Eugene Weekly : Coverstory : 8.27.2009

Citizens pack DeFazio’s health care town halls 
By Alan Pittman

When Congressman Peter DeFazio comes home to hold his summer rounds of town hall meetings, he usually gets 100 to 150 people to show up to his largest in Eugene. But last week, a standing-room crowd of more than 1,000 filled the biggest room at the Eugene Hilton conference center. 

While the mainstream media has focused on opposition to health care reform at other congressional town halls this month, DeFazio drew a standing ovation for his support of reform. 

“I feel very strongly we need a public option,” said DeFazio of Democrats’ proposal for government-run health insurance to reduce costs by competing with private insurers.

But, based on the applause, perhaps a fifth of the people appeared opposed to reform. One woman held a sign that read, “Healthcare, Just say Nobama.” To boos hushed by DeFazio, another woman said she even opposed the existing Medicare government insurance for seniors, an unpopular position Republicans in Congress have not dared take.  

In an interview after the meetings, DeFazio said, “There’s a lot of misinformation, obviously.” He added, “There has not been a very effective job communicating with people what health care reform means to them.”

DeFazio said people are still angry about the Wall Street bailout and the failure to pass banking reform. “People are concerned that it’s business as usual, and they are concerned that health care isn’t really going to be about them so much as it’s going to be about the insurance industry or the pharmaceutical companies.”

With health reform reportedly now floundering in Congress, DeFazio faults Obama for not being more clear. “The president should have had five or 10 clear principles from day one and said these are the things that have to be in this bill, or I’m not going to sign it,” DeFazio said. 

“He [Obama] was basically just pretty hands off until recently, and that’s a problem because Congress speaks with many, many voices and that’s been part of the confusion here,” DeFazio said, noting the many versions of legislation. “The president hasn’t clearly defined what his bottom line is and what he’s trying to accomplish.”

DeFazio said Democrats could try to go it alone without Republican support. Getting every single Democrat and independent to vote for reform for the 60 votes needed to avoid a Senate filibuster is “somewhat unlikely,” DeFazio said. But he said the Senate could “act like a democratic body and not like a private club and do things with 51 votes, which they could do under the Constitution.”

Such an approach would “stretch themselves a little bit and change their rules,” but DeFazio noted that Republicans threatened to do the same when they wanted to pass things. “Would it be the best message? Probably not,” DeFazio said of the non-bipartisan approach. “But if [Republicans] are not going to be constructive, and [Democrats] want to get a bill done, that’s a possibility.”

DeFazio said he’s doubtful reform will come out of the bipartisan Senate panel working on health care. The lead Democrat in the group, Max Baucus of Montana, “totally sold us out” in supporting the Bush tax cuts for the wealthy and the Medicare prescription coverage changes, he said. The Medicare bill was “a total rip-off for the pharmaceutical and insurance industry” at the expense of taxpayers and seniors, DeFazio said. 

The Republicans’ “principle negotiator” on the bipartisan Senate panel is Chuck Grassley of Iowa who, faced with a “right-wing primary” challenge for re-election, “has now begun talking about the euthanasia panels and other Republican blather,” DeFazio said.

Republicans have falsely claimed that Obama’s reform proposal includes “death panels” which will refuse care for grandmothers, a lie widely repeated on conservative radio and TV, but thoroughly discredited by facts.

“The odd thing here,” DeFazio said, is that the Medicare drug insurance passed and signed by Republicans under Bush and written by the pharmaceutical and insurance industry, has the same provisions of end-of-life consulting that Republicans have now falsely latched on to as evidence of “death panels.” The Republican’s Medicare Part D law “contains the same provisions,” DeFazio said. “Clearly this is just an excuse.”

DeFazio says he doesn’t know if the Senate will pass a bill with a public option of government insurance, but he thinks the House will. 

This week, Nobel prize winning economist and columnist Paul Krugman wrote that progressives, who have unsuccessfully pushed for a single-payer system such as the lower cost, higher quality plans in Europe, are now  “furious” that even a far weaker public option compromise may be dropped. “Progressives are now in revolt,” Krugman wrote. 

A woman supporting a single-payer system drew applause from an apparent majority of those attending the Eugene town hall. 

DeFazio responded that compared to many single-payer nations, “basically our insurance is twice as much as the nearest, and our outcomes are not better.” 

But DeFazio said he supported the president’s decision to oppose single payer in favor of improving the current corporate system. Single payer would have been too controversial, DeFazio said. “If we were discussing single payer tonight, we would have been in Autzen Stadium,” he said. “The Senate doesn’t even want to go along with a public plan option.”

A majority of the members of the 80-
member Progressive Caucus in Congress have previously said they won’t vote for a bill without the public option. 

DeFazio is a member of the progressive group but says he hasn’t gone that far. “There are a few people drawing an absolute line in the sand. I haven’t,” DeFazio said. 

DeFazio said he and others “have expressed very strong concerns” that reform include a public option to keep insurance costs down. But DeFazio suggested other options such as tightly regulating insurance, a public utility model with controlled rates or repealing insurance companies’ anti-trust exemption. “There may be other ways to rein in their price gouging, but one of the most straightforward ways is with the public option.” 

If the public option doesn’t pass, “a fall-back could be, but it might even be harder to do, to pass my bill to end their [insurance companies’] anti-trust exemption.” DeFazio cites a consumer group’s study indicating $40 billion in savings in car, home and health insurance from repealing the exemption. But consumer advocates have unsuccessfully pushed for repealing the anti-trust exemption for at least three decades.

DeFazio noted that efforts to reform health care date back to 1910 when Teddy Roosevelt was president. “We’ve been talking about it for 100 years.”

“It may be that the only way to get this done is for an extraordinary intervention and effort on the part of the president where he calls the principals to a conference somewhere, locks the doors and says we are not leaving until we get legislation,” DeFazio said. As an example, DeFazio cites an Air Force base conference under President Bush I where Republicans gave up their no new taxes pledge to close a budget deficit.

“If it takes three months or six months to get this done and get a good bill, then we should do it,” DeFazio said. Health care reform advocates have worried that any delay could make change more difficult, especially if Democrats face tough mid-term elections. But DeFazio said time may be on reform’s side: “The problems aren’t going away; they’re only getting worse.”

Here’s more from DeFazio at his town hall meetings in Eugene and Springfield:

• Bankrupt RV company Monaco failed to pay its half of insurance premiums for some employees, according to DeFazio. Now some former employees are facing medical bills that are not covered. “Many are being told they’re going to have to pay,” DeFazio said. 

• DeFazio said he heard from a business that worries it will be forced under by rising health care costs. Health insurance costs have doubled in 10 years, and the trend is for those costs to double again in the next decade, to $24,000 a year for the average family. 

• One leading reform bill would subsidize insurance premiums so that a family of four living at a poverty level income of $14,000 a year would pay $14 a month for family insurance. The same family would pay $200 a month if they had an income of $44,000 a year. 

• Some have proposed that co-ops would be an option to replace a government run public option. But DeFazio said that studies have shown that for lowering costs, “they don’t work.”

• An estimated 70 percent of the uninsured have jobs that don’t provide insurance.

• DeFazio said a woman with breast cancer testified that her coverage was canceled because of a pre-existing acne condition. The reform proposals would ban coverage refusals, DeFazio said, except for fraud. 

• The lack of universal health care means that many uninsured people end up in the emergency room because they lack preventive care. Hospitals are required to treat these people. The facilities make up the uncompensated cost of more expensive emergency room care by charging everyone else more. The uncompensated care adds an estimated $1,400 yearly cost per health insurance policy. 

• Preventive care is far cheaper than emergency room care. DeFazio cited the example of an uninsured woman with a complicated pregnancy who spent a week at McKenzie-Willamette Hospital at a cost of $60,000. The emergency delivery could have been prevented with a couple thousand dollars of prenatal care. 

• A bill DeFazio supports would provide student loan forgiveness to encourage more people to go into primary care in communities that need doctors. DeFazio also says he supports converting bank subsidies for guaranteed student loans into direct student loans that carry lower interest rates and cost taxpayers less. 

• Some insurance companies have “special benefit teams” that look for ways to deny coverage to people on their plans that have cancer, according to congressional testimony.

• Oregon is penalized for its efficiency by getting reimbursed for Medicare at a lower rate than East Coast states, according to DeFazio. He has introduced legislation to increase Oregon’s reimbursement rate. 

• If the federal government negotiated for lower drug prices like private insurance companies, it would save $40 billion a year on Medicare. But Congress outlawed such bargaining on the behalf of taxpayers.  

• A woman asked DeFazio how citizens can affect a debate in Washington that appears dominated by lobbyists. DeFazio said people should talk to people who don’t agree with them and should not assume others will speak for them or represent their interests in the debate. “Speak out,” he said.