Watching President Obama deliver his speech on health care earlier this month, Theresa Manville of Bay Village, Ohio, felt a surge of optimism. For a day, anyway, the focus had shifted from myths and hysteria, and back on a plan of action that could help Manville, who has suffered her whole life with rheumatoid arthritis, and thousands of others like her.
“I'm just really hopeful. He has such an enormous job ahead of him and unfortunately a lot of the misinformation got out there early and clouded the issue way beyond reason,” Manville told The Daily Beast.
“There’s no question the debate is not necessarily focused on the issues most relevant to people,” said Marc Boutin, the executive vice president and chief operating officer for the National Health Council.
For weeks this summer, the national conversation centered around two groups least affected by proposed legislation: senior citizens, who were targeted with phony “ death panel” rumors by conservatives like Sarah Palin, and illegal immigrants, the source of Rep. Joe Wilson's “You lie!” outburst. But as Obama's poll numbers stabilize and the conspiracy theories lose their initial momentum, the health-care debate may be shifting back toward those like Manville, who have suffered the most under the status quo.
A comparison on Google Trends shows that Internet searches for “pre-existing condition” in August barely registered compared to Internet searches for “death panels”. In the last 30 days, however, searches for "pre-existing condition" spiked, even topping "death panels" at one point, which are fading from the news.
The trend has been reflected in the press as well. A study this month by Harvard researchers—estimating that 45,000 Americans die every year thanks to lack of health insurance—garnered an impressive amount of coverage as a grim reminder of the human costs of the status quo. Other stories have popped up in the major papers and news sites that delve into the nitty gritty of the actual health-care system rather than paranoid fantasies. For example, The Washington Post ran a 2,000-word front-page story this week complete with an online video profiling a street in Gaithersburg, Maryland, and the many health-care frustrations faced by its individual residents. The next day, The Huffington Post ran as their lead story a local NBC report on a woman going blind because her insurance offered insufficient coverage.
The events of the coming months will nonetheless test Manville's enthusiasm. Like a lot of folks with chronic conditions watching the debate unfold in Washington, she’s anxious about the legislative process—and knows the eventual passage of a bill that will help her is no sure thing. “I feared that we were not going to have any kind of a resolution,” Manville said of her experience watching coverage of health-care reform, “and I think that would be tragic for our country.”
But she can take some small comfort in the way the conversation is shaping up thus far this fall. The Senate Finance Committee has rolled up its sleeves this week, and is mucking about in the fine print of amendments. The public’s desire for reform remains steadfast, according to the polls. And the news coverage of canards like death panels has largely subsided—replaced with a fresh media focus on the biggest stakeholders in the health-care debate: sick people.
Manville and others who have what the insurance companies call “pre-existing conditions” live in an odd political limbo. On one hand, opinion surveys consistently show that measures preventing insurers from denying coverage to the sick are among the most popular elements of the legislation under debate. Yet partly because of that consensus, this group of Americans, the demographic that would be the most affected by the passage of health-care reform, have often been all but overlooked during the discussions. Which makes them nervous.
"There's no question the debate is not necessarily focused on the issues most relevant to people,” Marc Boutin, the executive vice president and chief operating officer for the National Health Council, told The Daily Beast. He attributed the balance of the coverage during the August debates partly to “vital agreement about the exclusion of pre-existing conditions.”
Manville says she has noticed a shift in the tone and subject matter of the health-care debate since the town-hall hysteria of last month died down.
“I do believe the debate has become more focused,” she wrote in an email. “The majority of Americans truly want change for the better, yet they fear it. The specter of 'death panels' and other heinous twists of the truth scared many people at first. Yet after discussion among many and help from the media in debunking the scare tactics, common sense has prevailed.”
For Manville, passing even the weakest versions of legislation currently under discussion would have had dramatic consequences if enacted earlier. When she lost her job at an Ohio PR firm in 1992 and went into business as a freelancer ,she found herself unable to find affordable individual coverage thanks to her preexisting condition. Over time her health worsened, and without proper treatment she developed deformities in her hands and feet, requiring the once-athletic Manville to walk with orthotics in her shoes and undergo multiple surgeries for spinal problems. Only after her health deteriorated to the point that she was eligible for Social Security disability benefits was she able to receive health coverage through Medicare in 2004.
So what are the real prospects for reform affecting those with pre-existing conditions?
Allowing high-risk patients to buy insurance likely would require a mandate that all Americans purchase insurance, which would in turn require subsidies for poor and middle-class Americans to buy insurance—the basic planks of the legislation being debated and the subject of intense opposition from conservative lawmakers. But even the most bare-bones version circulated by Sen. Max Baucus (D-MT) has failed to attract a single Republican lawmaker's support. From the left, progressive Democrats are threatening to vote against legislation unless it includes a public option, raising another possible path toward failure. As was the case with previous presidents who have failed in their efforts to enact health-care reform, from Teddy Roosevelt to Bill Clinton, there is no guarantee a compromise bill would pass if the current legislation implodes.
In the meantime, one doesn't have to look far to find others like Manville, whose lives have been turned upside down by their struggle to find health care, nervously monitoring the current legislative battle.
Lori Hartwell, 43, runs a small grassroots organization, Renal Support Network, that helps patients with chronic kidney disease navigate the health-care system. A recipient of three transplants herself, Hartwell is fortunate enough to receive health care through her husband, Dean, who is a city employee, but her situation could be compromised were he to lose his job.
But it wasn't always so easy: After her time on a government program offering coverage to transplant patients expired, she found herself at age 27 unable to find insurance to help pay for the medication necessary to prevent her condition from worsening, which she said cost as much as $1,500 a month. At one point she entertained an offer from a gay friend to marry him in order to join in on his insurance plan.
“It was so weird but it was comforting,” she said of the proposal. “I was so happy that at least I have a plan.”
While Hartwell managed to find a job in the health industry that offered insurance, phony marriages are far from the only scheme she's seen desperate patients in her support network consider in a bid to get necessary treatment. She said that one volunteer for her organization suffering from chronic illness divorced his wife of 30 years because their combined income grew too high to qualify for Medicaid, the only means by which he could afford treatment without bankrupting his family.
“I just don't get the whole debate,” Hartwell said. “I'm scratching my head. I just don't understand why it should be so hard for people to understand why people need access to health care.”
While reform's fate is uncertain, momentum does seem to be building toward a mostly partisan bill either through co-opting one or two Republicans or through using reconciliation to enact reform with a bare majority. Laura Weil, director of the Health Advocacy Program at Sarah Lawrence College, said that the president's speech might have helped the effort by redirecting the conversation back to those who would be helped most by the proposed legislation.
“I hope so,” Weil said, “but I'm an optimist.”
Benjamin Sarlin is a reporter for The Daily Beast. He previously covered New York City politics for The New York Sun and has worked for talkingpointsmemo.com.