Wednesday, August 26, 2009

Town Hall & Health Reform Circus

Oh boy, what a circus!! I should have adjusted my expectations when the younger couple standing in line behind me were more interested in viewing the signs and "crazies" in the crowd. I asked them what they were interested in [regarding health reform], the response - "seeing the people, the crazier the better." Big Sigh.

Some of the organizations represented outside included:
Organizing for America (including folks from MoveOn, I think)
SEIU, Healthcare Now, Families USA
LaRouchePAC (crazies who portray President Obama as Hitler)
American Constitutional and Capitalism Defense Front (very much anti-reform)
Planned Parenthood, Operation Rescue
a group for Tort Reform and the "Leave Us Alone" Coalition

Oh, and I can't leave out the sign I saw from Prescott Pharmaceuticals, proud sponsor of "Cheating Death with Dr. Stephen T. Colbert." Remember this was somewhat of a circus.

In the pep-rally atmosphere before the event began in the South Lakes High School Gymnasium in Reston, VA, I believe it was the clever guy who created the "Go Skins" sign (on the back of his pro-reform sign) which got the loudest cheers from those in attendance.

It was a spirited atmosphere certainly, but during the speakers time I naively expected less disruption from the crowd. Don't know why I expected that, just did. Hundreds of people were turned away after the gymnasium reached capacity at just under 3000 people.

Jim Moran, the 8th district Congressman, invited a local Rabbi to speak at the opening of the event and to give an Invocation. Even the Rabbi was interrupted and booed a couple of times. Throughout the evening, I counted at least 42 times when members of the crowd yelled, heckled, shouted, and created a disruption. Then there were the times where the crowd cheered in an attempt to cover the boos. And sometimes it was hard to distinguish between heckling and cheering.

I do think that Moran did a good job presenting information which is included in the health bills which have come out of 3 House committees. He says that each of these have compatible details. We also received a 5-page summary of HR 3200, America's Affordable Health Choices Act. Here are some of the highlights:
  • Choice. People may keep the coverage they currently have if they so choose. Nobody will be forced to switch and 90% of wage-earners will be unaffected by changes.
  • Cap annual out-of-pocket spending to prevent bankruptcies from medical expenses. Even in the affluent 8th district, there were 800 families who went bankrupt last year because they couldn't afford healthcare expenses.
  • Guaranteed coverage and no exclusions for coverage of treatments for pre-existing health conditions. Prohibition of lifetime and annual limits on benefits. Limits the ability of insurance companies to charge higher rates due to health status, gender, or other factors.
  • The Health Insurance Exchange is modeled after FEHBP where individuals can go online and compare plans side-by-side and insurance companies must offer coverage which meets minimum standards (most often offering much more at a competitive price). The Exchange should provide competition in areas where insurance companies have virtual monopolies.
  • An essential benefits package, based on standards set in the law, will serve as the basic benefit packet for coverage in the Exchange and over time will become the minimum quality standard for employer plans. Preventive services with no cost-sharing, oral health and vision for children, and caps on the expense for an individual or family for covered services in a year. Mental health and substance abuse coverage will have full parity!!
  • Although Moran didn't discuss it (due to the 'affluent' nature of the district), Medicaid will be expanded with new federal funding including higher reimbursement rates for primary care. The Bill caps annual out-of-pocket spending and provides sliding scale affordability credits.
  • It improves Medicare by narrowing the 'donut hole' in the Part D drug program. Immediate 50% discounts on brand-name drugs purchased in the 'donut hole' and the donut hole will be reduced by $500 in 2001 and it completely filled over a number of years.
  • Improvements in Medicare enhance coverage by eliminating cost-sharing for preventative services, improve low-income subsidy programs, promote improved payment accuracy, encourage delivery system reforms (ie. 'never event' non-reimbursements), combat waste, fraud & abuse, end Medicare Advantage overpayments, and extend solvency of Medicare Trust Fund.
  • The Bill requires everyone to purchase insurance. No free-riders. If individuals choose not to buy coverage, they will be assessed a penalty fee of 2.5% of modified AGI above a specified level.
  • Building on current employer-sponsored coverage, employers will have the option of providing health insurance for workers or contribute funds on their behalf, an amount which will be based on 8% of payroll. The idea behind the penalty/contribution fees is to provide sufficient motivations for individuals/employers to obtain/provide insurance.
  • Small employers (with payrolls under $250,000) will be exempt from employer responsibility. The payroll penalty starts at 2% (payrolls over $250,000) to the full 8% (payrolls over $400,000).
  • The Summary we were presented with also includes information regarding: Prevention and Wellness; Workforce Investments; Controlling Costs. Expansion of Community Health Centers. Prohibition of cost-sharing for preventative services. Creation of community-based programs to deliver prevention and wellness services. A focus on community-based programs and new data collection efforts to better identify and address racial, ethnic, regional and other health disparities. Funds to strengthen state, local, tribal and territorial public health departments and programs.
The Public Option:
  • Provides Americans a choice, like Medicare, which will be included in the Insurance Exchange.
  • Citizens are still free to purchase coverage from Private Insurance companies if they so choose.
  • The Public Option won't be "cadillac coverage" but will be a basic benefit plan.
  • It will provide quality preventative care from the physician of your choice.
  • Doesn't affect 90% of wage earners!!
  • Moran said to the crowd - "I know you care about our friends throughout the rest of the country and not just ourselves." - This was in reference to having the Public Option which may not directly affect the constituents in the 'affluent' 8th district. However, he did point out that in Northern Virginia there was $100,000,000 in expenses for the uninsured and in uncompensated care last year.
Following the discussion above, Jim Moran went through several "myths" floating around and balanced them with facts to clear the misconceptions. He used slides which discussed 11 individual issues. I'll reduce some of the statements presented and expanded upon by Moran:
  1. The idea of "Death Panels" is pure nonsense. There is NO such thing. The Bill allows for reimbursement for the time the patient spends with his/her doctor in discussing preferences for agressive life-sustaining treatments, living wills, power of attorney, or other treatment chocies.
  2. Congress currently is and will continue to be subject to federal regulations regarding employer-sponsored plans. With that in mind, Congress will be impacted as much as any other person who has employer-sponsored health insurance coverage. By 2018, employer-sponsored plans will be required to meet the minimum coverage requirement.
  3. It will NOT result in expanded government control. Currently the insurance company holds all the power. This will put the patients and doctors in the driver's seat. Insurance company bureaucrats will not be able to stand between you and your doctor.
  4. There is NO rationing of care. The myth is that a committee will decide what should be covered in your case. He was referring to the Health Benefits Advisory Committee and didn't clearly explain what their function would be, either that or I didn't write it down because I'm already familiar with it. [My opinion is that nobody who knows can claim that there is "no rationing of care" within any fiscally-responsible system. There is too much demand for EVERYTHING and THE BEST, and currently rationing is done through insurance companies or the ability to pay. This is a discussion which is neverending in the health policy world.]
  5. Taxpayers will NOT be funding or providing credits for illegal immigrants. Section 246 of the Bill specifies that it will not pay for undocumented illegals.
  6. The Public Option will NOT force employers to drop coverage and force their employees onto the same. The Congressional Budget Office says that more employers are likely to provide coverage under the Bill, due to the 8% payroll penalty/fee.
  7. Abortion coverage is NOT mandated in any of the 3 House bills. Abortion will not be paid for by federal dollars, except in the case of rape, incest, or to save the life of the mother (which I believe is the way the law reads now). People can go to the Exchange and pick a plan which goes along with your personal preferences and views on abortion, whether the plan covers it or not.
  8. The Health Choices Commissioner will ensure that plans meet the required minimum benefits. It will NOT choose for you which plan you must have. You make your own choices.
  9. The Government will NOT have direct access to your bank accounts. Page 59 of the Bill allows for direct electronic payments to doctors. This is something which the doctors wanted to have included and which would minimize time between service and reimbursement from the health insurance company.
  10. The Government will NOT mandate all benefit packages in private plans. It will set a minimum for basic services. Private plans may (and will very likely) provide plans with greater benefits.
  11. The Government will NOT reduce physician services to all Medicaid seniors. Page 239 of the Bill adjusts how the Sustainable Growth Rate is calculated, a change which will actually increase reimbursements.
Next Howard Dean rose to speak but was immediately shouted down by a group led by Randall Terry (Operation Rescue) focused on anti-abortion. Truly rude behavior and a couple of men were escorted out, even after being offered the opportunity to speak for 5 minutes in return for silence during Dean's speech. Those from Terry's group who stayed continued to boo and heckle Howard Dean. Whether it was intentional or not, Dr. Dean kept his comments simple and to the point.

I believe that he made three points regarding the need for reform. I had significant trouble hearing his remarks.
  1. Healthcare costs more in this country than in any other country.
  2. We simply must cover everyone in some way.
  3. We need to have a healthcare system based on a Wellness Model instead of an Illness Model.
Dr. Dean then told us why he believes so strong in this and told the story of a patient who came to him with increased thirst, increased urination, weight loss in February. She was diagnosed with Diabetes and by May that year had been dropped from by her insurance company. This was 20 years ago and the woman was only 35 at the time. She became uninsurable.

Then there were questions asked from constituents (however, I must have missed where one could submit a card with questions, argh). They had 3 boxes labeled: for reform, against reform, and undecided. A card was drawn from each box in an alternate fashion.

This process was less than efficient and provided a few annoying moments when folks took the opportunity to make big statements, rather than ask legitimate questions. I would say that there were really only 3-4 honest-to-goodness intelligent questions asked. One woman even came up to the microphone pretending to be the person whose name was called....and she wasn't.

Howard Dean answered many of the questions and Jim Moran answered some as well. It is no secret that Moran is one of the more liberal Democrats and our district has been gerrymandered in such a way as to consolidate the more liberal areas. The Republicans actually did this more so in 2001, creating a situation where Moran is practically uncontested and the other local districts at least have a chance of electing a Republican.

You can watch a C-SPAN video of the event here -

Perhaps tomorrow, I will come back and try to detail some of the questions asked and the answers given. But right now, it's getting late and I've got health reform dripping out my ears. :)


  1. Oh Lisa, well done!! What a great comprehensive overview! Thank you so much for the link to watch.

    Our local senator, Frank Pallone, held a Town Hall last night and the behavior was unspeakable. Just as bad are the comments left at the online article at our local paper, the Asbury Park Press. The ignorance and racism is frightening.

    These thugs have nothing constructive to say. They are just hate mongering idiots.

  2. Thank you for the wonderful first-person account of a town meeting. Very interesting!

  3. Great Job Lisa and thank you for representing! I hope people get the FACTS str8 soon.

  4. Great Job Lisa and thank you for representing! I hope people get the FACTS str8 soon.

  5. Hi Lisa. Thanks for the write up. I saw news clips of the event and it looked spirited.

    In item 3 (of the 11 myths) you write, "It will NOT result in expanded government control."

    However, earlier you wrote, "The Bill requires everyone to purchase insurance. No free-riders. If individuals choose not to buy coverage, they will be assessed a penalty fee of 2.5% of modified AGI above a specified level."

    How do you reconcile the two statements?

    Jokingly (with a hint of humble truthfullness), I must say if you believe there will be no rationing I have some ocean front property in Oklahoma to sell you. ;-) Do you believe there will not be groups of bureaucrats deciding which initiatives to fund and where money shall go? I am already part of this process everyday in the Fed government for telecommunication systems. The process is very ugly, wasteful and inefficient. Money does not go to those groups who need telecommunication upgrades the most, it goes to those with the best political connections, or to those who can spend the money at the drop of a hat (whether they should spend the money or not), or to those who can make themselves look the neediest, whether they are or not. Also, when the money is spent it is spent on "Cadillac" type telecommunications systems instead of "Chevys" even though a Chevy would meet the need. This mondey spent on the Cadillac is at the expense of several groups who needed Chevys. I could go on... I look forward to your reply.


    Your Cousin Bobby

  6. Ah, Mr. Bobby Emrich, dearest cousin, hi!!

    Please keep in mind that I purposefully withheld my personal thoughts to myself on each point-by-point given by Jim Moran. To be true to what was said, I adhered to the order in which each statement was made. Not my show, but Moran's.

    The requirement for everyone to obtain insurance could be seen as increased government control. I see it as a minor change to the tax code. ;) Not an increase, just an adjustment.

    And personally, I do believe that everyone should obtain insurance. If nothing else, it would eliminate the lame argument given by some who state that persons with pre-existing conditions who can't get insurance coverage shouldn't have waited until they needed it to try to get it. "It's their own fault," so the rhetoric goes. Yeah, all those young and healthy really should be contributing to the same pot. Someday they will need services too.

    For Item 3 of the list of myths (which were presented and explained by Moran, not me), the topic is control between choices patients can make with their doctors. Not gov't over a person's taxes and thus contributions to societal systems.

    I had a neurology appointment yesterday morning. There was a 3rd party in the room (figuratively) when my doctor and I were trying to decide what tactic to take with some adjustments to treatment. That extra party was my insurance company.

    The (mythic) fear is that gov't will dictate what treatment choices are available or allowed for what patients. Nobody wants gov't bureaucrats dictating how doctors can practice medicine with arbitrary rules. But, honestly, we are already subject to that from insurance (if you are not protected by the requirements put in place for insurance companies who wish to sell plans under the FEBHP program). wink, wink

    Hey, now where's that beachfront property you are selling? I'm sure that you really meant to say "beach" not ocean. Lake Texhoma is large, but not THAT large and certainly not saltwater.

    The rationing statement is the one in which I DID interject my opinion on the matter (however briefly). Nobody wants to hear the word rationing, it brings to mind things like food rations, or rationing of lawn watering in the summer, or maybe even gov't surplus food.

    One of my favorite blogs is the Covert Rationing Blog. I've met Dr.Rich and truly this man has an excellent grasp on the inner workings of the healthcare system, including the covert rationing which occurs now.

    Regarding allocations of funds, you mean the "use it or lose it" aspect of department/project funding throughout the Defense Department? This coming from the theory that if you don't use up what you've been given, then you obviously didn't need the money.

    Yes, I despise those powerful political connections. Wish I had some of those. LOL. Now you should do all you can to get the money and resources to those Chevy's because, ya know, I pay your salary and contribute to your health insurance coverage (that is if you are still working at Tinker).

    So do an Emrich proud - fight for the little guy!! Seriously, if you were in my shoes, you'd likely have a political change of heart. Although I know that I've always been a bit different in the political department anyways from other members of my family (especially some of those family members, aunts and uncles, to whom you are not related).

    With 20-25% of my income going to health insurance premiums alone and with out-of-pocket expenses which are almost double my income, I'm interested in long-term survival. Yes, I know that the math above doesn't look like a solvable equation, but I've found one solution - an income below 200% FPL. Not fun.

    But hey, I'm sending hugs and kisses to you and Felicia and the kids. And I've love to hear more about the reform discussions going on in Oklahoma.

    Most respectfully and with big grins,
    Your cousin Lisa

  7. Hi Lisa. Thanks for the reply. I am for the little guy, which is why I am against this reform. We'll talk more when it is not so late. Have a great weekend!

  8. Hi Lisa, I appreciate your viewpoint and fatigue.
    I hope I don't make you tired with my response. I am not afraid of healthcare reform. I believe the system needs incremental changes and that no politician or CPA or lawyer should dictate.
    I do believe in tort reform but all the lawyer-congressmen don't want to take away their lawyer buddies' bread and butter.

    I do not want politicians in charge of healthcare.
    I do want independent people to be able assemble to make a group to get insurance which is what makes employer sponsored insurance somewhat affordable.

    Still I pay the price of premiums, working for lower pay as a civil servant for the government, show up for work every day spending my good days at work until I can't work anymore.

    And I signed up to have the doctor experiment on me so it would all be paid for ($40k/year meds, Dr visits, tests) no matter whether I have insurance or not.

    I was categorically denied disability insurance putting my house at risk.
    We have programs in Vermont like the Choices for Care waiver I work for and Catamount health. These are incrementally better than what you, Lisa and many others have access to.But still our "nursing home" eligibility allows people with assets of $300-400 thousand or more to pass those assets to family with a lawyer (who profits) while I see other starving shivering medically fragile people.
    Sure, I am one of the covered people who are happy with what I have at the moment.
    Sure, it could all change.
    But my opposition of the healthcare reform proposed by impatient self serving politicians is not based in fear.
    It is based upon my experience in healthcare, insurance and as a client.
    It is based on my experience with lawyers and politicians.
    No mystery to me any longer.
    The legal system has an underlying pathology, having politicians make rules that serve their buddies, not their constituents.
    Patrick Leahy never responded to my letter I sent to him and posted on my blog.