Health care rage: Why all the angst?

Health care reform town hall meeting in California
REUTERS/Danny Moloshok
People tape posters, featuring altered photos of President Obama and Adolf Hitler, to a table at a town hall meeting on health care in Alhambra, Calif., on Tuesday.

The nation’s grandmothers have reason to tremble right now, given all the talk about pulling their plugs.

But everyone seems to be spooked by something in the move to overhaul the health insurance system.

Some fears don’t fit the facts of the proposals before Congress. No one is proposing government “death panels” that could dictate the fate of grandmothers or anyone else. To make sure there is no confusion on that point, lawmakers told the Washington Post Thursday that they are dropping a provision which would have paid for end-of-life counseling to those seeking it.

Other fears, though, persist. We’ll get to them in a minute.

Fear of change
First, let’s consider fear itself. Don’t be too quick to dismiss the seemingly unfounded fear so many Americans have expressed at meetings around the country. Health care set them off, but their worries run beyond that issue, said Kevin Leicht, a sociology professor at the University of Iowa.

“Health care is standing in as a symbol for something very important in the country right now,” Leicht said. “There is an incredible amount of anxiety being expressed . . . . People are really afraid that there is too much change and that somehow or other they are going to be left in the dust.”

Kevin Leicht
Kevin Leicht

Dreading that dust is not entirely irrational, given the economic drubbing the middle class has taken in recent years. Wages stagnated while easy credit lured families into debt. Millions of jobs disappeared, taking away pensions and health insurance too. Wall Street executives played risky games with retirement savings and then got bailouts at the expense of the taxpayers who lost the savings.

“The anxiety is there and the problems are real — not being able to pay your bills, not being able to get and keep a steady job, not being able to keep your mortgage current,” Leicht said. “A nerve has been struck that is leading to all of this stuff being dumped out. Some of it has to do with health care, some does not.”

Republican Sen. Charles Grassley hit the nerve this week when he told his Iowa constituents that they had “reason to fear” the House version of a bill, which would provide for end of life counseling.

“We should not have a government program that determines you’re going to pull the plug on grandma,” said Grassley, 75, who is the ranking Republican on the pivotal Finance Committee.

Grassley made it clear he was talking about control over living wills and life support.

But think of the symbolism on another level. Even younger people who have felt powerless to control their own lives in these turbulent economic times could relate to the potent image of poor helpless grandma trapped in a hospital bed while forces beyond her control determined her fate.

While the provision has been scrapped from the Senate version of the bill, pull-the-plug rumors persist in a blizzard of emails and tweets. 

The White House is fighting hard this week to debunk the “malicious myth that reform would encourage or even require euthanasia for seniors.” Its response to that and other critics’ claims can be found here.

Meanwhile, there is something in this debate to scare us all.

Fear of getting the numbers wrong
Mitch Pearlstein looks back on Medicare funding and sees a history of government chronically underestimating the costs of that health care program. It has grown from $3 billion in 1965 to $420 billion this year and climbing.

Mitch Pearlstein
Mitch Pearlstein

“It’s a sign of the government having a real hard time predicting what various things are going to costs in government-run health care,” said Pearlstein, who is president of the Center of the American Experiment, a conservative think tank based in Minneapolis.

“Those folks who are less confident that government can adequately predict what things will cost are the folks making a lot of noise right now,” he said.

If you’ve reviewed the White House rebuttals at the link noted above, you’ve seen that the government does not propose to “run” health care, but it is pushing for a public insurance option to compete with private plans. Measures Congress and the White House are considering could cost close to $1 trillion, but President Obama says he will not sign a bill that does not offset the costs through a combination of savings and tax increases.

Pearlstein finds it hard to believe, though, that the proposals won’t eventually add to the national debt.

“The debt we are acquiring now is exceedingly dangerous,” Pearlstein said. “I don’t think people, for the most part, are feigning or making up their fear. . . . These are real fears.”

Roger Feldman agrees that Washington hasn’t fully come to grips with the cost of the overhaul proposals. An economics professor at the University of Minnesota, Feldman worked for the President’s Council of Economic Advisors in the 1980s, and he has directed national research sponsored by the Centers for Medicare and Medicaid Services.

Roger Feldman
Roger Feldman

“The hard truth is that if you want to save money you are going to have to reduce somebody’s payments, somebody’s income, some hospital’s revenue, some doctor’s revenue,” Feldman said.

One fear that erupted at town hall meetings this week is that runaway costs will force rationing of health care. That’s something insurers already do, of course. Almost everyone with insurance has an extensive list showing what’s covered and what isn’t.

If this country truly gets serious about controlling health care costs, though, we’ll see more rationing, Feldman said.

“It may be done explicitly, but I doubt that,” he said. “It may be done implicitly as we cut physicians’ fees to the point where they are not willing to provide as many services.”

Here’s the root of the financing problem: Whether the coverage comes from the government or private plans, Americans want all the care available, but they don’t want to pay for it with higher taxes, higher co-pays or higher deductibles.

Fear that nothing will change
Jeffrey Kahn has the same fear as Obama and nearly 50 million uninsured Americans. Kahn is afraid the drive for the overhaul will fail, leaving the country with the system it has now.

Jeffrey Kahn
Jeffrey Kahn

“That just isn’t ethically acceptable,” said Kahn, who directs the Center for Bioethics at the University of Minnesota.

Kahn also is president of the national Association of Bioethics Program Directors. The association has posted its own statement debunking some myths and explaining why it considers the status quo to be unethical:

“It is neither just nor fair. There is no morally defensible reason why some Americans get excellent medical care at costs they can afford and other Americans lose their homes or go into bankruptcy attempting to secure treatment for a seriously ill loved one,” he said.

Kahn expected debates over the details of the bills before Congress. But there seemed to be a consensus that the system must change. He didn’t expect that to unravel too.

“I can’t figure this out,” Kahn said. “For the first six months of this administration you couldn’t find a voice that said, ‘We don’t need to reform the system.’ . . . How did we go from that to people standing up and shouting what seems to be heartfelt anger?”

The suspense now is how Congress members react to the earful they are getting from some constituents, whether they will run scared from their own bills.

Roughly half of Americans still back Obama’s handling of health care policy, according to a new Gallup Poll.  But Gallup also reported that two-thirds of the people are closely following news of town hall meetings where opposition has been fierce.   

Fear covers competing ideals
Brush aside the fear, and you find Americans engaged in a tradeoff of ideals.

On one hand, we’ve been taught to help one another. Other major nations take care of their sick and we should too, the argument goes.

On the other hand, many argue convincingly that America is best served when individuals look out for their own interests and don’t wait for government to do it for them.

Polls suggest that most Americans care about the uninsured. But what if the fear-driven national mood tilts toward individual interests, if the millions who have coverage choose not to risk rocking the system for the sake of the uninsured?

The same problem confronted the Clinton administration in its failed 1993 bid to overhaul health care.

The Clintons focused mainly on expanding coverage, Feldman said. Determined not to repeat the Clintons’ mistakes, Obama decided he had to offer something to the insured middle class.

“What the middle class could get is health care cost control and quality improvement,” Feldman said.

But the execution of that strategy has been flawed, he said. Obama left it to Congress to negotiate a plan rather than pushing one of his own. Congress is kicking around at least three different Democratic proposals, and Democrats have fought among themselves over the details.

The upshot is that there is not one plan to sell to the American people, no clear outline of the benefits.

“They are dealing in vague generalities,” Feldman said.

Further, proponents of change haven’t hammered home the reality that the insured already foot a good share of the bill for the uninsured.

“It trickles down and comes out of every individual’s pocket, but here’s what’s bizarre: it comes out more from the insured,” said Leicht at the University of Iowa. “If you have insurance now, you are getting hosed.”

Fear of politics as usual
Politico asked observers whether the health care flare-up reveals the latest front in the so-called culture wars, which have pitted Americans against each other on abortion, embryonic stem cells, gay rights, euthanasia and so many other issues.

“As an evangelical Christian, I’ve certainly heard plenty of my comrades in faith accuse President Obama of being a socialist,” said Andra Gillespie, a political science professor at Emory University. “And lately, I’ve been getting e-mails urging Christians to oppose health care reform because it will lead to legalized euthanasia. Clearly, someone is trying to mobilize evangelicals using the language of the culture wars.”

By translating the particulars of the debate into culture war terms, opponents essentially are sending political code to followers who may be confused by the merits of the complex proposals, Leicht said.

“It’s code, most certainly code, and it’s been used to derail health care reform in the past,” he said.

In response, Obama’s team is cranking up political machines that helped propel him to the White House. 

“Unfortunately, some of the old tactics we know so well are back — even the viral emails that fly unchecked and under the radar, spreading all sorts of lies and distortions,” Obama’s senior adviser, David Axelrod, said in an email posted on the White House website

“So let’s start a chain email of our own,” Axelrod continued.

Uh oh! Now I’m afraid, too — afraid that we’re slipping back into pre-election political madness. 

Sharon Schmickle writes about national and foreign affairs and science. She can be reached at sschmickle [at] minnpost [dot] com.

Comments (19)

  1. Submitted by Terry Hayes on 08/14/2009 - 11:06 am.

    Sharon, not everyone is spooked by something in the health care reform movement. These crazies with their hysteria over Marxism coming to the USA are just ignorant patsies of the corporate overlords of America. If they had a brain of their own they would not be making such fools of themselves.

    Many people realize that this health care outrage is an organized right wing movement paid for by the people with the most to lose, the insurance companies. It’s totally bogus.
    Everyone I know, no matter their political affiliation, wants to be able to afford health care.

    These nutbags don’t mind giving up their liberty for security (i.e. illegal wiretapping) so when they scream about losing their rights, no one in their right mind should take it seriously. This is the senility of the elderly American Empire as it hobbles toward its inevitable fiery twilight.
    This country is nuts.

    Single payer is the solution.

  2. Submitted by steve dill on 08/14/2009 - 11:29 am.

    Change for the sake of change is what Obama is all about. He obviously has not put much brain-power into reseraching the helat care issue before trying to force-feed his eform down Americ’s collective throats. And, they don’t like the taste very much!

    In addition, why do the reformists refuse to discuss the 250,000 jobs which will be lost to reform? In my industry, medical sales, we have already lost 20,000 medical device sales reps in anticipation of reform. Learn more about the impact of health care reform on the medical sales industry at http://www.gorillamedicalsales.com

  3. Submitted by Greg Kapphahn on 08/14/2009 - 11:40 am.

    There’s no need to be afraid of the White House’s email. It’s straightforward, factual, and full of links to accurate information. The only people who might need to be scared of it are those who have been making up B.S. and spreading it around through their own bogus anti-reform email campaigns.

  4. Submitted by NIcole Masika on 08/14/2009 - 12:16 pm.

    “On the other hand, many argue convincingly that America is best served when individuals look out for their own interests and don’t wait for government to do it for them.”

    So would these people also like to do away with public schools,libraries, police and fire departments? That is the logical conclusion of that kind of thinking. There are some basic services for the common good that should be run by the government and health care is one of them. Terry is right, single payer is the solution, but I am willing to accept Obama’s incremental approach.

  5. Submitted by Greg Kapphahn on 08/14/2009 - 12:54 pm.

    Nicole, yes, some of them would like to do away with all those things, but MOST of them still want everything they have and more in the lines of government benefits and infrastructure, they just want someone else to pay for it.

    Their claim to rugged individualism is just a smoke screen for the rest of us and a set of blinders for them. Some of them actually claim to have “pulled themselves up by their own bootstraps” (google the phrase) which only goes to prove that they don’t understand even Newtonian physics, nor do they get that that phrase is and always has been a sarcastic joke.

  6. Submitted by Sheila Ehrich on 08/14/2009 - 02:51 pm.

    Where, oh where to begin.

    First of all, as the article states, those in favor of health care reform have done a lousy job of pointing out and explaining just how much of our current healthcare insurance premiums, deductibles and co-pays already go to pay for those with no insurance through higher bills from our hospitals and clinics.

    If people realized that 20% or 30%, or whatever percent it is, of their current premium or what they pay as their part of a bill already goes to pay the bills for people without insurance and that percentage is only going to continue to rise as more and more people are without insurance, then maybe, just maybe, people would see enough self-interest to sit down and discuss reform in a rational manner. But people need to know what the numbers are. And those numbers have to be repeated and repeated ad nauseum until it sinks in.

    Secondly, I find it ironic that the Right is screaming about “death panels”. As I pointed out in another article on MinnPost, they have been the ones who for years have demanded that even the most deformed child be born. Yet they are nowhere to be seen when the bills come due for the medical needs of these children, or when a parent has to quit their job to take care of the child. People do this out of their love for their child. Yet when a family needs assistance so one parent can stay home to take care of their own child without ending up in bankruptcy, Republicans have been standing there denying assistance in the first place, or with the ax ready to cut off whatever support they may have. Pawlenty being only the latest to wield the ax in the name of “No New Taxes!”.

    And what about those who are already being handed a death sentence because they cannot afford healthcare insurance and so when they become deathly ill are refused treatment? What about the millions of Americans who had healthcare coverage but have ended up in bankruptcy because they’ve maxed out their policy? Or couldn’t afford the co-pays?

    I know this doesn’t flow as well as I would like it to, but those who know we need healthcare reform need to speak up – give us the numbers, repeat them over and over and over; answer the “death panel” claim with the numbers of people who die every year for lack of coverage and care.

    MoveOn.org and the other progressive organizations need to spend some money on commercials telling the real stories of real people and their struggles without health care coverage. And, please, point out that all too often these are people who ARE working and may even have more than one job. This isn’t welfare, it’s people taking care of their neighbors. If you don’t want the government doing it then you need to step up to the plate and do it yourself. As a liberal Christian I again find it ironic that the supposed “Christians” and “pro-lifers” in this discussion are willing to let people die and go into bankruptcy to satisfy their own self-interest.

    One last comment, enough cannot be said about the fact that companies in the US are competing against companies in “socialistic” nations where the government provides the healthcare coverage. It’s one of the main reasons jobs go overseas to people whose healthcare is already paid for. If we ever want to seriously be competitive again with jobs that pay more than diddlysquat, then healthcare reform is mandatory.

  7. Submitted by ellen wolfson on 08/14/2009 - 03:39 pm.

    As a registered nurse I am absolutely appauled at these ridiculus protests against health reform. Doesn’t anyone understand that when people don’t have coverage they wait until their condition becomes critical and they end up in the emergency room, guess who pays for their care. Doesn’t it make more sense to provide care before it reaches this point. What happened to all these religious folks who talk about being my brother’s keeper.

  8. Submitted by Thomas Swift on 08/14/2009 - 03:56 pm.

    Well Shelia, you’re in luck.

    Moveon.org’s sugar daddy, George “America needs to be de-Nazified” Soros has pledged $5 mil to spew just the sort of peace and love we’ve come to expect from him and his ilk during the past 8 years.

    It’ll be “punch back twice as hard” with a paycheck attached…should be fabulous.

  9. Submitted by Terry Hayes on 08/14/2009 - 04:09 pm.

    Sheila, thank you for the brilliant post.

  10. Submitted by Greg Kapphahn on 08/14/2009 - 04:48 pm.

    How sad that, just like Detective Spooner in “I Robot,” the impoverished members of the rightwing sense the danger in rich people using their money to provide information to the world, but focus, as he did, on the wrong rich person.

    It wasn’t “Sonny,” the one out front and visible in public (Soros) that was the danger, was it?

    It was VIKI, the one so woven into all the information and protection systems as to be taken for granted and largely invisible (Murdoch).

    If the US goes down into fascism, it won’t be Soros that’s responsible, it will be Murdoch. It’s what he’s aiming for. It’s what he’s hoping for. We can only hope he leaves this mortal coil behind before he accomplishes his goal throughout the Western World.

  11. Submitted by Greg Kapphahn on 08/14/2009 - 04:49 pm.

    And since when, and in what TWISTED world are “peace” and “love” evil?

    Some of us truly are coming from the darkest corner of the dark side, aren’t we?

  12. Submitted by Bernice Vetsch on 08/14/2009 - 05:04 pm.

    If only it WERE true reform, which would be single payer and which would save us $400 billion per year in administration costs, instead of yet another piece of legislation alleged to benefit us but actually being orchestrated by the insurance and other medical-industrial-complex firms that will benefit from yet another law that protects their obscene profits.

    Right-wing millionaires are funding the propaganda that makes people fear “socialized medicine” (don’t I wish) putting us on a slippery slope to communism. Utter nonsense, but it apparently makes sense to those infected by the scare tactics.

    What we really have to fear is the form of fascism called corporatism, whereby government and corporate interests are viewed by government as identical. Just last week, the White House made a secret backroom deal with the drug industry to keep Medicare from negotiating drug prices. The tradeoff? The companies promised to save us $80 billion over 10 years — A DROP IN THE BUCKET compared to what we should have been saving since Medicare Part D was enacted.

    Congress fortunately rose up in outrage and will, I hope, stop the giveaway of more billions upon billions of dollars per year when we could, as the drug industry’s largest customer, negotiate at least as much of a discount as the VA (around 45-47 percent off retail).

  13. Submitted by Karen Sandness on 08/14/2009 - 06:02 pm.

    What a sad commentary on our anti-intellectual culture this whole mess is.

    People who probably slept through their high school history and civics classes are ranting on and on about “Communists” and “Nazis.” I’ve challenged some of them on the Strib’s website to read the website of the Communist Party USA and then come back and tell me how Obama is a Communist. No takers so far.

    The information is out there, but too many people would rather have KTLK and Fox News tell them what to think.

    Thinking is hard.

    The protesters could drive up to Canada for the weekend and ask real Canadians whether they’d prefer our system.

    Even if they don’t speak a foreign language, they could go online and read newspapers and even magazines from Canada, the UK, Ireland, Australia, and New Zealand.

    Nope, then they might learn that the radio and TV guys and the preachers in the megachurches are lying to them for cynical purposes, and then they’d have to start thinking for themselves.

    That would be really scary.

  14. Submitted by Ginny Martin on 08/14/2009 - 07:41 pm.

    If our Congressional members really wanted to know the facts about other countries’ health care, they could take a field trip to Britain, or Canada, or one of the other (virtually all industrialized and civilized nations) and see for themselves what this health care looks like. After all, few have been shy about making trips to Iraq, or Korea, or perhaps Florida or Nevada for conferences on all kinds of things. I’m sure many of us would be happy to help pay for it, if it resulted in a few more facts.

  15. Submitted by Kent Herschbach on 08/14/2009 - 10:23 pm.

    The I.G. of T.A.R.P. has reported that the bailout of Wall Street, has put the U.S. taxpayer on the hook for $23.7 TRILLION. I find it remarkable that Mitch Pearlstein has trouble spending $1 trillion on health care for America’s population. If we take back the bailout, there will be resources for a recovery. Kent

  16. Submitted by Glenn Mesaros on 08/15/2009 - 03:12 am.

    The IMAC (Independent Medicare Advisory Commission) is at the core of the Obama healthcare “reform’s” actual fascist agenda; it copies the “T-4” (Tiergarten 4) euthanasia program Hitler established in 1939, to create a board of physicians charged with saving hundreds of thousands of Reichsmarks yearly by terminating care to “lives not worthy of life.” The IMAC part of the legislation was written personally by Peter Orszag (OMB), giving power to this Commission to order prompt and mandatory cuts in Medicare/Medicaid funding of specific tests, treatments, procedures, drugs, etc. for seniors and poor people. This commission is also supposed to be made up of physicians, and healthcare “experts,” but at Orszag’s insistence it can be overruled by government actuaries and ordered to make even deeper, faster cuts.

    Ezekiel Emanuel, the top healthcare adviser at Obama’s Budget Office and brother of his chief of staff, believes it is “obvious” that people with Alzheimer’s or other forms of dementia (estimated as one of three people who live beyond the age of 65) should be denied health-care, since they are “irreversibly prevented from being or becoming participating citizens.” An essay published in the Hastings Center Report (Nov-Dec 1996) by Emanuel, Norman Daniels and Bruce Jennings, says in part:

    “This civic republican or deliberative democratic conception of the good provides both procedural and substantive insights for developing a just allocation of health care resources. Procedurally, it suggests the need for public forums to deliberate about which health services should be considered basic and should be socially guaranteed. Substantively, it suggests services that promote the continuation of the polity – those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberation – are to be socially guaranteed as basic. Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia.”

  17. Submitted by Richard Schulze on 08/15/2009 - 01:11 pm.

    Glenn Mesaros: I was wondering if you might give some thought to attributing the Lyndon Larouche website for all the material that you snip and paste from. An example would be the above posted comments.

    It just seems disingenuous not to give credit to someone else’ intellectual property. When instead you consistently post while giving the impression that the comments were your very own original thoughts and ideas when in fact they are not.

    I might add that there is nothing wrong with snip and paste. It should be credited as such.

  18. Submitted by Kevin Judd on 08/15/2009 - 09:38 pm.

    There are real concerns, and there are some inflated concerns. The president could have done without the UK doing this http://www.telegraph.co.uk/health/healthnews/5955840/Patients-forced-to-live-in-agony-after-NHS-refuses-to-pay-for-painkilling-injections.html right now.

  19. Submitted by Robert Gratz on 08/18/2009 - 06:57 am.

    The author suggests the genesis of opposition to healthcare reform’s public option is due in part to differing ideology. I agree. I suspect its enactment would be seen by the “right” to diminish their concept of the American experiment. I respect that passion. In many respects I share it.

    But here’s the thing. If I discover a fire in my bedroom I don’t call the fire department and ask them NOT to come. As a tax payer I need, and deserve, their assistance. Ideology is fine, up to a point, but we always need to be cognizant of the responsibilities that accompany our treasured American rights.

    The private insurance sector has for years had the opportunity to develop a fair and affordable plan within which all would qualify. In spite of government influence to encourage equity, their offerings have failed to live up to expectation. As our families’ need for adequate coverage intensifies, the more we’re forced to conclude healthcare insurance is a realm of service the private sector can not adequately deliver. We’re forced to look to the government for relief.

    As citizens of most other wealthy governments have done, our ideology needs, by necessity, to be nudged to accept healthcare insurance coverage as an activity similar to those of our police and fire departments, and we have long honored those entities as publicly funded successes.

    Ideology (like healthcare) is keenly personal, but it needn’t limit us in our willingness to care for one another.

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