Outlook: Obama's Health Plan At Risk?
Kennedy passed the liberal torch to Obama. Will he run with it?

Peter Dreier and Marshall Ganz
Professor of Politics and Director, Urban and Environmental Policy Institute, Occidental College, Author, and Lecturer, Public Policy
Monday, August 31, 2009 11:00 AM

Peter Dreier, professor of politics, director of the Urban and Environmental Policy Institute at Occidental College in Los Angeles and co-author of "Place Matters: Metropolitics for the 21st Century," and Marshall Ganz, lecturer in Public Policy at the Harvard Kennedy School, were online Monday, Aug. 31, at 11 a.m. ET to discuss their Outlook We Have the Hope. Now Where's the Audacity?, co-authored with Marshall Ganz.


Memphis, Tenn. : What can supporters of health-care reform do to support a substantial change and ensure we do not have a watered down health-care package?

Peter Dreier: Join forces with others who are involved in organizing for health care reform. In the last week, Organizing for American and Health Care for America Now have begun organizing local events. Join them. Do something PUBLICLY. Email everyone you know and get them to contact your Senators and Congresspersons, indicating your support a public option. Have a meeting at your house and spread the word. Contact and participate in Health Care For America Now - (http://healthcareforamericanow.org) or Organizing for America (http://www.barackobama.com/index.php)

or another group. Educate yourself. Besides HCAN, Kaiser Family Foundation and Physicians for a National Health Program are good sources of information. Also:

MoveOn.org - http://www.moveon.org


Peter Dreier: Good morning. This is Peter Dreier at Occidental College, in smoky Los Angeles. I'm here to discuss the politics of health care reform.


Marshall Ganz: Marshall here to discuss outlook piece. Look forward to questions.!


Los Angeles, Calif.: I've never understood why Pres. Obama chose to call it a "public option" instead of "Medicare for All." Why use new terminology which the Right can attack as "socialized medicine", as they have, instead of using Medicare, which everyone knows and pretty much supports? It would have been far more difficult to pin the "socialized" label on something that has been taking care of seniors for more than 40 years. Finally, is it too late to change the terminology? Can it and should it be done?

Peter Dreier: I agree. "Medicare for All" makes sense, although that would mean a Canada-like "single payer" system. In reality, President Obama's public option would be an expansion of Medicare for those who choose it, but many people would still have private insurance if they want it.


Bristol, Conn.: I am going to be on Medicare in a few years and am worried about the coverage. I had colon cancer 8 years ago and will be one of the throwaways that Obama is talking about. My doctor told me that I am just like any other person in the U.S. but have a colonoscopy every 3 years. They will deny me those because of age.

Peter Dreier: You're believing the Republican and right-wing propaganda.

This is simply NOT TRUE. This is a good example of how the Limbaugh lunatic crowd, and the Republican leadership, has distorted the public debate over health care reform.


Durham, N.C.: I have health insurance and I have not used my insurance since I became insured. My fear is that because I have a preexisting condition I will not get any treatment. What will the pubic option do for me.

Peter Dreier: A public option would not deny coverage to anyone with a pre-existing condition.

In fact, that is one of the cornerstones of Obama's plan that would apply to all PRIVATE insurance companies, too -- no denial of coverage for pre-existing conditions.


Fairfax, Va.: Good Morning Mr. Dreier and Mr. Ganz, Paul Krugman in a NYT opinion piece today argues that achieving health reform is more difficult than under Nixon because of the expanded lobbying influence of the insurance industry and the polarization of politics. What is your take? Also, do you think passage of a health-care reform bill will improve President Obama's approval rating which have taken a dent during the health care debate?

washingtonpost.com: Missing Richard Nixon (The New York Times, Aug. 30)

Marshall Ganz: Good morning!

One reason that achieving real reform today is more challenging is the success of the conservative movement in demonizing government as an instrument for public good. Nixon, recall, proposed a minimum annual income, something that today would be decried as some form of socialism. With the Reagan presidency came "government as the problem" - not because it was the problem - but because it advanced the cause of civil rights, women';s rights, environmental protection, etc. President Obama has not only an opportunity, but the necessity of using his bully pulpit, proposals, and gift of public narrative to reeducate us as to the necessary positive role that we must use government to play if we are to advance our interests as a whole, as a nation, as a community able to "provide for the common defense, promote the general welfare, and secure the blessings of liberty". And, if we can all make health care reform happen -- like social security and Medicare - it will be the beginning of a process of rebuilidng our capacity to work together to advance our common interests.


Richmond, Va.: Thanks for your work and taking our questions.

Here is my theory why Obamacare is loosing some momentum. This is from a very lay person's view, so I would appreciate your comments. I really feel the main reason for the hesitation is folks don't like the idea of it being government run. Most will agree that private-run insurance has all sorts of problems, but one seems hard-pressed to find a large government-run multi-billion dollar program that gets an A+ over many years of operation. Pentagon? IRS? CIA? Medicare? The Post Office?

So...how much of this is just plain old dislike of Federal Government?

Peter Dreier: It is important to distinguish what the PUBLIC thinks and what a few SENATORS are doing and saying. Public opinion polls show that the vast majority of American people WANT some kind of government-funded insurance plan. In fact, Medicare is VERY popular with the people who have it. MOST Democrats in the House and Senate agree that a public option is a good idea. It is only a handful of Democrats -- who I call the Baucus Caucus - who are standing in the way of a public option.


Arlington, Va.: What IS the health reform plan? Is it the House version or the Kennedy HELP bill with a robust public option? Or is it a Finance Committee bill with no public option and watered-down co-ops? The former is ALREADY a compromise; the latter is worse than nothing in that it enriches insurers on the backs of people who can't afford health insurance in the present climate.

Peter Dreier: Both the House and Senate will come up with separate bills. The key principles of a good health insurance reform include universal coverage, public option so people can make a choice of plans, no denial of coverage for pre-existing conditions, ability to keep insurance if you change jobs, affordability, progessive financing


Silver Spring, Md.: I would like to see a good document put together that is sent out widely that lays out the key facts and counters the main myths. Is such a document available?

Peter Dreier: Health for All Now is a good source of information


Durham, N.C.: Why can't the Dem leadership make the Blue Dogs come around to public plan?

Peter Dreier: The Blue-Dogs will respond when they feel the public pressure. It isn't just up to the Dem leadership. The point of our article was the need for broad public mobilization so that the insurance industry and the Blue Dogs feel the heat.

Marshall Ganz: Great question. The pressure could best come from constituencies organized within their districts, who are not fearful of launching a primary challenge. This is a high risk strategy, to be sure, but any primary challenge, if it has some real clout behind it, can be a major problem for an incumbent, even if he or she holds on to his or her seat. As Pierson and Hackman show in their book, Off Center, this was one of the main tactics used by the conservative movement to move the Republican party to the right. It's important also to identify their source of funding, political alliances, etc. in order to locate other points of pressure -- but these are things that the Democratic Party itself can't really do.


Frederick, Md.: Was interested to note in your article that there was no mention of the cost to the American taxpayer for health-care reform. There are certainly 'parts' of health care that need reform such as preexisting conditions, tort reform and insurance abuse but these fixes will not increase the deficit by such enormous amounts nor put an unwieldy bureaucracy in place. We do not have a good track record of managing bureaucracies efficiently. "Movement' tactics reek of the 1960's....do we need to go there to achieve reform? I found your article very disheartening and threatening for our country.

Marshall Ganz: The 1960's brought us Medicare, Civil Rights, Women's Rights, Environmental Protection, etc. etc. etc. The reaction to the 60's by those whom these changes made fearful is what has done all the damage, including crippling government. Social security and Medicare are both highly efficient, especially when compared with the bloated private bureaucracies typical of the insurance companies -- and their self-serving bonuses. Our public servants -- local, state, and federal - deserve our respect and our support so they they can do their work well for all of us.


Rockville, Md.: I am waiting for the Conference Committee product. Until then it all looks like speculation to me.

Peter Dreier: Don't wait for either House of Congress to produce a bill before you express your views to them. Whatever bills they produce will be much better if they hear from constituents, especially in public, as part of organizations. The "tea party" crowd represents a TINY sliver of the voting public, but they've managed to get a lot of attention because they've acted in public.


Princeton, N.J.: The President says we have to take incremental steps. Medicare for All IS an incremental step. Step one was Medicare for the highest risk pool, old fogies like me. Step 2 is Medicare for everybody else which is actually easier because it does not cost any more (see below). Step 3 would be more efficient medical practice.

The main reason that it is far better to extend Medicare to everyone is cost. Private insurance companies waste about $400 billion each year in high overhead and physician and patient compliance costs. There is another $100 billion wasted on high drug prices to companies that spend 3 times as much on "marketing" as on R & D. This $500 billion each year can be used to pay for the extension of Medicare to everyone. If you simply add a public option, you are leaving the $500 billion on the table. You are simply adding cost. This is just stupid.

Do you support HR767 the 70 page bill that simply give an improved Medicare to every man, woman and child in the US?

Peter Dreier: I like the idea of Medicare for All. People who support single-payer (which is what Medicare for All is) should raise their voices. That will help push the debate in the right direction


Tampa, Fla.: If a public option for health insurance is so bad because it's socialism, why are public options for crop insurance, export insurance, and flood insurance not socialism and not so bad? And in Florida, you can add public option homeowners insurance in the form of Citizens.

If Elmer Fudd can have the public provide him crop insurance, and if the Wall Street bankers can have the public provide flood insurance for their Hamptons summer homes, then I demand the public provide me my health insurance.

Peter Dreier: I live in Pasadena, CA, where firefighters -- public employees -- are right now risking their lives to save lives and homes. Nobody thinks that fire-fighting is something that the private sector should do. This is a responsibility of government. It should not be done for profit or provided only to those who can afford to pay for it. Health care should be the same.


Silver Spring, Md.: Another question: I see several organizations trying to mobilize the troops. I think someone needs to be in charge and people take direction from them, such as Organizing for America. Right now things are too fragmented and not well organized. Your comments?

Peter Dreier: The more people who are organizing, the better. OFA is doing its thing. Health Care for America Now is doing its thing. Other groups, like Howard Dean's Democracy for America, and MoveOn, and others, are doing their thing. A grassroots movement can't be "top down" Groups can communicate and coordinate, but the strength of grassroots movements comes from the bottom up!


Austin, Tex.: Is there any point in writing to senators/congressmen who are guaranteed to vote against any form of health-care bill? I feel unrepresented in this battle because, although I want to see a good bill (with public option) passed, I know there's no chance in heck that my representatives will support it.

Peter Dreier: It always helps to let your Senators and Congresspersons know how you feel. It is even better when you do so with others, and do so publicly, even if they say they oppose a public option. Write letters to the editor. Join others and hold rallies and meetings. Ask your elected officials: which side are you on? The insurance industry, or the people in your district (or state) that need affordable health insurance? The more people that do this, the harder it is for your elected officials to oppose it. And it helps keep them accountable when they are up for re-election!


Silver Spring, Md.: Do you think that Obama is failing because he is not framing health care the way Ted Kennedy always did, as a moral issue before anything else? Is Obama's pragmatic starting point blurring what he really stands for in this issue? He makes it into an economic issue, or an efficiency issue, and that is where the debate is veering off, or being seized by the Right, into How can we pay for it? Rather than, it is the right thing to do, so how can we make it happen?

Marshall Ganz: I do think appreciating the moral foundation of health care reform is critical. In the campaign President Obama demonstrated an unusual ability to communicate the values, the moral sources, at the core of his candidacy -- equality, inclusion, community in diversity, opportunity -- than any Democratic Presidential candidate had been able to do, perhaps since Robert Kennedy. This capacity for moral leadership is exactly what is called for now. At the end of the day the question is whether we can step up to the obligation to "heal the sick", at the core of every faith tradition, or be defeated by simple greed and fear. One of the main reasons we are expected to heal the sick is that "the sick are us" -- we cannot build walls high enough to seal out the sick, the infirm, the suffering. What we need to grasp is the fact that there are some things that we have to do for all of us, or none of us can be secure in our enjoyment of them. So, yes, I think the moral argument has to be made.


Birmingham, Ala.: Remember when Walmart entered the supermarket business, many were sounding the death knell for the large supermarket chains. While the competition was too much for some, others thrived and new markets, such as the very upscale Whole Foods, opened. Admittedly there are people who shop in Whole Foods who would never grace the door of a Walmart and vice versa, the point, however, is that the customer had options which in turn kept many of these larger supermarkets honest, if only because they knew there was strong competition in their neighborhood.

The same can be said for health care where competition is desperately needed in order to provide affordable care to the average American. I work at a health-care facility and see first hand the hoops the insurance companies put patients through. It is demeaning, disgusting and infuriating. I strongly support the public option the public option for the same reason I do most, not all, of my grocery shopping at Walmart. I get more value for my money.

This is what I think these "elected officials" in Washington are missing. Unlike the late Senator Kennedy, their tenure in office has left them far removed from what the American people are going through and left them terrified by a few loudmouths at town hall meetings, most of whom I would wager shop at Walmart, but are too hyped up on misinformation to see how health-care reform benefits them.

Marshall Ganz: Go Birmingham!!!


Richmond, Va.: I think the only way to get the word out about what health reform really means would be to do a TV show called Health Care with the Stars and have celebrities asking health care questions to experts in the field. Maybe people would finally learn some facts.

Marshall Ganz: Good idea!


Greensboro, N.C.: It's not just the insurance companies. Nearly fifty years ago, when America's national policy on health care was last seriously debated, it was scuttled not by the insurance companies, but by the focused efforts of the AMA and its allies.

As the son, and son-in-law, of physicians, I am keenly aware of the role the American Medical Association (America's most successful trade guild) played in reducing the number of American medical schools, and restricting the number of slots in the schools they did approve. As a result, there is an artificially and deliberately created shortage of American doctors, along with high earnings for those who do get through the system. In other industrialized countries, where both access to health care and the overall national health outcome is reported to be better than in the USA, there are more doctors. They reportedly enjoy and take pride in their work, even though their own compensation is far less than the prevailing rate for AMA physicians.

What can be done to curb the excessive zeal the AMA, in the name of "Quailty", exerts on suppressing adequate availability of medical school slots, so that all who are qualified and wish to can become MDs? We seem to have lost sight of this key piece, vital to curbing excessive medical expense and improving American health.

Marshall Ganz: This is an important piece of the puzzle, highlighted in the recent New Yorker article about health care in McAllen, Texas. It's much more of a both and than an either/or.


Falls Church, Va.: Hello Peter, Great article. I had the opportunity to attend that so called raucous health-care town hall hosted by Rep. Moran and Howard Dean in Virginia last week. Debate is good when it is about the issues. But some of these people who show up at the town halls are not talking about health-care reform but instead spewing hate and lies!. What do guns have to do with health insurance? Will dubbing health-care reform "socialized medicine" help pay for my $2,500 emergency room bill from 2007?. Please explain this phenomenon because I don't understand where this is coming from?

Peter Dreier: Most of the "tea party" folks are ideological conservatives who have two things on their agenda - they want Obama (and Democrats) to fail and they want to "flush government down the bathtub," as Grover Norquist once said. Attacking Obama's health care plan is a tactic in this larger crusade. I attended my local town meeting, interviewed some of the tea party folks, and wrote an article about it for Huffington Post. They were there to oppose abortion, stem cell research, and taxes in general. When I asked them where they got their information about Obama's health care plan, they told me from Glenn Beck, Rush Limbaugh, Bill O'Reilly, etc. That's propaganda, not information.


Prescott, Ariz.: A few weeks ago, Sen. Joe Lieberman said that we should wait until after the recession is over to deal with getting uninsured people some sort of insurance coverage.

Now it is my understanding that the aspects of either the House or Senate bills that get coverage for the uninsured largely do not kick in until 2013 and phase in until 2018. We are left with a couple different scenarios for what Lieberman was indicating with his statement:

1. Lieberman believes we will still be in a recession in 2013, in which case this is a seriously under-reported and explosive statement.

2. Lieberman is ignorant of what these bills actually entail, in which case he should not be on TV talking about them like he is some sort of authority.

3. Lieberman is a dishonest person who doesn't care what is in the bill and is sowing disinformation and doubt.

What do you think the correct scenario was?

Marshall Ganz: It's a good thing we didn't wait until the Depression was over to establish Social Security.


Choice: I am 71 years old and have had 11 different private health insurance plans. All of them restricted my choice of physician. All of them interfered with my physician's choice of treatment. Now I have Medicare. I have complete freedom to choose my doctor; I have never been turned down. Medicare never comes between my physician and me. I would never, never go back to what I had before Medicare; I would never, never take Medicare Advantage.

I like Medicare so much, I want every man, woman, and child to have it.

Peter Dreier: It is people like you whose voices are being drowned out. Don't just tell your story in a chat-room like this. Write a letter to the editor of your local paper; put something up on the web; call Health Care for America Now and let them know how you feel and they'll help you tell your story in public. Most Medicare consumers feel the way you do, but they need to let their Senators and Congresspersons know it in a public way.


Tampa, Fla.: I'd like to submit a second question. My primary-care physician told me that over half of all pharmaceutical research is funded by the taxpayers. Is this correct? I understand this is accomplished via the Bayh-Dole Act, which I understand to allow private companies to use taxpayer funds but keep the patents.

If this is correct, then aren't the taxpayers paying twice for the drugs developed through this taxpayer-funded mechanism: once when they pay their taxes, and again when they pay monopoly prices for the patented drugs?

Should not Medicare be allowed to negotiate prices for any drugs developed with taxpayer funds?

Marshall Ganz: Of course. This is yet another example of the corporate welfare that taxpayers have been supporting for years -- and which adds up to many more millions - or billions - than the resources we devote to equalizing opportunity for all of us. It is a pattern that runs through our entire system which must be changed if we are to be able to use government as a genuine instrument of reform.


Peter Dreier: I have to leave now. I enjoyed this.

Bottom line: we can get a good health insurance reform if people make their voices heard. The vast majority of Americans want reform. Don't let the insurance industry and the right-wing Republicans drown out their voices!


washingtonpost.com: Marshall Ganz expresses his thanks for your comments and questions.


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