This article first appeared in the St. Louis Beacon, March 9, 2010 - If Patricia Brennan had a chance to talk health-care reform with President Barack Obama Wednesday in St. Charles, her advice would be this: Keep it simple and keep it clean. A political independent and a health-care financial analyst, Brennan was turned off by the Democrats' backroom deals that had less to do with health insurance than with appeasing some lawmakers to win their votes.
Brennan's attitude changed when Obama stepped in with a "wonderful" alternative plan, one stripped of the deals, outlined to the public in less than a dozen pages and addressing many of her concerns.
Brennan's shifting views reflect the seesaw mood of voters interviewed by the Beacon before Obama's visit to St. Charles. Many, particularly those in the center, are frustrated both by nay-saying Republicans and wheeling-and-dealing Democrats. Others, mainly Republican, continue to oppose the initiative, while still others, largely Democrats, are impatient for change.
Obama's proposal, offered partly to revive the Democrats' lost momentum on health care, includes expanding care and addressing tort reform through alternatives to malpractice litigation. These are two ideas Brennan embraces.
"The issues are so complex and you get huge (monetary) verdicts based on emotions," she says. "I'd like to see some sort of system, like bankruptcy court for medical malpractice and allow judges who are specially trained to understand the issues and protect people but not hurt providers."
Brennan also likes Obama's promise to review what she says is needless "duplicative bureaucracy" in the insurance industry. She adds that if "the morality of the issue doesn't move people, maybe the economics will. This is just another situation where the true cost of something is hidden."
Obama's plan also would prevent insurance companies from denying coverage because of pre-existing conditions. It would be financed by taxing some high-cost employer-sponsored policies and raising the Medicare payroll tax for individuals earning more than $200,000 and couples earning more than $250,000.
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Obama estimates that his plan would cost $950 billion over a decade, falling between the Senate bill's price tag of $871 billion and the House's $1.05 trillion. All three bills would offer insurance coverage to roughly 31 million uninsured people by 2019.
The president's appearance in St. Charles County not only gives him a chance to preach to the choir but to appeal to independent voters. The stakes are high: If Obama loses this political fight, the Republican Party will paint Obama and his fellow Democrats as weak and ineffective after spending a year on the health issue and having nothing to show for it.
HEALTH CARE 'NOT A FUNCTION OF GOVERNMENT'
David Finck of Washington, Mo., would like to tell Obama to get the federal government out of health care.
"That's not the function of government," says Finck, a financial adviser. "My health care is my responsibility. I really don't need the government telling me I have to buy health insurance."
Finck says that people should be more self-reliant because "health care is primarily a responsibility of the home."
What would that mean for people who cannot afford health care? People should do what they "did before government got so interested in health care," says Finck. "There was a time when people took care of each other. I'm not sure that was all bad for family" to take care of their members.
He didn't indicate which party he favored, but he dismissed the Democrats' reform as "a naked grab for power over the most intimate decisions individuals should make for themselves."
In fact, some voters say they already chip in, just as Finck suggested, but add that health reform is still needed. Linda Buchanan of St. Louis says she and others in her family provide financial underpinning for her retired mother because "insurance (premiums) and medicines rise constantly. So we pitch in to take up the slack."
Buchanan, a teacher, says she senses not a little hypocrisy in the way some depict health reforms as too costly. She says some opponents are "suddenly looking at the cost" but raised no similar outcry about cost when the issue involved propping up the auto industry, "big bank bailouts," and the wars in Iraq and Afghanistan. Overlooked, too, she argued, is the fact that many middle-class American families are struggling to preserve their health care.
"The rising cost of health insurance is taking more and more from our take-home pay each year," she says. "Adding insult to injury, we are expected to pay larger deductions before we receive certain services, especially diagnostic tests."
MISSED OPPORTUNITIES
Judi Linville, a retired teacher at the University of Missouri at St. Louis, and a Democrat, blames her own party for some of the confusion in the health-care debate.
"The Democratic plan has changed so many times I'm not sure what is in it," she says. But she credits the party for trying to address the plight of the uninsured, give doctors higher reimbursement for treating Medicare patients and taking a stand against rising insurance costs.
Her concern is that subsidies the party would pay to make health insurance affordable would amount to subsidies for insurance companies.
"All of the approaches by both parties seem more concerned with how to get people insured, and how to keep insurance companies profitable instead of how to make our expert health care more accessible to everyone," Linville said.
As for her personal situation, Linville of St. Louis County says she wouldn't be surprised if UMSL eventually reduced her health benefits or raised deductibles and out-of-pocket costs because the university, like most others, is facing a "financial squeeze."
She is equally disturbed about the lack of guidance to help the public sort out the facts about competing proposals. She says the fight between the two political parties amounts to "a game of whose statistics you want to believe, and how they are publicized." The public would benefit, she says, from more information about consumer protections and cost estimates, especially in the context of net cost after savings.
"Sometimes you have to pay something to save money," she says of GOP attacks on the cost of health proposals from Democrats.
DEPENDING ON COBRA
Nancy Schiller of St. Louis has lost plenty of sleep over health. She's a political independent who takes the middle ground. She opposes a public option but supports closer government scrutiny of insurance companies. Unemployed, she receives health insurance through COBRA, a program that allows workers to keep their group health insurance benefits temporarily after they lose their jobs.
When Schiller held an administrative job, she was enrolled in a health plan that provided no comprehensive coverage but offered $750 in yearly benefits for doctor visits, medicine and tests.
While the premiums were reasonable, she says, "by the time you take money out of your paycheck for insurance, 401K and flexible spending, you really don't have extra money left to pay the medical costs in addition to what your insurance pays."
Besides, she added, the company's plan required her to pay the next $2,500 in medical costs once it spent the initial $750. She worried about being wiped out by a potential serious illness. Meanwhile, she's generally pleased with the temporary COBRA coverage she got following unemployment. In fact, she feels blessed in some ways, but would certainly tell Obama about a friend whose insurance is "going up so much that even with her raise, it was like getting a 20 percent pay cut."
That, Schiller argues, is an example of why some changes are needed.
One strong supporter of the public option is Theresa Hebron, a south St. Louis resident and a retired federal employee. The public option, she says, would "encourage the major insurers to keep their premiums reasonable and is also a precursor to a one-payer system, which I support."
She says the current system is broken and argues that Republicans would make matters worse because "those persons with sufficient income, education and savvy will get the best health care. Those persons who have less income, education and in poor health will get what is left over or nothing at all."
She also thinks that any legislation approved by Congress should allow women to pay for abortion coverage in the insurance open market, while restricting federal payment for this procedure.
FIX THE ECONOMY
On the other hand, voters like Sandy MacLean, a Republican from Clayton, says the public option was one of the worst ideas proposed by Democrats.
In the short run, the Democrats' plan as currently constructed "probably will work," says MacLean, a retired vice chancellor at UMSL. But in the long run, he says, the plan would lead to a more "expensive, inefficient" federal bureaucracy. The best thing Congress can do, he argues, is focus on tort reform and on fixing the economy rather than health care. He reasons that people with jobs could better afford to buy health insurance.
Cheryl Hammond, a self-employed computer consultant in St. Louis and a Democrat, agrees, saying "If we don't fix the economy, there will be no money to pay for anyone's health care." She adds that Democrats tend to think people have a right to health care while Republicans seem to think it's a privilege. As a small-business woman, she's concerned that she could be priced out of health insurance. Already, she says she has seen the cost of her coverage rise to $662 a month from $572.
Hammond says she refused to pay the increase and decided to double her deductible instead to $5,000. Her plan is bare bones, including no prescription drugs and no vision or dental care.
"This is for one person who only has high blood pressure and no other health conditions," she says.
Others seem to accept rising cost as inevitable. Mark Burgess, an internet technology consultant in St. Louis, believes most Americans want reforms, but says, "Republicans have been successful at portraying the reform in a negative way."
He wants Obama to know that his health insurance is going up by roughly 25 percent this year.
"We had already set our deductible to $7,500. Now we'll just grin and bear it."Funding for health reporting is provided in part by The Missouri Foundation for Health, a philanthropic organization whose vision is to improve the health of the people in the communities it serves.