Follow me on a one year journey through my home state of Pennsylvania as I explore how the Patient Protection and Affordable Care Act (PPACA) will be implemented and impact individuals, groups and institutions in the state. You don't need to be from Pennsylvania to relate to these stories. They could be your friends, family, neighbors or yourself. My journey begins in the summer of 2011.
On Tuesday March 27 I entered a time machine. The biting cold of a March day hung over the Supreme Court as it cast a cold gray shadow over the early morning events, events that delivered me back to August 11, 2009.
This was the day my then senator, Arlen Spector, hosted the first of the infamous “town hall” meetings in Lebanon, PA. That day, almost 3 years ago, I went to hear my senator speak about what I thought would be “wonky” healthcare policy about an issue that I held near and dear to my heart. I craved to hear and thoughtfully discuss solutions to an issue I constantly struggled to wrap my head around because there are so many complexities lying behind it. As I went to engage in what I thought would be a serious policy discussion, I found anything but that.
That August morning I wasn’t able to get anywhere near the building that held the meeting and I never got in. Instead, I spent the time in the streets with thousands of screaming protesters making rhetorical and shallow claims about broad ideology: socialism, big government and the like. The sound was deafening. As I stood in the streets, the chaos permeated into every pore of my being and settled into my core leaving me with a pit that hung heavy inside me for the next 2 ½ years. I was disheartened, confused and scared.
While I continued to grapple with the complexities of this issue, I knew that it lay at the heart of a complex sociological picture of a changing global economy, a decreasing middle class and exponentially rising costs of healthcare. These ideas I simply could not put it into a 4 word protest sign. It required deep and thoughtful analysis. I grew scared that this noise and politics was overshadowing a real and serious dialogue. The 2 ½ years that followed that day I dug deeper to study this issue and engaged in personal self-reflection as a stroke survivor. Out of that, “Health on the Horizon” was born.
This Tuesday March 27 I stood in the chilling shadow that the Court cast over the crowd. The cold penetrated my thick wool coat and sent me into a shiver, as did the shouting that resonated from the crowd. As the opposing sides fought to overshadow and out-scream each other, the decibel wars of the speaker systems began. While one group spoke over a speaker, the other raced to turn up their volume and shout louder. Under this shadow of noise, paraded an array of people dressed in an assortment of characters: The Statue of Liberty, Ben Franklin, George Washington and even Mickey Mouse (or at least his hands). I was disappointed in this scene, but also in myself. I was participating in the very thing I was striving to move beyond. I regretted my trip to DC.
Under the aura of regret, I made my way to the perimeter of the crowd. I found my own space at the edge of the Court steps. I turned around and put my back to the shouting crowd and stared at the awesome pillars that supported the high court. Staring at this great building I was filled with a presence, a power that was greater than me and I was absorbed by its mightiness. Radiating from the marble walls I could hear the voices and struggles of generations past that had also come to this place to find their answers. They sought answers to questions that challenged the era in which they lived, a process that has withstood the test of time. They had faith in it and now it was our turn.
A sense of peace overcame me and the noise that echoed through my head began to disintegrate. As I turned back around to find my own way to engage in democracy, an amazing thing began to happen. Two of the main organizers for the opposing sides had come to an agreement to take turns with the microphone, whereas each would have their individual opportunities to have their voices heard without interruption. It worked.
As I listened to often sad, but real stories of people and their challenges with healthcare, the group began to discuss specific provisions in the law. After that, I found my place at the periphery of the crowd with the sign I had created about Pennsylvanians and details of the law. I waited for people to approach me. For over 6 hours people read my sign, asked questions and we discussed detailed pieces of the legislation.
Not everyone I spoke with supported the law and some were skeptical. As the late afternoon began to set in, I engaged in a conversation with a physician. He was not a supporter of the law but as I spoke with him I found our only option was to seek common ground. We agreed on the Medical Loss Ratio, Rate Review and the things that are driving up healthcare costs. Where we didn’t agree with each other was on thelifetime cap provision and the sustainable funding of the law. He did not believe the CBO report to be accurate and he also believed the law would weigh heavy costs on his practice. He also felt thelifetime caps would disrupt the business model and cause insurance companies to go bankrupt.
While the CBO states that the new healthcare law is fully financed through a combination in savings from medicare and medicaid, taxes and fees, it also projects a reduction in the deficit. He refused to believe this. For me, a business model of allowing people to die or slip into poverty trying to treat illness is simply unacceptable in the wealthiest nation in the world.
However, as I watched him speak, the intensity of his voice, his veracious tone and the sharp gestures created in his body language sent me another message. I have seen this message in many people I have met for this project. It was the message of anxiety and uncertainty. Maybe everyone expresses it in their own unique way. I was beginning to understand this and this anxiety needs to be acknowledged.
As the late afternoon sun now illuminated the awesome pillars of the Court, I graciously shook the physician’s hand and thanked him for the thoughtful dialogue. I panned over a new crowd that was beginning to descend upon the area. Ben Franklin and The Statue of Liberty had returned.