Tuesday, August 11, 2009

Health Care Shoutdowns: Liars and Demagogues

One of the striking new developments in the health reform debate is the occurrence of “shoutdowns”, where opponents of health reform, in events that obviously orchestrated, show up at appearances by Democratic Congressmen to scream against health reform (addressed by two recent articles in the NY Times, August 8, 2009, “Beyond Beltway, Health Debate turns hostile”, http://www.nytimes.com/2009/08/08/us/politics/08townhall.html?ref=weekinreview, and “Where have you gone, Joe the Citizen?” http://www.nytimes.com/2009/08/09/weekinreview/09stolberg.html?ref=politics).

According to these articles, many of the demonstrations are organized by Freedom Works, Tea Party Patriots, Sean Hannity and other well-funded right-wing groups. While freedom of speech is a good thing, preventing others from speaking, and preventing the events from occurring, is more suggestive of Brown Shirts than Americans. The conservative radio commentators, such as Hannity, O’Reilly, and Limbaugh, the right wing think tanks and activist groups, and the reactionary billionaire individuals and corporations that fund them, are bankrupt when it comes to health reform ideas, but are clear what they do not want. Coverage for all. A public option. A single payer system. Anything that will limit the profits of the insurance and pharmaceutical industries. But how do they get regular people out to yell and scream?

Well, some of them are ideologues themselves. Some of them have drunk the Kool-Aid of “no government” (except when it benefits me), or no socialism. There are always, in every country, multiple groups arrayed across the political spectrum. But the other way to get these folks out is to lie to them, to make them believe that health reform will take away their health care, limit access to their doctor, take away their current government benefits (“Keep the government’s hands off my Medicare!” is a nonsense chant heard all too often, and not nonsense to the chanter.) Misinformation is everywhere. A member of my family received an email containing the following nonsense: “…you will see that after 65 all Health Care will be limited and the people (SEC. to be specificied) will make our health care choices for us. Also the community service people will be in on the act to deny and/or approve (this is ACORN) OBAMA and his crew are denying what this plan is and they keep saying you get to choose, however, if you persist in reading you see that in 2013 all other plans are frozen out and only the public plan remains. Then the government wants access to your bank account so that after you are dead they(the government) can and will seize assets.”
What? Are these paranoid nuts, or just liars?

CJ Janovy, editor of the Kansas City Pitch, recently attended an “event” of this sort in a KC suburb which she describes on her blog, “Saturday morning's protest: Coffee and crabbiness with Cleaver in Lee's Summit”, http://blogs.pitch.com/plog/2009/08/saturday_mornings_protest_coffee_and_crabbiness_with_emanuel_cleaver_in_lees_summit.php : “Most ridiculous thing anyone said -- and more than one person said it ‘I'd rather have no health insurance than government health insurance.’” *

More disturbing yet are the threats of violence, so far only involving fistfights. However, as reported by Rachel Weiner in the Huffington Post, http://www.huffingtonpost.com/2009/08/10/gabrielle-giffords-town-h_n_255656.html, “…one visitor dropped a gun at the meet n' greet held in a Douglas Safeway,” by Congresswoman Gabrielle Giffords (D., AZ); and these opponents were not only unhappy with the Congresswoman, but with the fact that trade unionists were present to support her. “One of the callers to the Service Employees International Union said, "I suggest you tell your people to calm down, act like American citizens, and stop trying to repress people's First Amendment rights... That, or you all are gonna come up against the Second Amendment."

OK. So I’m upset. Like a lot of pointy-headed intellectuals, I would rather argue the issues than shoot them out in the middle of the street like a hero in one of my beloved Marty Robbins songs (although Rep. Gifford might end up needing the services of the Arizona “Ranger with a big iron on his hip” http://www.cowboylyrics.com/lyrics/robbins-marty/big-iron-11880.html [1]). I do believe that supporters of health reform need to start turning out in massive numbers. But people who want to read more about this, including incisive commentary, have a lot to choose from. In addition to the sources cited above, there is an excellent piece from Robin Wells in the Huffington Post August 8, 2008, recommended by Paul Krugman, http://www.huffingtonpost.com/robin-wells/what-obama-needs-to-learn_b_254714.html, who notes that “Our uniquely noxious blend of racism, right wing politics, and moneyed interests exploiting racial fears and economic insecurity have hollowed out the core of moderation in American politics. In an unbroken line from Goldwater to Limbaugh and Palin, the Republican party has committed itself to scorched-earth tactics that have shredded the economic, political, and moral fabric of this country.”

What I can do is to address some of the concerns that people, such as my relative who sent me the anonymous email quoted above, may have after this right wing onslaught. The ones making these assertions, from Palin to Limbaugh to Hannity to O’Reilly to Mitch McConnell to John Boehner to Freedom Works are evil liars, but regular folks hearing these lies may legitimately be worried. OK, here goes:

No, the plans being put forward by the Democrats, President and Congress alike, are not going to euthanize your grandmother. They are not going to leave you naked, without health insurance. They are not going to cost you a lot more – in fact they are likely to cost you less, unless you are very wealthy. (Note: this descriptor, “very wealthy”, generally applies to the folks mentioned above and the owners of the big insurance companies and their lobbyists, but not to the folks actually showing up and yelling.)

These plans are not what I have been advocating for, a single-payer system where one payer would cover everyone, and save lots of money at the outside by elimination of not only insurance company profits but the massive inefficient billing and collecting infrastructure (see previous blog entries), but it is to the extent that they would come a little closer that is (to put it mildly) agitating the right.

No one will lose their Medicare. Indeed, much of the “public option” being discussed would be expanding Medicare, the most popular, and one of the most successful, government programs ever implemented, to more people. HR 676, the single-payer bill sponsored by Rep. John Conyers and cosponsored by nearly 100 house members, is in fact called the “Improved and Expanded Medicare for All” bill. HR 3200, the current house bill, is not single-payer but does expand Medicare. The costs will be higher than I would like, not because of any “government involvement” but specifically because of the retention of private health insurance, which will necessitate maintaining the huge and costly billing and collecting infrastructure. However, currently direct government funds account for nearly 40% of our health care spending (Medicare, Medicaid, insurance for government employees and retirees at all levels) and when the taxes not paid on employer-sponsored insurance are added in, it is almost 60%. That 60% of OUR healthcare spending, which leaves 47 million people uninsured and tens of millions of more poorly insured, is more than that spent, per capita, to cover everyone in any other industrialized country. Yes, multimillionaires might spend about $10,000 more per year under HR 3200. What is wrong with that? Regular people would not.

And no one is going to euthanize your grandmother. In fact, your grandmother, your mother, you, and your children will get better care. This is a “red herring”, a complete distortion of a discussion about efforts to control costs by not doing procedures that do not benefit people but still have the potential to harm them. This makes perfect sense, and is the way it should be, and is the way I want it to be, and is almost certainly the way everyone would want it to be for themselves and their families, but is not the way that it is now. The reimbursement system that we currently have rewards doing procedures, even procedures that are not proven to benefit anyone, that will definitely not benefit the patient affected, may do them harm, and often are expressly against a patient’s wishes (e.g., your grandmother who has expressed her desire to not have any interventions except those that increase her comfort). I have discussed this at length in various columns, including Feb 13, 2009, Jun 22, 2009 and especially “Clinical Guidelines and Technology Assessment”, May 12, 2009 http://medicinesocialjustice.blogspot.com/2009/05/clinical-guidelines-and-technology.html.)

The people who are stirring up the pot are liars and demagogues, looking out, at bottom, for the financial interest of the billionaires and insurance companies that fund them. Regular people should not believe them. We are better than that. We need to support a health reform program that covers everyone. And reject these scare tactics. And be vocal about it. And make sure that we don't allow Brown Shirts to set the tone of the debate.

[1] As best as I can find, copyright Elvis Presley Music, Inc., Unichappell Music Inc.

* I had an idea for a bumper sticker that was made for these people: "We don't need to provide health coverage to everyone. If you think it's wrong, we can leave YOU out!". Of course, the problem would be that they would turn it down when healthy and then coming asking for it when they got sick and needed it. We would have to make them sign waivers that they would never ask for it. Maybe their billionaire friends in the health insurance industry would take care of them.

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