At The Town Hall

Here are my thoughts and observations about last nights town hall meeting with Fl-12 rep Adam Putnam. Driving up I was greeted by Public Option Now signs lining the entrance and parking lot. There were around a dozen public option supporters handing out material just outside the doors.

I would estimate between 150-200 people in attendance. The dress ranged from I-just-came-from-work to I’m-retired-and-this-is-what-I-wear. A good percentage appeared to be retirement age.

Adam started his remarks by saying that there are four major issues facing Congress, but I missed the fourth, and he didn’t really elaborate on the last one. Those three — Cap and Trade, Card Check, and of course, Health Care Reform. He called them “game changers,” a major shift from the way we do things as a nation.

Before taking questions he listed some of the things that he thinks should direct the debate on health care:

• Greater access
• Afforadability
• The individual, along with their health care professionals, should be the ones to make medical decisions
• Government should not limit choices
• Private insurance should remain the foundation

He had one very interesting statistical note on the expatriation rates of doctors by country. Canada has a rate above 10% and the UK is above 5% (sorry, I didn’t get the exact number). The US rate is 0.6% and most of those are doctors which have decided to go on the mission field. The numbers for nurses are similar. There is a reason that medical professionals trained here practice here.

He spent several minutes talking about how much the US spends on equipment, research, and innovation. One stat – MRI Machines: In the US there are 25 MRI machines per million people. In Canada and the UK that number is 5 per million.

One big issue is how difficult it is to project future health costs. He cited the huge difference between original CBO projections for Medicare and Medicaid and the quickly realized realities.

One point he made that I thought was particularly important, and often under discussed, is the effect federally implemented plans will have on state budgets. The impact could be a budget buster for many, if not most, states.

His suggestions for the discussion:

• Association Health Plans – where groups of people, bound by some association, could purchase insurance at group rates typically reserved for companies. Perhaps we could have the “Bloggers Health Plan”
• Malpractice Reform
• The ability to sell plans across state lines
• Electronic Medical Records. He called this the area where there is the least partisan disagreement.
• Incentivize wellness and fitness
• Small business tax incentives

He remarked that mandatory coverage of pre-existing conditions without mandated participation for all can not co-exist.

He also touched on the timing of things in Congress. The House leadership has expressed a goal of bringing HC to a vote before Thanksgiving, although he believes that it may extend through the end of the year, or into early 2010. In any case, he said the issue is on a short time line. Because of the focus on HCR, he thinks that Cap and Trade and Card Check will be pushed off until early next year.

I wasn’t able to stay for all of the Q&A portion, but I did stay for the first few.

The first question got quite a bit of positive reaction from those in attendance.

Q. Is it constitutional/legal/possible for Congress to pass a bill that is not in it’s final legislative form?

A. He said that the bill, in it’s present form, is in many ways conceptual. There are at least three separate versions that are being melded in the House. The version that is eventually voted on, however, will have to be specific and final. He took the opportunity of this question to say that it is critical for the final bill to be available for people to see prior to Congress voting.

Q. This questioner likened what the government is doing as equivalent to being forced to support a particular charity.

A. His answer addressed the issue of cost in the bill, which currently range from $873 Billion to $1.3 Trillion. Cuts to Medicare could be $500 Billion. One method of revenue generation under discussion is a VAT on medical devices and a surcharge of 2.5% on people making $250,000 or more. One option is to change the surcharge to 5% on those making a $500,000 or more. He pointed out the fact that many of those in either scenario are small business owners. He made the point that these options would have the effect of costing small businesses more than Fortune 100 companies. He repeated the point that state governments will have to come up with more money as well. A lot more money.

The final question I was able to stay for:

Q. What about fraud in existing government programs?

A. Fraud, along with waste and abuse, are unbelievably high in existing programs. Florida is particularly bad. While eliminating or reducing fraud, waste, and abuse won’t solve all of the cost problems, they are important and costly factors.

It was interesting to attend, and I wish I could have stayed longer. While there was a significant presence of those supporting a public option, most questioners (of those I had the chance to hear) appeared to want government to leave us alone.

If anyone else was there and had a different view, or was able to stay longer, please let me know.

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