CJR’s Town Hall Meetings, Part IV

The view from Main Street, Columbia, Mo.

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 way 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.

In his big health reform speech the other night, the president said that small businesses will be required to either offer their workers health insurance or chip in and presumably cover the cost of purchasing policies in the individual market. Sounds like Massachusetts to me, where employers pay a token penalty for not offering health insurance to their workers. But the president said that, under his proposals, 95 percent of small businesses will be off the hook, either because they are too small or have small profit margins. That was it. No details, no definitions of “small business,” or what kind of tax credits they will get, or if they’ll be enough to make shopkeepers buy coverage.

When we chatted with small business owners, employees, and customers in the college town of Columbia, Missouri, most didn’t know much about Obama’s health plan, and they certainly had no clues about where small businesses fit in. Based on Obama’s remarks, they probably still don’t.

The day I met Bizzie Tseggai she was folding T-shirts at ACME Global Industries, one of those college town shops that design T-shirts with funny sayings and logos for fraternities. The walls are decorated with off-the-shelf designs for customers to choose. Tseggai says the shirts can be decorated in thirty minutes. She has been working at ACME for more than a year, but like most workers for small business, she doesn’t get health insurance.

When she turned twenty-four last January and was no longer a full-time student at the university, she was kicked off her parents’ heath policy. She says she doesn’t have the greatest health history, but can’t afford the $300 to $400 a month that insurance would cost, considering that she makes “peanuts”—between $250 and $280 every two weeks. “I am completely debt free right now, and I want to keep it that way,” she said. What could she do? “I could beg my parents to buy the insurance or work at Starbucks (which provides workers with coverage). Those are my only options right now.”

“I know nothing about health care reform,” she admitted. Tseggai had never heard of the individual mandate that Obama finally mentioned Wednesday night—-the clause that would require her to buy insurance, maybe with subsidies if she jumps through the hoops to qualify. “I really don’t know what he’s trying to do,” she said. “I don’t watch much TV.”

Ruth Walker, fifty-four, is part-owner of an art shop called Bluestem on South Ninth St. She and her partners scour arts and crafts fairs across the state, looking for the best work to sell in the store. The merchandise from painters, potters, quilters, and jewelry makers is of exceptional quality. “We don’t provide insurance for our three part-time employees,” she said. “We hope they have other insurance.” Having lived for a time in Australia and Great Britain and seen how efficient and easy it was to get full care, she believes “it’s the job of a government to provide health care.” Walker says she can’t believe the hue and cry over the public option. “I’m just disgusted,” she told me.

How would reform affect her and her business? “I don’t know,” she said. “I assume people would benefit, but I really don’t know how it would affect me. I don’t know what health reform is about except that insurance companies have to take everyone.” Walker did question whether the Democrats were forceful enough. “I don’t think the Democrats have protested enough,” she explained. “I’m concerned our senator will be bowled over by the negativity.” Presumably she meant Sen. Claire McCaskill, who had some rough going at a town hall meeting this summer. So what’s going to happen in the end? I asked.

“Nothing,” Walker replied.

Vicki Smith, age fifty-nine, is one of Walker’s employees who does not have insurance. A fiber artist who works with paper, Smith has had coverage off and on during her life. “I work very hard to stay healthy,” she said. “I don’t go to the doctor unless I have to, and then I pay for it.” Smith was pretty knowledgeable about the reform effort, although she admitted she didn’t know many specifics. “It’s to make it available to people who can’t afford it,” she explained. “It would be cost efficient and non-discriminatory.”

How would reform affect her? I asked. “I don’t know, other than it would make it available if I need it,” she answered. She had never heard the term “individual mandate,” but worried that she couldn’t afford to buy the required coverage if she didn’t qualify for a subsidy, as many people will not. “Currently the cost is prohibitive for someone who works part-time and has a preexisting condition,” she told me. Finally, she said: “It would be cheaper to pay the penalty than buy the coverage.”

I walked into El Rancho, a restaurant on Broadway that bills itself as a fast, authentic Mexican eatery. According to Inside Columbia magazine, El Rancho was the area’s best place for Mexican food in 2009. I was hoping to chat with the owner and the staff making taco salads and enchiladas. But it was getting on toward lunch time, and everyone was busy, so instead I tried to talk to some diners. Many did not want to talk about health care.

A family from East St. Louis was in town delivering their nineteen-year-old daughter to college. “At this time, health reform is not important,” said the wife, who refused to give her name. “I don’t know a whole lot about it, and I don’t feel like it’s affecting us.”

Her husband chimed in. “Basically it’s just kind of fuzzy to everybody,” he said.

Did they want to know more, I pressed. “Not at this time,” said his wife. “I don’t want to know more. It has been in the news. If we were really concerned, we could find out about it.”

Elly’s Couture was my last stop. “It’s a clothing store catering to women between ages sixteen and thirty-six. We sell fun college clothes—cool dresses for sorority girls to go out in,” said Amanda Schubring, a twenty-four-year old part-time employee. Schubring is also a part-time student at the university, majoring in fashion design and merchandising. Clad in short jeans and a long, turquoise T shirt and straw hat, she was a great advertisement for the store. But health insurance and health reform had not registered with her. “Honestly, I don’t know much about it,” she confessed. “Mostly I don’t think about it. I need to be worrying about it technically, but I don’t.” She said she didn’t know much about Obama’s plan and was “not educated about it.”

Elly, the store owner, was working at the computer. She didn’t particularly want to talk about health insurance for her six part-time workers. She herself has coverage. “I don’t know anything about Obama’s plan,” she said. Tax credits, insurance coverage, exemptions from requirements might well have been the stuff from another planet.

Has America ever needed a media watchdog more than now? Help us by joining CJR today.

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.