Monday, August 10, 2009

Health Care Reform is Salt Lake Light Rail. Trust me - it makes sense

When I lived in Salt Lake City, as preparation for the Olympics, Salt Lake City decided to put in a light rail system. It would go from downtown Salt Lake, and extend all the way out to (if memory serves me correctly) South Jordan. The idea was pretty simple - a train system that could run up and down the city, and the town buses would simply slave to that. Get on a bus, ride to the light rail to where you need to go, get off and either be within walking distance or get onto another bus. Salt Lake City already had a pretty decent bus system - but the light rail would make it excellent.

Only problem was - this was Salt Lake City. And people protested the building of a light rail. Protested spending "my taxpayer dollars on something I don't want or need!" Protested - with signs, in city meetings - about how they wouldn't touch it, how it was a big waste, how any government spending was just evil. Evvvviiiillll!

Even though it would reduce driving, decrease gas spending, improve air quality with less cars running (and in a city like Salt Lake that can be hit with some horrible smog because of the air trapped by the mountains, any little bit helps).

In the end, the light rail was built anyway.

And it was a hit. Huge hit. So huge, that it was packed the first several weeks and they had to add in extra cars. So useful, that the Mormon church buys up the entire light rail every six months for their biannual conferences and the entire city rides for free. Why? Because instead of having everybody try and park downtown, people can get a cheaper hotel room on the outskirts of town, get onto the light rail, and be downtown in 20 minutes bypassing all of the traffic.

So successful, that last I heard from residents, they were planning on extending the light rail all the way up and down the state so more people could save gas and money. I wonder how many people are still protesting this "evil government" service that provides so much worth to the city, to the residents, to the businesses?

When I sat in the Health Care Town Hall meeting, it felt like being back in Salt Lake during those light rail meetings. Granted, not quite as many rude shouters - but there were still angry people outraged that their government would provide a service that *they* didn't personally approve (even though the democratically elected leaders did, and in a representational democracy that's how it works).

People are screeching that *they* personally didn't approve health care reform (even if a majority of the voters do). Government has no place in providing health care based on the Constitution. Then again, the Constitution doesn't mention roads, light rails, or other things, but it does say:

"...promote the general welfare..."

And the Necessary and Proper clause:

"The Congress shall have Power - To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution in the Government of the United States, or in any Department or Officer thereof." - aka, Congress has the power to make whatever laws it needs in order to fulfill its charter (as long as it doesn't violate citizen's rights as defined in the various Amendments or steps on the Executive or Judicial branches' powers.) So if Congress decides to make a law to institute health care, or food safety, or the like to "promote the general welfare", it can do so (again, provided it doesn't trample on someone's personal rights).

My bets is at the end of the day, we're going to have a health care bill. I'm hoping it has the Three Big Things I think it will need to be real reform: constraining health insurance companies to prevent them from denying care, requirement that all citizens are signed up for insurnace, and the Public Option to provide competition against private insurance companies as a check on their power.

If it does, I'm going to bet that US Health Care Reform is going to wind up like Salt Lake Light rail - a lot of noise and protest, followed by a long period of "Woah. This is *awesome.*"

Saturday, August 08, 2009

How to Make Health Care Town Halls a Success

How to Solve the Mob Tactics at Health Care (or other) Town Hall Meetings

Thursday night, I had hoped to attend a town hall style meeting with US Congress Member Kathy Castor and State Representative Betty Reed. The plan is that I would hear these two ladies and duly elected representatives talk about how the health care bill was shaping up, their views, and take questions. I expected that there would be some people who agreed with the idea that there needs to be insurance reform, and some that wouldn’t. Each sides would put forward their questions, and everybody would learn something even if we didn’t all agree.

Yeah. What was I thinking. In the tradition of the Constitutional debates, where Benjamen Franklin stood up shouting “SHUT UP! SHUT UP! SHUT UP!” at Hamilton, who screeched back “I’M NOT HERE TO LISTEN TO WHAT YOU HAVE TO SAY!”, a group of what I assume to be Teabaggers showed up to do nothing but, for almost 90 straight minutes, scream, shout, let it all out and generally make sure that nobody could hear anything at all. Because after all, having a civilized debate like adults is too much to ask for.

OK, the last was sarcasm. It was an ugly experience that every single one of the Shouters should be embarrassed about. It’s behavior that I would not expect out of my youngest child who is five years old and know that you at least take turns.

The problem is, the Shouters are dominating the Health Care Town Halls, sponsored by corporate interests who have created “Astroturf” grass roots organizations that have been filling the Shouters with outright lies. Such as “The Obama Health Plan will euthanize old people.” Or “The Obama Health Plan will raid your checking and savings accounts to pay for it.” Even as recently as a few days ago, quitter Sarah Palin came out saying that the Obama Health Plan would set up a Death Panel that would have killed her Down Syndrome child.

With these kinds of lies filling them, the Shouters are told to show up, disrupt meetings, and prevent anything from being said. As I saw with Congressperson Castor, every time she tried to explain what was in the bill or even what her ideas were, the Shouters screamed like someone was pulling on their Teabags too hard.
It was the most unpleasant 90 minutes of my life. And since that night, I kept thinking about how to prevent such things in the future. How to allow for the free flow of ideas, without letting them get hijacked by people who have no interest in hearing any other view but their own being screeched at their duly elected representatives?

Do insurance reform supporters just get louder? Not useful, since that simply perpetuates the problem of noise silencing proper discussion. Bringing more signs? Holding up protest artifacts? All of this just generates noise.
The goal should be Meeting, Not Mobs.
Here are my thoughts on how to have the kind of town hall meetings we want to spread information, while still allowing those of a dissenting view a chance to air their questions. These ideas will take some work. But, based on what I saw Thursday night, I believe they stand the best chance of working.

The Steps:

  1. Control the Flow
  2. Sign the Contract
  3. Register and Document
  4. Any Disruptions Will Not Be Tolerated

Control the Flow


5 Police Officers from the local community (if possible, others in plainsclothes for the ground floor).

1 volunteer per every 20 seats.

At least 5 police officers from the local community – two at the doors leading inside, three inside. This can be reduced depending on the size of the town hall to be had, but seeing as 200 seat meeting drew some 1600 people according to some reports, this is probably a good number.

The volunteers are to lead people to their seats. From the beginning, there should be this sense of control via the health care town hall organizers. This is not in a mean or overly authoritarian way. Volunteers should be polite and helpful, but their task is to direct the flow of people coming into the meeting area, and take them to their seat. People will not be allowed to simply sit where they want.

Wait, you say. How do we know people will follow the rules? Hold on. That’s coming.

Sign the Contract


1 Printed Contract Form for each person we believe will show up

As each person enters, they must put show ID and sign a Town Hall Contract. Each Contract Form says something akin to this:

I, _______________________________ , do agree to follow the rules for this town hall meeting. I seek to learn what my democratically elected representative and their staff have to say. I will not be disruptive during the meeting. If I have questions, I will hold them until the end of the meeting, and then I will wait until I have been called upon to ask them in a respectful manner.
If I violate these rules, I understand at the discretion of the Town Hall staff and volunteers I will be asked to leave.

Signed: _______________________

Date: _________________________

Naturally, if someone has better language, I am certainly open to it. While this document may or may not be considered a legal contract, the point is that it binds them at their word at least. This basically tells them “If you’re here to cause trouble, you will be kicked out.” And, since the words “…discretion of the Town Hall staff and volunteers” basically means they aren’t allowed to say “What? What gives you the right to do so?”

This is not a "loyalty oath" or other such nonsense. It does not dictate a view they must subscribe to. It simply lets them know what the rules are, and if they can not follow those rules, they may leave.

This step also has another point. It slows things down. It sets a tone – politeness. Civility. It also lets us process each person one at a time, not as a mob, but as individuals.

If they do not want to sign this contract, they will be asked to leave. Period. There are no second chances. The first time they say “I don’t want to sign this,” or refuse to comply with instructions, they must *immediately* be escorted from the premises, preferably by one of the law enforcement officers.

This will be hard for some people, because we want to be nice. We are – we are giving them every opportunity to follow the rules in order to allow everyone a chance to participate. If they wish a Mob instead of a Meeting, they were perfectly welcome under their 1st Amendment Rights to hold that elsewhere, such as inside their house with their friends. Then they can Mob to their hearts content.

Register and Document


1 camera that can be hooked into a computer (such as a web camera)
1 laptop computer to take the pictures
1 printer to print out names and pictures later.
Label paper for name tags for as many people as you think will show up

One thing I observed about the Shouters is they did not want to put their name down onto any pieces of paper if possible. This step is again part of that control and tempo. Once they have signed the contract, their picture will be taken onto the computer and a nametag printed for them. Their picture will be taken, and they will have a name tag made for them.The picture is so when the speaker calls on them, they will have a printed list of names and pictures so they can call them by name so there is no confusion.

It also has the added advantage of freaking the snot out of anyone who wanted to use the anonymity of a Mob to hide themselves. I know – OMG taking pictures so scary! It’s necessary. If people intend on acting reasonably, then they have nothing to fear. If they can not follow the rules and have their picture taken, again, they will be escorted out immediately. No questions, no second chances. Have a nice day.

Any Disruptions Will Not Be Tolerated

This is the most important step. No disruptions. We should at the beginning have a statement read by the facilitator that lets people know people will want to clap, or applaud, or any other expression within reason. However, disruptions, screams, and shouts will not. The first time someone has a problem with this, both a volunteer and a law enforcement officer will be called to escort that person from the room.
This is crucial. By now, with the controls in place, most people should get the message. The first sign of trouble, however, must be met swiftly, but politely. The rude Mob person must be sent outside. They can scream and shout out there (without breaking any “disturb the peace” laws, of course) – but this is a Meeting, not a Mob.

I recognize that these efforts will take some prior planning. These are not draconian, do not require anything other than decency and respect. It does not require anger meet with anger or noise with noise. But they establish proper controls, and allow everyone to participate in the Meeting and, whether they agree or not, be able to gain something from the discussions.

Thursday, August 06, 2009

My Night at the Tampa Health Care Town Hall

Tonight I headed up to South Tampa, Florida to sit in on the Health Care town hall with US Congress Member Kathy Castor and State Representative Betty Reed. What I got was a front row ticket to pure rage.

I've seen the news lately, so I had an idea of how noisy these events are around the nation. When I arrived, some two hours before the event started at six, there were already 20 some odd people there. Many of them were going over questions, such as "If Obama can't pick a dog in six months, why is he trying to get us to pick a health care plan in six weeks?" (which I thought ignored the other 60 years we've been discussing health care). One gentleman was trying to tell me that insurance companies should be allowed to cancel people's policy, because people would get sick, then sign up for health care, and as soon as they were treated cancel their policy - yet he didn't want it to be mandated that people would have to sign up for insurance to avoid such a situation. The answer seemed clear: If you don't have insurance, it's your own fault, and if you get sick and insurance cancels you, that's your fault too.

I was lucky in that I knew one of the organizers who let me get in a little early to the front row seats. I think the original plan was to have the front two rows or so filled with people who really wanted to hear about the health care bill, instead of letting those rows be dominated by the protesters we've been seeing on the news at other health care events.

If that was the plan, it was not successful. As people came in, several tried to disregard the "RESERVED" seating signs, including one gentleman who ripped it off the chair next to me and stuck it in the chair in front. "Come on man, that's not cool," I said, pointing out the rest of the entire room was empty.

"I don't see why anyone should have reserved seats here," he told me.

"The disabled?"

He finally moved, and I moved the "reserved" sign back to its seat.

Before the doors were open to allow people to sit, it was nonstop shouting. Shouting from people outside who pounded on the doors to be let in and complained because they weren't being allowed to start taking seats 40 minutes before the event was to begin. Shouting because they were told to let people through who were reporters or were supposed to be on the council.

Shouting as the room was filled to capacity and the others had to wait outside, holding signs like "I can't read, cut taxes" (which made no sense to me at all). When Representatives started coming in, people started shouting "No! No! No! No!" The town hall hadn't even started yet.

One thing I noticed was that many of the Shouters, and I came to call them, came in very organized. Many had 3x5 cards with printed questions. Sheets of paper printed out with highlighted text, usually held in the same kind of binder. I'm not sure if they all shopped at the same office depot, but the similarity was eerie.

Reverend Dixon, a prison minister, started off the room with the Pledge of Allegence. And that's when the shouting started. As people read the pledge, one woman shouted out at the "of the United States of America" part "UNDER GOD!" earlier than anyone else (maybe she thought it was the United States of UNDER GOD) - and when the room got to "under God", there was a sudden angry shout of "UNDER GOD!" as if they didn't think people would hear it the first time from the lady who shouted early. Reverend Dixon gave the opening prayer - and then the rage fest really got started.

As Representative Reed introduced Congressperson Castor - boos erupted. The gentleman next to me stood up to applaud her, and many in the room was on their feet clapping for her. Outside the door, a steady chant started.

"BULLSHIT! BULLSHIT! BULLSHIT! BULLSHIT!" Castor hadn't even started yet, and people were screaming. Yelling. Fights broke out outside. Castor held two taped together microphones to her mouth - but then the mob shifted tactics to "YOU WORK FOR US! YOU WORK FOR US!" Every minute, it was a new rage filled series of shouts to keep her from discussing her points. She asked the crowd how many of them paid for health insurance through their employer - and people started shouting.

"READ THE BILL!" People in the crowd kept screeching at her, including one tall gentleman behind me I'll call Mr. Shouty. Throughout the entire time Castor tried to address the crowd, tried to explain what the bill was about, he and so many others around the room screamed "READ THE BILL! READ THE BILL! READ THE BILL!" Then, because she tried to explain how the health care bill would try to provide health care for those who were uninsured, the screams changed to "TYRANNY! TYRANNY! TYRANNY!" "WE LEFT ENGLAND FOR THIS!"

Some of the people who were there to hear the bill tried to shout back at the protesters "Let her speak!"

The reply? "No I won't!" by Mr. Shouty. Instead, he turned back to Castor shouting "60 MILLION JOBS LOST! WHAT ARE YOU GOING TO DO ABOUT 60 MILLION JOBS?" I didn't get that one. He was protesting insurance reform, but wanted Welfare or extended unemployment benefits?

The shouts continued. Castor couldn't even be heard over the din as Mr. Shouty held up a copy of the pocket constitution. "WHERE IS HEALTH CARE IN HERE! SHOW ME WHERE HEALTH CARE IS IN HERE!" (My friend @MariaLaino on Twitter replied "The Necessary and Proper Clause, bitch.")

Castor kept trying to go on over the din, as Mr. Shouty and his group kept screeching "SHOW US IN THE CONSTITUTION WHERE HEALTH CARE IS!" Castor talks about the Donut Hole in Medicare - and the Shouters start screeching "THAT'S TED KENNEDY'S BILL! IT'S TED KENNEDY'S FAULT!"

And as Castor was winding down, the Shouters started squealing "LISTEN TO US! LISTEN TO US! WHY WON'T YOU ANSWER OUR QUESTIONS!" This after almost 20 to 30 minutes of nonstop screaming and temper tantrums from the moment she started walking towards the podium. They hadn't heard a word she said, and screamed when she left the room under escort.

With every speaker, it was the same. A pushing match next to me erupted between Mr. Shouty Man and a union rep who got in his way. Ms. Lee Stirrat stepped up to explain the healthcare issues and about how even she has problems with insurance and trying to get the medication she needs. The Shouters all groan and start shouting, drowning her out as she's trying to explain the problems with people trying to get care under insurance.

When State Representative Reed came back to the podium, the shouts only continue. "FOLLOW THE CONSTITUTION! WHY AREN'T YOU FOLLOWING THE CONSTITUTION!" Evidently, following the constitution means not taking turns with your views, but screaming the other person so nobody can hear anything at all. The Florida Health Commissioner makes the case that life, liberty, and the pursuit of happiness requires a healthy body - a claim that lead to more jeers from the Shouters. He tried to discuss infant mortality issues, only to be screamed at that "OBAMACARE PAYS FOR ABORTIONS! DON'T TALK ABOUT INFANT MORTALITY WHEN YOU KILL BABIES!" Even when he protested he never performed an abortion, it didn't matter. Other Shouters squealed every time infant mortality was said "ILLEGALS! ILLEGALS! ILLEGALS!" This became a refrain. When 40 million Americans without health care was brought up - that was all illegal aliens. Because I guess "real Americans" can pay for their own healthcare. Like, pregnant teenagers.

Dr. Collins, a nutritionist, for a brief time held the room as she explained helping people who have come out of heart surgery - only to be shouted at when she tried to explain people who didn't know how to get good nutrition. Evidently, this was an impossible concept for the Shouters that people don't know how to eat healthy.

Finally, after almost an hour, police offers started pulling people out of the room who were just disruptive. Mr. Shouty was the first, to the applaud of many in the room - but there were still many Shouters to go. As one Ms. Coe stood to explain that as people have lost their jobs - people have lost their health care. The response by the Shouters? "Be more responsible!" One woman shouted out "Responsibility, Oprah!" Yes, the speaker was a black woman.

I think the lowest point was when Reverend Dixon came up to speak, and started to discuss the progress that had made during the 60's and 70's. The woman behind me started shouting "Yeah - we know what you did during the 60's! We know the 'progress' you made!" The look on Reverend Dixon's face was heartbreaking. He knew what she meant - civil rights. The progress made by civil rights groups for equality was some sort of slur now thrown back in Dixon's face.

She knew what he did during the 60's and 70's. Marched for equal rights maybe, or protested.

The questions that came next followed were mostly by Shouters who remained. Why are we paying more for health care when we have so many deficits? When Mr. Newton explained that health care currently costs us a lot of money because people have to use the emergency room - which they are required by law to treat, passing on the costs to us, and so health care reform would be cheaper - yup. The rage was back to shout at him. Conspiracy theory questions were asked, like "The bill says the federal government will gain access to all of our checking accounts." Some guy next to me let me know that when the government took over health care, nobody would go to the doctor because the government would be allowed to read your health care records. Why they would I don't know, or why HIPAA laws wouldn't still apply- but that was this man's fear.

In the end, that was everything for this meeting. Fear and rage. Rage that Castor wouldn't ask questions about 30 minutes of constant screaming at her. Rage that the public option even existed because it would drive regular insurance companies out of business -and when Mr. Newton brought up the example of the US Postal Service versus USPS, the Shouters, well, shouted that "YEAH! AND UPS IS BETTER!" Which, I guess proved his point, but the Shouters acted like they had won some important point. Rage at the uninsured that were all illegal aliens, or were having all of the babies who needed government funding to be born - because "no true American" would be without health care or would be a single mother having a baby. Rage that the public option would somehow destroy health care, or destroy medicare, or something. Rage that people said that insurance companies shouldn't be allowed to drop people from care, or that there were people losing their jobs (evidently all Obama's fault), or that the national deficit was so high (again, also evidently all Obama's fault for waging the War in Iraq then spending money to save the financial system and stimulate the economy). Rage that Rep Reed wasn't "following the Constitution" because it didn't mention health care (then again, it didn't mention interstate roads either).

By the end, the rage was effecting even the health care supporters who tried to shout down the Shouters towards the end. It became like a weird recursive shouting event, as the Shouters shouted and the other people shouted at the shouters to shout them silent.

When it finally ended, almost 30 minutes early I think, I walked out - and the Shouters were still out there, now shouting about Acorn for some reason (maybe they believe insurance policies will be issued by Acorn supporters or something).

A group of 5 police officers stood talking next to the parking lot. I stopped next to them. "Gentlemen, that was more excitement than one man deserves to have. Good job." I tipped my hat as they laughed and drove away.