( – promoted by Clark)

Crossposted on Daily Kos

Over the recess I have been following, along with all of you, the often alarming reports coming out of town hall meetings with our elected officials.  Earlier this month Sen. Claire McCaskill had scheduled town hall events in the St. Louis area, but the one planned in University City was cancelled at the U.City School District’s behest due to security concerns, so I never got to see a health care townhall in my immediate area.

When Sen. McCaskill’s second round of townhalls was announced, I decided to go to the one in Hannibal, the closest location to me, to gauge how the health care debate was going in the more rural sections of the state.  

That there is still interest in the health care issue is evident from this photo, showing a full gymnasium during the discussion.  The Hannibal News-Courier estimated the crowd size at 475.

Hannibal, a river town in the northeast of Missouri, is best known as the birthplace of Samuel Clemens and the setting for his two most famous works, The Adventures of Huckleberry Finn and The Adventures of Tom Sawyer.  It is a small town of about 17,000 residents of overwhelmingly white descent (Wikipedia entry).  In 2008 Marion County, in which most of Hannibal is incorporated, voted 61% McCain, 37% Obama–so I was expecting a large turnout of conservatives at the event.

The health care event was scheduled for 9:30AM, August 24th, at Veterans Elementary School, just west of Hannibal.  I arrived just after 8AM to find about 20-30 people in line.  Most of the arrivals I saw were people my age (50) or older.  Of those showing any political affiliation, most that I saw were conservatives; a few had “Teabagger” buttons on.  A few younger participants came out to demonstrate for the public option,

Which led to some spirited but respectful debate from a few of the conservatives present:

I really didn’t see any of the vein-popping red-faced arguing that we have seen in some of the coverage.  I had to lean in to hear the discussion, in fact–and it wasn’t because it was noisy outside.

As the gym filled up, local media went around to get some interviews.  The person sitting next to me turned out to be a World War II veteran who was aboard the USS Brooklyn (CL-40) during the war.  He was against the public option!  Just down from him was a couple with “teabagger” buttons on, whom I engaged with as little as possible; I really just wanted to observe and report, and not get into any potentially nasty discussions.

Brent Engel of the Hannibal Courier-Post interviews Len Moss, WW II veteran.  I thought the slogan above the stage area, reading “For when the one great scorer comes to write your name, he writes not that you won or lost, but how you played the game.”  Heh.

Slips of paper were left on each chair for all participants to write questions or comments on.  I got my comment in early, and hundreds followed.  A staffer came out to announce that Sen. McCaskill would choose the questions/statements at random, which elicited some applause and no boos.

Wes Shoemeyer introduces Claire McCaskill.  The basket in front of the podium contained our questions and comments.

Right on schedule, State Sen. Wes Shoemeyer introduced Sen. McCaskill; she was greeted with a standing ovation from about 40% of the crowd, and polite golf-claps to nothing from the rest!  Then there was an invocation (long winded and right-winged, as you might expect) followed by Sen. McCaskill leading everyone in the Pledge of Allegiance.

Sen. McCaskill’s opening remarks mostly concerned how she would be running the meeting, and that she was interested in all points of view; she emphasized, “I am accountable to all Missourians” in her brief statement.  One rule she made was that she would only answer questions from people actually present; if she called out a name and no one answered, she would move on to the next question.  She asked for a show of hands to gauge support for health care reform; less than 40% of the hands (including mine) went up.  Many more went up opposing it!

Now to the questions.  Sen. McCaskill called out a name, and gave the questioner a chance to ask the question themselves, or for her to read it.  Most questioners asked her to read; in a few cases there was some back-and-forth with the questioner afterward, but not much.  What follows is all paraphrased unless it is in quotes:

Question: Why do you (Democrats) want to penalty tax the uninsured?

Claire McCaskill (CM): Restated problem of rapidly rising costs of health care; mentioned $700-1,200 per person in what she called “hidden taxes” (not sure if she meant actual taxes or increased premiums) to cover uninsured.  Her point was that if all purchased insurance, the risk pool would be spread out, and costs could go down as a result.

Statement: Our free-market health care system is the best in the world–80% of Americans want to keep it.

(question greeted with some murmers from the pro-reform people, and audible snorting from yours truly.  Sorry, I don’t have those Midwest manners down yet!)

CM:  No change in health care policy means huge increases in health care costs.  Made the point in talking to farm families in Missouri that one of the things that is holding family farming back is the rise in health care costs; she mentioned farmers who had sons or daughters get jobs in town solely so they could get health care benefits for their families.  CM emphasized “no government takeover of healthcare” but got a big round of booing from the anti-reform attendees.

Additional point was made about Medicare and about the fast rise in entitlement costs in the budget.  She said she would NOT vote for any health care plan that was not “deficit neutral”, and stated that she had no interest in voting for a single-payer health care system.  

I think I knew this about her already, but it’s still an “ouch”.  I really think single-payer via expanding Medicare is the way to go, but there you are.

Question: Why can’t the VA system be integrated into Medicare, so that efficiencies from the VA system can be incorporated?

CM:  Emphasized initiatives to go to electronic records as part of the stimulus appropriations (soft but audible booing at the word “stimulus”) to integrate systems and cut costs.  Emphasized that VA would be a stand-alone system completely unchanged and unaffected by health care legislation.  

Question: Where can we find a list of facts on health care reform, as opposed to spin from journalists?

CM: gave URL for Senate HELP Committee’s page to view legislation (http://help.senate.gov/), the only bill reported out of Senate committee at present.  (link to legislation is on left side after scrolling down).

Emphasized that many amendments were offered for the bill that came out of the HELP Committee, and that approximately 150 Republican amendments were accepted, vs. 30 from Democrats. &nbsp
;(WTF?  At least I only thought that real loud.)  Discussed the six senators on the Finance committee working on, in her words, a “bipartisan way forward”.

(“GACK!!!!!”, I thought–but I kept it to myself.  Continuing:)  

CM: The major goal is to stabilize health care costs.  Then she made a statement that it is too easy for all of us to read stories from our side of the aisle, and encouraged all attendees to read from all sources of information, even those you don’t agree with.

I’d do it, if there was an actual non-batshit crazy conservative site out there.  I took it as a dig at Fox News and their viewers, even though she didn’t mention them by name, and there were a few angry murmers from the anti-reform folks.

Question from a nurse practitioner: Has the collaborative approach to health care being used as a possible model for primary health care?

CM: Said yes with respect to federally-funded health care and cited the study showing that the Mayo Clinic had better patient outcomes and satisfaction, while spending less than half per patient on care versus more traditional providers.

Question: Can the health care bill be split and sections voted on seperately?

CM: This is possible.  Floor votes will most likely be on sections of the bills, not the bills in their entirety.  She made the point that most legislation is unwieldy in language and is nearly unreadable for most people, would like to see simplification of legislative language so that citizens could read legislation, and help keep loopholes out.  

(General applause from all factions.  She then got off on a tangent:

CM: if we changed our health care system to prevention of chronic conditions such as diabetes, we could change the deficit.

Interesting.  I’ll have to run down average costs of preventable conditions and see if this is true.  Empirically, it makes sense–less diabetes, less spent on health care–but I wonder about the dramatics.

Statement: Health insurance industry is lobbying against health care reform, while airing ads supporting it.

CM: Said the insurers are trying to work around health care reform.  Does not oppose their lobbying.  Told attendees to pay close attention to who is financing the ads they see in newspapers and television.

Question: How are we going to fix the deficit on Medicare?

CM:  Emphasized that simple cost containment would not be enough.  A lot of the work being done in health care reform is to close the loopholes in Medicare Advantage so that the insurers don’t rake in large profits, and to close the donut hole on Medicare Part D, which she emphasized was passed as an unfunded mandate with no provision to negotiate costs of medications.

Stated that any tax increases would be on the wealthy, and that no one making 250K or below would see a rise in income taxes….

At this point the loudest booing of the session occurred, with a few people shouting “liar!”  That’s about as tense as the meeting got, though there were a few outbursts from people, quickly shushed, including by the Senator herself.

Question: Please define the difference between a public option and a co-op.

CM:  A co-op would be a consortium of private insurers in a non-profit enterprise; a public option would be government-run.   In response to a shouted question, “what about free enterprise?” stated that private firms can compete against co-ops or the public option.  She said co-ops had been tried in various states with some success.

Question: The Federal Government can’t reimburse car dealers in a timely fashion for the CARS program. How can they run health care?

Loudest cheers of the day were for this question, from the anti-reformers, of course.  But watch how CM pivots on the answer to the question:

CM: reiterated her vote against the CARS program, for the very reasons named by the questioner.  Said that government doesn’t do everything well, but does some things well.  Called for show of hands for all veterans (applause), stated support for the firefighters (applause) and support for the police (applause).  Then immediately turned on this point to emphasize the effectiveness of Medicare and its low administration costs as compared to private insurance.  (applause from the pro-reformers, stunned silence from the anti-reformers)

And an audible “well played, Senator” from me.

Question: Will you work for tort reform?

CM:  Looked at tort reform in Missouri, and other states such as Texas and Florida, and saw a 75% drop in medical malpractice suits, but stated that insurance costs were increasing in all of the tort-reform states, Florida most of all.  Tort reform is “not a magic bullet.”

One of the few interruptions during the meeting was well before the actual tort reform question was selected, from an angry-looking woman in the audience.  The Senator refused to answer it at that time, so as not to reinforce shouting out of questions.  The lady wasn’t happy, but she got her question answered after all.

Question: Do you support 24 million in Social Security funds to change to electronic records?

CM:  actual appropriations for this came from the stimulus (more booing).  Said that Social Security trust fund is being spent, and that we must find a way to change methods of appropriations so that spending is “disciplined and merit based.”

Sen. McCaskill emphasizes a point during the discussion–and no, it wasn’t about Sarah Palin’s tiny, tiny brain!

Question:Why not tax bad foods/fatty foods as an alternate means of financing health care reform?

CM: Opposed the method, said that addressing other areas of cost would be more effective.  Went back to co-ops and said she was open to them, but supported a “limited, constrained public option” as best means for cost containment.

This gentleman was the only one to rise and ask a question himself, rather than let the Senator read it.  This is what he said:

All I’m hearing is insurance reform, not health care reform.  I believe the economy is the greater problem.

CM:  Talked about how over many years of elections, health care reform was discussed, but no action taken for decades–now people are saying we’re going too fast on health care reform!  Says that fixing health care can help the economy, and that one reason they are taking their time is to make sure any health care legislation doesn’t hurt the economy.  

Question: Will Medicare change?

CM: No discussion of changing Medicare benefits other than fixing Medicare Advantage and closing the Medicare Part D donut hole.  Called for show of hands on who had seen the “free mobility scooter” ads.  Said that aggressive marketing of these “free” scooters actually meant that taxpayers were paying for them, and that maybe half of the scooters being approved for Medicare reimbursement may be unnecessary.  Said decisions on the need for a scooter should be made by a doctor.

It was late in the meeting, and she pulled up the last two questions.  She started the first one by saying, “is Andrew Ah…bi-shire in the room?”  I had completely forgotten I had left a question, and figured the odds were that mine wouldn’t get picked anyway.  I was so caught off guard that
when the Senator asked me if I wanted to make my statement myself or for her to read it, I told her she could read it.  D’oh!!!! (for reasons that will become apparent later)

My statement:  Please pass health care reform with a strong public option.  We are about to break from high insurance costs.

I did, at least get a good round of applause from the pro-reform contingent. The Senator nodded, but made no additional comment.  On reflection, I wished I had asked what her definition of a “limited, constrained public option” was.  D’ohh!!!!  She went right on to the last question:

Statement:  Spending is out of control in Washington DC.  One billion to Brazil for offshore exploration?

CM:  Huge problem of money going to oil companies and that they exploited a loophole in legislation on offshore drilling.  She said, “it feels like we lost our minds” as a description of what constituents must think of what’s going on with spending.  Then she discussed the need for the TARP legislation and stimulus, to general grumbling.

The Senator finished by saying that she had a full house in Moberly to get to (her second of three townhalls today) and that she needed to be going.  She thanked all of us for our participation.

This was no combative townhall.  The questions were generally good, and the conduct was generally good also.  There were moments in the Senator’s discussions where I thought she was reaching the anti-reformers; whether that translates into support for any initiatives is an open question.  At least this wasn’t a free-for-all, and at least everyone left amicably.

As for Senator McCaskill, I didn’t agree with a number of her answers, and I would much prefer she stands firm on a public option, even as she defines it.  But she has a tough job representing Missouri, which has small but concentrated pockets of urban liberals at each end, and a whole lot of rural conservatives in between.  I did come away with the impression that all Missourian’s opinions were important to her, and that’s all we can ask from our elected officials.

Now if my big chicken of a Congresscritter will get off his butt and do a townhall, I’ll be satisfied!

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