By Ceci Connolly
Washington Post Staff Writer
Tuesday, December 30, 2008
DUBLIN, Ind., Dec. 29 -- Dolly Sweet, 77, has battled cancer more than once. She's a fighter. But when her doctor recently prescribed a medication that cost $35,000 a year, she felt she had no choice.
"I canceled the medicine," she said matter-of-factly to former senator Thomas A. Daschle, President-elect Barack Obama's top health adviser, who had come to the fire station here on a quest for "fresh ideas" on improving U.S. medical care.
"I wonder if you could talk to the drug companies," Sweet asked Daschle. "That's more than my Social Security."
Daschle, seated on a metal folding chair with pen in hand and videographer in tow, symbolically kicked off the incoming administration's effort to revamp health care with a grass-roots event that not-so-coincidentally mimicked the types of gatherings that Obama drew on to build support for his presidential candidacy.
"It's stories like that that can make a huge difference as we try to persuade members of Congress and others about the importance of trying to make the system better," Daschle told Sweet.
Even before taking office or introducing concrete policy proposals, the administration-in-waiting is moving to build public support around the broad notion that the U.S. health system needs an overhaul. To Washington veterans, the approach may seem backward, or even naive, but Obama is betting that the energetic, technology-savvy supporters who fueled his candidacy will act as a potent counterbalance to the traditionally powerful special interests that have defeated similar reform efforts.
Daschle told the 35 people at the open meeting in Dublin -- one of 8,500 that will be held nationwide -- that it was "designed really to engage the public, to get out of Washington and hear directly from you about your concerns, about your recommendations, about ways you think our system can be made to work better." Aides said Daschle plans to attend another health-care forum today, at the Congress Heights Senior Wellness Center in Southeast Washington.
Travis Ulerick, an emergency medical technician in this town of 700, organized the session out of what he called frustration over the hardships he sees every day on the job. His ambulance recently picked up a woman who, after suffering a seizure, begged to be let out of the vehicle because she could not afford the $300 fee for transportation to the hospital.
"We have one of the best health-care systems in the world if you have money," said Ulerick, 25. "It's one of the worst if you're poor."
Local doctors complained that insurers dictate medical decisions and that Medicare rates do not cover the cost of services. Low fees, coupled with higher education loans, are forcing many physicians to quit primary care for more lucrative specialties, they added.
Jill King had her own theory about why her friend's cancer medicine was so expensive: Drug companies spend too much money buying meals for doctors.
"When we combine the stories of Dublin and multiply that times 300 million people, we begin to appreciate the magnitude of the problem," said Daschle, who has been nominated secretary of the Department of Health and Human Services.
Through its Web site, the Obama transition team invited Americans to host health-care forums over the holidays. It provided "kits" that included a sample agenda, tips for a moderator and a plea for "particularly poignant stories to illustrate the need for healthcare reform."
A videographer documented Daschle's trip -- complete with footage of him walking through Indianapolis International Airport -- to post on the transition Web site. Other groups were encouraged to send photos, videos and reports.
Chip Kahn, president of the Federation of American Hospitals, which represents the for-profit sector of the health-care industry, compared the early outreach campaign to military maneuvers before an assault. Kahn marveled at how Obama had mobilized millions on behalf of his candidacy and said the grand experiment in high-tech, participatory democracy will either fizzle in six months or "change the nature of American politics."
It also appears that this month's sessions are geared mainly toward Obama's core supporters, a group predisposed to embrace the effort, Kahn said. "The Obama playbook is to engage everyone as long as they can, try to avoid getting into the details as long as they can," he said. "But in health care, details matter."
Industry groups, such as insurers, are objecting to Obama's idea to create a public insurance program for people who cannot buy private coverage. They have encouraged employees and allies to attend the sessions, though Obama supporters such as AARP, MoveOn.org and the Service Employees International Union have mobilized tens of thousands on the other side.
At a hospice in Sarasota, Fla., patients and providers alike spoke of the need for more primary care doctors and preventive services. The group that met in the Las Vegas home of Ruby Waller concluded that a single-payer system similar to the Canadian approach might make better sense. "There's too much profit in health care," said Waller, 53, who has diabetes.
Just before Christmas, Sreedhar Potarazu hosted a group in McLean, where participants complained that they do not know how to evaluate the quality of their care. "They don't feel like they are getting information needed to make better decisions," said Potarazu, a physician and entrepreneur. Half of the 40 people at the session said they were satisfied with their physicians; several reported being hounded by collection agencies for unpaid medical bills; and six knew about standard screening measures, such as when women ought to have mammograms.
"That's worrisome," Potarazu said.
In Dublin, Penny Sitler said the Obama administration should follow the lead of her employer, Draper Inc., in devising incentives. The shade and equipment manufacturer opened an on-site clinic where she, her husband and their two children get checkups, flu shots, lab tests and even minor surgery -- all free. "It's a real nice benefit for employees, and I'm told the company is saving money, too," said Sitler, who did not vote for Obama.
For Obama loyalists, however, the gatherings are less about concrete policy solutions and more a demonstration that "we're here, and we're ready to work," Ulerick said.
"I have faith Barack is true to his word," Waller said. "He listens to the grass roots."