The Courage to Tell the Truth
August 31, 2009
I love pleasant surprises and that's just what I got at the Iowa Farmers Union Annual Convention in Marshalltown this weekend.
A few months ago my coworker Steph Larsen and I co-hosted community health care reform forums in towns across Iowa. The forums provided the opportunity for folks to get together and talk about their ideas and concerns on health care reform.
At one of the forums a man showed up who had a lot of concerns about health care reform. In fact, he wasn't sure he supported reform at all. He felt the health care system had worked for him and didn't see the need for reform.
Chris Peterson, Iowa Farmers Union Board President
I saw the same man at the Iowa Farmers Union convention this weekend and boy, his tune sure had changed. He gave me an atta-girl pat on the back, shook my hand, thanked me for the Center for Rural Affairs' work on health care and told me how important health care reform was to Iowa Farmers Union.
I was throughly shocked and wondered what had made him change his mind.
I'll never know for sure what made him realize the importance of health care reform but I am willing to bet Iowa Farmers Union members influenced him a great deal.
It's people like Chris Peterson, Iowa Farmers Union board president, and Iowa Farmers Union staff Amber Anderson-Mba who have the courage and fire to tell the truth about health care reform and change minds.
As the health care debate continues, never doubt your ability to change someone's mind with the truth.
The Cost of Doing Nothing is Too Great
August 27, 2009
At a town hall meeting on health care reform in South Sioux City this week, Senator Ben Nelson addressed a crowd of 100 or so constituents from northeast Nebraska.
The crowd was largely elderly, folks were friendly, but I could tell immediately that people wanted to get down to business. With health care reform occupying space in our newspapers, time on TV and radio, and conversations with our friends, families and co-workers, most of us have an idea of what we want to see from health care reform. And folks at Ben Nelson's South Sioux City town hall meeting were not afraid to ask for what they want.
People asked about developing electronic health records to avoid duplicating expensive medical tests, someone else wondered how we can bring enough doctors to rural areas to care for the increasingly elderly population. A retired nurse worried that we would pitch the existing health system instead of building on what is already working.
Most everyone, it seemed, had suggestions about where they want health reform to lead us.
Because so many voiced specific recommendations about what health care reform should do, I was surprised when about one-third of the room raised their hand when Sen. Nelson asked if anyone thought we should do nothing about health care.
This "do nothing" attitude is something I simply cannot agree with. The cost of doing nothing is too great for all us in rural America.
I'm convinced we need health care reform. Right now.
Respect Doesn’t Sell Papers
August 27, 2009
Last Wednesday, I had the opportunity to attend a town hall meeting in Omaha with Nebraska Senator Ben Nelson. Attendance was estimated at over 1,000 people. You can view the webcast of the event here.
I got to be one of the lucky 300 who were in the room with Sen. Nelson as he answered questions. In his opening statements, he said that his office has received over 100,000 letters this year, more than twice what he receive in all of 2008. The fact that people are so engaged on this issue is exciting to me, because this is how democracy is supposed to work - active citizens staying informed on important issues and holding elected officials accountable.
Most people's questions quickly revealed their political leanings, and Sen. Nelson did a good job of being frank, honest, and accurate in his answers and assessments. Health care is an emotional issue, and the Senator tried to calm people's anxieties as he responded to people's questions. I walked away feeling that Sen. Nelson is taking his job to represent the best interests of Nebraskans very seriously.
I was also impressed with the crowd. The media likes a good controversy, and so what we hear a lot lately is the disruptive behavior of a vocal few. But the folks in the room where by and large respectful of the diversity of opinions. The two outbursts were quickly quieted, not by Sen. Nelson's staff but by the other participants of the meeting who wanted to maintain respect for all present.
I have never been more impressed of my fellow Nebraskans.
I do have to say though that the media coverage of the town halls, and of the health care discussion overall, has been disappointing. The saying goes "If it bleeds, it leads" and in absence of blood, any garden variety controversy will do. The press coverage I've seen of the town halls overblows what's really going on - a few terse words exchanged becomes "a near riot".Nebraskans are more respectful than that.
The same day in Iowa, Secretary of Agriculture Tom Vilsack was also engaging citizens at the Iowa State Fair. (Hear an article and radio clip of the event)
While Sen. Nelson's meeting focused almost exclusively on health care, Secretary Vilsack spoke about a variety of issues, from rural development to climate change. On the issue of health care, he spoke of the need for reform by referencing the high number of rural Americans who are uninsured and said the "status quo for rural America is not acceptable".
Sec. Vilsack answered questions about the shrinking number of family farmers, the need to "level the playing field" for independent livestock producers and cited USDA hearing on the topic slated for January. He wants to put people to work building rural infrastructure and linking local people to local economic opportunities.
My colleage Matt Russell, owner of Coyote Run Farms and Drake Ag Law professor, said he was "impressed with the thoughtfulness and systems approach the secretary is taking. I'm confident the USDA is putting people and tools in place to capture opportunities"
All of this is to say that this summer seems to be the summer of political engagement for rural people, and I couldn't be happier.
A Faithful Perspective on Health Care: Part II
August 26, 2009
By Sabrina Miller
Sabrina Miller is a Young Adult Intern with the Rural Response Committee of the Nebraska United Methodist Conference. Her first in this series of blog posts is here.
My primary goal in speaking with people about health care is to create a space of respect, love, and open conversation, and let differing opinions exist while having exhilarating discussion. As I talked with folks in local churches about health care reform, similar topics continued to arise, and fear that reform would leave them without care.
Many were retired and comfortable with their Medicare insurance, and appreciated the personal relationship they were able to have with their health care providers. Some people were disconnected from the realities in their communities. One town in North Central Nebraska receives 70% of its hospital income from Medicaid alone, and many patients with Medicare or no insurance.
I encouraged participants to see a bigger picture: If you are Christian as I am, we must look beyond our personal needs and fear, and see how care can be provided for every person, each a temple of God.
Issue 1: Health Care is working for me, therefore it does not need to be reformed. I talked to people with employer provided insurance that paid well over $10,000 a year, and up to $18,000 including co-pays. While they receive the care they need, they pay very high amounts for it.
This system may be working for those who have good benefits and steady jobs, but the self-employed and individuals who work at small businesses which are the heart and savior of small communities suffer. They often cannot afford insurance, or if they do purchase it, pay higher costs and receive less reimbursement. This leads to medical debt, and neglect of preventive care.
And of course, I hope we will consider the needs of the 47 million Americans with no insurance at all, no longer a marginal number, but overwhelming in scope.
Issue 2: Uninsured individuals don’t want insurance, or could afford it if they lived more frugally. This argument is invalid firstly to the Christian who wants to provide care for every person. Secondly, uninsured people are often families with full-time employment, some poor, but more and more frequently people who are simply not offered health care by their employer and feel they can’t afford insurance which itself costs more than the poverty line income.
If you have to choose between health insurance and food or utilities, immediate needs must be met. Other people without insurance do not have it because of pre-existing conditions, like diabetes or a mental health issue. The people that need good health insurance are those least likely to have access to it.
In my next post, I'll explore other issues on this topic.
428% Rears Its Head Again
August 25, 2009
We get Harper's Magazine at my house. One of the regular features I enjoy is called Harper's Index, where they list a bunch of interesting statistics that are related and grouped together form a kind of story. This month's included these statistics:
Percentage change since 2002 in average premiums paid to large US health-insurance companies: +87%
Percentage change in the profits of the top ten insurance companies: +428%
Chances that an American bankrupted by medical bills has health insurance: 7 in 10
I've written before about the ridiculously high profits that health insurance companies earn by denying care to sick patients. One more reason we need health care reform - protection from corporations that can't tell the difference between right and wrong.
It is not right - I'd even go so far to say un-American - that we can have insurance whose very purpose is to cover us in an emergency and still have an unforeseen accident or illness ruin our financial lives. No one asks to get sick, but it still happens. It's time we stop the injustice.
A Solution in Search of a Problem?
April 17, 2009
By Jon Bailey
Editor's note: This is a piece written by our Research Director, Jon Bailey, in our weekly legislative update regarding the Nebraska State Legislature. We thought it would be informative for all our blog readers who may face similar threats in their states.
Thanks to a question from an alert reader, we are providing analysis of a bill that we have not previously included in the Update. LB 263, introduced by Sen. Rogert, seeks to forbid any political subdivision (i.e., any county or municipality) from action prohibiting or regulating “matter regarding the registration, labeling and sale, storage, transportation, distribution and notification of use of seeds, fertilizer and soil conditioners.” The bill was advanced to General File on a 7-0 vote of the Agriculture Committee and was designated a Priority Bill by the Speaker. The bill explicitly protects local zoning authority and zoning enforcement.
LB 263 is nearly identical to a bill introduced in 2006 (LB 834) which also advanced to General File but received no further action in the 2006 session. The bill is also part of a national movement to preempt any local authority over seed and plant regulation. At the end of 2008 state legislative sessions 15 states had adopted statutes similar to LB 263.
Some states – notably California – have witnessed local governments adopting prohibitions against the use and planting of genetically modified seeds. In Nebraska, however, it does not appear that any local government has attempted or is even contemplating such a move. No matter what one thinks of genetically modified seeds, it would be pure folly for any local government in Nebraska to attempt to regulate or prohibit their use. In 2008, 86 percent of corn and 97 percent of soybeans planted were of some sort of genetically modified variety. LB 263, therefore, is in many ways a “solution” in search of a “problem.
In 2006, we opposed LB 834, mostly out of concerns for the Legislature trampling on local control and for the precedent adoption of LB 834 might create. But that probably was an incomplete analysis on our part. Bills like LB 263 actually are examples of corporate interests exerting influence to obtain unnecessary policy in ways that can ultimately hurt attempts by small farms to develop entrepreneurial activities and markets. For example, taking the language of LB 263 to its logical and plain meaning could result in harm to organic farmers by not allowing local notification policies in the case of pesticide or herbicide drift or genetic drift (the winding blowing sprayed chemicals from one field to another, or the genetic characteristics of genetically modified crops pollinating with non-genetically modified crops). The possibilities of drift have the very real potential to ruin organic crops or create legal issues with the corporate dealers of genetically modified products.
If the Legislature is determined to consider bills like LB 263 they should follow the lead of most of the 15 states that have enacted similar laws and also provide resources and a state commitment to entrepreneurial agricultural pursuits such as organic production and locally produced food. Unfortunately, few bills have been introduced to support these efforts and those that have been introduced are stuck in committee (LB 130 included below, for example).
In 2006 we opposed LB 834; in 2009 we will do the same with LB 263.
Sowing Poor Rural Health
April 15, 2009
Note: This is my latest post over at Change.org.
Still think the health reform debate has little to do with sustainable farming and food?
Think again.
I was struck by two stories on Morning Edition on NPR that drove home the point to me that health reform and healthy food and farming systems are deeply interwoven.
I've said before that if we want sustainable food and farms, farmers need affordable and guaranteed health care options. Unless the farmer has a husband or wife that has a job off the farm that provides health insurance, many farm families find themselves buying expensive health insurance as "individuals", instead of a group plan that shares the costs and risks among many families. As a result, farmers and their families are often stuck with high premiums and deductibles, translating into thousands of dollars of costs if everyone is healthy, and even more if a family member gets sick or injured.
Farmers deserve better than that, and these NPR stories remind me of how broken the system is for people trying to buy health care as individuals.
The first segment I heard featured two women who received cancer diagnoses and thought their respective health insurance plans would be covering the costs. The first woman, Susan Braig, had a "catastrophic policy" covered hospitalization, and Ms. Braig felt sure that it would cover her diagnosis.
When she learned she had cancer, she assumed her policy would cover all of her treatment. "A lot of it was my own inexperience, assuming every cancer treatment was a hospitalization or surgery," says Braig. "I didn't realize a lot of cancers are now being treated like chronic diseases."
Most of Braig's care was conducted out of the hospital. The MRIs, bone density scans, ultrasounds and chemotherapy were all done in her doctor's office. Her medical bills have now put her $40,000 in debt.
What kind of country do we live in that allows people to go into financial ruin for a $40,000 debt she or he did not choose and could not avoid?
The second segment was even more disturbing for me because it sounded eerily similar to something I experienced in my mid-twenties.
During the last economic bust, I [author Sarah Varney] got laid off and couldn't afford the monthly COBRA payments for my health insurance. I applied for an individual plan through Blue Cross.
I was 28 at the time and had no health problems...I got a letter from Blue Cross saying I was denied. They told me it was because my medical records showed I'd gone to the doctor complaining of stomach pain. The pain had long since gone away, but Blue Cross said if I wanted insurance, my doctor would need to fax a note guaranteeing I didn't have stomach cancer. He faxed the letter, and eventually I got a plan.
It makes you wonder, though, if Blue Cross didn't want to insure me — a healthy 20-something — how on earth do actuaries determine who's a good risk and who's not?
The piece went on to say that women pay more for health insurance because we go to the doctor for check-ups more often and because we can get pregnant. Last time I checked it takes two people to conceive a child, but women bearing the costs of reproduction is clearly a topic for another blog post.
I wanted to do some checking of my own, so I went to Blue Cross Blue Shield of Nebraska for a comparison. I pick an average plan and compared costs for men and women. Sure enough, the minimum monthly premium for a 30-year-old non-smoking woman was $150, while the same plan for the identical man was $100. If they'll even accept your application.
All this is to say that the health insurance deck is stacked against people, especially women and families, who want to start a farm and thus need to buy insurance on the individual market. It's not right, and we must fix it if we want sustainable farms and food in the future.
Read the rest of the post here, including actions you can take.
April Newsletter: health care, community development, and more
April 7, 2009
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If the April newsletter hasn't already arrived on your desktop or doorsteps, check it out! This issue has great articles like "The Top 10 Rural Issues for Health Care Reform" and "Grants Available for Direct Farmer-to-Consumer Marketing." |
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I Won the Lottery!
March 31, 2009
I won the lottery!
OK, not THE lottery. A lottery. In order to attend the White House Regional Forum on Health Reform in Des Moines, IA on March 23, regular folks had to register in a lottery for a ticket. When I saw the email, I knew this was an opportunity to help advocate for the health care needs of rural communities. And I learned that to be a good organizer, sometimes you need to use your elbows.
The Obama Administration has promised to listen to the American people and to embrace transparency and accountability. These forums are a great opportunity to test what "listening" looks like to the Obama Administration. Input does not necessarily translate into a seat at the decision-making table, so these forums are a way for us to determine how serious Mr. Obama is about real democratic participation.
Four prominent Democrats moderated the forum - Iowa Governor Chet Culver, Director of the White House Office of Health Reform Nancy-Ann DeParle, Iowa Senator Tom Harkin, and South Dakota Governor Mike Rounds. Notably absent was Iowa Senator Charles Grassley, who will be instrumental in any reform effort by virtue of his high position on the Senate Finance Committee.
In the opening remarks, Sen. Harkin discussed the need for prevention and wellness. Gov. Rounds emphasized the need for rural areas to have a say in upcoming reform. White House Health Reform Director DeParle, on the job for only a week, gushed about the special place that the President has for Iowa and told her to head there first thing.
Gov. Culver explained for each topic in the agenda an "expert" would introduce the topic, and then audience members - experts in their own personal experiences - would be picked to share their thoughts.
After a few of these topics passed, I heard it - rural health care! My hand shot up to speak, and I even had a statement prepared:
Rural America faces the same health care issues as urban America - skyrocketing costs, too many uninsured and underinsured, and a health care delivery system strained to the point of breaking. There are, however, unique rural health care challenges. The Center for Rural Affairs released a report today detailing rural America's top 10 health care reform issues, with an emphasis on challenges faced by rural small businesses and the self-employed as well as support for a public insurance option.
How will the Obama Administration address rural America's unique needs related to affordable insurance, access to quality care, and a declining rural health care workforce?
I was not selected to speak, but rural issues were well represented by a good friend of the Center for Rural Affairs:
... Iowa Farmers Union president Chris Peterson of Clear Lake said he’s glad the forum was held in the Midwest, as most Americans don’t understand the challenges rural citizens face. “Rural Iowans struggle with finding affordable insurance. Even solidly middle class farmers are feeling the pinch. Nearly one in eight Iowa farmers battle outstanding health debt,” Peterson said. “I am one of them.”
Peterson, who is 53, was kicked off his private insurance plan about two years ago for what the company said was a preexisting condition.
Peterson and his wife, who has no private insurance either, have accumulated $14,000 in medical debts in the past two years. “The health care system in this country is dysfunctional and burdensome,” Peterson said of the private insurance industry. “…Personally, what I’ve been through, it seems at times it’s a Ponzi scheme — they’re taking your money — or (it’s) just the robber barons pulling money out of your pockets.”
Right on, Chris. I only wish I had thought to give him our newly minted research paper [PDF] or at least the summary [PDF] so that he could reference it and hand a copy to Ms. DeParle. As it was, I was still angling for a chance to give it to her myself.
In their closing statements, Sen. Harkin was convinced that we must have a public plan, Gov. Rounds thought we can make a system that increases efficiency without sacrificing quality, Gov. Culver wanted public-private partnerships, and Health Reform Director DeParle felt optimistic that there will be a compromise.
Of course the irony of the politicians' vague statements was that they did not really reflect what people had said at the forum. I have a healthy amount of skepticism that moderators were in fact listening enough to take citizens' ideas into account when making decisions about reform, but willing to give the benefit of the doubt - it's been a long time since we had an administration who wanted to listen at all.
By the time the meeting adjourned, I was still holding the Top 10 Rural Issues for Health Care Reform. This paper was written in rural America, based not on a few listening sessions but on 35 years of living the rural life. I couldn't walk out the door with it in hand, so I elbowed my way to the front of the room where Health Reform Director DeParle was standing, surrounded by a knot of people waiting their turn. Before I got near enough, though, her staff began to usher her towards the back door.
Heck. No.
I scurried back to where I thought she was headed and as she stopped for a photo-op, I had a moment of doubt and - I'll admit it- intimidation. She's a busy person after all, and clearly has places she needs to get to. I quickly brushed it aside though, because I can't expect anyone else to advocate for rural America if I can't summon the courage when presented with an opportunity to do so.
I called her name and she turned towards me. I held out the paper as I introduced myself, and she took it as she walked out the door. Even I was surprised at how easy it was to push through the buffers that surround politicians.
I hope she reads it and remembers what Chris Peterson said about hard-working Midwestern families feeling the financial strain of unfairly high health care costs. That as she goes back to Washington, DC to make decisions that affect millions of rural people, she recalls the faces of the people who cared enough to attend these forums and that she has enough courage to make reforms that will foster prosperity and opportunity in all our communities.
Right now we have a short window of opportunity to push for the needs of rural people. We have to assume that what the politicians tell us is true - this fight will all be over by year's end. Is that enough time - for us and for this administration - for real people to have a real role in shaping a new health care system that works for rural America?
It is if we act now.
We need face these decision-makers like the real people they are, even though we know they are insulated, handled, and filtered everywhere they go. Clearly the process of reform is polarized and politicized, but it's our job to surround them with unfiltered, uninsulated people like ourselves to make sure their eyes and ears process our stories and field our requests.
The good news is there are opportunities both to inform decision-makers about the health care situation in rural communities. The administration has a website where you can view a statement by President Obama, read the live blog of the Des Moines forum, see the dates and locations of the next two forums and submit your ideas or questions about health care.
And don't stop there. Sign our health care petition. Pass all of these links on to everyone you know and weigh in with your congressional delegation.
Need other ideas for getting involved? Contact us at the Center for Rural Affairs or leave ideas for getting involved in the comments. Don't wait another day.
Onward!
Health care is a racket!
March 19, 2009
Note: This is the latest health care post of mine over on Change.org.
"Health care is a racket!"
I said this as I tossed my latest statement from my insurance company on the kitchen table.
It said that I owed a lab in California $95, which I was expecting. I have not met (what I thought to be) my $1,500 deductible yet, so I pay out of pocket until I do. I get this.
The first unpleasant surprise was that only $85 of the charges would count towards my annual deductible because
Reason: M25 - Your coverage does not provide benefits for charges in excess of our reasonable allowance. This amount is your liability.
Considering they have a vested interest in not paying what something actually costs, I have a hard time with this. It would be similar to me walking into our local café and ordering a sandwich, then telling them how much I would pay for it after I’d eaten it.
The second unwelcome surprise was that because this provider, a dentist, was “out of network”, the $85 goes towards the much higher “out of network” deductible. It reminds me of an exclusive high school clique - if my provider does all the random "right" things, she can be included. I asked this my dentist why she is not in one of these networks, and she said it was because they try to tell her how to treat her patients. I don’t blame her – I wouldn’t want a big corporation telling me how to do my job.
Not that I have a choice of what dentist or doctor I go to. I thank my lucky stars that there is a one of each – part time only – in my little Nebraska town. Because of the limited choice of providers, there are only a few insurance companies my employer can consider.
Read the rest of the post, including why I think a public option is important for rural communities here.
