Failure to Communicate

President Obama will address a joint session of Congress on September 9, 2009 to speak about health care reform.

It is the hardest and strangest argument to make in American politics, to convince Americans that a health care system in which a person can select their own doctor, make a modest co-payment, and have the federal government pay the balance of the medical bill is worst than the current system that leaves millions uninsured, discriminates against people with preexisting medical conditions, and results in millions more of Americans facing bankruptcy.

At a Florida town hall meeting, a woman said, “I am a single uninsured mother of an uninsured child, yet still do not want the government involved in my health care.”[i]

Protesters have disrupted congressional town hall meetings with false arguments, disgracing our democracy.

Yet President Obama has failed to convince Americans that reforming health care is necessary.

It is not entirely the President’s fault. Republicans are refusing to cooperate with the Democratic President.

The Main Stream Media (MSM) has focused on congressional town hall meetings that are being disrupted by angry citizens.

Republicans, conservatives and the MSM have colluded to distort provisions in the health care reform bill.

Former Alaska Governor Sarah Palin commented on her Facebook page that President Obama’s health care bill would create a Death Panel that would essentially decide who is worthy of health care. Senior citizens, the infirmed, the disabled, and her youngest child would be denied coverage because they are not productive citizens.

Ms Palin was referring to a provision in the health care bill that would pay for consultations with doctors over end of life medical procedures.

A patient and a doctor discuss what types of treatment the patient will permit in the event of incapacitation, to prevent family members from trying to guess what the patient really would have wanted. The consultation would also prevent family members from making the difficult decision of when to end treatment.

Ms Palin, the Republicans, and the MSM refuse to acknowledge that the United States already has death panels. They are called HMO’s. Health insurance companies make decisions on who lives and who dies, not based on a productivity formula, but on the impact on the company’s profits. If medical treatment costs too much, then there is a good possibility insurance companies will not pay. In our current health care system, inability to pay is enough to deny medical treatment.

We have an exclusive health care system. It excludes people without money from medical treatment.

Liberals, progressives, socialists, communists, Martians, Vulcans, and the Creature from the Black Lagoon want to create an inclusive health care system, a system that will cover every American man, woman and child, regardless of their ability to pay.

The President has failed to convince Americans that an inclusive health care system is better than an exclusive health care system.

To borrow a quote from a movie, “What we’ve got here is failure to communicate…

“Some men you just can’t reach.” The President insists on working with Republicans even though it is obvious Republicans are not interested in health care reform. “Which is the way he wants it. Well, he gets it.”[ii]

The President’s failure to communicate is due to his administration’s failure to follow some basic public policy rules.

First rule in public policy, define the problem.

President Obama correctly argues that there are 48 million uninsured Americans. HMO’s drop sick people from their coverage. Individuals with preexisting medical conditions are denied health insurance. Americans cannot afford to pay their medical bills.

Stories help. A master communicator like President Obama could use stories from ordinary Americans who have had problems with HMO’s, or did not have health insurance.

The President included stories of ordinary Americans in his August 16, 2009 Op-Ed article published in the New York Times.

A self-employed woman cannot get health insurance because she has Hepatitis C.[iii]

Another woman cannot get health insurance because of injuries she sustained in an accident when she was five years old.[iv]

“A man lost his health coverage in the middle of chemotherapy because the insurance company discovered that he had gallstones, which he hadn’t known about when he applied for his policy. Because his treatment was delayed, he died.”[v]

President Obama could use a high profile incident to justify the need for health care reform.

Heather Sherba was one of the twelve innocent victims who were shot by a deranged gunman at the LA Fitness in Collier Township in Pennsylvania. She is 22 years old. Ms Sherba’s age disqualifies her from her parents health insurance plan. She is unemployed, and cannot afford to buy health insurance on her own. Ms Sherba will probably not be able to obtain health insurance because she has a preexisting medical condition – a gunshot wound in her right leg.[vi]

If Ms Sherba gets married, her husband’s health insurance company could deny medical coverage for his wife because she has a preexisting condition.

Ms Sherba’s family and friends tried to raise money to pay her medical expenses by washing cars. They were able to raise about $500.00.

Ordinary citizens forced to wash cars to pay medical bills shames our country.

Ms Sherba had the unfortunate luck of getting shot in a gym by a total stranger, and is probably carrying a five figure hospital bill she cannot afford to pay. She was the victim of a random act of violence. That random act of violence left Ms Sherba uninsurable.

Health care reform is personal for two reasons. First, I am an asthmatic, but I have not had an asthma attack since 1984. I make an effort to take care of myself, but what would prevent my health insurance from dropping me if get a life threatening disease?

Second, my father was afflicted with a medical condition in the mid 90’s. He does not like hospitals. He tried to tough out the medical condition, but it was painful, and one night the pain was too great to endure. My sister took him to a private hospital. He was examined. The doctors determined he needed surgery. He was being prepared for surgery when my sister was asked to produce his health insurance card. She informed the hospital official that he did not have insurance. Surgery was cancelled. My father was given a list of over the counter pills he could purchase at a GNC. The pills would reduce the pain.

But the pain did not go away. My father was a member of a union, but he had no health insurance through his employer or the union.

Some time later, my father went to a municipal hospital. Municipal hospitals cannot refuse a patient without health insurance. He underwent surgery, but the doctors discovered one of his kidneys was severely infected during the operation. After the operation, the doctors tried to save the kidney, but the damage was too great.

My father is Spanish dominant. He asked me to be with him at the hospital, to talk to the doctors, and get some answers. The doctor informed me that the infected kidney would have to be removed.

I did not have the heart to tell my father that he lost a kidney, so I lied to him. I told him the doctors were going to open him up again to get a better look, and if the kidney could be saved, then it would. Otherwise, the doctors would have to remove the infected kidney.

My father was in the hospital for one month. He underwent two surgeries. If not for Medicaid, the hospital bill would have bankrupted our entire family.

My father should not be have been denied medical care because he did not have the ability to pay a medical bill.

The President should have also argued companies cannot afford to pay health insurance for their employees.

Small companies cannot grow because of the rising cost of insuring their employees.

The President’s argument would be stronger if he framed the argument as a civil rights issue, instead of a financial issue.

It is wrong to discriminate and deny health insurance against individuals with preexisting medical conditions.

It is wrong to discriminate and deny health coverage to individuals based on their inability to pay.

Second rule of public policy; propose a solution to the defined problem.

President Obama did not offer a specific set of solutions. He wanted Congress to participate in the process of reforming health care. Congress had the latitude to create a bill, but the President wanted a public option in the health care bill. The public option would compete with health insurance companies. The public option would also give access to health insurance to uninsured and uninsurable Americans.

President Obama’s failure is more pronounced in this phase of public policy because the solution became fragmented when he granted Congress the latitude to create its own health care reform bill.

Liberals argued for a single payer system. Conservatives argued for a market based solution. More competition will reduce the costs of obtaining health care insurance.

The American fringe element argued nationalizing health care would release the Four Horsemen of the Apocalypse.

The urgency to pass health care reform was lost when President Obama handed the responsibility to Congress. The President should have offered a concrete solution to a specific problem to a nation that collectively suffers from Attention Deficit Disorder.

In the absence of a single payer, Medicare for every American health care system, President Obama should have instructed Congress to create a hybrid health care system.

The hybrid system would consist of private health insurance companies, and a public health insurance option. Anyone who is happy and confident with their medical insurance can continue to pay for the service.

But public health insurance is necessary for those Americans who cannot afford health insurance, are denied health insurance because of a preexisting medical condition, or their employers do not offer health insurance. The public option is a safety net to insure Americans have access to health care.

Third rule of public policy; how to pay for health care program.

The method of paying for President Obama’s health care reform bill is vague. He argues that two-thirds of the money will come from savings from modernizing medical records, more cost efficient procedures, and savings from other programs. The other one-third will come from increasing taxes on individuals who earn more than $250,000.00 per year.

I understand the raising taxes part, but I have trouble understanding where the two-thirds part will come from. Americans are correct to be skeptical about funding a program, as large as health care reform, from nebulous revenue sources. Accounting tricks rarely work.

Paying for health care reform requires ingenuity, an independent revenue source.

There are approximately 305 million people in the United States. Americans spend money. We buy take-out food, books, magazines, clothes, office supplies, computers, video games, groceries, flat screen TV’s, cars, houses, etc. We go to the movies, sporting events, amusement parks, and casinos.

In 2007, 56 million tourists visited the United States. Tourists also spend money; mostly on stuff Americans don’t buy.

The Gross Domestic Product (GDP) of the United States was approximately $14 trillion in 2008. Suppose 10 cents on any item purchased in the United States is reserved in a health care fund.

The ten-cent surcharge would be a flat fee. If I spend $7,000 on a used car, ten-cents goes into the national health insurance fund.

If I buy a hotdog and a beer at a baseball game, ten-cents from the beer and hotdog combo, and ten-cents from the ticket to the baseball game goes to the national health insurance fund.

If I go to the supermarket, and spend $60.00 on groceries, ten-cents goes into the national health insurance fund.

Medical treatment will not be free. Americans will continue to make $10 or $20 co-payments when they go to the doctor, and when they get a prescription filled at a pharmacy.

In addition, working Americans will continue to fund the national insurance fund through the Medicare taxes withheld from their paychecks.

The national health care fund will be continually replenished as long as Americans and tourists continue to spend money.

This alternate revenue stream could fund a universal Medicare program.

With these public policy rules, the problem was clearly identified, a reasoned solution is proposed, and a method to fund the program was offered.

Conservatives argue a single payer system is socialist, fascist, and tyrannical.

In his speech on Wednesday, President Obama should argue for health care reform by borrowing from one of President Roosevelt’s famous “Four Freedoms” speech. Two of the freedoms apply to the health care debate: Freedom from want. Freedom from fear.

Health care reform is founded on two essential freedoms. Freedom from want. Americans should not be deprived of medical care.

Freedom from fear. Americans should not be afraid of getting sick. Americans should not fear crushing debt resulting from an illness.

Americans should not dread receiving a letter from their health insurance indicating a medical bill will not be paid.

Parents should not be afraid of the financial consequences of a sick child.

Medicare for all is liberating, not tyrannical. Americans should live in the comfort of knowing that their country will be there for them when they are sick and vulnerable, when Americans need help the most.

And remember, the people arguing against national health insurance have health insurance.


[i] Michael McAuliff, “Fear and Loathing, Not Always Facts Fuel Health Care Forums in Florida and Country: Undercover Report,” New York Daily News, August 31, 2009.
[ii] Cool Hand Luke, 1967.
[iii] Barack Obama, “Why We Need Health Care Reform,” New York Times, August 16, 2009.
[iv] Barack Obama, “Why We Need Health Care Reform,” New York Times, August 16, 2009.
[v] Barack Obama, “Why We Need Health Care Reform,” New York Times, August 16, 2009.
[vi] Rachel Maddow Show, September 2, 2009.