In this August 20, 2009 photo, President Obama spoke during a town hall meeting on healthcare at the Democratic National Committee headquarters in Washington. (Alex Wong/Bloomberg)
A woman who felt President Obama had let the middle class down has changed her mind.
By Spike Dolomite Ward
December 6, 2011 I want to apologize to President Obama. But first, some background.
I found out three weeks ago I have cancer. I'm 49 years old, have been married for almost 20 years and have two kids. My husband has his own small computer business, and I run a small nonprofit in the San Fernando Valley. I am also an artist. Money is tight, and we don't spend it frivolously. We're just ordinary, middle-class people, making an honest living, raising great kids and participating in our community, the kids' schools and church.
We're good people, and we work hard. But we haven't been able to afford health insurance for more than two years. And now I have third-stage breast cancer and am facing months of expensive treatment.
To understand how such a thing could happen to a family like ours, I need to take you back nine years to when my husband got laid off from the entertainment company where he'd worked for 10 years. Until then, we had been insured through his work, with a first-rate plan. After he got laid off, we got to keep that health insurance for 18 months through COBRA, by paying $1,300 a month, which was a huge burden on an unemployed father and his family.
By the time the COBRA ran out, my husband had decided to go into business for himself, so we had to purchase our own insurance. That was fine for a while. Every year his business grew. But insurance premiums were steadily rising too. More than once, we switched carriers for a lower rate, only to have them raise rates significantly after a few months.
With the recession, both of our businesses took a huge hit — my husband's income was cut in half, and the foundations that had supported my small nonprofit were going through their own tough times. We had to start using a home equity line of credit to pay for our health insurance premiums (which by that point cost as much as our monthly mortgage). When the bank capped our home equity line, we were forced to cash in my husband's IRA. The time finally came when we had to make a choice between paying our mortgage or paying for health insurance. We chose to keep our house. We made a nerve-racking gamble, and we lost.
Not having insurance amplifies cancer stress. After the diagnosis, instead of focusing all of my energy on getting well, I was panicked about how we were going to pay for everything. I felt guilty and embarrassed about not being insured. When I went to the diagnostic center to pick up my first reports, I was sent to the financial department, where a woman sat me down to talk about resources for "cash patients" (a polite way of saying "uninsured").
"I'm not a deadbeat," I blurted out. "I'm a good person. I have two kids and a house!" The clerk was sympathetic, telling me how even though she worked in the healthcare field, she could barely afford insurance herself.
Although there have been a few people who judged us harshly, most people have been understanding about how this could happen to us. That's given me the courage to "out" myself and my family in hopes that it will educate people who are still lucky enough to have health insurance and view people like my family as irresponsible. We're not. What I want people to understand is that, if this could happen to us, it could happen to anybody.
If you are fortunate enough to still be employed and have insurance through your employers, you may feel insulated from the sufferings of people like me right now. But things can change abruptly. If you still have a good job with insurance, that doesn't mean that you're better than me, more deserving than me or smarter than me. It just means that you are luckier. And access to healthcare shouldn't depend on luck.
Fortunately for me, I've been saved by the federal government's Pre-existing Condition Insurance Plan, something I had never heard of before needing it. It's part of President Obama's healthcare plan, one of the things that has already kicked in, and it guarantees access to insurance for U.S. citizens with preexisting conditions who have been uninsured for at least six months. The application was short, the premiums are affordable, and I have found the people who work in the administration office to be quite compassionate (nothing like the people I have dealt with over the years at other insurance companies.) It's not perfect, of course, and it still leaves many people in need out in the cold. But it's a start, and for me it's been a lifesaver — perhaps literally.
Which brings me to my apology. I was pretty mad at Obama before I learned about this new insurance plan. I had changed my registration from Democrat to Independent, and I had blacked out the top of the "h" on my Obama bumper sticker, so that it read, "Got nope" instead of "got hope." I felt like he had let down the struggling middle class. My son and I had campaigned for him, but since he took office, we felt he had let us down.
So this is my public apology. I'm sorry I didn't do enough of my own research to find out what promises the president has made good on. I'm sorry I didn't realize that he really has stood up for me and my family, and for so many others like us. I'm getting a new bumper sticker to cover the one that says "Got nope." It will say "ObamaCares."
Spike Dolomite Ward is the founder and executive director of Arts in Education Aid Council, a nonprofit organization that is restoring the arts to public schools in the San Fernando Valley. http://www.aieac.org
Fortunately for me, I've been saved by the federal government's Pre-existing Condition Insurance Plan, something I had never heard of before needing it. It's part of President Obama's healthcare plan, one of the things that has already kicked in, and it guarantees access to insurance for U.S. citizens with preexisting conditions who have been uninsured for at least six months.
....Which brings me to my apology. I was pretty mad at Obama before I learned about this new insurance plan. I had changed my registration from Democrat to Independent, and I had blacked out the top of the "h" on my Obama bumper sticker, so that it read, "Got nope" instead of "got hope." I felt like he had let down the struggling middle class. My son and I had campaigned for him, but since he took office, we felt he had let us down.
So this is my public apology. I'm sorry I didn't do enough of my own research to find out what promises the president has made good on. I'm sorry I didn't realize that he really has stood up for me and my family, and for so many others like us. I'm getting a new bumper sticker to cover the one that says "Got nope." It will say "ObamaCares."
And there you have it: Obama's core problem with his supporters from 2008, the ones who listened to his soaring rhetoric and believed he really was going to transform Washington — and have since been bitterly disappointed. This has always been something I could understand only intellectually, since I never for a second paid any attention to his stump speeches. Of course they soared! Of course they promised a new era! That's what politicians always promise. Why on earth would anyone take this seriously, when every single other piece of evidence showed him to be a cautious, pragmatic, mainsteam, center-left Democratic candidate?
Beats me. But lots of people did take it seriously, and now Obama is stuck trying to convince them in very practical, non-soaring terms that he really has done a lot for them. That list is pretty long and includes a big stimulus bill, a landmark healthcare reform bill, student loan reform, an end to the Bush torture regime, the Lily Ledbetter Fair Pay Act, a hate crimes bill, a successful rescue of the American car industry, resuscitation of the NLRB, passage of New START, the death of Osama bin Laden, withdrawal from Iraq, a decent start on rationalizing Pentagon procurement, repeal of DADT, credit card reforms, unprecedented gas mileage improvements, a second stimulus in 2010, and passage of financial reform legislation.
Were there disappointments too? Sure. Obama badly mishandled cap-and-trade, has a weak record on civil liberties, escalated the war in Afghanistan, has been unaccountably sluggish on appointments, treated the financial industry too gingerly, and failed to seriously address underwater mortgages, among other things.
But that's to be expected. This is the real world, not utopia, and Obama is a cautious, pragmatic, mainsteam, center-left Democratic president. So how do you win back the people who believed the soaring rhetoric and either don't know or don't care about Obama's impressively long list of concrete achievements? It's his essential dilemma. Maybe Spike Dolomite Ward can give him some suggestions.
Dr. Donald Berwick was already in Massachusetts when I spoke to him Sunday afternoon. He was back in the Newton home where he’d lived for 30 years, being pleasantly interrupted during our conversation by his 2-year-old grandson. His last day in Washington as the administrator of the Centers for Medicare and Medicaid Services [ https://www.cms.gov/ ] had been Thursday. Friday was packing day. Saturday was moving day. And, by Sunday, he was already talking about his too-short, 17-month tenure as the nation’s top Medicare official in the past tense. Which, alas, it was.
Dr. Berwick, I’m here to tell you, was the most qualified person in the country to run Medicare at this critical juncture, and the fact that he is no longer in the job is the country’s loss. Berwick started out as a pediatrician and health care researcher at the Harvard School of Public Health and eventually became vice president of the Harvard Community Health Plan (now known as Harvard Pilgrim Health Care [ https://www.harvardpilgrim.org/portal/page?_pageid=1391,1&_dad=portal&_schema=PORTAL ]). There, he became enamored with the ideas being promulgated by management gurus like W. Edwards Deming and companies like Toyota, which believed that companies could create processes — and a mind-set — that would allow for both continuous improvement and continuous cost reduction. Indeed, they believed that the two went hand in hand.
Latching onto these ideas, Berwick helped start — and, for the next 19 years, run — the Institute for Healthcare Improvement [ http://www.ihi.org/Pages/default.aspx ], which was devoted to applying them to health care. The result would be healthier patients who spent less time in hospitals — and a culture that wasted less money on things that didn’t lead directly to a healthier population.
As the insurer of one out of every three Americans, Medicare is in an enviable position to push for health care improvements, if it chooses to. And with a budget larger than the Pentagon’s — and a consensus that its spending must be brought under control — no government agency has a more urgent need to cut costs. Surely somebody who has spent his career focused on these two issues would seem to be just the ticket.
But there’s one more thing about Berwick: He believes that President Obama’s health care reform is “an important moral step toward universal health care.” As he put it when we spoke: “Because of it, our country is, at last, making health care a basic human right. It is a majestic thing.”
Naturally, this view made him anathema to Republicans, who blocked his nomination in the usual way. They pored through his old speeches and articles, plucked out a few comments they objected to — he once praised the British health care system! — and announced that they would never confirm him.
President Obama was not deterred the way he had been when Republicans objected to Elizabeth Warren becoming the chief of the new Consumer Financial Protection Bureau [ http://www.consumerfinance.gov/ ]. Instead, in July 2010, Obama named Berwick to the post in a recess appointment that did not require Senate confirmation. But, like all recess appointments, it was temporary. Berwick left the post just weeks before his appointment was set to expire.
What did Berwick accomplish in those 17 months? A lot — though not nearly as much as he would have liked to. His focus, as it has always been, was on improving the quality of health care and cutting costs. “On my third day,” he said, “I held a staff meeting for all 5,000 members of the staff, and I said, ‘You all think that you are in the business of paying bills. Yes, you do that. But I also think Medicare can be a force for change.’ ” He added, “I tried to reconceptualize it as an improvement organization.”
As Berwick tells it — and others affirm — the Medicare staff had been hungering for such a mission. “We had a triple aim,” he says. “Better health care. Better health for the overall population. And lower costs. I thought that, my goodness, given the resources and the reach — and the great staff, which was a wonderful surprise — we ought to be able to help health care providers do much better.”
Health insurers and hospitals, who had generally thought of Medicare as little more than a stodgy, bureaucratic insurer, began to see it in a different light as well, as Medicare staffers, trained as “improvement coaches,” began to share ideas and push for simple, sensible steps that would, for instance, keep people with chronic medical problems from having to be constantly readmitted to the hospital.
Of course, 17 months is hardly enough time to complete such a transformation, and it is hard to know if Berwick’s emphasis on quality will stick. What he needed, most of all, was more time — precisely what the Republicans wouldn’t give him.
By refusing to confirm him, Republicans won a pointless victory against the president. But, if the day ever comes when they — and the country — truly get serious about reforming Medicare, they may regret giving a pink slip to the best man for the job.
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