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What Do the Grassroots Care About?

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The tea parties might be astroturfed. They might be underwritten by large donors. But I basically agree with Marc Ambinder: They represent an authentic, and strong, sentiment. I think that sentiment is more about minority opposition than health-care reform, but it's real.

The obvious question is why they're not overwhelmed by supporters of the bill. Aside from an incredibly small slice of incredibly rich people who might -- or might not! -- be hit with a small surtax on income in excess of a million dollars, health-care reform isn't going to be much of a burden on anyone. But it will be a huge help for uninsured people with low incomes. Huge. For them, it's almost a straight cash transfer.

But they're absent from the debate. I don't mean that their situations receive insufficient sustained attention, though that's also true. I mean they themselves are not present. They number in the tens of millions -- many more people than are involved in the protests or rallies -- yet they're not marching in the streets or demonstrating outside the Capitol or overwhelming their congressional town hall meetings. Anecdotal reports suggest that most of the bodies the left is turning out are union members. By virtue of being members of a union, union members do relatively well on wages and health care, and are already pretty politically active. Similarly, the conservative rallies are populated not by titans of industry or hedge fund managers, but by people who probably won't see any changes from health-care reform at all.

It's a real reminder that the poor in this country are almost entirely unorganized. And that changes political incentives. White House officials have frequently noted to me that 95 percent of the people who voted for Barack Obama had health-care insurance. 95 percent. That number was presumably higher for John McCain.

The electorate, in other words, looks like America after health-care reform passes, not before. The people who are politically involved -- both in general and on this issue -- are not the people who will be most affected, either for good or for ill. Rather, they're the people who are ... the most politically involved. That doesn't render their feelings less authentic or valid. But it does make large legislative campaigns harder for both sides, as the battles are more reflections of existing political divisions and trends rather than of the actual need for the policy.

Photo credit: AP Photo/Nati Harnik.

By Ezra Klein  |  August 5, 2009; 10:35 AM ET
 
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Comments

I don't agree with Marc Ambinder. These are the teabaggers, now joined by LaRouchies and birthers, who have been funded by AHIP to disrupt meetings, and intimidate. This is not an authentic opposition. There is an authentic opposition, but not the people who are bussed in to disrupt meetings and keep civil discourse from happening.

Posted by: cmpnwtr | August 5, 2009 10:49 AM | Report abuse

Mostly agreed. But one caveat: just because the anger is REAL doesn't mean it's important. There was a lot of anger at Sarah Palin's rallies last year, and it was presumably very authentic. But that side lost anyway, and no one was seriously suggesting making public policy based on what those yahoos thought.

Posted by: colby1983 | August 5, 2009 10:49 AM | Report abuse

Like Erza said, it's anger felt by a very vocal minority. More than likely, a very small minority. Happens all the time. Those that scream the loudest are the ones that are in a corner. I'd say most people aren't showing up b/c they know this will happen. If reform did not happen, then you'd see the other side up in arms about it.

This is the anti-health care reform minority's last stand. And they aren't going down without raising up one hell of a ruckus. It's a democracy, so no matter what, they have a right to be heard.

However, the fact that there are so many that cannot even fend for themselves should shame most of the country into trying to help them, not trying to scuttle reform.

You would think the people in these rallies would have some shame left in them, and care for their fellow man.

Posted by: JERiv | August 5, 2009 10:55 AM | Report abuse

There is a premise in your statement, Ezra, that the poor mainly have something to gain from a health care bill. My sister in law who is facing life threatening cancer, who has lost her employment because she can't work, will lose her less than adequate health insurance when the COBRA runs out. She will then lose her access to treatment and die in an impoverished state after losing her home. So don't tell me this reform is about poor people. Because when we have a system of health coverage that covers only some people who have employment, then there is no health coverage security in this country because what happened to my sister in law in her 50s, can happen to anyone.

Posted by: cmpnwtr | August 5, 2009 10:55 AM | Report abuse

"The obvious question is why they're not overwhelmed by supporters of the bill. Aside from an incredibly small slice of incredibly rich people ... health-care reform isn't going to be much of a burden on anyone."

The number of people who don't have insurance but want it is small relative to the number of people who have insurance and are relatively satisfied with it. So why should there be overwhelming support for a bill that takes money from a small minority of society and gives it to a different small minority of society? Since the coalition for this is largely made up of progressives who already have insurance, and since the bill does little to bend the cost-curve down or constrain long term costs, there's no reason for the average American to support this bill.

Posted by: JohnTurner1 | August 5, 2009 11:03 AM | Report abuse

The problem is that there is no lobby for 'general public' much less for 'those who do not have health care right now.'

Although one could argue that our Representatives and Senators should serve this function, there are very few who (at least appear to) actually do that (e.g., Sanders, Feingold).

Posted by: terraformer5 | August 5, 2009 11:08 AM | Report abuse

More people keep voting for more people to vote themselves more benefits that nobody can now afford. The result is GM and the solution is to vote for more benefits which nobody could afford to start with. AIG is going to insure everybody, because they did such a fine job providing insurance. Keep up with the losers ladies and gentlemen. The are expecting bonuses. Personally I think they've got another thing coming. I'm thinking embalm-cremate-bury, take no chances. You can think what you want. I don't care.

Posted by: Dermitt | August 5, 2009 11:35 AM | Report abuse

That should keep them busy and being busy means that you don't have time to be afraid, so be of good courage and neither be dismayed. It's a war out there and we'll be winning. The others too.

Posted by: Dermitt | August 5, 2009 11:37 AM | Report abuse

The 10:55 comment -- in addition to being a heart-rending illustration of the cruelties and inanities of America's health insurance "system," points to an alternative strategy Democrats might have considered (though it's too late now). It might have made sense -- remember, as Ezra points out the vast majority of voters possess health insurance -- to make the primary focus of the legislation -- and to overwhelmingly keep the emphasis on -- helping people who already are insured.

It could have been pitched as a "we're going to stop the insurance industry from doing all the nasty things they've been doing" bill (which surely would have been popular) -- with the proviso thrown in (almost as an afterthought) that people who are denied or priced out of health insurance policies could join a public option (with no mandate) or a federally-chartered national cooperative. Yes, adverse selection means these folks would be expensive to insure -- but I doubt they'd be that expensive -- because there are also plenty of healthy people who'd like to get but can't afford health insurance.

If such a bill were to pass, we'd have a form of universal health insurance: we'd have universally available and affordable insurance for all who want it. And that would be a good base from which to build as time goes by.

I understand the logic of swinging for the fences, and I do hope progressives succeed, but it's admittedly a high stakes strategy. Sometimes I think a Delongian approach might have made sense.

Posted by: Jasper99 | August 5, 2009 11:41 AM | Report abuse

birthers, tea partiers, joe the plumber, swift boaters, and the like are media phenomena, "real people" with an axe to grind whose voice is super-amplified into the media narrative by the media

media world is a small part of a real world

Posted by: jamesoneill | August 5, 2009 11:49 AM | Report abuse

"...health-care reform isn't going to be much of a burden on anyone. But it will be a huge help for uninsured people with low incomes. Huge. For them, it's almost a straight cash transfer.

If it were truly as simple as a straight expansion of Medicaid to cover those of the uninsured who are citizens and unable to procure insurance for lack of income or poor health status, to be paid for by increased taxes on the wealthly, the bills wouldn't run to 1,000+ pages and cost in excess of $100 billion a year.

Posted by: tbass1 | August 5, 2009 11:53 AM | Report abuse

One funny footnote, in the same vein as the now famous "keep the government's hands off my Medicare" comment.

Over on "The Treatment," Howard Pollack reports on attending a pro-reform rally in Chicago. Among the single payer advocates who were there to protest was one guy who likened the current bills to "treating a heart attack with an aspirin."

As any physician can tell you, the first thing that the ER does when someone who might be having a heart attack comes through the door is give them an aspirin.

Maybe he really means that these reform bills are an excellent and important first step toward dealing with the health care crisis, but I suspect he actually is just confused.

Posted by: PatS2 | August 5, 2009 12:03 PM | Report abuse

Take a good look at the "tea party" picture featured at the top of the article. Seeing as that party was definitely crashed by HCAN and health care reform supporters (the majority of the people in the photo), it is interesting that the article it is all about grassroots opposition to health care...?

Posted by: jlowndes | August 5, 2009 12:04 PM | Report abuse

Ezra--

Just for your information, the AP photo you included on your post concerning health care grassroots movements contains at least eight pro-reform signs that I see. I should know, I'm in the picture. SEIU and Health Care for America Now! turned up nearly as many pro-reformers to protest the Patients First rally as people actually in attendance of the rally.

I think the real question is one of tactics. As ThinkProgress recently exposed, http://thinkprogress.org/2009/07/31/recess-harassment-memo/ people trying to kill reform are doing so not through reasoned debate, but through attempts to silence the debate entirely. While it's important for pro-reformers to show up en masse, this means little when the Jim Demints of the world take the low road. Perhaps they're afraid that people might actually like what's in the proposed bills.

Posted by: glyf | August 5, 2009 12:21 PM | Report abuse

It is amazing how a popular conservative movement is so easily dismissed. Protest all day on the left and they're expressing the legitimate concerns of average citizens. But, protest in support of a conservative view and you are a bunch of underwritten crazies.

Posted by: marisman | August 5, 2009 12:33 PM | Report abuse

As a sidenote I'll mention that the majority of Americans don't have Internet access: drive into Virginia a mere eight miles beyond the beltway and you'll find populated suburban areas where homes have only the option of dial-up access. A Bush-era definition change allowed communication companies to report as fully-served any zip code in which at least one customer received a billing for Internet services, thereby skewing statistics. Sen. Mark Warner has for more than 20 years personally (that is, not as an elected official) examined the problem and can offer considerable expertise on the subject.

If one travels west on I-66, one reaches an area in which residents now (as a result of digitization) have only one source of television news and one source of printed news. Those sources, like all others, have editorial biases.

The ramification of lack of Internet access (and news access in general) is that residents of many areas simply have no access to the sort of discussion which might lead to the formation of an opinion (pro or con).

This is not a limited problem: all MSAs beneath the top fifteen experience it to some degree. No newspaper should wonder why its revenues drop as it provides increased on-line service -- such services simply don't have the reach of the printed counterparts; likewise, no one should wonder why the political process has become increasingly polarized.

Posted by: rmgregory | August 5, 2009 12:58 PM | Report abuse

"bills wouldn't run to 1,000+ pages and cost in excess of $100 billion a year."

HR676, Medicare for All runs to 70 pages and wouldn't cost any more than we are now spending because we would save the vast amount wasted by private insurers (overhead and compliance costs and high drug prices caused by drug comoany marleting.

"treating a heart attack with an aspirin."

Right, a better analogy is treating a TB patient with band aids while the rest of the world is using antibiotics.

Posted by: lensch | August 5, 2009 1:15 PM | Report abuse

> The obvious question is why they're not
> overwhelmed by supporters of the bill.

My spouse attended a health-care town hall with the senior legislative director of our congressman. 800 attendees, of whom at least 650 were pro-reform or neutral and 150 were anti-reform. Or just anti-Obama, it was hard to tell. In any event the 19% used screaming, bullying, physical intimidation, mass blockades, and some judicious shoving to prevent ANY of the 81% majority from speaking or even having any of their signs seen from the stage, and the drove most of the Congressman's staff out with storms of noise and verbal violence.

I'm not sure what you mean when you say the pro-reform people aren't trying to speak, but with tactics like that in use it truly does start to look like a Wiemar situation.

Posted by: sphealey | August 5, 2009 1:28 PM | Report abuse

Your premise that health care will be funded by a 'teeny tiny' tax increase on a few rich people is ludicrous.

When has the government successfully contained cost on anything?

Social Security (even with Al's lock box): going broke

medicare: going broke

Post Office: Can't contain the cost of a stamp

Amtrak: Always back at the federal trough BEGGING for more money.

FEMA: All those trailers people couldn't live in.

The people at these town halls don't want the government getting involved and screwing things up more. the same people who allowed Fannie and Freddie to run wild, are writing this bill.

Not everybody in this country thinks passing on massive debt to future generations is some great gift.

Getting rid of all the state regulations that prohibit 'pools' of people in different geographies coming together will do more to lower cost than ANYTHING the congress could put together.

Posted by: sma2009 | August 5, 2009 1:38 PM | Report abuse

Why should most people be interested in health-care "reform" when ten million of those for whom we're going to be taxed to provide health care, nearly a quarter of the total, are illegal aliens?

Although I think if Jose or Maria is injured in an auto accident here in the States, he or she certainly should be treated for injuries in a ER, but I'm not in a frame of mind to pay for their total health care regimes for their entire lives.

Posted by: wdivingston44 | August 5, 2009 1:59 PM | Report abuse

Hmm first wonkiness. It's not possible that health care reform is a pure transfer to the uninsured and might or might not take from anyone else. First it does have to be funded and either the rich or people with gold plated insurance will pay. Second, the uninsured might receive less health care in dollars spent if they are insured. Instead of having their kids flu treated in an ER with space age technology, they will have it treated in a doctors office just like the insured. This is not a cash transfer to the uninsured, it is a huge improvement in efficiency. That's how health care reform can deliver a huge amount of benefit to many at very little cost to any.

Now a fact. You are wrong -- at least one uninsured person has shown up. The guy who suggested that Dodd kill himself is uninsured.

http://tinyurl.com/lgm369

Posted by: rjw88 | August 5, 2009 2:01 PM | Report abuse

Why should most taxpayers favor health-care "reform" when nearly a quarter, ten million, of those whom we are going to be taxed to cover are illegal aliens?

Although I certainly think that if Jose or Maria is injured in an auto accident here in the States he or she should be treated for those injuries in an ER, but I'm not prepared to be stuck with paying for all of their health bills for the rest of their lives here in the States.

Posted by: wdivingston44 | August 5, 2009 2:08 PM | Report abuse

Half of the undocumented aliens have health insurance.

And now my usual comment:

Myth - "It will be very expensive to get good health to everyone."

Fact - Actually there's a way we can have better universal health care at no more than we are now paying (see 5. below). Here are the facts (cf. www.pnhp.org):

1. We waste $100 - $200 Billion a year on the high overhead of insurance companies.
2. We waste $200 - $300 Billion a year on doctors filling out forms for insurance companies.
3. I don't know the compliance cost of patients fighting with insurance companies, but it must also be in the 100's of Billions.
4. We pay the highest drug cost in the world to drug companies that spend twice as much on profit and three times as much on "marketing" as they spend on research. This is about another $100 Billion each year.
5. Because of the above, we could give Super Medicare (few limitations, no co-pays, no deductibles and complete drug, dental & mental coverage) to everyone at no more cost per person than we are now paying.

Other countries with single payer systems get better health care as measured by all the basic public health statistics and they do it at less than half the cost per person. If we build on our rotten system, we will get a health care system with rotten foundations.

Posted by: lensch | August 5, 2009 2:54 PM | Report abuse

lensch wrote:

"HR676, Medicare for All runs to 70 pages..."

but is not under active consideration is it?

"..and wouldn't cost any more than we are now spending because we would save the vast amount wasted by private insurers (overhead and compliance costs and high drug prices caused by drug comoany marleting."

I don't believe there are enough savings to be had nor do I think such changes would necessarily be desireable. For instance, I'm happy to learn or be reminded of the existance of a drug through advertising. I woulndm't want to see commercial freedom of speech curtailed. In fact, would opposed the government exapnding the control what I consumers may learn about treatements.

Posted by: tbass1 | August 5, 2009 3:07 PM | Report abuse

Dismantling and underfunding government programs does give one the impression that they don't work. Justifying further cuts. Programs for the poor make excellent targets. Plus it has the benefit of further disenfranchising people who are politically inconvenient.

For those with the anti-immigrant sentiment, you do realize there are plenty of depressed non-immigrant communities without health care. Like Appalachia:
http://www.npr.org/templates/story/story.php?storyId=111066576

You can't cover those people without a lot of subsidization. A public option (preferably along the VA model rather than regular Medicare) would be better at controlling costs. A handout to private insurance results in zero incentive to control prices, as they probably wouldn't be paying out on their own dime.

Posted by: elainelinc | August 5, 2009 3:08 PM | Report abuse

"For instance, I'm happy to learn or be reminded of the existance of a drug through advertising."

You are probably in a small minority. Exceptfor Canada, no other country allows advertising of prescription drugs. When I was young, we didn't.

Prof Alan Sager of BU has spent his career studying drug companies. He has found that they spend about 11% of their budget on R & D, 19% on profit (about twice the average of all industries) and 34% on "Marketing". This includes not only the odious TV and magazine ads, but the thousands of unqualified "pushers" who visit physicians' offices to get them to use various drugs and the many payments to doctors such as fake educational conferences at fancy resorts and stipends to give talks to other doctors based on faulty information supplied by the drug company. The purpose of all this "marketing" is to get us to use drugs we do not need or to use expensive new drugs even when cheaper older drugs are as effective or even more effective. It is clear that we could cut drug prices by at least a third and not impact research at all. This would be about another $100 Billion in savings each year.

Your physician can tell you about treatments; he doesn't have a conflict of interest.

Posted by: lensch | August 5, 2009 3:13 PM | Report abuse

"[Prof Alan Sager] has found that they spend about 11% of their budget on R & D, 19% on profit (about twice the average of all industries) and 34% on 'Marketing'."

Marketing and Sales pay the bills. Without these efforts, lower sales would require that drug makers charge more per pill to recoup their costs even assuming a much reduced marketing expense. These higher prices would, in turn, depress unit sales (and with it profit) and in no time R&D investment would dry up.

High costs for novel drugs are of less concern to me than a reduction in innovation. Consumer welfare is increased when there is a steady stream on new drugs - initially because a choice of an expensive drug is a choice you wouldn't have if it didn't exist and, in the longer run, because the cost inevitably falls as the patent expires.

"The purpose of all this "marketing" is to get us to use drugs we do not need or to use expensive new drugs even when cheaper older drugs are as effective or even more effective."

That's a gross exaggeration. The alternative, also exaggerated, is a government which ensures that patients are not informed of or reimbursed for costly novel medicines.

Posted by: tbass1 | August 5, 2009 4:42 PM | Report abuse

tbass1 - Please read Ezra's interview with the chief of the division of pharmacoepidemiology and pharmacoeconomics at Brigham and Women's Hospital (http://voices.washingtonpost.com/ezra-klein/2009/08/will_health-care_reform_save_m.html) and this article

http://newledger.com/2009/07/how-medical-breakthroughs-happen-a-response-to-megan-mcardle/

Posted by: lensch | August 5, 2009 4:57 PM | Report abuse

I understand the tone of the essay. However, I take issue with who benefits or not from health care reform. Clearly, those who are uninsured would directly benefit the most. But, on the other hand, those of us who support health care reform, single-payer as the dream, but a public option as a fall back position, really do believe that ALL OF US BENEFIT from reforming the system.

Insurance premiums continue to rise, public hospitals treat a growing number of uninsured thereby taxing everyone, businesses lose productivity due to sickly workers who can't afford simple doctor visits, lost wages for those who remain sick but also don't have paid sick days, creating a competitive disadvantage for employers who do supply health care to their employees in industries where others do not, etc. etc.

So you see, we all suffer from our current system even the loud and disruptive mobs that are showing up at the town hall meetings.

Contrary to the essay, I believe union members have their own health care at stake. Every time a group of unionized workers renew their collective bargaining agreements, one of the most contentious issues is the cost of health care. Employers, facing rising premiums, attempt to force the costs on workers which unions resist, with good reason. Many of the most contentious bargaining fights occurr for just this reason. In fact, unions should flood these town hall meetings and ensure that the meetings aren't disrupted!!

Posted by: edster1 | August 6, 2009 11:34 AM | Report abuse

President Obama may fail over Health care, because the Democrat leadership of Sen Harry Reid, Speaker Pelosi added these services free-of-charge to the 20 million plus illegal immigrants and their families. The cost is trillions of dollars according to Robert Rector, top analyst of the Heritage Foundation. All these money will be further accentuated by the cornucopia of other welfare entitlements, that will keep attracting millions more illegal aliens. These mandatory federal laws are enforced on taxpayers by the IRS, which has drained state, county treasuries for absolute decades. America cannot have a government run health care system, until restrictions are placed on anybody who are unable to prove their citizenship status or residency. Like Europe, America has been invaded by mass hordes of legal and illegal immigrants, with consequences of a overburdened government health care system.

Posted by: infinity555 | August 6, 2009 9:53 PM | Report abuse

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