A Report from the Trenches
About ten days ago, after blogging about the failure of Democrats to organize for health care, I emailed both my Senators, Jack Reed and Sheldon Whitehouse, asking them to stand firmly for the public option. My reward last Monday was an invitation to attend a town hall in the northern part of the state which both of them planned to attend. It took place on Wednesday evening at a senior center and proved to be a most educational experience.
I arrived a little later than I had planned and only barely managed to find a parking space. A small contingent of right-wingers was on hand with signs and literature at the door, including some followers of Lyndon Larouche, who twenty years ago competed with the hare krishnas for space at unsecured airports. Spaghetti, meatballs and salad were provided, and I stood up rather than retreat into a distant corner where there might be a chair. Both Senators were in shirtsleeves and tieless. I was very proud of them both.
They began the way the argument should be done: health reform isn't an experiment or a question of doing good, it's a necessity. Whitehouse gave some of the chilling figures (I didn't take notes) on escalating costs. As I recall, our spending on health care has doubled in less than a decade and is on the pace to do the same. This has put a crippling economic burden on many businesses, led, of course, by the auto industry. Meanwhile, the number of uninsured is increasing (and that, as we learned later, is actually contributing significantly to increased costs.) Then came questions. The crowd, naturally, was composed of a majority of seniors, but included a number of young people as well.
The first question--and probably the majority of them--came from a dedicated, hostile conservative, who protested that at previous meetings, both Senators had expressed their support for the bill. While he complained bitterly that he and others did not want the bill passed and did not want the government messing in his health benefits, he (and many subsequent questioners) never acknowledged that there might be a substantial constituency of Americans who disagreed with him, or even bothered to threaten the two Democrats with a loss of support in the next election. His own righteousness, it seemed, should be enough to determine their vote. Both replied very calmly that they thought that something had to be done. Quite a few of the conservative questioners routinely mischaracterized the bill, making statements that simply assumed that it constituted a government takeover of the health care system. Some seniors talked that way too. Whitehouse and Reed did allow themselves the luxury of asking everyone what health benefit they had, and when many seniors replied, "Medicare," there were chuckles around the room.
Foreign health care systems came up. A 75-year old immigrant from Germany explained that his adult life had been evenly split between there and the United States, and spoke up for the kind of guaranteed care his homeland offered. "Many Americans," he said, "think they have insurance until they suddenly need it." He added that his wife's small business had had to stop offering coverage because it had become too expensive. But a younger woman, who had with her a young son who she said had cerebral palsy, claimed to have spent some time in Britain under the National Health system, and talked about how hard it was to get an appointment and how afraid she was to cancel it. (I began to wonder, on my way home, about that story, and whether in fact temporary residents can take advantage of British national health. Any comments would be appreciated.) The conservative opposition maintained an undertone of anger throughout the whole meeting, groaning, exclaiming, and challenging the two very unflappable elected officials at every turn.
Yet it gradually became clear that there were plenty of Administration supporters at the meeting as well--including several health care professionals. One nurse talked about the expense of care, and referred specifically to "what is done to patients, not for patients." In response, Senator Whitehouse talked about a move a few years back (when he was a state official) to upgrade intensive care units around the state. A half million dollars of new equipment, he said, could potentially save millions of dollars a year--and hospital administrators had actually said that it would not be easy for them to sacrifice such a large revenue stream! A young doctor, who supported reform and even a single-payer system, quoted an older doctor to the effect that he couldn't understand why he had been so opposed to Medicare, since it had made him so much money. He also told an amazing story of a patient without insurance who needed a month or two of continuous treatment for an infection of some time. Because he lacked insurance, the patient was not eligible for treatment at home and would spend that time in the hospital, at enormously increased cost. Several people spoke in favor of a single-payer system but the Senators said that it was simply not possible politically.
The crowd also included about five white-coated medical students from Brown University, and Whitehouse called on them. They spoke up very effectively for reform and cost control as well. It was interesting, it occurred to me, that while half a century ago doctors were leading the opposition to Medicare, now the insurance companies had become the main stumbling block to reform. I am also seeing and hearing more and more stories, including a recent one about stents on NPR, indicating a great deal of disagreement among doctors about how, and why, patients are given expensive care. By this time I was hoping to be called upon and had decided what I was going to say.
I was among the last called. The questioner before me was an elderly woman (though a most energetic one) who had printed out eight talking points from a conservative website, and who insisted upon reading them all. (By the time she got to "five" the crowd was rumbling, but the Senators made no attempt to interrupt her and she was not to be deterred.) They tried to respond to several of them. Then Whitehouse called on me.
I identified myself and my home town and said that I have been living in Rhode Island for almost 20 years (I wanted to mention that because my accent does not show it), and that I felt very lucky to have two Senators who were trying to address this very serious problem in a calm and rational manner. First, I said, I wanted to say about a word about Medicare. I was a few years away from taking advantage of it, I said, but I was old enough to remember when it was passed. A coalition of Democrats and liberal Republicans passed it over the violent objections of conservatives who said that it was socialist, un-American, and liable to take away our freedom--an argument made in particular by Ronald Reagan in one of his standard speeches. "I hope everyone in this room," I said, "especially the undecided people here--all three of you [that got a good laugh]--will think about whether we would be better off if we had listened to the Barry Goldwaters and the Ronald Reagans and the Richard Nixons and never passed Medicare." (At that point, a few younger conservatives said, "Yes!") Then I turned to my own biggest complaint: the advertising of prescription drugs. I didn't mind, I said, that my benefit contributions and Medicare contributions were paying for other peoples' Cialis and Viagara, but I most certainly did mind that they were also paying for millions and millions of ads for those products that I saw every time I watched a major sporting event. Surely, I said, patients knew when something was wrong, and doctors should be able to prescribe the proper treatment. I asked how many people realized that the drug companies spend more money on marketing than on r & d. I said I was amazed this wasn't a bigger issue in the current debate. Reed replied that the only proposal on the table was one that would tax the money the drug companies spent on ads. Several people immediately approached me to say how much they agreed with that point.
The meeting concluded shortly thereafter and Reed, who lives in my town, approached me. I said the meeting confirmed my fear about the debate--"all the intensity is on the other side." He replied that that was why Ted Kennedy had been so sorely missed this year. I said some one had to take up the slack.
Kennedy's name brings up another issue which the Republicans have successfully made it a taboo to raise--the unknown amount of money spent on dubious care in the last year of life. A Times story on Friday on Kennedy's treatment made this point very effectively. Kennedy had the most common and most lethal form of brain tumor, for which there is no cure. Treatment improved some years ago when local radiation was substituted for irradiating the whole brain. But the chemotherapy he received was approved after a study showed that it improved median survival from one year to fourteen months. That such a result can lead to the approval of a drug--instead of an instruction to the drug company to keep working in the hopes of coming up with something better--is in my opinion a very significant symptom of what is wrong with American health care. Personally I am quite confident that if I had such a diagnosis I would be sure to find out how much the treatment could be expected to extend my life--and that if it could not, at least for some time, restore me to something resembling full health, I would refuse it. (Because of some diagnostic problems of my own a few years back, incidentally, I have been close enough to that situation to have had that belief tested in real life, and it held up.) Sadly, all the Republican lies about "death panels" have made it extremely difficult to even discuss these issues, but they are a big part of the problem.
With the help of that story, I plan to raise that question at another town hall some day. Meanwhile, the experience confirmed what I have been saying here in spades. The battle for reform is a battle between reason on the one hand and raw emotion on the other. A vote on reform, I think, would have produced a pretty evenly divided result in that meeting, and quite possibly a majority in favor. An applause meter would have registered a significant majority against. Face to face with their constituents, Whitehouse and Reed kept their cool as ably as any general under fire, and for that I admired them. But Reed was right: some one has to step into the void that the death of our Massachusetts neighbor has left.