Every couple of weeks for the past 15 years or so I have gone to get my hair cut by a woman in Villa Park. I’ll call her Liz. She’d be mortified if I used her real name. Liz works in a small shop where she gets paid a portion a what she takes in in business plus the tips her customers give her. Her income is modest but she lives very simply. When her Mom died a couple of years back, she was able to afford a tiny condominium in Wood Dale with the inheritance. Prior to that she’d lived with her Mom. Liz’s employer doesn’t provide a health plan and she is unable to afford the premiums for an individual plan on her limited income. Even if she could, preexisting condition limitations on any policy she might purchase make it unlikely she would get the care she needs.

Liz may have a serious medical condition. Because she knows that I am a health care professional, she tells me about her symptoms when I visit and looks to me for advice. At my insistence she has gone to see a primary care physician, paying out of pocket for her visits. He helps her out by giving her medication samples which she takes but her condition isn’t resolving. Her doctor wants to refer her to a specialist who will need to perform an endoscopy to definitively diagnose and treat her condition. Liz has consistently refused because she has no means to pay for such an expensive procedure. Instead she just hopes that her condition will resolve itself. She has lost weight and sometimes feels too sick to work but can’t afford to take a day off. Eventually she will probably end up in an emergency room where she will get care that could have been provided much more effectively and for much less cost in a specialist’s office. Her delay of care has the potential to be life-threatening.

Liz is one of Peter Roskam’s constituents. He was elected to represent her interests in Congress. She is one of thousands of people just like her in the 6th District who work hard for a living and still can’t afford to buy into our healthcare system. Peter Roskam doesn’t even seem to know these folks are alive. Or else he just doesn’t care.

Peter Roskam claims to listen to his constituents. But look at his remarks from WLS 890′s Don Wade and Roma show last week:

“My constituents want doctors and patients to be reconnected in ways that make sense to them. They want to see us make sure we don’t stifle medical innovation, which in this country is great. Think about the devices and the transforming nature of things that have come upon and been made available to us within our lifetime. You got to make sure those things don’t get stifle because government alone certainly does not come up with those medical devices. It is largely the private sector.
…
“My folks are looking for the right to know from their Health Care providers. Who’s doing a good job, who’s not doing a good job – publishing some results – morbidity results and success rates of different hospitals and physicians. And they are also interested in doing everything they can to contain costs because for small businesses, for that manufacturing core that I represent in DuPage and northwest suburban Cook county, those guys are struggling from 19,20, 23, 25% increases in their insurance premiums and I don’t think the President’s plan hits the mark in terms of cost containment.”

Wrong, Peter. Your constituents want to be able to go to the doctor when they get sick.  Your constituents are not the “manufacturing core”. Your constituents are people like Liz who are sick and can’t get care. And their President has proposed that we fix that, and Democrats in Congress are working hard to make that proposal a reality. And what are you doing, Peter? You are fighting tooth and nail to ensure that real healthcare reform never happens. You are doing this by trying to scare people about a “government takeover” of healthcare.

Listen to Peter Roskam’s staged “interview” on WIND’s Big John and Cisco program last week:

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Lets look at Roskam’s arguments:

• Roskam warns that breast and prostate cancer survival rates in the United Kingdom are much lower than ours here in the United States, implying that the quality of care will suffer here if we diminish the role of the private sector in healthcare. But Roskam is using a couple of statistics very selectively to compare healthcare under a public single payer system to our own. Roskam fails to address the overall cost-effectiveness of the U.S. healthcare “system”. The United States currently spends about 17% of its gross domestic product on healthcare. That figure may grow to 20% by 2017. At that astounding level of spending 46 million Americans are uninsured and are getting ineffective incomplete care. We are the only wealthy Western industrialized nation that does not ensure that all citizens have  at least minimal coverage. And even those who are covered by insurance plans are often choosing to do without care due to rising healthcare costs and shrinking benefit plans. And here we spend 6 times as much per capita on administrative expenses as in industrialized European nations. Medical tourism is gaining increasing popularity in this country. U.S. citizens are traveling to places like India and Thailand for major medical and dental procedures because quality is high and costs are low. Some health plans and employers are beginning to look at it as a means of saving money. For all the money we spend on healthcare here, quality of care leaves much to be desired.  Our infant mortality rate is higher than in all other developed countries and we rank 46th in total life expectancy. Between 1997 and 2003, U.S. mortality amenable to health care interventation (preventable death) declined much more slowly than in the 18 other industrialized countries studied. (4% vs an average of 16%). A 2000 study by the World Health Organization ranked the U.S. healthcare system 37th in overall effectiveness (the U.K. ranked 18th with much lower spending.) While the cancer survival rates that Roskam quoted are not without controversy, they probably do relate to a real phenomenon in that the market creates incentives here for spending on highly lucrative new technologies involved in cancer treatment while it encourages neglect of more mundane but ultimately more important aspects of care like prevention and primary care. And not all Americans share equally in the benefits of those new cancer treatments. A recent study showed that uninsured or medicaid recipients were more likely to be diagnosed with 12 common cancers at a late stage when they are less amenable to treatment. In short, American healthcare is bad and getting worse when stacked up against our peers. In fact, our system is a terrific model of why its a bad idea to let the market alone drive the provision of healthcare.
• Roskam complains that Democrats are using deceptive language and tested talking points to steer the debate. I don’t want to give this more attention than it is worth but this is the pot calling the kettle black. MediaMatters has already pointed out that Roskam is pushing Frank Luntz talking points on healthcare reform. Luntz is a Republican political consultant who has authored a set of talking points aimed at helping Republicans in Congress prevent any action toward healthcare reform. Roskams remarks show heavy indebtedness to Luntz. You can read the Luntz document here courtesy of Think Progress. One of the high points for me was: “The cure rate differentials between the United States and countries with government-run healthcare is a powerful weapons. You need to assemble a list of the five most staggering facts that show better cure rates in the United States than our neighbors in Canada and our cousins in Great Britain. Focus on the kinds of diseases that touch the most people in the most personal ways, like cancer and heart disease. The facts must be accurate – because our research indicates that this kind of information really will move people. It personalizes the harm of government-run healthcare in a powerful way.” Sound familiar?
• Roskam complains that a public option will result in a “government takeover” of healthcare. This is Luntz’s chief talking point in his document “The 10 Rules For Stopping the Washington Takeover of Healthcare.” This phrase is pretty meaningless and is designed only to scare and upset you and to boost Glenn Beck’s ratings.
• Roskam claims that you will have no choice in a public option.  We currently have a public option covering many millions of Americans. It is called Medicare. Medicare recipients have much greater choice of providers than the rest of us.
• Roskam claims that a public option will deter medical innovation. Medicare has been around since the 1960′s and medical innovation hasn’t slowed. But we have already talked about the perverse incentives the market creates in the direction of that innovation.  (i.e. toward lucrative high technology vs effective primary and preventive care).
• Roskam says you will have to wait a long time for care if the Democrats reform healthcare. Roskam does not substantiate this claim with evidence, just an anecdote about an aunt. For many Americans a wait for care would be a vast improvement over no care at all. But we have no real reason to believe that this will be the case. Medicare recipients are not waiting for care.
• Roskam says there will be rationing. Again, these are just scary words from the Luntz talking points. We already have rationing. Rich people and public officials like Roskam get Cadillac care. The working poor get next to none. Thats how we do rationining in this country and essentially that’s what this debate is all about. Roskam and his ilk want to protect that privileged Cadillac care for the very rich at the expense of those of you who have to sweat to earn a living. Its not much different from his stance on taxation really. As with any good, we do need to have a method of fairly allocating healthcare. We will never have a plan that we can afford that covers everything for everyone.  And we need to rationalize the kind of care that we give to people at the very end of life, when much of the care we render is actually futile and causes needless suffering. Our present system of allocation of care is very unfair. It is based upon wealth and status.
• Roskam claims that bureauocrats will make medical decisions for you. This is, again, straight out of the Luntz talking points: “With government run healthcare, politicians and bureaucrats make your healthcare decisions for you.” Roskam offers nothing to substantiate this wild claim. Under Medicare, physicians make treatment decisions. As with any insurance plan, there are limitations to coverage, and not all aspects of care are reimbursed by the plan.

So what does Roskam offer to my friend and his constituent , Liz, as a solution to her inability to healthcare?

• We should improve medical data transfer
• We should control Medicare waste and fraud
• We should have medical tort reform

I’m sure all of that will be a great comfort to Liz. Why if we are dilligent, in 20 or 30 years she might be able to afford to see a doctor again.

No Peter. We need universal access to care now. And you are standing in the way.

Unlike many progressives, I am not wedded to a single payer solution or even convinced that it would be workable in the near term. I don’t see how you can turn a monster like the current U.S. system into a public single payer system overnight. I believe that the private healthplans bring much to the table in terms of controlling costs and improving outcomes and transparency and that we would be foolish to bring about their demise. They have been unfairly demonized in the current debate. Healthplans provide a check on excesses by other sectors like hospital systems, drug companies, and unscrupulous physicians. Rather than rebuild a healthcare system from the ground up, the goverment should be given powers to help correct some of the perverse incentives created by the market and to get all components of the current system working together toward common ends. But I also believe that universal coverage is non-negotiable. We have to provide it, and if the only way to do so is through some kind of public option, then so be it.

Peter Roskam is using his position and his platform to obstruct progress toward universal coverage and his constituents should let him know that they won’t stand for it. Please call him today and demand that he stop badmouthing the present efforts toward healthcare reform and work with the Democrats to achieve universal coverage this session. You can reach him at (202) 225-4561 in Washington or at (630) 893-9670 in Bloomingdale.

BTW: Roskam accused President Obama of being defensive in his speech before the AMA. You can judge for yourself but IMHO this guy was not defensive, he was in command: