Reasoning with dining room tables

I suppose the forum sponsored by South Dakota Public Broadcasting and AARP-South Dakota at NSU last night was an attempt to circumvent the delusional scurrility that has subverted the discussion of health-care reform and to put the focus back on the issues that reform measures are intended to address. The fact is that it is probably impossible to have a reasoned fact-based discussion of health-care matters. The right wing is dedicated to avenging its loss of the election to Obama, not attending to the health-care needs of the country, and that makes any focused discussion of the issues impossible. Nevertheless, there were a few moments at the forum when some individuals tried.

Coverage of the event by both the traditional and Internet media demonstrate the level of distraction that detracts from any productive discussion. In the newspaper and television coverage, more space was given to the 20 or so protesters outside the Johnson Fine Arts than to the 250 or so inside. Tom Daschle is still an obsessive hate-object for the hate cult, and the media covered more of that than the substance of what is at issue.

Daschle repeated a statement of the problems that define the crucial issues with health-care:

• Cost


• Quality


• The number of uninsured and under-insured.

Questions were submitted on cards, a usual and customary procedure in forums where moderators try to keep the discussion on track. It allows moderators to eliminate the redundant, the specious, and the merely malicious. In trying to summarize the nature of the individual questions, moderator Cara Hetland commented that to many people health-care has a very personal aspect. And that is why the inane demonstrations put on by the protesters are so frustrating and unproductive. For many months, Senator Johnson and Rep. Herseth Sandlin have held meetings with health-care providers and constituents throughout the state to gather specific instances of where health-care works and where it doesn't. The analysis of many specific situations is what provides the answers to the problems. But those individual stories, while anecdotal by themselves, collectively define what needs to be done.



The comments elicited by generalizing the questions submitted were in themselves too general and vaguely referential to provide clarity and specificity about proposed solutions and what they would address.



Perhaps the most clarifying moment came when Dr. Tom Huber, a family physician from Pierre who is president-elect of the South Dakota Medical Association, explained why he thinks the proposal that has led to the "death-panel" charges is so important. Both his mother and mother-in-law died recently of age-connected ailments. He pointed out that for people on Medicare, 30 percent of their medical costs are accrued during the last month of their lives. Expensive life-prolonging treatments might give them another month of intense pain and suffering, but can do nothing to stop the ineluctable advance of death. Dr. Huber stressed how necessary it is for people to have counseled thought about what provisions they wish to make for this eventuality.



None of the panelists at the forum, except for Tom Daschle and Dr. Huber, are supporters of current proposals for health-care reform. They consisted of representatives of the Chamber of Commerce, the Association of Healthcare Organizations, the insurance industry, a small business owner, and the AARP. The AARP is a strong advocate for reform but is very emphatic in saying that it endorses no proposals under current consideration. Tbe panelists indicated a need for some kind of changes, but were critical, at least by implication, of pending legislation. They offered no specifics on what could be improved, and many indicated they did not understand the House bill.



The insurance industry representative criticized the 1,000-pages and said it is unfair to the public to advance such a complex piece of legislation. Tom Daschle said that if the curren health-care system were translated into bill form, it would take thousands and thousands of pages.



The bill under consideration by the House is an example of convoluted bill writing. The falsehoods created about by opponents are not readily refutable by specific language because the bill contains a maze of cross-references that make it virtually unreadable on a computer screen.



A few of the panelists stayed behind after the televised part of the forum to take questions from people on the floor. The first quesitoner had an accusation concerning the AARP stance, and was quickly told he was factually wrong. We left at that point.



An essential fact of health-care insurance is that fewer and fewer people can afford. One question was whether there were really 48 million people without health-care insurance, or was it a matter of 20 million people who decided to buy a car instead. The question was snarky, but still gets at the problem. When people are faced with the need to make decisions between trnsportation, housing, and health-care, health-care probably gets deferred by a matter of economic necessity. The rising cost of health-care and the fact that it takes up such a huge percentage of the family budgets is the problem.

Little coherent information about health-care reform is availble. If anyone is really interested, they might took a look at this very interesting and incisive presentation posted on Behind Government Lines.