CJR’s Town Hall Meetings, Part II

The view from the heartland—the patients

Everyone, it seems, is trying to take the pulse of the electorate—Americans who, as the saying goes, vote with their feet and may well decide the fate of this effort to change the American way of health care. The pollsters, the wordsmiths, the PR firms, and the stealth groups have been out in full force, trying to influence the hearts and minds of people turning out at town hall meetings. All this leaves reporters in a pickle, though: How do they know what people really think? So we at Campaign Desk decided to use that age-old reporting tool—the man-on-the-street interview—and set out to look at what men and women we met have to say about health reform. The series is archived here.

We have come to believe that the entire debate, its complexity and its nuances, has been taking place 30,000 feet above the heads of people in whose name the reform battle is being waged. Our interviews confirmed that observation. Of course, our results are not scientific, but we think they offer some pretty good clues to the way ordinary Americans are thinking. Too many people we met are not engaged, have heard lots of wrong information, and have no idea what reform means to them.

Columbia, Missouri, a typical college town, is almost smack in the middle of America. What better way of listening to ordinary people, we thought, than to talk to shopkeepers on Main Street; students around the Missouri campus, who will soon have to buy their own insurance; and patients at a community clinic, who have a big dog in this fight. Columbia has a reputation for being a blue oasis in the middle of a very red state, yet we found people skeptical of the president’s ability to produce health reform and unaware of what reform would mean for them. Some people I met had tried to follow the debate, but recently lost interest and just tuned out; they were people who once supported reform.

I began my interviews at the Family Health Center, which offers primary care, dental, and mental health services to patients with low incomes. That afternoon, a steady stream of patients and caregivers came in and out of the large, well-kept waiting room with furnishings provided by the local Rotary Club.

Kathy, who wouldn’t give her last name, was waiting for a hearing-impaired patient who would need Kathy’s translation skills during the medical exam. The patient didn’t show up, and Kathy had time to chat. She indicated she had some notion of what the debate is about but confessed, “I don’t understand what plans are on the table. I don’t think it’s worth the emotional and mental energy on something that’s not on the table. I’d like to know what’s going on, but I am not going to base my opinion on unsubstantiated sound bites from the media.” She had heard of a public plan and offered this assessment: “We need to be careful in crafting another government-run system.”

Kathy, forty-one, owns a small business—the kind that struggles to pay for health coverage for its workers. The sixteen people she employs to provide interpretation services work part time. Some are uninsured, and others have coverage through a spouse. “I have no idea how it (reform) would affect me as a business owner,” she said. “I hope it would provide a resource. I really don’t have much of a buffer between the price of our services and my payroll. I don’t know if it will be an opportunity for my employees to have insurance.”

Rose Shepherd, seventy-three, was waiting for her disabled adult daughter, who is a clinic patient. She didn’t know much about reform, either. What did she want to know? “I kind of want to know what the end result is,” she told me. “I’m afraid that people who have more are so afraid that those who have less will get some of their more.”

Personally, Shepherd was worried about Medicare, and hoped reform would mean that Medicare would cover more things so she didn’t have to work full time selling jewelry at Wal-Mart. I work there for health care, she says. Last year, Shepherd and her husband paid $2500 out of pocket for medical care, in addition to the $230 per month for their Blue Cross Advantage policies. Their combined Social Security income is about $1600 per month, so health care eats a big chunk.

Our conversation returned to what particulars about reform she might be interested in. “Who could I really trust to tell me?” she asked. Should the media tell you more, I probed. “God no,” she replied. “It’s all sensationalism. You can’t believe what you hear.” She didn’t watch much TV, she said, although she made an exception for PBS and Dancing with the Stars.

James Kelly was a first-time patient at the clinic. At fifty-three, he’s beginning to have joint pain in his knees and shoulders. Most of his life he was an auto mechanic, but now, with the pain, he can’t crawl under cars any more. So Kelly sells cars at South County Motors in Ashland, where business has not been good. He hoped that, with the students back, sales might pick up. Kelly, who was missing some teeth, said he knew nothing about health reform. “I’ve been listening to talk radio but haven’t made any decisions about what they are saying,” he said.

Kelly has made a decision about health care, however: he knows he needs it, and went to the University of Missouri hospital. There, doctors treated him for back pain and sent him to the Family Health Center. He has no insurance. Kelly wanted to talk more, but a nurse called his name—at last it was his turn to see a doctor.

Betty Dudley came in with her grandson, Jaheim, for his back-to-school check-up. Dudley, forty-five, who works as a para-professional for Columbia’s public schools, had some opinions: “I don’t think health reform will make much of a difference, but I don’t know much about it. I depend on God to provide for my family.”

If health reform will help anyone, it would be people like fifty-seven year old Jackie Johns, who lives in a rural part of Boone County. Johns worked for thirty-nine years, mostly at a medical transcription service. She now is disabled from arthritis, and receives Social Security Disability (SSDI) benefits. She is also in Medicare’s no-man’s land—the two-year waiting period to gain eligibility for Medicare benefits. “Five more months to go,” she says. “I’m on the countdown.” The government makes disabled people on SSDI wait two years before they can get Medicare—to save money, the government says.

During the wait, people on SSDI find other ways to pay for care. Johns applied for Medicaid, but she needs to accumulate $564 in bills every month before Medicaid pays. Sometimes she doesn’t reach that amount and comes to the clinic for help, where she can pay according to a sliding fee scale. Early on in this debate, the pols talked about shortening Medicare’s waiting period, but Johns says she hasn’t heard anything about that. When she worked, she always carried insurance, but in the last few years of her work life she couldn’t afford the out-of-pocket costs required, because her deductibles were too high. “Nobody talks about the real, day-to-day problems people have affording these deductibles,” she wanted me to know. “You don’t hear them talk about how hard it is to afford the deductibles. It all gets lost in the blah blah. How long can you keep ignoring such a big signal of peoples’ problems?”

Johns seemed disillusioned, and blamed herself for not knowing more about health reform. “I think Obama’s plan is kind of vague,” she said, “but maybe I didn’t read up enough in as much depth as I should have…. For the last twenty years, I kept thinking that we’d have a revolution, but we’re too fat and lazy. National health insurance has been a dream for so long.”

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.