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...

Lest We Forget...

Long Black Line

Spencer Bohren

everywhere you look
everywhere you go
you read it like a book
it's the only way to know
how high the water got
august twenty-nine
that hurricane last summer
left a long black line

sometimes it's to your ankles
sometimes to your knees
sometimes it's to your chest or head
or up above the eaves
water filled with chemicals
water filled with gas
water spillin' everywhere
a city under glass
water laced with poison
god knows, of every kind
you don't want to know
what's in the long black line

you can go to church
confessin' all your sins
you can tell your brothers
'bout the shape this world is in
you could tell your sisters
judgement day is come
he's dealin' with the devil
he's thinnin' out the scum
this one it was water
fire comes next time
all of this is written
in the long black line

i will never leave this place
you hear some people say
then there's the ones
who just can't hardly wait to get away
lots of others have no choice
they're livin' in a void
their house is wrecked, their job is gone
their lives have been destroyed
the people comin' back
no tellin' what they'll find
one thing will be waitin' there
the long black line

drivin' on the highway
you go too fast to tell
but get down in the lower nine
it's like a walk through hell
out along the curb
it's everything we own
we sacrificed our every lives
to this mighty storm
beautiful new orleans
oh, she was so fine
now everywhere you go
there's just the long black line

the long black line
the long black line
the long black line
the long black line

some people say the sinners
brought it on themselves
others say the climate change
will send us all to hell
some people blame the government
they speak of genocide
there's some that don't say anything
they just want to hide
even strong men fall apart
they break down and cry
mother mary pray for us
the long black line

every single minute
every single day
you wonder are you doin' right
you wonder should i stay
'cuz everything is broken
all the lines are down
confusion walks down every street
there's rumors all around
the media is black and white
politicians whine
everything is broken
except the long black line

the long black line
the long black line
the long black line
the long black line

god help the lower nine
the long black line

Audio sample here...

Health clinic helps keep NOLA music alive. More about the New Orleans Musician's Clinic here...

Here's Spencer Bohren's rendition of "Wade In The Water":

Sunday Funnies & Arts

As always, click to enlarge...

The Listening Room:

Kickin In My Stall, Kenny Bill Stinson. Although he specifically invokes Hank Williams and Jerry Lee Lewis, it's the spirit of John Lennon that infuses this rollicking set of ten country rockers and downright, down home rockers. Stinson's guitar breaks are a joy and the equal of his songwriting, which finds its best expression in remembrances of his mother's love of music ("Rhinstones and Butterflies") and of his own musical influences ("Turn Me On Dead Man"). Available from the Louisiana Music Factory.

What Have You Done, My Brother?, Naomi Shelton and the Gospel Queens. Gospel music from so deep in Shelton's southern soul that it edges up against James Brown and Wilson Pickett. Shelton's career has taken her from the chitlin' circuit to the night clubs of New York, and this first album is long overdue. Not to be missed.

Choices, The Terence Blanchard Group. As a musical exploration of the moral choices we make, it doesn't always work (although Dr. Cornel West's excellent spoken word contributions clear things up). But as jazz? Man, you couldn't ask for more. Anchored by a brilliant rhythm section and the piano of Cuban Fabian Almazan, Blanchard's band surges forth in superbly layered compositions, but also knows when to lay back and let quiet work its eloquent magic. The musical choices are right on, from beginning to end...

Ever had a conversation like this?...

I can smell jasmine and oleander covering this evening like a wide cotton bed sheet of white class lace...

Katrina collection...

Patrick Kennedy eulogizes his father...

Sunday Gospel Hour: Naomi Shelton and the Gospel Queens sing "What Have You Done?"

Weekly Address: Lessons And Renewal Out Of The Gulf Coast

I'm glad to hear that FEMA will be operated on a professional basis and that arcane federal turf wars are being brought under control. It's great to hear that eleven cabinet members have visited the Gulf Coast and that the president plans to himself. Still, these hardly address the issues of recovery or the lack of confidence people have in their own government. The president rightly raises the latter as a critical issue, but I wonder whether he makes the connection to that and the health care reform battle.

I'm not blaming President Obama for what happened after the hurricane struck. The grossly, the inhumanly, inadequate federal response lies at the feet of President Bush. Moreover, the political moment for massive federal programs -- such as a Gulf Coast Authority -- to rebuild the Gulf Coast has probably come and gone, victim to Bush's incompetence and a failure of vision by congressional Democrats (who could have pushed hard for this after the 2006 election).

But if there were ever a crisis of confidence in government, it came after Katrina. That crisis colors the health care debate: People who know that the current system is inadequate and who despise insurance companies remain fearful of making as minimal a reform the public option because they think -- they know -- that the government will botch it just like it botched Katrina and Iraq. That we elected a new administration in response to this doesn't go far enough in these people's minds.

It's nice to know that roads and schools are being rebuilt (although they likely needed that before Katrina) and it's reassuring to hear a president talk about the importance of wetlands in a way that connects to everyday concerns. Nontheless, I would be much happier with a stronger statement the spoke to an ongoing commitment by the Administration to work to rebuild the Gulf Coast in a bipartisan fashion. We have a Car Czar, a Drug Czar, and plenty of other czars. Why not a point man or woman who can press Congress for meaningful action and keep the executive branch focused? In any event, government action in the Gulf Coast must be more public, more concentrated, and simply more...

Hurricane Katrina Deceased Victims List: Quick Stats...

Pump Tha Party on Katrina Day!...

Bearing witness: Slidell, three weeks after...

It is the glory and greatness of our [the Democratic party's] tradition to speak for those who have no voice, to remember those who are forgotten, to respond to the frustrations and fulfill the aspirations of all Americans seeking a better life in a better land.

Senator Ted Kennedy, Address to the Democratic National Convention, August 1980

The Public Option

It's been a downer week, bottoming out, of course, with the loss of Ted Kennedy. Perhaps his death will give new impetus within the Congress to health care reform, but I doubt it. Rather, one hopes that it will reenergize progressives into standing up to the bullies and demanding real reform. To this progressive, real reform is impossible without the widely misunderstood public option.

The public option is not:

• single-payer health care as in Canada
• government-supplied health care as in Great Britain
• a welfare program for those unable to afford private insurance
• (regrettably) "socialized" medicine in any way, shape, or form

The public option is an alternative to purchasing private health insurance. With a public option, people have the option of purchasing insurance from the federal government at market rates. The insurance industry opposes the public option because they are a cabal seeking to protect what amounts to a monopoly. Rather than offer competitive choice, they oppose it. A public option would threaten such insidious practices as recission, denying requests for expensive procedures, refusal to cover preexisting conditions, and outright denial of coverage.

Make no mistake about it: If you have private insurance that you have purchased yourself or are covered through a small business, you are in effect underinsured. Insurance companies think nothing of taking your money for years, then denying coverage due to technicalities (recission), on the basis of "experimental" (new) procedures, or raising rates on a small business until they are forced to drop coverage.

As Nicholas Kristof points out in today's must-read column,

The insurers are open to one kind of reform — universal coverage through mandates and subsidies, so as to give them more customers and more profits. But they don't want the reforms that will most help patients, such as a public insurance option, enforced competition and tighter regulation...

Remember the three essentials of health care reform: A public option, enforced competition, tighter regulation. When someone tells you that they are for reform but against Obamacare, ask them what reforms they support, why they are adequate, and how they achieve the goals of the three essentials...

The fourth anniversary of Hurricane Katrina...

Get out your handkerchiefs:

Friday's Choice: Paul Sanchez sings "The Foot Of Canal Street" at the New Orleans Jazz & Heritage Festival (more on this great song here):

Health Care Meanderings

(Thanks to Stone Soup Musings.)...

Congressman Jim McDermott (D-WA) scores a bulls-eye:

Somebody has to keep the insurance companies honest. They complain that they can't compete with the public option, sort of a strange response to be coming from the private sector. (Seattle Times, 8/27/09, B6)...

Is he right or is he right? After all, the private sector constantly lectures us about how much better and more efficient they are than government. They should welcome the chance to prove their point...

I'll see you there, at the foot of Canal Street...

I find myself deeply saddened by the right-wing mob tactics at the health care town halls. The people who profess to claim color-blindness and who excoriate both President Obama and Sonia Sotomayor as racists use lynch mob tactics to bully and threaten our elected representatives. Does anyone really believe that the president's race isn't a factor? That he keeps his dignity and aplomb intact is a tribute to his humanity, patience, and faith in people to ultimately do the right thing.

Congress simply cannot allow itself to be intimidated by such bullying. If they do, the whole country will lose more than health care reforms. After all, if the United States means anything, it's that the rule of law and deliberation trumps mobs and violence. We haven't always followed the better angels of our nature, but this time it is essential that we do lest we allow a violent minority to control events...