hall Meeting

Last Sunday afternoon, I attended a health care Town Hall meeting sponsored by Rep. Jay Inslee (D-WA1). Inslee, one of the good guys, is popular in his district and was greeted with a standing ovation from about 1500 people filling a high school gymnasium. Although the crowd was largely supportive, a few signs opposing health care reform ("No Obamacare," "I Like My Health Care/Pay For Your Own") dotted the crowd. The sign that received the biggest cheer, though, was one that read "Republicans: Have You No Shame" on one side and "Health Care For People Not Profit" on the other.

Inslee began the meeting with with a recitation of the factual reasons driving health care reform:

• 47,000,000 Americans are uninsured, including
• 4,ooo,ooo since the onset of the recession
• 10,000 working families a day lose insurance
• annually, we spend $2.2 trillion (emphasis mine) on health care
• 60% of all U. S. bankruptcies are due at least in part to unpaid medical bills
• 80% of the uninsured work
• the rest of the industrialized world spends $2800 per person annually on health insurance or coverage compared to $6500 in the U.S.
• U.S. life expectancy is below that of Bosnia and Jordan
• as a per cent of the economy, health care costs have risen from 8% in 1980 to 16% today
• without reform, trends indicate that health care costs will be 35% of the economy by 2040

Inslee pointed out that this means that raises go more and more into health care spending, leaving unsaid the point that uncontrolled health costs drive down the standard of living as people and businesses put more and more of their resources into insurance. He concluded this part of the meeting by observing that "When people say we can't afford health care reform, I say we can't afford to do nothing."

Inslee then turned to the efforts currently underway in Congress. Amidst a few forlorn cries of "Read the bill!", he pointed out that five committees -- three in the House and two in the Senate -- have reported out bills while Senate committee remains in negotiations. Rather than talk about all five bills, he concentrated on the work of the Ways & Means Committee of which he is a member.

This bill proposes to finance health care reforms through a series of efficiency measures and a surcharge on the top 1% of income earners. (This would return the tax rate to pre-2000 levels.) In terms of efficiencies that could be gained, Inslee gave as an example a best practices clearinghouse used by Seattle doctors to significantly reduce Medicare costs.

Inslee's claim that much of the financing could be achieved by the elimination of "waste, fraud, and abuse" provided the first opening for the wingnuts, who jeered the claim. This struck me as odd, as it's an article of faith with these people that WF&A exists everywhere in the government (the military excepted). Apparently, it's too much of a leap for them to buy into an excess of WF&A in an industry who insurers spend 25% of their costs on administrative overhead. After all, it takes money to deny claims.

More heartening was the response to the surcharge, which was applauded without much resistance from the right. It just may be that people see through Republican charges of a massive tax increase.

Inslee next summarized the contents of the Ways and Means Committee bill:

• no one is required to change health plans (he pointed out here that if you have health insurance, you pay on average hidden tax of $1200-1300 annually for uncompensated care)
• covers 97-98%
• small business owners receive a permanent tax credit of 15% and exemption for payrolls of under $5000
• closes the Medicare Part D loophole
• bans insurers from rejecting applications and claims for reason of a pre-existing condition
• provides for a public option
• limits premiums of low income earners to 12% of income

He then took questions from the floor, which I'll review tomorrow...

Let the mystery be...