Wednesday, August 12, 2009

My Letter Back to the White House

From: "David Axelrod, The White House"
Sent: Monday, August 10, 2009 12:38:19 PM
Subject: It's time for a reality check

Dear Friend,

Anyone that's watched the news in the past few days knows that health insurance reform is a hot topic — and that rumors and scare tactics have only increased as more people engage with the issue. Given a lot of the outrageous claims floating around, it’s time to make sure everyone knows the facts about the security and stability you get with health insurance reform.

That’s why we’ve launched a new online resource — — to help you separate fact from fiction and share the truth about health insurance reform. Here's a few of the reality check videos you can find on the site:

CEA Chair Christina Romer details how health insurance reform will impact small businesses.
Domestic Policy Council Director Melody Barnes tackles a nasty rumor about euthanasia and clearly describes how reform helps families.
Matt Flavin, the White House's Director of Veterans and Wounded Warrior Policy, clears the air about Veteran's benefits.
Kavita Patel, M.D., a doctor serving in the White House's Office of Public Engagement, explains that health care rationing is happening right now and how reform gives control back to patients and doctors.
Bob Kocher, M.D., a doctor serving on the National Economic Council, debunks the myth that health insurance reform will be financed by cutting Medicare benefits.
There's more information and a number of online tools you can use to spread the truth among your family, friends and other social networks. Take a look:

We knew going into this effort that accomplishing comprehensive health insurance reform wasn't going to be easy. Achieving real change never is. The entrenched interests that benefit from the status quo always use their influence in Washington to try and keep things just as they are.

But don't be misled. We know the status quo is unsustainable. If we do nothing, millions more Americans will be denied insurance because of pre-existing conditions, or see their coverage suddenly dropped if they become seriously ill. Out-of-pocket expenses will continue to soar, and more and more families and businesses will be forced to deal with health insurance costs they can’t afford.

That's the reality.

Americans deserve better. You deserve a health care system that works as well for you as it does for the status quo; one you can depend on — that won't deny you coverage when you need it most or charge you crippling out-of-pocket co-pays. Health insurance reform means guaranteeing the health care security and stability you deserve.

President Barack Obama promised he'd bring change to Washington and fix our broken, unsustainable health insurance system. You can help deliver that change. Visit, get the facts and spread the truth. The stakes are just too high to do nothing.

Thank you,

David Axelrod
Senior Advisor to the President

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Dear Mr. Axelrod,

I read with interest, your many articles and videos to address the unfounded concerns about pending health care legislation, but it did not address the founded concerns about the pending health care bill.

Here are the following things I find have not been adequately addressed by any of the speeches or statements offered by the President, the White House or the legislators in their town hall meetings, press releases and op-ed pieces:

1) the claim that all costs will be budget neutral over the next ten years. Only in government does this sort of financial wizardry actually make sense or seem possible. The cost of health care for the private sector keeps going up because of spiraling demand for health services. As the surplus of baby boomers tap into Medicare, Medicaid, social security and this new government largess, a much bigger strain on the system will take place than currently projected.

If we can't afford to fund Medicaid and Medicare and SCHIP fully, then why do we think we can afford to take on 14, 43 or 50 million uninsured?

2) Hypocrisy: If it was bad for Bush to increase the deficit, and bad for Reagan, and bad for the Republicans under Clinton, then it is bad now. The R or the D makes no difference. We can't demand more from the government on a monumental scale and not expect a corresponding increase in spending, deficit or otherwise. Even the Congressional Budget Office says your numbers don't add up.

2) The funding of possibly assisted suicide. Now I heard the lady talk about how the end of life counseling is only about living wills and end of life care and that doctors will be reimbursed by the government for having these helpful talks.

But the content of those talks is of significance, and it matters that our government will pay doctors to talk about living wills and end of life care because it is the government subsidizing end of life planning through a third party.

It makes people nervous, not because they fear change --a broad based and frankly unworthy charge, but because the content of those discussions which we as tax payers will be financing is not discussed or expressly spelled out.

I understand that this is not mandatory and that you worry the Republicans are demonizing one aspect of health care to doom all of it. But you should understand that those of us who have taken the time to read at least some of the bill and who try to stay informed understand that if you reimburse someone for recommending something, they do it more often.

The drug companies do this with doctors, and thus we have a nation that takes antacids, Viagra, and pills for every ailment from restless leg syndrome to insomnia and all the sufferings in between. If the government pays for the talks, the talks will happen. It stands to reason, and thus people are concerned where these talks will lead eventually.

Talking about how to manage one's affairs at the end of life is a matter that is personal and usually involves family and lawyers, rather than the government and doctors. So having a third party, Uncle Sam, in on the conversation makes us wary.

Where are the checks and balances to ensure that one's personal convictions and not the doctor's or the government in power which will change from time to time, remain superior? We need a written guarantee that "communitarianism" medical care as advocated by Dr. Ezekiel Emanuel, one of the President's top health advisors, will not be eventually deny care of a pre-existing condition, chronic condition or advanced age to mitigate expenses. There have been plenty of written pieces by key advisors that indicate when someone has a serious permanent pervasive or debilitating condition, the Doctors that currently enjoy key positions of power and influence with the President, counsel against additional medical care as a rule.

The premise that health care reform at present will not include the government making those decisions apriori for patients does not preclude the government from eventually opting to adopt a cost effective measure of doling out medical treatment. There needs to be an explicit guarantee within the confines of the legislation that all end of life care shall be determined by the parties in question and not by the government or proxy by the government refusing to pay. (Especially, when some of the people advising on this health care bill have written as friends of the court in cases involving assisted suicide, and have connections to the formerly called Hemlock society). (See Jill Stanek's website for details if you wish).

3) Moral issues like abortion.

For some people, this moral issue is the crux of their problems with the universal health care. These are people who care about the poor, who donate to charity, who pray and make meals for families in need, but who also hold themselves to a standard they believe is from God. To require people to violate their religious beliefs to satisfy a health care program that wishes to offer all things to all people is to (as a government), demand that people deny their beliefs in order to comply with the will of the state. This is a troubling precedent as I'm sure you can understand.

People do not like being told they must fund something they find morally wrong. People do not like feeling like they have no choice. Cut out the stuff that is not medically necessary --like abortion. Make sure these issues which are not medically required for continued existence, are expressly NOT funded to eliminate debate on the issue. There will then be more public support.

The idea was to provide medical care for people in need, to ensure everyone had access to critical medical care and systemic medical treatment for health issues. If you would insist abortion is only a choice, then it is optional and as such it is not a medical necessity but a preference. We do not need to pay for someone's preference, especially when some of us consider the choice itself an evil act.

3) Private vs. Public care. Overwriting and underwriting are the two great sins that the government excels in committing. If there is an increase in cost for providing private care as versus public, most businesses won't offer private except to lure high power people into their business. If there is not a guarantee that the government plan shall not undercut the private by such an extent as to penalize businesses that offer private, (as is currently in the bill, with 8% increase penalty tax that businesses must pay if they do not offer public options), private insurance shall only be the privilege of the very rich or the members of Congress.

Underwriting: Currently, the underfunded insurance assistance programs offered by the government --the aforementioned Medicare, Medicaid and SCHIP and also COBRA, fail in their stated objectives for lack of funding. Doctors won't take Medicare and Medicaid because it traditionally underpays by as much as 70% in some cases. If public becomes the only option and underpays what doctors need to meet the bottom line of having an office and a staff and the materials to treat patients, they will leave the profession, leaving a glut of patients in a lurch and in need. The lines for available doctors will get longer, and the care of less quality owing to a lack of capacity to address the sheer volume of demand.

Put in an agreement that public will not undercut the private offerings thus making private a thing only for the rich, or consequently rendering private insurance, a thing of the past.

4) Security: You've said we can keep the health care we have if we like it, but there is no guarantee that with the presence of a public option, the cost of the private care won't skyrocket. If it does, all who can't afford private, must accept the public and that will mean 1) losing one's coverage, 2) losing one's doctor 3) a change in care. Government guarantees are not exactly gold standard in this day and age. So it comes down to trust, which must be earned by careful stewardship and thoughtful responses and crafted legislation.

5) Conviction: It's hard to believe you care this much about health care when you did not help draft the bill, have not offered your own version, and don't seem worried that this might break what is not broken in the system and not fix what you declare must be resolved. Simply put, we do not trust your guidance when you've exercised so little of it in the creation of this bill, and seem only willing to exert your influence to bully the American people into accepting whatever Congress deems to send you. Again, trust is the vital component that is missing. For those that believe in you, they see no wrong. For those that did not, your administration has done little to alleviate their concerns or gain their confidence.

6) Redress of problems. If care is not rationed but not unlimited, there must be a point when the government, like the insurance company, says "No." Rationing as you have argued already occurs in private care when people are denied coverage, dropped from coverage or refused payments for doctor services rendered.

There are checks and balances in the private sector for when the answer is "no." One can sue; one can complain to the government about the tactics of a specific company, one can go to the press and to charities to get additional information, aid and possibly a solution.

Redress of when someone is told "No" by the government needs to be carefully explained to the public or they will fear an Orwellian type system unsympathetic to the plight of the helpless, commercially unviable and elderly. The health bill already states that we cannot sue.

With all due respect to the President, as hard as it is to fight insurance companies, it's harder to fight city hall.

7) Prior experience, prior writings, prior words: The types of literature put out by many of your key officials that are providing counsel and advice do not help alleviate fears about a government program that will eventually become Logan's Run, Soylent Green, or some type of Houyhnhnms society.

When Peter Singer in the New York Times talks of how a teenager has more added value and thus is worth more to the state than the elderly, I find such thinking morally and ethically disturbing, as well as implicitly scary. Dr. David Blumenthal, another advisor recommends "slowing medical innovation to control health spending." Blumentahl thought it was debatable whether timely care that Americans get is worth the cost.

Delays in treatment that clog up the ER are part of what prompted this health care crisis in the first place, when people must wait hours for basic care at a place designated for emergencies.

I do not feel comforted by the counsel of the President's top health advisors. These are not the scare tactics of the right or the Republicans, these are the words of your own advisors, who presumably believe what they say and intend to enact policy that reflects those beliefs.

And then there are the President's past words, when he offered a morphine drip instead of a pacemaker for a vibrant elderly grandmother as a cost cutting alternative. These past words have memory in the public sector and as such are not going to be ignored just because they contradict the image you wish to present now.

7) Finally, people resent being demonized for having dared to discuss their concerns in town halls and with legislators. Granted not all of the discourse has been cordial, but frankly, those in power have seemed woefully indifferent to the concerns of those who did not vote for them.

In a representative government which I submit, this still is, these voices still matter as much as the Democrats did when they did not hold the House, Senate or White House. They should not be trivialized as stupid, vulgar or uninformed. They should not be considered traitorous for sending out emails or discussing articles and talk shows. To brand people as such because they disagree is to stoke the fire and make people much more distrustful of anything that is subsequently said.

I hope you can address some of these issues instead of answering only straw man arguments that further indicate an unwillingness to bend even the slightest to the public concerns that hold merit. I do agree, the stakes are too high to sit and do nothing. I look forward to your response.

Sherry Antonetti

1 comment:

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