Where Is The Public Voice On Healthcare Reform?

[ Posted Thursday, June 18th, 2009 – 16:21 UTC ]

The debate in Washington over healthcare reform seems to be missing an important voice: the public. Where are the crowds of people demanding better healthcare? Where are the voices of those who have healthcare horror stories to tell? Where is the grassroots effort to define the problem adequately?

Sadly, I have no answers to those questions. I suspect, if anyone bothered to find out, the answer would be: "They're busy working at their jobs, terrified they'll be fired and lose what health insurance they've got."

So far the Washington debate over healthcare reform has been moving steadily away from the reality most Americans face. The average American has much more concrete concerns than the political gamesters on Capitol Hill seem to appreciate right now. People are concerned with things like: "Will I lose coverage if I lose my job?" and "Will my insurer drop me like a hot potato if I get really sick?" and "Why are insurance companies allowed to get between me and my doctor and dictate what treatments I receive?" or even "How will I ever be able to afford insurance, as my company doesn't offer it?"

Those questions seem to have been bulldozed in the debate inside the Beltway. Nobody, to be blunt, seems to be defining the problem in real-world terms that people can relate to. The big fight right now is over a "public plan" and what, exactly, that will mean. If you just listened to the politicians on the issue, you'd think it was a fairly contentious issue with the general public. You would be wrong. NBC and the Wall Street Journal just released a poll showing exactly the opposite. They asked [Page 25 in the PDF of the full results]:

In any healthcare proposal, how important do you feel it is to give people a choice of both a public plan administered by the federal government and a private plan for their health insurance -- extremely important, quite important, not that important, or not at all important?

A whopping 76 percent replied "extremely important" (41%) or "quite important" (35%). Only 20 percent answered "not that important" (12%) or "not at all important" (8%). This shows almost a four-to-one general approval for a public plan.

There's an even-more astounding poll out from Lake Research, which breaks down the results by party affiliation. Of the 73 percent support they found in general, 79 percent of independents supported a public plan option, 77 percent of Democrats, and (the astounding part) 63 percent of Republicans also favored the public plan. Bob Cesca has links to this poll, as well as others which show similar results.

In other words, people in red states get sick, too. Even states with Blue Dog Democrats have people that not only get sick, but also get really sick of the way they are treated by their insurance company (if they're lucky enough to have insurance, that is).

Unfortunately, Congress hasn't exactly gotten the memo. The "public option" is being ripped to death in various committees right now, by elected officials who are quite obviously out of touch with the mood of their constituents. Perhaps it's those boatloads of money the healthcare industry shovels into campaign re-election funds? Just a thought....

So where is the public's voice in all of this? President Obama has held a townhall meeting and given a speech in the last week, but he cannot win this fight alone. Where are the horror stories from average Americans splayed all over the television screen? Where is the spirit of public theater? Where, for that matter, is Michael Moore (who knows a thing or two about public theater, and about the healthcare debate)?

Horror stories aren't that hard to find. The Bob Cesca piece I cited earlier is titled: "'My Face Was Ripped Off' and Other Arguments for a Public Option," and spotlights a dandy example -- the story of a woman who had her face ripped off by a bear, and then had to fight her insurance company to pay for her medical care.

These stories are quite common (although not all involve spectacular details like getting mauled by a bear). There are, literally, millions of these stories out there. So why are they not being heard from? Where is their place at the table?

The American Journal of Medicine published a study recently which shows the scope of the problem Americans face [PDF version of the entire study]. From the first page of this study:

Using a conservative definition, 62.1% of all bankruptcies in 2007 were medical; 92% of these medical debtors had medical debts over $5000, or 10% of pretax family income. The rest met criteria for medical bankruptcy because they had lost significant income due to illness or mortgaged a home to pay medical bills. Most medical debtors were well educated, owned homes, and had middle-class occupations. Three quarters had health insurance. Using identical definitions in 2001 and 2007, the share of bankruptcies attributable to medical problems rose by 49.6%.

. . .

As recently as 1981, only 8% of families filing for bankruptcy did so in the aftermath of a serious medical problem. By contrast, our 2001 study in 5 states found that illness or medical bills contributed to about half of bankruptcies. Since then, the number of un- and underinsured Americans has grown; health costs have increased; and Congress tightened the bankruptcy laws.

In other words, it's not that hard to find people badly affected by our current healthcare system.

Unless you're a politician, I guess.

Think of how this would re-frame the debate for everybody: have some committee call a hearing with the heads of the biggest health insurers in the country. Have five people per company step up to the microphones and detail how they were screwed by that company. Then ask the CEOs to their face: Why did this happen? Press them on the issue: What will the healthcare reform plan which the insurance industry backs (whatever that happens to currently be -- co-ops, whatever) do to change this situation? If the answer is "nothing," then throw out their plan and start over.

The public does not need to be educated that there is a problem with healthcare in America today. Washington politicians, apparently, do need to be educated on the severity and scope of the problem. Otherwise they wouldn't be talking about half-measures and weaseling out of doing the right thing in the hopes of reaping more healthcare industry dollars for their campaign chests. The organization Change Congress has shown how easy it is to use the leverage of public opinion and public shame against these Democrats (Blue Dogs and others).

The public's voice needs to be heard in this debate. If the people lead, the leaders will follow. But if the people never get heard, then the leaders will pull an enormous bait-and-switch, and we'll get a Potemkin victory -- a "healthcare reform" bill that gets signed among cheers and smiles, and which does little to solve the actual problems of our healthcare system.

To put it in medical terms, we don't want passage of a healthcare reform bill to be like the old joke: "The operation was a success. The patient, unfortunately, died on the table."


-- Chris Weigant


6 Comments on “Where Is The Public Voice On Healthcare Reform?”

  1. [1] 
    Chris Weigant wrote:

    Note To ChicagoMolly -

    You asked me for the cite on the "62% of bankruptcies" claim I made a week or so ago. It took me awhile to dig out the original article, my apologies for the delay.


  2. [2] 
    Osborne Ink wrote:

    I've already called my representative's office on this. Unfortunately, neither of my state's senators (Shelby and Sessions) would ever vote for a public option unless you snuck it into a bill and didn't tell them.

  3. [3] 
    Michale wrote:

    Well, Obama's Doctor spoke up about the healthcare plan..

    Like all Doctor's, he don't like it very much.. :D


  4. [4] 
    akadjian wrote:

    I also contacted my rep and donated to Howard Dean's campaign to raise awareness on the subject. They've done a good job to frame the issue more as you are suggesting, Chris.

    Unfortunately, the health care and pharmaceutical lobbies are going to great lengths to frame this as public vs. private.

    Same marketing trick they always use. They might as well be making it about freedom vs. communism. When you can't win the argument, change the conversation to one you can win.

    Funny thing is, the debate in Washington is not about whether government will get involved. It's about how they will get involved.

    Scenario 1:
    The health care industry wants government money for the needy to go to them so that they can provide insurance. This is the so-called private option. In this scenario, the government acts as financier and the health insurance companies act as a middle man between the people and the government.

    Scenario 2:
    The government acts as insurer . This is the option that has the health care industry screaming. Why? Because it cuts out the middle man. The people are directly insured. Now if the government is going to be giving out my money, I would rather see it going directly to those in need rather than having insurance companies take a cut off the top for profit and overhead. I don't care how efficient an insurance company is, it's not going to be as efficient as if it weren't there.

    Both options involve the government. The big difference is that the lobbyists are fighting for their industry to be the middle man. However, they call this the "private" option as if there were no government involvement.

    And they appear to be winning because of the asymmetry of false information and lobbyist marketing drivel.

    But to your point, Chris. Insurance and pharmaceutical lobbyists are driving the debate on their terms in order to profit from the situation.

    If you were to ask an average person, they have totally different concerns and don't even really seem to care about public/private. In fact, many are probably frustrated with their private insurance.

    But the way the large corporate lobbies win is to leverage the media they can buy to reframe the issue in a way they feel they can win. In this case, government vs. private health care.

    It's really the news media that has dropped the ball by doing little more than passing on the lobbying propaganda shoveled their way.

    In Washington, it's not about what's best for the people, but about how to make large amounts of money by influencing government. And this is something that frustrates both conservatives and progressives.

    - David

  5. [5] 
    akadjian wrote:

    p.s. Apologies for the long post, but you touched something interesting and dear to my heart.

    I also think it's really interesting to compare the anti-smoking legislation and the health care legislation. One of the biggest differences between the two pieces of legislation? Lobbying firepower. R.J. Reynolds, the largest tobacco firm, and the health care industry have both supported anti-smoking legislation.

    Health care reform, however, does not seem to enjoy the same level of big business lobbying support.

  6. [6] 
    Michale wrote:

    I also think it's really interesting to compare the anti-smoking legislation and the health care legislation.

    Outlawing all forms of tobacco would go a LONG way towards bringing down healthcare costs..

    I am all for something like that.


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