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Will We Be Honest in Our Healthcare Reform Effort?

Donna Smith

I finally heard an honest soul speaking about the healthcare reform efforts thundering ahead in advance of President-elect Obama's inauguration.  And that's a big step in the right direction.

Single payer supporters – hundreds of thousands of healthcare professionals, the 90-plus Congressional members, learned people and regular Janes and Jims – who believe in a publicly funded, privately delivered healthcare system have suffered to be at these magnificent "tables" full of selected stakeholders meeting feverishly but fairly quietly to support an already crafted agenda while appearing as though they are vetting all options for the healthcare reform that is decades overdue.  Some honesty here would be good.

The bodies continue to pile up like cordwood while the polite conference table inhabitants smile and applaud one another for their ever-so-conciliatory motion to embrace and enhance and entitle the for-profit healthcare insurance companies and the big pharmaceutical companies under the guise of true reform.  Jump for joy, we are told, you'll all be able to buy private health insurance.  Oh, and they'll be better controlled.  Whoopee! A bail-out by any other name would still smell as foul...

So, what was the honest response and explanation I heard?  I actually heard a relatively high level Congressional staff member say we cannot consider single payer reform because many members of Congress have a visceral reaction to that sort of reform even being debated or discussed – or God forbid – seriously considered.

What is a visceral reaction? "Proceeding from emotion or instinct rather than from intellect; deeply emotional," Webster's definition of a visceral reaction.

And why do so many members of Congress have such a deeply emotional and intellectually void reaction to single payer?  Because they rely on insurance and pharmaceutical industry contributions for campaign funds.  It's that simple, said the Congressional staff member.  This is not a revelation, is it?  But it sure was refreshing just to hear it said straight up and without any sugar-coating by a person who knows the ins and outs and who is working directly on reform.

It won't be intellectual honesty or even what's best for the nation and its people that decide this reform effort, I heard.  It will be the big campaign contributors.

But, wait, didn't we – the voters for whom no similar visceral reactions are had – hand over some pretty big bucks to the Obama election effort?  And with great joy and great promise?  Yes, we did.


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And aren't we dying at the rate of 60-plus each day as we go without access to healthcare while the visceral reactors smile and preen and pat each other on the back for carefully crafted plans and carefully staged public hearings during which carefully selected witnesses bolster the plans that will hold visceral reactions at bay?  Yes, we are still dying for healthcare. Death is just about as deep-feeling as it gets.

Isn't the nation struggling with industry and public entity collapses and budget crises pushed and fueled at least in large part by health benefit and insurance costs for employees and retirees and public employees and poor folks on Medicaid and uninsured folks showing up for care in the most costly ways?  Yes, we are. 

Aren't millions of folks struggling without jobs from which they can get employer-based healthcare and therefore also without enough income to afford any COBRA benefits or private purchase of coverage?  Well, yes, there's that too.

But, are we now hearing all the realities of every plan – the true costs to the nation, the true costs to us as patients and as taxpayers and as voters?  And, the true cost in lives, in bankruptcies, in foreclosures and the fall-out from those losses of those who will be forced to carry sub-standard coverage because they are disabled or otherwise physically diminished from an insurance underwriting perspective?  I really wonder how the insurance industry will wiggle around discriminating against those with serious illness – but wait, insurance companies already are allowed to discriminate against women of child-bearing age while men of impregnating age are charged less. Single payer has some outstanding cost saving and quality control aspects – and inherently avoids some of the Americans With Disabilities Act lawsuit (and EEOC related claims) potentials ripe in the multi-payer, for-profit plans as being touted right now.  Yet, no, we are not hearing all of our alternatives honestly and openly debated. 

I still have great hope that the truth will prevail.  President-elect Obama is putting good people in place to work on healthcare even if some of our Congressional members are struggling with single-payer induced visceral reactions (will those be pre-existing conditions, I wonder?).  Sen. Tom Daschle is one of those good people (and is to be our new Secretary of Health and Human Services and health policy czar), and I know him to be a straight-shooter.  His South Dakota roots and his upbringing compel that in his character.  More importantly, his intellectual curiosity and respect for the long arc of history is well developed.  I'm told that arc (at least in moral terms said Martin Luther King, Jr.) bends toward justice.  And while one person cannot move mountains, certainly one person of his stature can impact the process.

But I also see too much cozy and comfy back-slapping, maneuvering of information release and glad-handing with just one side of the equation right now, so I will remain hopeful but guarded that the intelligent and committed people who espouse a single payer way of solving the crisis will be at least as welcome to the banquet as those devoted health insurance profit-takers and campaign purchasers who print the menus, set the prices and then collect the checks.  The American people are growing a lot smarter through this whole bail-out process and giving us more insurance salesmen isn't going to fool us into thinking we've got better healthcare.

The nation's healthcare plan is too important to allow less than full disclosure and full investigation of all of the options – the flaws, the strengths, and the empirical data that will help us all arrive at a place that bends toward justice and better health.  We've all been thanking our lucky stars that we'll be welcoming more intelligent leadership into the discourse.  Now let's not allow them to give in to visceral reactions that leave the intellect behind.

Donna Smith is a community organizer for the California Nurses Association and National Co-Chair, Progressive Democrats of America Healthcare Not Warfare campaign

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