At last week's rally in Raleigh for President Obama's "Let's Get it Done" tour, more than 1,000 people chanted "public option, public option," as Jeremy Bird, deputy director of Obama's Organizing for America effort, listed the president's priorities for reform. They include cutting health care costs and preserving market choices, Bird shouted over the crowd, adding: "We are going to give you an option, including a public option!"
As President Obama prepares to address Congress and the nation about health care, his spokespeople have threaded a needle about his position on the public option. While Obama still supports it and thinks it's a critical element of cost control, he's also listening to the handful of congressional Democrats who oppose it—and whose votes are needed to pass any sort of reforms—to hear if they have a better way to control health care costs.
It's increasingly evident, however, that Obama's most ardent supporters are also listening, and they've concluded that the public option is nonnegotiable. What's also evident is that, for all the media focus on right-wing critics of government programs, there is at least that much anger—and it runs across the political spectrum—about the destructive role played by private corporations in the health care system.
It came out in Raleigh when Dana Cope, president of the State Employees Association of N.C. (SEANC), assailed the state's biggest insurer, the nonprofit Blue Cross Blue Shield of N.C., and its CEO Bob Grecyzn's $4 million annual pay package.
"They're afraid they might go out of business if they have to compete against a public option?" Cope shouted as the crowd roared. "I say, pack 'em up boys."
Cathy McCarthy, a medical writer from Durham, was also listening. She lived the first 40 years of her life in Canada, with its single-payer system of government-supplied health care. She's lived here for 15 years and said the United States is culturally too different to accept a single-payer system.
Because of Canada's harsh climate and vast wilderness, people have historically needed to band together via a strong central government to survive, she says. The U.S., by contrast, is built on an ethic of "self-creativity, individual enterprise and distrust of government."
Moreover, the Canadian health care system has its weaknesses, just as the American system does—albeit different ones. Canadians have lots of frontline doctors, but not enough specialists, she says. Here, it's just the opposite—and our costs are far higher for similar results, she said.
But as much as the American system of private insurance fits us culturally, McCarthy argued, "you need a check and balance, because on the other side of that spirit of creativity, people go too far" in their pursuit of money and profit.
In June, McCarthy underwent surgery at DukeMed to replace both her knees. Her surgeon was top-notch, she said, and today her knees are like new. For his work, plus 14 days of hospitalization, her total out-of-pocket cost was less than $1,000.
That's because her husband is on the Duke faculty and has first-rate insurance. "It should be that way for everyone," McCarthy said, and the best way to guarantee that it is "is with a public option."
Health care reform won't succeed, said Kay Zwan, who had come from Wilmington for the rally, unless it breaks the insurance industry's monopoly on decisions of life and death. That's why she thinks reform must include a public insurance option.
Before the rally, Zwan told organizers about a call she'd taken the day before at the nonprofit Disability Resource Center, where she works. It was from a 36-year-old mother of three who was diagnosed in February with cervical cancer. Because the woman's husband had lost his job, they were uninsured, and she'd received charity care through the emergency department of her local hospital. But it wasn't comprehensive care, so while it included radiation and chemotherapy, the plan didn't include a CT scan until four weeks ago, when an ambulance brought the woman, who was in severe pain, to the hospital again.
The scan, Zwan said, revealed extensive metastasizing of the cancer to the woman's liver. "She's going to die prematurely because of a system that is designed to protect profits, not human life."
Zwan's own story is that of a 22-year-old son with a terminal neurodegenerative disease called Wolfram's syndrome, a husband with late-stage kidney cancer and a family that lost its private insurance coverage when Zwan was laid off from her sales job with a pharmaceutical company.
Maintaining her private insurance under COBRA would've cost $1,800 a month, she says. Her unemployment benefits were about two-thirds of that amount, and now that she's working—at the DRC part-time plus a second part-time job with N.C. Fair Share, an advocacy group—she earns too much for public assistance but not enough to afford private insurance.
So the Zwans go without. Her son and husband receive care through Medicaid and other public programs, she said. She and her 20-year-old daughter are uninsured.
"Disease doesn't discriminate, but the private insurance industry does, because they can," she said. "They have all the power. They decide whether people will live or die. Until we break the monopoly that's breaking America, we haven't won this fight."
Before she was confronted with how private insurance works, Zwan said, she usually voted Republican. In November, though, she voted for Obama and the Democrats because they promised health care reform that included a public insurance option. "We gave them the Senate, the House and the White House," she said. "They cannot turn their backs on us now."