Recently there has been a swarm of press surrounding the issue of health insurance reform. This issue is the subject of one of the most contentious debates this decade, attracting hordes of voters (both for and against) to town-hall meetings and other events. Republicans seem stubbornly opposed to any reform of any type, despite their public statements that they wish to compromise. Throughout this debate, Blue Dog Democrats have been trying to put the brakes on reform in various ways, trying to please both conservative and progressive voters in their home districts. While a number of these votes are not important, we cannot afford to lose many more.

In a recent article from thehill.com, it was announced that 23 Democrats have said that they will vote no on health care reform. Some are definitive answers; others seem willing to move on the issue. Still, this is the same type of thing that we have seen from Democrats in the past on this very same issue. They simply do not seem to be able to hold the party together well enough to be able to pass sweeping legislation. They simply do not possess the lock-step mentality of the Republicans, and this hampers them immensely.

The conservative Democrats who block reform have got to be there for their people on this issue. I understand that those who live in conservative or highly contested districts must deal with the realities of their post. They must, above all else, maintain their roles as representatives lest they lose their seats to Republicans. In order to have any effect at all they must maintain the position.

However, it is a problem comes when a Democrat panders too much to their conservative voters. Quite frankly, if a Democrat cannot even vote yes on a staggeringly important bill which we may not have another chance to pass for another century, then they have no business in that party. If they cannot support a bill like this, when they are needed the most, then we may as well cede that seat to a Republican. We may as well because those Republicans will then have to play defensive toward the progressives in their district, and thus annoy their own caucus. Though our current majorities in both chambers may be nice numerically, these sorts of “Democrats” aren't helping anyone by deceiving their constituencies.

I do not feel that it is unreasonable to ask that these Blue Dog and conservative Democrats straighten up. To do this, their constituents will have to hold them accountable. We, as voters, cannot be taken in by them as they talk through both sides of their mouth. Yes, it sounds reasonable to delay a vote for a few more months – but this is just another delay tactic to wait until reform is impossible. Yes, they want to include conservative ideas in the bill – but only to cover their own backsides (rather than a sense of bipartisanship).. Yes, they may even claim that many in their districts do not support this bill. But when it comes down to it these Congressmen and women know that this is the right thing to do. We must see their double-speak for what it is – just another attempt to get re-elected. We must tell them what they need to hear – that if they stand a chance at re-election then they had better listen to us. We are the people they were elected to represent – the quiet majority. True, we may not scream at them now, as do their conservative constituents. But they need to know that if they fail to act, they will be made to remember us on election day.

Andrew S. Bailey, MSW
Co-chair, Missouri Association for Social Welfare, Western division
http://bootstraps.blogspot.com

One cannot avoid the healthcare reform debate going on in America today. Without a doubt, our healthcare delivery and payment system needs reform on multi-levels but it is important to deal with the facts and work to dispel misconceptions in healthcare.

One major misconception is that overcrowding in hospital emergency departments (ED) is due solely to the influx of the uninsured using the ED for basic medical needs. Actually, those with health coverage utilize EDs at about the same rate as the uninsured use EDs. In addition, it is an inaccurate generalization to suggest that the uninsured routinely use EDs for convenience.

While we are seeing more uninsured patients in our emergency rooms, they also are the sickest of the sick. This can be due to many factors: Health issues often arise “after hours” and sometimes even primary care physicians tell patients to seek treatment in an emergency room because of the availability of immediate testing or diagnostic equipment. It can sometimes be a challenge for the uninsured working poor or near poor to access basic medical care.

In addition, it is common for an uninsured patient to wait until a simple illness progresses in complexity until it is imperative to seek care in an ED. Often, the patient is so sick that he/she must be admitted to the hospital as an inpatient. Some of these patients are sick solely because they cannot afford their medications. For example, at Truman Medical Centers a majority of our patients have co-morbidities, meaning they have more than one disease. Many also suffer from mental illness. As a result, they may be prescribed multiple medications, which are difficult to purchase with limited resources. As a result, patients may choose what to fill, or take less than the prescribed dosage so that their prescription will last longer. In addition, because of limited resources, patients may ignore seeking appropriate follow up care after an ED visit.

It is crucial that any expanded health coverage include adequate prescription drug coverage, particularly for those who suffer from co-morbidities and because of health care disparities. This step, along with incentives to promote healthy lifestyles and wellness, would have a significant impact on health outcomes and on the cost of providing healthcare in this country.

In addition, it is imperative that any health reform strengthen and sustain the safety net. Truman Medical Centers provides one-third of the uncompensated care in the Kansas City area. We have learned from the Massachusetts experience that there will always be a need for a strong, vibrant safety net hospital system, and it is vital that health care reform allow TMC to continue to meet that need in Kansas City.

Mark Steele, MD
Chief Medical Officer
Truman Medical Centers
Kansas City, Mo