Building a Better Understanding of Health Care Reform

On Tuesday night, the newspaper held its 27th Public Square. The topic was health care reform. Unlike our September Public Square on health care, which featured presentations by Reps. Bobby Scott and Eric Cantor, this session was devoted entirely to comments from the public. A DVD of the proceedings, which were eminently civil, will be sent to Virginia's two senators and the five congressmen representing parts of Central Virginia. Our publisher, Tom Silvestri, moderated. This week's Commentary is publishing edited comments from most of the more than three dozen people who shared their thoughts. To see the entire Public Square online, go to TimesDispatch.com, keyword: Public Square.

Tom Silvestri, publisher: With Congress considering complex and controversial bills about health care reform, we figured we'd open the floor up to the public . . . .If you've used the format of writing a letter to your congressman or -woman, you can read portions of it here. We're going to send copies of tonight's program in DVD form to our two Virginia senators, and the delegation from central Virginia, so they'll also hear it.

Chris Dorsey, Richmond: I will address this question, or these questions, to Sen. Webb and Sen. Warner. I wish they were here to answer them. I believe in always following the money, and the monetary source of the insurance industry, the Pentagon, and all other institutions that control the United States government is the Federal Reserve Bank, which lends out trillions of dollars without disclosing where the dollars go, the interest rate on the loan, or the collateral. My question, among others, to Webb and Warner, is, who owns the Federal Reserve Bank? And should the American people trust a central bank that behaves like a Ponzi scheme? And how do you respond to people like myself, who say that you are bought and paid for by institutions like the insurance industry, the Pentagon, and the IT industry?

Mike Craven, Mechanicsville: Why are we in a health care crisis? The answer: There's no team effort between the preventative and reactive sides of health care today. In fact, they pull each other apart. To be successful, we must recognize failure. The preventative side of health care's failing. This is reflected by the reactive side of health care, that documents the growing rate of obesity, diabetes, and heart disease. Medication for cholesterol, blood pressure, and triglycerides have increased since 1960. Unless we provide unity in the message of prevention, America's left to assume anything is better than nothing -- not a winning attitude.

Niels Hagglund, Manakin Sabot: I would like anyone in the room to identify for me a federally sponsored national social services program that is delivering the services that it claims are in its venue -- and doing so on budget . . . .There are many programs that deliver what they're supposed to. But I have yet to hear of one that is within budget. . . . I find that the government's trying to put itself into a position where it will either administer or try to control the future of health care in this country. And it's very clear, with this limited experience, that it has developed neither the skills nor the tools necessary to control the administration of health services programs, or the costs contained there. Secondly, it seems as though the government is trying to put itself in a position where it's going to help me and all of us decide what is best for our own individual health care. That's something I personally don't want, and I don't need. I will make my own decisions about health care. I will be responsible for those decisions, and I will live with the consequences that come with that. . . . If the government is allowed to continue with programs that they want to put in place, they will fail. And the people who will be hurt most are the same people that get hurt every time by a government program failing. And that is the poor.

Joe Andrews, Richmond: This is an open letter to Sen. Jim Webb and Sen. Mark Warner: In light of your support of health care reform, I trust that you will be voting for legislation that will not only be beneficial to the health care industry, but will also serve the best interest of the health consumer. While I am very supportive of the Obama administration's efforts to deliver greater health care coverage for the American people, it is my hope that you will make certain that you support legislation that will not only reduce health care delivery costs, but will also be affordable for the poorest of our citizens. There should be some kind of subsidy to help low-income people to purchase insurance, without unduly penalizing those who choose not to have health insurance. In addition, I believe that the Senate bill should also contain a prohibition against the federal funding of abortions, which was included in the House bill that was just passed.

I also think that health care providers should have the right to refuse to provide federally funded abortions, if this violates their conscience. Emphasis needs to be placed on funding prevention programs, and in keeping people well, rather than always waiting for them to get sick before we provide financial support.

Margaret Davis, Chesterfield: I've been very upset ever since I heard that some of the senior Medicare benefits could be taken away. All my life I've been blessed with good health, until the last year. I go to a great doctor, who's very thorough. He sends me for the tests I need, and could have saved my life in the last year, by sending me to have the proper tests to discover what's wrong. And I do not want this changed, and have a government say, "Well, we're going to take and cut this test out, and we're going cut that test out." Life is precious. And I do not want this change for anyone. I do not want anyone denied medical treatment when it's needed, and I do not want benefits cut . . . .If I can't afford something, I don't buy it. But it seems like our government officials have a large credit card, with no limits. It has been shocking to see how huge sums of money have been given away to some, while taken away from others . . . .I think the government health care plan should be sent back to the drawing board, to come back with a better way to pay for health care, instead of using money by cutting Medicare benefits.

Durwood Usry, Richmond: I believe that there are many who fall through the cracks, unable to afford health care coverage. And I'm not talking about the unemployed, the homeless, or even the working poor. I'm talking about other productive members of our society who can't afford even a modest health insurance policy. I'm talking about middle-class Americans, those who aren't a part of an insurance plan offered by a large, major corporation. People who need to buy their own insurance policies. People like me. I'm a small-business owner. My few employees are insured by policies held by their spouses. But my spouse is self-employed, so we buy a small group policy through Anthem. But I have a challenging health history. Two cancers, a triple bypass, all in the last 12 years. But I'm fine now. Healthier than I was before. And it's really difficult to explain that to my insurance company. Fortunately -- and this is a major point --Virginia is one of 35 states that mandate that health insurance be offered to all Virginians. If I lived elsewhere, there is a possibility that I would have no insurance at any cost. So, I have health insurance. But you better believe that I'm rated, and I pay dearly for it. My health policy costs more than my mortgage. But it's the first thing that gets paid every month. Indeed, my health policy is increasing to $1,300 a month, and that's just me. My wife is $269 a month, and she's very healthy. You do the math. It's over $19,000 a year. But we have coverage, and we can pay for it. It's not easy, but we do it. Our policy isn't a particularly rich policy. We have a $5,000 deductible. And I can't imagine what it would be if it was higher or lower.

I'm guessing that many, if not most Americans, could not afford to pay $1,500 to insure two people every month. What options do families have, if there's been a pre-existing condition, or health history? Or like me, apparently, bad genes. I eat right. I'm active. I'm not a couch potato. What do they do? They could be employed, productive members of society, but they just can't afford health insurance. There needs to be some option for people like that, and for people like me. People who are willing and able to pay something for health insurance, just not something that has them paying extraordinary amounts.

Scott Broaddus, Glen Allen: One characteristic about good management, good rules, and good regulations is to be self-corrective. To reward voluntary proper behavior and to punish voluntary bad behavior. It constructively benefits all who are involved, and promotes self-sustainment. I would like the voters to be told which health care reform bills reward those citizens practicing healthy lifestyles, such as healthy body fat ratio, weekly weight-bearing aerobic exercise, and at least annual medical exams. And penalize those citizens with unhealthy lifestyles, such as obesity, smoking, illegal-drug use, little or no proper exercise, and no regular medical exams. And please tell our voters that you will not support any bill which does not consolidate the federal employee health care program within the reform bill. There should be no different bills, or policies, for Congress.

John Kmec, Chesterfield: The current 2,000-page health care reform bill, as passed by the House, does nothing to slow the rising cost of health care. And instead, adds a huge new entitlement program, complete with many new agencies and bureaucracies that in all likelihood will actually increase health care costs. The Congressional Budget Office scored this bill as being budget-neutral at a 10-year cost of $1 trillion. However, the accounting relies on gimmicks that would be illegal in the private sector, and would even make Bernie Madoff blush with embarrassment. Just to give three examples: The bill assumes $400 billion in cuts to Medicare and Medicare Advantage programs, through fraud elimination and in improved efficiencies. That hasn't happened in the 40-plus years of Medicare's existence. And so the likelihood of that happening in the future is zero.

Second, the bill also assumes that the $250 billion in Medicare reimbursement payments to physicians, paid for outside of this bill, doesn't count toward the cost of health care. By that logic, if I were to buy a copy of

The Times-Dispatch by taking 50 cents out of my left pocket and 50 cents out of my right pocket, that would actually cost me less than if I took a dollar out of my wallet. It doesn't make sense. Third, the 10-year cost of the bill relies on collecting revenues beginning in 2011, but only beginning to pay out significant benefits beginning in 2013. Gee, that's really great. I think I'll take out a 30-year mortgage on my house, but I won't begin to pay it back for five years. Interestingly, as an aside, the individual mandate penalty portion of this bill doesn't take effect until 2013, which is after the 2012 election. As for the public option, if you like the way the government has handled the availability of the flu vaccine this year, you'll love the public option. Taken all together, the true 10-year cost of health care reform is closer to $2 trillion, not $1 trillion, and would add $1 trillion to the deficit.

John Vellines, Chesterfield: Health insurance is expensive because health care is expensive. Health care is hospitals, doctors, laboratories, prescription drugs, etc. All very expensive. We may have the best in the world. I don't know. But there's another reason why the cost of health insurance is so high. It's really quite simple. The receiver of the service is not the payer of the service. The receiver is not the payer. There is no consumerism in health care. So, I would like to see our senators first of all vote no to all the proposals that are pending, and start over next spring, and build a real health reform program around affordability. And that would include expanded use of consumer-driven health care, including HSAs, and, also, real and effective malpractice reform.

Seth Croft, Richmond: As the co-chair of the board of directors of the nonprofit organization, the Virginia Anti-Violence Project, I know how difficult insurance companies have made it for small nonprofits like us to offer health care coverage to our employees. Over the past three and a half years, we've only had one full-time staff employee, which left us with virtually no bargaining power to negotiate a fair premium, and we were at the mercy of insurance giants like Anthem. To cover our single employee, it cost our organization nearly $500 per month. That's almost $6,000 a year, for a bare-bones policy, some of which of that money could have been better spent delivering direct services to victims of violence in Virginia. Also, that $500 a month did not cover any of our employee's pre-existing conditions, which in fact were the majority of their health costs. Our employee has moved on to bigger and better things. But because of the exorbitant rates that Anthem charges for health insurance, and fewer grant opportunities because of the economic slump, we are now unable to offer health insurance to our new employee. To compensate for this, we've had to cut our employee's hours from 40 a week to 30, in hopes that they may find a part-time job either that offers health insurance, or will pay them enough extra to afford one of the outrageously priced individual plans that Anthem has to offer.

The only hope for small businesses and organizations like ours to provide affordable health insurance to our employees is for Congress to pass a public option. Without a public option, we would still be subject to unreasonable premiums, and continue to be forced to slash our employee's hours and reduce our services to make ends meet.

Catherine Cabe, Montpelier: Those of us who are here to oppose this legislation as it sits are also mindful that we need to do something about insurance problems. I understand that. But this all-or-nothing that is proposed is not going work . . . .The Congressional Budget Office has warned that imple menting this program as proposed will collapse Medicare and Medicaid. Yet, without reading and understanding what's in it, our left-leaning officials have vowed they will foist this on our citizens. What part of "collapse" do we not understand? We're considering turning our health care over to the group that shoved secured bondholders under the bus in the auto bailout in order to give taxpayer billions as payback to union supporters. By their actions, these officials told us that they have no respect for the rule of law.

Ron Melancon, Glen Allen: The federal gov ernment does not always keep their promises. All you have to do is ask the first people who were here before we came, the American Indians . . . .But now the federal government is promising to do health care better. Government, fix your messes first. Maybe, then maybe, you can address health care.

Frederick Fisher, Charles City: We cannot afford our present system. As you've heard tonight, it's not really an insurance system. You can pay insurance for years and years and then your company goes belly up, and you go out and you get sick the next year, and you're not rated with anybody. It's a plan of one. And that is not insurance. It only makes sense, I think, to rate the entire country together. Another problem with our system is that it seems that the uninsured are not a part of the system. And they only become a part when they're very sick. I take my hat off to the President and the Congress for tackling this. I don't think they've got the ideal system yet, but at least they're working on it. We need a system that that citizens pay, and not companies. The cost of health care for American companies makes it difficult for them to compete. The government should provide basic health coverage for anyone and everyone. If anyone wants better coverage, they can buy additional insurance themselves.

Zubair Hassan, Richmond: I'm a cardiologist in Richmond, in practice for almost 40 years. I think the need for health care reform sometimes gets drowned in abstraction. So, I'll just give you two recent cases. Number one, it's about a 50-year-old man who was working stuffing bags with mulch. And he collapsed at work. He was taken to Petersburg hospital, where he was told that he was probably having a heart attack, because he had been treating his chest discomfort as indigestion for two weeks, it appears, because he didn't have insurance. Of course, the next day he had to come back, because of severe pain. He eventually got a bypass. But he had a severe heart attack. He's disabled for life. Now all of us are paying for his workman's compensation for the rest of his life, while his own family's a disaster.

Now, for those people who say young people have the choice, they don't need insurance -- there's a 27-year-old man, a cook, laid off last spring. And a few months later, he starts developing incontinence and weakness of his legs. He went to three different emergency rooms. For those people who say unemployed people can get help at the emergency room? He went to three different emergency rooms. He had tens of thousand of dollars of work, of imaging. But he did not want to be admitted, because he did not have insurance. Eventually, he went to a charity clinic, and was referred to a specialist, and now he's getting care. But he has permanent weakness of his legs, and incontinence.

A third man, about 60 years old. He worked as a builder, and made enough money to pay for his insurance. But he had a heart attack when he was 41. And in the last two years, he has had no work, he couldn't pay his insurance. Which, for him alone, was almost $2,000 a month. And in the last year here, a tragedy of his young son, 23 years old, dying suddenly, unexpectedly, he could not get any treatment. He's been missing doctors' appointments, missing his medications. That's why we need health care reform. Ever since the dawn of history, the well people have taken care of the sick. People who could help others, have helped them. Helped the family members, helped their friends, helped their fellow citizens. Now, I want everybody to remember that even before there was a Constitution, the battle cry for the nation, was, "Life, liberty, and the pursuit of happiness." I can assure you, there can be none of those if you don't have good health.

Linwood Russell, Richmond: This is a national security issue, when it comes to our health. But for Congress, it's not. Because they have the insurance policy that they need. So, what is the problem? We elect them, but they can't decide what's good for us? But they can decide what's good for them. You know, sometimes you got to just look over and say, "Well, how much is this pharmaceutical, this insurance company, putting in their campaign?"

Jill Hanken, Richmond: I work at the Virginia Poverty Law Center. Over the past few months of debate, it seems clear to me that most people from both political parties agree that health reform is needed. There appears to be agreement that it's unacceptable for people to be denied coverage for pre-existing conditions. It's unacceptable that the sickest people run into insurance caps, just when they need health care the most. It's unacceptable that people who change their jobs or lose their jobs usually lose their health insurance coverage as well. It's unacceptable that tens of millions of Americans, including 1 million Virginians, are uninsured, mostly because they don't have insurance through their work, and they don't have enough income to buy expensive individual policies. The need for health coverage for all Americans was first discussed 100 years ago. And we are now, finally, at the brink of reaching this goal. It is hard. It is complicated. And yes, it takes a very large piece of legislation to put all the pieces together, because all the parts are interrelated.

For example, we can't eliminate pre-existing condition restrictions without requiring everyone to have insurance. We can't require everyone to have insurance unless subsidies are available to make it affordable. We can't have a mandate without penalties and enforcement mechanisms. We can't bring down premium costs without true competition from a public option. We can't change the medical cost curve without mechanisms to improve quality and access to preventive care. We can't offer quality affordable health care to all Americans without spending more money. And to pay for new costs, we have to adopt reasonable revenue measures and offsets.

I believe that HR3692, the House bill that was just passed, meets these enormous challenges and weaves together all of the necessary components. The Senate bill should follow the same basic framework. It is shameful that the strongest and richest country in the world has allowed its health care system to have so many gaps and so many problems for so long. It's time to just make it work, and get it done.

Anil Kohli, Midlothian: Millions of people have been denied health insurance for supposedly having pre-existing conditions, or dropped from insurance after paying people for a long time. The leading cause of bankruptcy in the country is health care cost. People are suffering from heart disease, diabetes, cancer, and are even dying prematurely because of lack of health care. And some of us are pro-life. It is an immoral and scandalous situation . . . .Don't think, "I have health care, I don't care about somebody else." Let's not play politics. Let's not do personal ideology with people's suffering and lives. Congress should pass a health care reform bill.

Jan Hurley, Chesterfield: I can't decide whether I am Alice in Wonderland, or our Congress and the president collectively are Alice in Wonderland. The unthinkable seems to be happening all around us. May I preface my questions by saying that I feel we should support the health care of people, especially children who cannot afford to do so. And that includes the elderly, if they can't afford to do so. Let me also say that Medicare has been a good deal for seniors, and perhaps we should pay a greater part than we do. And I'm not talking about people who can't afford it. But for $90 to $95 a month, seniors are getting, really, a very good plan. I know it's fraught with fraud and all that stuff, but we're still getting good care . . . .

There seems to be so many hidden agendas in the development of the various health care bills. Why are they not more transparent? Why isn't a summary of the bills available? . . . Why is it difficult to adjust both the coverage of pre-existing condition, and the control of insurance cancellations without this vast takeover of health care? . . . Just how big do you want the federal government to be? How many new agencies will have to be formed to deal with these health rolls?

Wayne Lewis, Richmond: I'm basically for some sort of public option. I don't really like it being in the executive branch, and subject to elections. Back in the early 1900s, the United States created the Federal Reserve Banking system, for better or worse. It got us through this point. Basically, I think that the country needs something along those lines, to introduce competition to the health insurance companies.

Patricia Churchill, Richmond: I want to talk about a concern that I have that became a deeper concern today. And that is a tax on women in this health care bill, and in an announcement I heard today about mammograms. It seems to me that we are going in the wrong direction here. We're using our personal prejudices to try to enact rules and laws that will keep women from being in control of their own bodies. Thinking that we, an individual person, can tell another person how to live their life. We don't know their circumstances. We don't know anything about their health. We don't know anything. But because we have an individual belief -- "No, you can't pay for abortion, you can't pay for anything." Without knowing anything about the circumstances.

That's one attack on women. The second attack, today, on the news, if you watch television, you saw that this governmental task force says women from ages 40 to 49 don't need mammograms any more. Not because they haven't been shown to indicate that women have cancers, but not enough women do to make it important. In other words, if there were only this many thousands of them, that's not a significant number. Let them die. They don't really need mammograms. And so my concern is this -- and I want the senators to know: We cannot pass this health care bill cutting costs on the backs of women. And we cannot continue to let women be victimized. I'm sure that if the test had to do with prostate cancer, they would not be making such a rule. But because all this stuff is done by men -- and guys, I really love you. But all these rules are being made up by men, and they are at the expense of women.

Joe Dabney, Richmond: We've been trying to get health care for the last 40 or 50 years here in this country. One of the wealthiest countries in the world. And while we sit here and deliberate, there are those that are dying for lack of it. Men and women all over this country. Gay, straight, black, white, atheist, agnostic, red, yellow, purple, green, and anything in between, we are all God's children. And we are all entitled to health. Good health. Health care. And if the wealthiest have to give it to us, let it be. Like one of the speakers said, it has always been those who have who have looked out for those who don't have. And you're no healthy or I'm no healthier than the sickest person in this room. The chain is no stronger than its weakest link. How can you look one way while one is suffering from a contagious disease? We're human beings. And while we're sitting here in this meeting, there are those dying, in this country. Dying. The children and the parents are dying, because they don't have health care. Or they don't have it adequate. So that when you go to get something done, you end up getting a leg cut off, or an arm cut off.

So, if you're sitting in here tonight, and you're speaking against health care, and just putting the price on it, you missed the mark. We're talking about lives. Now, we count those who are killed going overseas. The young ones we're sending that way. But no one says anything about those that are dying here. When you get home, check out how many died while you sat here and spoke: "Well, we can't afford this." When can you afford it?

Terri Vetter, Henrico: I have long considered myself a liberal. I haven't voted for a Republican in 15 years. Nonetheless, I do not support the health care reform bill that recently passed the house. It is just way over the top. The cost is prohibitive. Gee, I wish I could just say, "The cost doesn't matter." But it does. We can't bankrupt ourselves, and this legislation doesn't further the main goal -- to lower the cost of health care. I would be supportive of just about any legislation that actually accomplished that goal . . . .

Some 20 years ago, health insurance started covering mental health. It used to be that if you wanted psychotherapy, you'd pay for it out of your own pocket. No sooner than health insurance companies started covering the cost of psychotherapy, the cost of an hour of a psychologist's time virtually doubled overnight. And I think that's pretty pertinent to just about every other aspect of health care. So, if you're able to tie the deliverance of health care to the payer and not detach it from the people who are receiving health care, I think that you can lower the cost there. Someone else made a point about a system of awards for healthy living and the opposite for unhealthy living. I've supported a public option that will put a wedge in the insurance companies' exorbitant costs. But the public option does not necessarily need to include a welfare option. I think it's a good goal to bring down the cost of health care, to enable people who currently cannot afford it to be able to afford it. But it needs to be done sensibly, and I don't think that at the moment, that's the case.

Sherleen Bright, Henrico: I'm here to speak tonight as a health care worker, without health insurance. I can't help but respond to what I just heard, because it kind of astounded me. Because I ran into a situation tonight with one of the people that I care for. I found out that I couldn't get paid for the care for them, but I found out that I had to make a decision whether life was more important than money. And I think I chose to care for that person, whether I was going to get paid for it or not, because life was more important than the dollar bill, to me.

Reid Carter, Richmond: The health care reform legislation has a whole bunch of good intentions, and it's going to result in a whole bunch of terrible consequences. I believe that the more government details and structures they put together to try to solve the problem, the more likely they are to have created a system which is actually going to be worse than the solution at the beginning. The initial goal is worthy. If we can reduce the cost of health care, it'll help businesses. It'll help individuals, it'll help people throughout the entire system. But right from the beginning, they have ignored and put off the table things that could have helped bring it down, such as removing some of the state barriers for shopping for insurance.

Isata Turay, Richmond: I've lived in Africa, England, and the U.S. And I have a distinction to make. In England, there's assistance for wellness program, for every citizen in England. And it's a shame that the only difference between the United States and Africa is that in Africa, money is demanded before delivery. In United States, money is demanded after. And if you can't pay a debt, you're penalized for that. So, I have a suggestion for the representatives, that they look into the success story of England in health care reform, and try to help the United States follow that path.

Donque Cochran, Henrico: Reform needs to happen. We're dealing with real issues, and as someone made a comment earlier tonight, while we're sitting here debating, people are dying . . . .For a small business owner, if you're not providing any type of insurance, your employees are not going to show up. We have people who have worked with us -- people who have children -- who go into work sick. And knowing that, knowing that they are sick. However, they have to provide so they have to go to work, to make these real-life decisions.

Charles Anderson, Richmond: I'm a recent retiree from Alcoa, which was Reynolds Metal Co.. I worked there 39 years, was on the health care insurance. At one time, I didn't have to pay it. It was a good insurance . . . . Our company left Richmond, Virginia, which was one of the main companies in Richmond at one time. I know a lot of good people that didn't have 30 years on their job. They lost their health care. And when you lose your health care, you know what? The little unemployment that they get, they've got to worry about what bills they're going to pay. If they're going to be able to have any money left to even pay their insurance premium. Because when they left that plant, they've got to worry about: Can I keep health care? If you've never been in that situation, you don't know how hard it is to sit down there and worry about paying health care or paying for your house or a roof over your head, or food on the table. You've children, they've got to have clothes. Got to go to school, want to look like something. You know. They've got to eat. We're always worrying about ourselves when we're working. It's fine when we're working. But when you're working, what's going to happen then? We've got to realize, there are people out here that are suffering.

Bill Ryan, Midlothian: We're approaching Third-World status, mentally. You hear a lot of people asking their neighbors to help them out. But they don't ask their neighbor directly. They'll go to their congressman and say, "I want these people taxed to pay for my benefits." We're coming to a point, what I call political and social cannibalization. And the society cannot survive when one citizen can demand of another citizen the product of his labor. It does not work. The Founding Fathers understood that . . . .Every problem in the United States has got the thumb print, the hand print, the footprint of the federal government, the state government, or the local government on it. And what do we do? Rather than going up and telling them to get out of the way, quit messing around with it, let the marketplace work, we go up there and say, "Give us more government control."

Stephen Dwyer, Richmond: I'm 13 years old. And I don't think that currently we can have a health care plan. Because we currently owe China almost $1 trillion in debt. Which means that we owe them $50 million in interest each year. That means that by 2029, our interest rate will be higher than what we actually owe to China. Because of this, I don't think that we can keep adding more things to our federal deficit, and that we're trying to bite off more than we can actually chew.