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The real villains 

The wingnuts and scolds who show up to disrupt town-hall meetings get nearly everything wrong about the health-reform bills that are stalled in Congress, but some justice would be served if they at least got their villains straight.

Whatever atrocities they imagine, whether it is killing off old folks and the disabled, dictating the doctor you must see and the medical care you get, more undeserved public charity for the shiftless poor or confiscatory taxes, it is the secret plot of President Barack Obama, and maybe of Nancy Pelosi, the “Botoxed” speaker of the House of Representatives as they like to call her. But, as everyone ought to know, Obama has had little to say about the shape that reform should take. He just wants somebody to fix things. But to whatever extent their delusions have a basis, the harpies and fearmongers should be vilifying someone else.

Take the charge by Sarah Palin, echoed by Republican members of Congress, Newt Gingrich and screamers at public forums, that an Obama “death panel” would determine when it was time for old folks and the severely disabled to die. It's the basis for all the “euthanasia” talk. Here's one instance in which they cite a section of a bill, a particularly harmless and noble one. It deals with hospice care and planning and would pay for in-home care for the disabled and terminally ill.

That happens to have been the singular work of U. S. Senator Johnny Isaakson of Georgia, a right-wing Republican best known for his ardent opposition to abortion and embryonic stem-cell research. Isaakson led a campaign in Georgia to get citizens to discuss their personal wishes for end-of-life care and for two years he's been fighting in the Senate for Medicare to reimburse end-of-life care and planning. He persuaded the Senate Health and Welfare Committee this spring to include it in its health-reform bill, and the House bill writers picked it up.

If the health-insurance overhaul is going to mess with people's current good care, they should blame not Obama but Mitt Romney, the former Massachusetts governor who claims the mantle of Ronald Reagan. It's all his idea. Romney's universal health insurance program in Massachusetts, which he undertook on the advice of the CEO of Staples, the world's biggest office-supply retailer, is the template for both the House bill and the legislation reported by the Senate Health, Education and Labor Committee.

Massachusetts in 2006 mandated that everyone in the state buy insurance unless they could prove they could pay for their medical care themselves, set up an exchange where individuals and small businesses could go to shop for insurance, used taxes on insurance companies and medical providers to provide a government subsidy for families (of four) making up to $66,000 a year to help them pay the premiums, and greatly expanded Medicaid coverage for the eligible poor. Romney boasted in 2006 that he had set up a system for automatically enrolling the poor in Medicaid whenever an uninsured poor person showed up at an emergency room or clinic for treatment.

Except for a public option to private health insurance plans that would be provided in the federal exchange, that pretty fully describes the major outlines of the health reforms now before Congress. Romney said he got Sen. Edward M. Kennedy, chairman of the Senate health committee, on board with his plan, which brought along Democratic lawmakers.

Ninety-seven percent of Massachusetts residents are now insured, by far the highest rate in the land. Three years later, the costs are outstripping the forecasts because Romney opted to cover everyone first and then undertake cost controls later. The public option in the congressional health plans will help reach the cost-control goal by forcing economies on private insurers and providers.

Medical decisions should be left to my doctor and me, not the government, the protesters rage. But their anger should be directed not at Obama or government generally but the insurance industry. Every government plan in the United States preserves that framework except the Medicare managed-care plans run by the insurance companies, and that would not change under either of the congressional proposals. But for most Americans who get their care under HMOs, PPOs or another of the alphabet-soup networks, people's choice of providers is limited and the companies can reject coverage for procedures or deny coverage altogether for pre-existing conditions or a suspicion of future health problems.

Bill and Hillary Clinton's big health reform bill collapsed on the same bogus attacks in 1994. It sought to give people an option to the growing limited-choice plans, but the fact that it mentioned them in the course of regulating them gave critics an opening to say that Clinton would corral everybody into them. Now, only 7 percent of people with private coverage are still in traditional indemnity health plans where that pure doctor-patient relationship prevails. That was the wail of Louise in the famous Harry and Louise commercials that turned the tide against the Clinton plan. A disembodied voice said the government would dictate people's choices. “Having choices we don't like is having no choice at all,” Louise said glumly. She was Louise Caire Clark, who hired out for small acting jobs.

Her earnestness struck a chord with viewers.

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