Before I detail the good, the bad, and rehash the very ugly about Rep. Ed Royce’s August 8, 2009 town hall, I tip my liberal hat in thanks to the Congressman for holding more than 100 town halls during his 16-year tenure. Agree with Rep. Royce or not, he listens and responds to all questions and questioners, as time permits. And he’s prepared. He does his homework.
The Good
Last week, I blogged that I hoped to ask Rep. Royce “… how he plans to address the health insurance needs of his constituents if he plans to vote down America’s Affordable Health Choices Act,” which is House health care reform legislation.
The good news is that Rep. Royce had responses, however sparse, to that burning question. Royce voiced support in:
- Disallowing pre-existing conditions as basis to deny coverage;
- Implementing portability for all health insurance plans; and
- President Obama’s belief that “enormous savings can be made in current systems.”
While this list is pitifully short of addressing the reform needs for existing health insurance policies, and does little to address the desperate needs of uninsured residents of Royce’s district, it’s a start.
The Congressman likely realizes that certain reforms are legislative fait accompli, and he wants to be seen as jumping on the bandwagon for provisions that will benefit his constituents. I hope his commitment to real health insurance reform is deeper than that.
The Bad
Rep. Ed Royce consistently pandered at his town hall to the conservative crowd’s worst instincts with words sure to rile-up the mostly elderly attendees:
- Despite firm public assurances by President Obama, Rep. Royce threatened that Democratic health care reform will cover illegal immigrants.
- Rep. Royce repeated the myth flatly denied by the White House that the elderly will “lose Medicare options to fund” Obama’s health care reform.
- At every possible chance, Rep. Royce invoked the name of Massachusetts Congressman Barney Frank, to animated groans, hisses, and head-shaking sighs.
- For good measure, Rep. Royce also reiterated threats of people losing and/or being taxed on their existing employer-based health care policies.
And my personal favorite, Rep. Royce carefully explained to the room that “Government-Run Care Means Lower Survival Rates for Cancer.” (See Royce’s hand-out at right.) The unmistakable message: Adopt Obama’s plan, you are more likely to be fated painful death by cancer.
Never mind that the U.S. government wouldn’t be “running” health care delivery… Never mind understanding the assumptions, particulars, or even dates for the “worldwide population based study” vaguely cited… Never mind that most aspects of European and proposed U.S. health care systems are not comparable.
The predictable result of Royce’s fear-laced mantras was frightened elderly conservatives who became more frightened, and who left armed with few solid facts, particularly about the dire consequences of not reforming rising medical costs.
The Very Ugly
As I reported yesterday, political literature containing Nazi imagery linking President Obama and Adolf Hitler was openly disseminated inside the room just prior to Rep. Royce’s arrival.
The Congressman issued a statement today that an individual “… was able to sneak several highly objectionable fliers… into the meeting” and “Any attempt to portray me or my office as endorsing these repugnant fliers is 100 percent false.”
All well and good, I suppose, except that there wasn’t much sneaking. The young man distributing the 16-page booklets strode confidently up and down stairs on both sides of the room, loudly hawking the slanderous hand-outs as though he was selling peanuts at Anaheim Stadium. “Sneaking” is hardly the operative term.
But regardless, the tone was set. The damage was done. Constituents read the trashy booklets, and they took them home for their families and friends to read. The angry and frightened became more angry and frightened. And rational discussion of health care reform became even more impossible.
I have no doubt this won’t happen again at Rep. Ed Royce’s town halls. I have little doubt that Rep. Royce is horrified that this rubbish was distributed. That’s not the point.
The point is that it was distributed. That his staffers could easily have stopped it. And that they didn’t have enough respect for non-conservative constituents in the crowd to stop it.
My suggestion for Rep. Royce is that he and his staff focus on addressing all his constituents at town halls, not only Republicans.
Why try to stop the handing out of the flyer, what about First Amendment and equal access? If the flyer is rubbish then the people should be smart enough to challenge its contents as they challenge the Health Care Bills being worked on. If the flyer is truly rubbish then those that have attached their creditability will suffer. Town Hall meeting is not about one point of view.
I wonder why the Orange County Register not only failed to cover the first local town hall conducted by an OC member of Congress, but also failed to cover the distribution of such hateful literature? Maybe it is because it was Royce’s town hall and they didn’t want to stir up more Republican ire after the whole Van Tran – Andy Quach mess?
I am a board certified emergency physician with 30 years of experience and have seen “America’s Emergency Safety Net†gradually erode. I have personally suffered episodic ill health due to work stress and am forced at the age of 56 to consider retiring from my specialty. Many of my colleagues are burned out and want to leave the specialty of Emergency Medicine. Government has mandated we see all comers but is reducing our compensation disproportionately.
Please help improve access to “real” emergency care and not increasingly overwhelm us more by your bureaucratic mismanagement.
While an Emergency Medicine Resident at Harbor-UCLA in Los Angeles County in 1982 I treated an overdose patient that was inappropriately transferred from a neighboring hospital. This case became one of the sentinel cases in California that resulted in anti-dumping statutes that later led to passage of Federal EMTALA in 1986. I worked on a California/American College of Emergency Medicine Committee with Michael Jay Bresler, MD, FACEP, who is given credit for establishing several legislative amendments during his tenure on the Cal/ACEP Board.
I therefore speak with some experience in helping to draft legislation to improve patient care outcomes when suffering emergencies.
Lets for a moment agree to disagree…
Having worked in an Urban ER for 7 years that serves primarily the indigent, I have seen that providing Managed-MediCal in no way guarantees access to care. Instead, it puts up more HMO barriers, and many frustrated patients have no alternative but to seek non-emergent and non-urgent advice at an Emergency Department.
I am afraid that the currently proposed AAHCA of 2009 (“America’s Affordable Health Choices Act of 2009â€) will guarantee coverage but does not guarantee timely access to care. Enrollees will be forced to stand in line at increasingly overcrowded ER’s.
My plan would be to provide vouchers for the patients declared “stable†by triage standard and who could be safely directed to affiliate-licensed Urgent Care Clinics for timely rapid evaluation and care.
The problem is, at present, this type of referral would violate EMTALA, and ER’s & Hospitals prefer the “bread and butter cases†waiting (for as long as takes) to fill in their “down-timeâ€.
According to HealthDay News, patients on Medicaid already have difficulty accessing health-care providers, according to a recent national online consumer survey by PricewaterhouseCoopers (PWC) Health Research Institute. Nearly a third of Medicaid patients reported waiting 30 days or more or an appointment with a doctor. What’s
more, many Americans still use the emergency room inappropriately. According to PWC’s consumer survey, more than half of those who went to the emergency room in the last year did so for non-emergency reasons. http://news.yahoo.com/s/hsn/20090807/hl_hsn/expandinghealthcoveragemaynotimproveaccess
Ten years ago and again last year, Harbor-UCLA ER (where I did my internship and residency) performed a study that showed that 10% of the LWBS (left without being seen) patients had significant morbidity and mortality within 24-72 hours of their initial attempted visit.
My plan would be to have these potential LWBS patients directed to the clinics for a timely evaluation.
The Canadian Plan is indeed an excellent plan for most patients. Problem is, doctors were guaranteed a significant salary increase by the government and they did indeed get it according to several Canadian friends I have spoken with.
No such plan seems to be feasible in the United States where there are no longer available financial resources short of increasing taxation. Instead, the present plan seems to further guarantee reduced reimbursement to US physicians.
This will not engender acceptance and may jeopardize real health care reform in the Unites States.
I DO believe there should be a National Health Care Plan.
I just do not agree that the present plan, as written, guarantees access to timely care… it is just false hope…
Respectfully submitted,
Mark S. Wagner, MD, FACEP
PO Box 338
Dana Point, CA 92629
310-218-3892
mswagnermd@cox.net