America needs healthy debate to end the paralysis of polarization

Illustration by Forest Byrd

President Barack Obama may be losing his grip on solving the national health-care dilemma. A recent poll conducted by CBS and The New York Times found that 40 percent of Americans — as opposed to 47 percent a month ago — have confidence in his handling of health care. A plurality — 47 percent — disapproves of the way he’s handling the issue.

Clearly, there’s a problem with health care in this country. And Obama was eloquent, expressing that in his campaign and promising a solution, leading to his decisive victory.

“Every day in this country,” he said this spring, “more and more Americans are forced to worry about not just getting well, but whether they can afford to get well. Millions more wonder if they can afford the routine care necessary to stay well….Health-care premiums have gone up three times faster than wages have gone up. So desperately needed procedures and treatments are put off because the price is too high. And all it takes is a single illness to wipe out a lifetime of savings.”

Indeed, according to the Center for American Progress, the projection for the average family premium in the next decade is over $22,000.

This summer has seen a series of so-called “town hall meetings” across the country, ostensibly to inform Americans about the bill pending in the House of Representatives, H.R. 3200, titled “America’s Affordable Health Choices Act of 2009.”

We cover real town-hall meetings every week. Sometimes they’re loud and sometimes they’re messy, but they serve a purpose because the citizens of a particular town get a chance to speak directly to those who are elected to represent them. Often, the exchanges lead to action.

By contrast, the “town hall meetings” on health care reform aren’t meetings at all. While they may have been set up to inform the public, that’s not how they’re being used. We covered one in our midst last week as Democratic Congressman Paul Tonko, who represents the 21^st District, held a forum in Bethlehem that drew about 1,500 people. That forum, like others across the nation, served only to ramp up the rhetoric between two extreme camps. There is no place for middle ground or compromise at such venues; there is no give and take, no thoughtful deliberation. That will have to take place in Congress, far from the shouts of the madding crowd, if our country is to solve its health-care problems.

Unfortunately, much media coverage has centered on the fury at these forums and on the outrageous claims that have been made, leaving many people confused about what the act would really do.

It is posted in its entirety online at the Library of Congress website. The plan would guarantee coverage to all individuals and employers with automatic renewal, prohibiting exclusions for those with pre-existing conditions. It would also prohibit premium variances, except for reasons of age, area, or family enrollment, and it would prohibit rescission of coverage without “clear and convincing evidence of fraud.” Grandfathered coverage would be exempt from the new requirements.

The act would limit annual out-of-pocket expenses to $5,000 for an individual and $10,000 for a family.

The act would also create an independent agency, the Health Choices Administration, headed by its own commissioner, which would set up an insurance exchange to provide individuals and employers access to health insurance coverage choices, including a public health-insurance option. There would be an affordability premium credit and an affordability cost-sharing credit for low-income individuals and families.

The act would require employers to offer health benefits coverage to workers and to make contributions towards the coverage or make contributions to the exchange. Businesses with payrolls below $250,000 would be exempt from the requirement.

Medicare and Medicaid, both part of the Social Security Act, would remain in place with some amendments.

The act would address needs of the health-care workforce through loan repayment and training, setting up a Public Health Workforce Corps, addressing diversity, and establishing an advisory committee on health workforce evaluation.

Finally, the act would provide prevention and wellness activities, set up a Center for Quality Improvement, revise the drug discount program, and set up a school-based health-care program and a national medical device registry.

The White House website has a “reality check” section at http://www.whitehouse.gov/realitycheck/ that features videos of various experts rebutting myths and falsehoods about the proposed health-care reform.

You can keep your own insurance, says Linda Douglass of the White House Office of Health Reform, debunking the myth that the act will force Americans out of their current insurance plans or force them to change doctors. To the contrary, she says, reform will expand choices.

Matt Flavin, director of Veterans and Wounded Warrior Policy, says that nothing in the health-insurance reform will affect veterans’ access to the care they receive now but rather, he says, the president’s budget greatly expands coverage for veterans who have been denied access in the past.

Christina Romer, chairwoman of the Council of Economic Advisers, says reform will ease the burdens on small businesses and help level the playing field with big firms that, on average, pay much less to cover their workers.

Reform will make insurance more affordable to those with disabilities, says Mike Strautmanis, the father of a child with a disability and the chief of staff for Valerie Jarrett, who advises the president on intergovernmental affairs; it will eliminate discrimination in purchasing health insurance so families won’t be turned down if a parent or child has a pre-existing disability or other health condition.

Refuting one of the most egregious assertions — that of a “death panel” alleged by Sarah Palin, the defeated vice presidential candidate — Douglass says that there is no such panel in any of the bills being considered in Congress. To the contrary, the House bill gives Americans and their families more choice and access to counseling and information on end-of-life care if, and only if, they choose to pursue it.

Finally, as the current cost of American health care looms at over $2 trillion a year, Jared Bernstein, director of the Middle Class Task Force, debunks the myth that Americans can’t afford health-insurance reform. Not only has the president demanded that reform not add to the deficit in the short term, he says, but reform is the only way to get skyrocketing health-care costs under control. While now health-care accounts for 17 percent of our economy, Bernstein says that, in 20 years, it will become 30 percent, crowding out other worthwhile economic activity.

President Obama says that he will squeeze “expensive inefficiencies” of almost $180 billion of excess payments to private insurers, lowering drug prices and making “drug companies pay their fair share” while lowering the rate at which high earners can itemize their tax deductions.

The president says treatment will pursue the most effective rather than the most expensive course, emphasizing quality over quantity, says Bernstein. He also points out that a third of health care has to do with obesity, smoking, and lack of exercise. The president’s health-care reform will save money, he says, by stressing prevention and wellness.

As the debate plays out across the nation, it is being discussed on our pages as well.

“The biggest cause of bankruptcy and financial hardship,” writes Brian Sheeley, “are unaffordable medical and hospital bills.” He writes of a friend with a broken hip that cost $65,000 to repair. “Even with the standard 80-percent coverage, she would still be charged over $12,000 plus the deductible. The result? Instant stress, instant misery, instant bankruptcy.”

Joseph T. Amodeo cites studies in his letter this week to demonstrate the impact health care can have on both governance and national security, and he notes that the United States health-care system ranks 37^th in the world, based on patients’ satisfaction. He’s frustrated that people can’t see the difference between “socialism” and “social insurance” like Medicaid and Medicare.

Amodeo laments the current situation: “The sad part is the public servant gets the golden health plan and Joe the Plumber gets to pay for it.” Amodeo is justified in his frustration over not being told concretely how Americans will pay for health-care reform.

Letter writer Mark A. Dunlea, executive director of the Hunger Action Network, argues on our pages this week that the Democratic Congressional proposals fall far short, forcing people to pay for expensive, inadequate insurance. Dunlea points out that Americans now spend far more per capita than any other country and argues that for-profit private health insurance should be eliminated as it is in other industrialized countries.

  Dunlea is right that America needs health care that covers everyone, cuts costs, and gives patients rather than health-insurance companies control over their medical decisions. While the Republicans have offered no viable, cohesive plan, the Democrats’ H. R. 3200 bill is already a compromise. But it is at least a step in the right direction.

At last week’s forum in Bethlehem, Congressman Tonko got in a constitutional duel with a constituent that illustrated a central hurdle in passing any health-care reform legislation. Henry Lampman, who described himself as a disgruntled Republican, said he did not want the government to tax people to pay his medical bills. He held a booklet of the United States Constitution and cited the 10^th Amendment, limiting the powers of the federal government to those specified in the Constitution, as evidence that the Democrats’ bill is overstepping those bounds.

Tonko responded by opening his own booklet of the Constitution and reading the commerce clause, which allows Congress to levy taxes to provide for “the common defense and general welfare of the United States.”

Amid the ravages of the Great Depression, the American government responded with the Social Security Act, which gave us Medicaid for the poor and Medicare for the old. We believe that these are times that call for equally radical measures.

At last week’s forum, Tonko quoted Franklin Delano Roosevelt’s famous inaugural words, stating that the president wasn’t speaking about external forces as much as internal strife facing the nation when he said, “The only thing we have to fear is fear itself.”

What’s paralyzing us now is polarization — not fear. We need to look for common ground and work for the common good.

— Melissa Hale-Spencer, editor