Monday, July 6, 2009

What Health Care Reform Looks Like From the Ground

A Letter to President Obama from Precinct 384

This quick note is about a serious difficulty we are having with Organizing for America’s (OFA) health care talking points.101

I am an “Obama soldier” from the campaign -- precinct 384, NE Albuquerque, neighborhood team 39. Naturally, I went to the new OFA office this morning after receiving last night’s phone call. I met the all the friendly, bright eyed, eager folks hunched over their laptops and picked up a copy of the canvassing material.

After looking through it, I am concerned that this effort is making the same mistakes that were made in the campaign -- at least, the same mistakes with respect to the precinct 384 “voter universe.” For 30%-40% of the voters in this precinct, the talking points are a “clear miss.” In fact, I suspect that they even go so far “off target” as to be insulting. This is too similar to an unfortunate repeat of what happened in the endless 2007 - 2008 Presidential campaign “slug fest” where the most persuasive campaign issues seemed to simply be “over our heads and over our pay grade.”

I’ll note the exact conflicts the “Three Principles”President Obama’s promotion plan presents in the real life situations of this constituency.

1. Reduce Health Care Costs
This constituency: They usually don’t pay for treatment. They wait until things get really serious, then they go to the ER and apply for “No Pay” treatment. That process is frustrating, uncertain, demeaning and time consuming. They suffer from all the subtle indignities of this process -- especially when they know that other people have actual health plans. They are totally ready to pay more taxes to get dependable care.

The emphasis on “keeping” your doctor means very little to my neighbors. They don’t have a doctor. They have probably never seen the same doctor more than once or twice. They are completely accustomed to taking what they can get. “Go to the Doctor,” to them, means packing up the family and waiting in the ER for 5 or 6 hours, then not having enough money for medicine until payday.

2. Allow Choice of Coverage and Doctor
This constituency: They have never made any choices at all so far. Period. No choices! Coverage to them means the “safety net.” They, frankly, don’t understand what “choosing a coverage” means. They have never had an employer provided insurance plan, although they may know people who have. A 21st Century version of "keep away."

3. Better Quality Health Care
This constituency: They have no way to make an opinion about health care quality aside from their memory of outcomes. They haven’t experienced enough of a variety of health care, that is, the variety that is implied in the talking points, to make a judgment. As for reducing the paperwork, they have never had health care other than the “No Pay” kind which is always chest deep in agonizing, belittling paperwork.

I’m not interested in starting a class war here, but the OFA material seems basically intent on doing just that. Precinct 384 contains an awful lot of voters who are simply put off by choice issues presented to them at this level. The choice the voters in this neighborhood have made is simply one in favor of improved access to health care.

We registered a lot of these people who had never voted before to elect the President. When we talked to them and approached them in a suitable way, they were completely ready to learn about the election politics and VOTE! However, the Presidential campaign had the same “over their heads” direction as this health care thing, and we could have failed to deliver this state if all this population remained “left out” in favor of a campaign targeted at more prosperous urbanites.

Precinct 384 voters have the same worries as most other Americans. They know that, in a well designed response to the grave damage done to the country during the autocracy, major investments in not only health care reform, but also in climate change, energy policy and educational resource allotment, will mean huge spending bills moving through the legislative process. In the past, they have seen every such possibility of actual progress being ruthlessly looted as it is “negotiated” into oatmeal in the Congress. Traditional hillbillies, crooks and neo-con bigots join forces with "bought and sold" Democrats, emerging from their dens to savage any good idea, that is, to extract every possible illegitimate advantage for their friends and campaign contributors.

About 1/3 of New Mexico is watching these health care developments while “looking up” from the very bottom of the heap. We are a poor state with lots of immigration, education and public service issues. Our neighborhood team made our own campaign literature for 2008 for just this reason. And -- this seemed to work well. Both the President and OFA must make more of an effort to include this constituency by focusing on a description the new system and what it will be like for Americans in this very real situation.

I was never much of a John Edwards fan, but he talked about “Two Americas.” He was right. In New Mexico we need “Two Campaigns” and some way to keep them pointed at the right constituencies. The neo-cons are already targeting the new Democratic Congressional delegation from New Mexico. We can’t let this slide back to where we were when the state went for Bush in 2004.

To President Obama: “Remember us! Tell about a plan that relates to our ‘on the ground’ reality. We support you now, and we will continue to support you, but we would like to be included in the debate!”

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