Healthcare We Can Believe In

I am not a wonk. Usually this is not a problem. But when it comes to healthcare reform, it matters. You see, I long to dash forward, flaming sword in hand, to champion President Obama's healthcare plan. Every day I get e-mails from Health Care for America Now, Organizing for America, MoveOn.org and similar groups urging me to write my Congressman, attend a town-hall meeting, host a gathering. But how can I speak knowledgeably about a plan that does not yet exist and in which the parameters keep shifting?

I'd like to tell people, Obama's plan is great--for example, it has a public option that will insure those who can't afford private coverage, help rein in the insurance companies by competing with them for members and drive down drug prices through forceful negotiation. But maybe the final bill won't allow the government to negotiate drug prices, because that's the price of Big Pharma's support, which apparently the Obama administration negotiated for in secrecy. Maybe it won't even have a public plan; it will have insurance co-ops instead. And then, maybe, I should say those will be just as good, as Rahm Emanuel's brother, Ezekiel Emanuel, the MD/PhD bioethicist, says.

OK, but what are insurance co-ops? I poked around online for fifteen minutes and discovered that they're untested, small, unregulated, that they exist in twenty states and that Senator Kent Conrad of North Dakota really likes them--but I didn't discover what they actually are. I understand "public option," and "public" has a good, strong ring to it--it says, Healthcare is a right, part of the common good, something everyone should have, and if you can't afford it in the marketplace, the government will provide it. "Insurance co-op" speaks a whole other language, of commerce and complexity and exclusivity.

Sarah Palin puts forward crazy lies about how "Obama's death panel" will euthanize Trig Palin and the elderly; right-wing radio hosts like Rush Limbaugh talk about socialism and compare Obama to Hitler. We respond with wonkery: burdens lifted from small business, the unsustainability of rising costs. But people who would believe Obama wants to kill Grandma are the last people who'll respond to rational economic arguments. They are too irrational and, let's face it, too ignorant. The retirees ranting about the evils of government healthcare don't even get that the Medicare they rely on is a government program.

Whatever happened to, um, health? Wasn't that a big part of the original case for reform? The 46 million uninsured, the 20,000 people who die every year for lack of medical care, the studies showing that people without insurance get worse care than those with it, even after car crashes? Where are all those people with infuriating stories of being denied essential care by insurance company bureaucrats, and those who thought they were covered when they weren't, and those who were hit with huge bills because of fine print in their contracts? What about the people who can't quit their jobs because they need the insurance? The people who struggle and sacrifice to pay enormous premiums? The people who cut their pills in half to save money, or who can't afford them at all? And what about doctors? My internist and gynecologist no longer even take private insurance because of the endless hassles and frustrations. Why don't we hear more about how fed up doctors are with the status quo?

Listening to the radio earlier this summer, I heard a 59-year-old nurse named Robin Batin testify in the most heart-rending way before the House subcommittee on oversight and investigations, chaired by Representative Bart Stupak. When she developed invasive breast cancer, her insurance company, Blue Cross and Blue Shield, rescinded her coverage because of a pre-existing condition--dermatitis--even though her dermatologist called to say it was acne, not, as the company claimed, a precancerous condition. Stupak confronted the heads of Assurant Health, UnitedHealth and WellPoint with the fact that there are some 1,400 conditions that can be used to cancel a policy, most of them so minor and obscure that the executives had never heard of them. Between 2003 and 2007, the three companies saved $300 million by rescinding at least 19,776 policies. By the time Batin finally got her surgery, her tumor had doubled in size. The Congressmen were shocked--they had no idea. Neither did I. The program? This American Life. I love Ira Glass, but come on, people! "Rescission" should be a word on the tip of everyone's tongue by now.

As of this writing, it is far from clear how much of the vocal opposition to reform represents wider popular feeling and how much is a mobile mob of gun nuts, birthers and teabaggers paid for and organized by lobbyists and Republican outfits like Americans for Prosperity, Conservatives for Patients' Rights and FreedomWorks. Several polls show a majority of Americans still want reform. But polls don't mean much politically if everyone stays quiet. Where's the superb organizing the Obama campaign was famous for? Where's the pushback from the left--for the public plan, or even for single-payer? It may be a non-starter in Congress, despite the upcoming vote on Representative John Conyers's HR 676, but one thing you can say for single-payer--it's easy to explain and to understand.

Oh army of Obama supporters who swarmed the country less than one year ago, we need you back knocking on our doors and sleeping on our sofas. We need you to stand on street corners handing out fliers that explain what healthcare reform is really all about and how people can make sure it doesn't get swallowed whole by the drug and insurance companies. Surely you're not too young and strong and healthy and vegan to care about boring parent stuff like health insurance? The diss on you was always that you were infatuated with Obama's charisma and with vague notions of "change"--not with the long slog of political engagement. That isn't true, though, is it?