I Won the Lottery!

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!