ANALYSIS:Barack Obama starts his summer holiday today . . . abuse ringing in his ears from extreme conservatives who think his healthcare reform proposals more appropriate to a fascist or communist regime
‘EVERY TIME we come close to passing health insurance reform, the special interests fight back with everything they’ve got,” President Barack Obama told a friendly crowd of 1,800 at a town hall rally on Tuesday. “They use their influence. They use their political allies to scare and mislead the American people. They start running ads. This is what they always do. We can’t let them do it again. Not this time. Not now.”
Obama delivered the message as anger flared outside his event and at congressional town halls across the country, sentiments the president’s top advisers say they take seriously even as they decry what they view as a mix of genuine outrage and ginned-up activism.
As the president spoke, protesters outside held posters declaring him a socialist and dubbing him “Obamahdinejad” after the Iranian president. People screamed into bullhorns to protest against a bigger government role in healthcare. “Nobama Deathcare!” one sign read. A young girl held up another sign that read: “Obama Lies, Grandma Dies”. Television broadcast images of an unidentified protester wearing what appeared to be a gun.
The speaker of the House of Representatives, Nancy Pelosi, has accused some protesters of “carrying swastikas,” Brian Baird, a Democrat from Washington, declared the protesters guilty of “Brownshirt tactics”. A Republican senator, Jim DeMint from South Carolina, compared America under Obama to Germany in the 1930s. Neo-con radio broadcaster Rush Limbaugh talked of “similarities between the Democrat Party of today and the Nazi Party in Germany”.
David Axelrod, a senior adviser to Obama, said the president had for weeks been “relishing” the opportunity to engage directly with people to defend his efforts to overhaul America’s healthcare system.
“His instinct whenever there is controversy or debate is to wade in and speak directly to people,” said Axelrod. “There is a whole lot of misinformation out there. The best way to deal with it is directly.”
The angry crowds at congressional town meetings did not reflect the larger society. “Most Americans are interested and concerned about this issue and are listening intently. There are people on all sides of the debate who are a little over the edge. They tend to be the best TV.”
In Pennsylvania, the state’s Democrat senator Arlen Specter faced an unruly audience who booed and jeered as he attempted to respond to accusations that the healthcare legislation pending in Congress would allow government to deny them care, steal money from their bank accounts and obliterate private insurance.
Obama’s top advisers said they were adjusting their tactics and message to confront head-on the often caustic public debate.
“We’ve definitely made some changes in the last week or so to be more aggressive,” one senior adviser said, “as it became clear that this was a debate that was going to play itself out in a campaign-like way.”
Last Tuesday’s town hall meeting was the start of what White House officials promised would be a more pointed response to the crescendo of what Obama called misinformation coming from the critics of his health reform efforts. And the debate has raged ever since, mystifying foreign observers and causing some British medics to defend the UK’s National Health Service, the incarnation of healthcare evil in the eyes of some of Obama’s conservative critics.
White House chief of staff Rahm Emanuel argued the contrast between Obama – whom he described as “reasoned, calm, looking like an adult in the room” – and some of the more bombastic protesters would also work to the administration’s advantage in the debate.
“I think the public looks at screaming, swastikas, attacks . . . It’s not a persuasive argument,” he said. “If anything, it is the opposite.”
Aides also took pains to try and point out they were not trying to pack the crowd with Obama supporters. Aides said 70 per cent of the tickets were given to people who signed up online, and distributed at random. The remainder went to the school community and local lawmakers’ offices.
Yesterday, Obama was scheduled to hold a town hall meeting in Bozeman, Montana, to discuss the plight of people dropped from their health insurance plans because of an illness. And at a third session today in Grand Junction, Colorado, Obama intends to raise the subject of high out-of-pocket costs, such as co-payments and deductibles.
Grand Junction is home to just 45,000 people but to healthcare reformers, it is the land of innovation – a place that provides high-quality healthcare at a fraction of the regular price. The local health maintenance organisation offers prenatal care to all women in the county. Doctors evaluate themselves partly on the cost-effectiveness of treatments. Nurses often follow patients home from the hospital to help prevent relapses.
“It’s a great example,” said Len Nichols, a healthcare economist at the centrist New America Foundation in Washington who co-wrote a paper on the area’s record. “They have managed to contain the natural impulses of excessive competition and the medical arms race . . . Everybody’s looking into this.”
According to Dartmouth University researchers, Grand Junction’s cost of $5,800 per Medicare patient is 30 per cent lower than the national average. In contrast, the cost per patient in Los Angeles is $10,800. The city is the sixth cheapest community in the US for healthcare, with Honolulu registering as the most cost-effective and Miami the most expensive.
In the face of loud attacks from the right, many of Obama’s closest advisers are cautioning against panicking about the fate of his top domestic initiative. They said cable news tends to focus on the loudest voices, not necessarily the majority, and stressed that some town halls had been civil discussions.
“The key here is to not overreact to the cable TV catnip of the moment and lose focus on the overall plan for passing comprehensive health insurance reform,” deputy communications director Dan Pfeiffer said.
The president’s senior aides argue the seething anger at the town halls recalls the strident language at Sarah Palin’s rallies in the waning days of the presidential campaign. Internal polling during the campaign reassured Obama’s staff that independent voters were turned off by the tone of some of Palin’s supporters, an adviser said.
“There’s a very legitimate debate to be had about healthcare on the merits,” a senior White House official said. “But by hanging their hat on provably false claims that tend toward the absurd, the opposition delegitimises their argument.”
Digging into the specifics of those accusations, on Tuesday Obama denounced the claim by Palin, who resigned recently as governor of Alaska to pursue, many believe, her own presidential ambitions for 2012, and other conservative critics that he supports having a panel of experts to decide whether patients live or die. “The rumour that’s been circulating a lot lately is this idea that somehow the House of Representatives voted for ‘death panels’ that will basically pull the plug on Grandma,” Obama said.
He said the provision in question would allow patients to get counselling on living wills and end-of-life care – an idea that has “gotten spun into this idea of death panels”.
“I am not in favour of them. I just want to clear the air,” Obama said. In his opening remarks, he said: “Let’s disagree over things that are real, not these wild misrepresentations.”
Obama moved to refocus the discussion on voters’ self-interest, on what people will gain from his health insurance overhaul.
While a few of the nine questions Obama fielded challenged how his overhaul would work, none of them was harsh – a sharp contrast to the hectoring audiences showing up to challenge lawmakers over the last week since Congress took a break from healthcare deliberations and headed home."What is truly scary, what is truly risky, is if we do nothing," Obama said. In that case, he warned, people's health insurance premiums will continue to skyrocket and the national deficit will continue to grow because Medicare and Medicaid "are on an unsustainable path".– ( The Washington Post)
Additional reporting by Philip Rucker and Michael Gerson, and also by Nicholas Riccardi of the Los Angeles Times
The Bills: what is proposed
The US healthcare reforms seek to overhaul the $2.5 trillion US healthcare system via three different Bills being fashioned in the US Senate and the House of Representatives, supported by President Obama.
In essence, they aim to change the insurance industry rules, expand coverage to nearly 46 million uninsured people and hold down costs, all without an increase in the federal deficit.
The Bills propose variously to:
bar discrimination based on gender or pre-existing medical condition, and guarantee that coverage and benefits cannot be rescinded after coverage has issued.
There would be no annual or lifetime caps on benefit payments. Premiums could vary only according to family size, geographic region, tobacco use, age and benefits provided.
Under the Senate Health Committee Bill, individuals are required to obtain coverage or pay a penalty of up to $750 per year. To help people pay for it, credits would be available up to an income of $88,000 a year for a family of four.
Employers are required to pay 60 per cent of coverage for workers or pay $750 per year penalty. First 25 employees are exempt.
The government health and human services department would decide what is in a basic insurance plan required to be offered to all.
SENATE Health Committee and House Bills provide various forms of individual subsidies on a sliding scale up to four times the poverty level ($88,000 for a family of four). The Bills also provide for some form of premium credit or tax subsidy for small businesses.
MILLIONS more people would become eligible for state Medicaid health plans for the poor. All of the Bills include provisions to improve quality of Medicare programmes for the elderly. Payments to be designed to encourage quality, not quantity of services.
– (Reuters)