John Edwards' Health Care Event in Dubuque

Yesterday, Sunday Feb.18, Senator Edwards appeared in Dubuque, Iowa to hold a "town hall" type event on health care issues. I have put this together from my notes. Direct quotes are in quotation marks. I have done my best to paraphrase the remainder while retaining their intended meaning. My comments and asides are set off in square brackets []. If some other remarks appear to be my own, they probably are.

I arrived about ten minutes before the scheduled starting time for the event at the Grand River Center (no link provided because they have a picture of W on their web page). Of course, the campaigns schedule these events knowing that folks will be trickling in past the scheduled time, and we know that it won't start on time, either. By the time the Senator entered the room, we had had a chance to sign in, find a seat, and to introduce ourselves to the people on each side of us. I sat between a woman who was knitting something from yarn she had spun from the fiber produced by her own llamas and sheep. On my left was a woman who was studying for a master's in divinity. We were interrupted only by a brief welcome from the Mayor of Dubuque. My very crude guess would be that there were 200-300 in attendance.

The announcement over the sound system and the Senator's entrance to some music seemed a bit over-produced and forced, like it was a live tv show rather than a live event. The feel was a bit off-putting. I didn't recognize the music, but some of you might. It had a refrain of "It's time like these..."
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Senator Edwards outlined the agenda for the meeting. He would make his remarks about health care, then the floor would be open to questions on all subjects. Then he started off with some small talk about his and Elizabeth's books, his appearance on the Daily Show, etc.

Now, onto the message: Health care. 40 million Americans have no health insurance.

[Is does this number refer to US citizens? legal US residents? all US residents? I won't get a chance to ask, and the point is that having such a large number uninsured people in the country affects how all of us get healthcare and pay for it. ]

He cites percentages of increase in costs. I have to admit I missed the specifics on that one as I was still wondering about the questions relating to the first statement. Nonetheless, most of the people in the room were ready for his solutions, so his set-up of the premises was not as crucial here as it would be in front of a critical audience.

He talked about "job-lock" - how some people are unwilling to change jobs because it could adversely affect their health insurance coverage. He cited it as a problem that can keep people from reaching their potential because of self-limiting of opportunity. ["Health insurance slavery" instead of "wage-slavery," perhaps. Regardless of the size of the problem, it was a way to introduce concerns about pre-existing conditions, long-term care and mental health coverage as problems to which he would offer a solution.]


Senator Edwards then asserted that he is the only candidate to lay out a truly universal health plan. It is based on the concept of shared responsibility - that all of us have to take responsibility for our country and the things that need to be accomplished.. [This part of the presentation did not seem to flow well, it started to introduce the plan, then meandered to some other concepts that were related ] There are things that need to be done in this country that can't wait for the next election, and expect the next president to solve all our problems. "Tomorrow starts today" in this room.

[Now back to the introduction of the plan. I will only summarize because a more detailed outline of his plan is available.

My summary of the plan:
1. All employers cover their employes or pay into a pool for coverage.
2. Everyone has a choice of private plans or a government plan.
3. There will be a minimum acceptable level of coverage, but no maximum. Coverage includes mental health care and preventative care.
4. Everyone is required to be covered.
5. There will be a health insurance subsidy inversely proportional to income until zero subsidy is reached at about $80k/yr.
6. Full portability
7. Cost containment to be achieved by lowering administrative costs, upgrading records technology, streamlining claims process.]

Reasons we need to do this:

Moral responsibility - the wealthiest nation on earth can afford to make sure everyone recieves quality health care and we can do it.

Pragmatically, it not only helps the poor, it helps the vast majority of the middle class because it takes the worry out of maintaining coverage in the event of job changes, getting coverage for pre-existing conditions, long-term care, etc. Even for those who receive no subsidy, it still provides the benefit of lowering overall costs and making sure there are no gaps in coverage.

In addition, it removes health insurance costs out the cost of doing business in the US. That is, the cost savings he envisions would mean that it would cost employers less to provide health insurance than it now costs.

Applause line: "Dramatic changes are needed."

He ended with the personal story of going through cancer treatment with Elizabeth and thinking of how that would have gone had they been among the 40 million Americans with no health insurance.

Now on to the questions.

Q: Is everything covered. What about deductibles and copayments?
A: Yes, there will be deductibles and copayments, based on your ability to pay. And preventative care is covered, including tests, as long as your doctor says the testing is important for your long term preventative care.

Q: [I could not hear the entire question, but it had to do with whether there would be equality of service under the health care plan.]

A: Under this plan, there is a floor, a minimum level of coverage, and it is a high level. The standard is high and the quality is high.

Q: A college student asked about NCLB and about college costs.
A: We tend to think of education too narrowly as K-12, or K-12 plus college, but we should think of education as a lifelong experience. The President needs to lead on this, from early childhood care to headstart, to making sure that we put the best quality teachers in front of every student. He cited the recommendations of a panel of educators and administrators who recommended we should raise teacher pay to $80k/yr. - not just to benefit teachers, but to attract and retain high quality people in teaching. Their opinion was that then if teachers were not doing their jobs, their peers would take care of any lack. [I did not follow the logic on that point, but he did attribute it to some supposed experts and did not claim it for himself.]

On college costs: college costs are a burden to students. Large amounts of debt coming out of college steer graduates into careers focused on making a lot of money to pay off those debts whereas some would likely go into careers in helping professions and community work that typically pay less but for the debt. He referred to a program called "college for everyone" he was involved in as a pilot program in a county in eastern North Carolina. Funds were raised so that they could promise every student that if they (1) graduated from high school; (2) were eligible for college and (3) would work ten hours per week, the program would pay their costs. 60-70% signed up.

A later questioner reminded the Senator to address No Child Left Behind and asserted here opinion that the real agenda of the Bush Administration was to undermine public education.

"Kids don't get educated by being tested to death." There is a tension between giving teachers freedom to teach and the need to know that the system is working. Changes needed include measuring students against themselves in order to measure progress rather than testing against some arbitrary standards. There need to be less extensive but better methods of assessment including subjective evaluations and objective tests to be sure that progress is made at an acceptable level. NCLB is not what we need.

Q: If you were still in the Senate, would you defund the war in Iraq?

A: Let me address the whole Iraq situation from this question. As President, here's what I would do, but we should not wait until after the next election to do it. First recognize that there will be no military solution at this point. The only solution to the situation is political. At it's core, the government of Iraq was a Sunni dominated government when Saddam Hussein was in power. The Shia were out of power then, and had been for a thousand yeas. Now that the Shia are in power, they do not want to give it up. That situation calls for a political solution. What we are doing now is that we are enabling bad behavior. We are telling the Malaki government that they had better find a solution. But they ignore those entreaties and we continue to police their civil war and keep them in power.

The Edwards approach would be to pull 40-50 thousand troops out right now. Pull out the rest over the next year, in consultation with the Shia led government and whatever Sunni leadership we can identify, an in consultation with Iran and Syria (which both have reasons to want Iraq to be stabilized). Redeploy some of the troops to Afghanistan because it's going in the wrong direction now. Keep some troops in Kuwait on the ready.

Shifting to Congress, since obviously the current administration is not going to do what Edwards would do. "This is no longer about politics - it is about men and women dying. It is time to stop debating and time to start acting." Congress should cap troop levels at 100k. It should adopt funding cuts to force a draw down while making sure the troops there have what they need in the field. In 2002, "Congress did not give authority to police a civil war."

Q: Referenced attacks on Edwards the questioner attributed to Senator Biden.

A: You heard me, you make the judgment. What Senator Biden said was wrong and we will assume he was misinformed and made those statements based on bad information. We are running a positive campaign, our job is to make sure every single caucus-goer knows what I will do as president. This is a very serious business - choosing a president. We need to have a deep knowledge of the candidates. We need to trust our President. You have to use your judgment.

[I don't recall hearing what it was Sen. Biden said.]

Q: A person identified himself as a West point graduate and commented that "I suppose you know what that means about my position on Iraq."

Q: Border security and illegal immigration are a threat to our security and our future:

A: We have three choices on illegal immigration.
1. Pretend that there is no problem.
2. Find 11-12 million people who live in the country and deport them.
3. Solve the problems that arise mostly with our southern border.

Of course we know there is a problem. We can address the problem at our southern border by assigning more personnel and equipping them with better technology to police the border.

As for the people who are living here now who came illegally, this is an issue that is used to divide Americans. But what we need to do is to do what is morally right and what is practical to move ahead. The practical thing we can do is to provide a path to citizenship to those who are here illegally but are otherwise law-abiding. First, they will have to come forward and admit that they came here illegally and pay a fine. They will have to learn to speak English. Then they can move through the process for citizenship.

[I noticed two points here. First, these questions focus on illegal immigration through Mexico, whereas there is also illegal immigration from other parts of the world. Many such people from Europe already speak English. Second, it should be implicit that there would be increased funding for English classes as the demand for such classes would presumably jump as people opted for the path to citizenship.]

Q: What would you do to lessen our addiction to oil?

A: Let me expand that question to also address global warming and climate change. America uses 22 million barrels of oil a day. 12 million barrels a day are imported. America has 4 % of the world's population but we emit 25 % of the greenhouse gases. These are issues we need to address right now. If we wait until it becomes an immediate crisis, it will be too late. So what to do. We need to invest in clean energy in a comprehensive way. "We need to be patriotic in things other than war." We need to step up conservation efforts. Americans have to do it. We can't wait for the President, but the support of the President can lead us to do better.

We should institute a hard cap on CO2 emissions in America. Institute a cap and trade system where there is an auction of emission rights. Then ratchet down the cap each year until we cut our emissions to an acceptable level. America cannot solve this problem ourselves but we must be the leaders. China is adding an average of more than one new coal-fired power plant a week. Those plants are not scrubbed, and those emissions will affect the whole world. We need to get our own house in order on this so that we have the moral authority to lead. If we are not leaders at home, how can we expect to exert leadership in the world?

The world wants to see America exhibit a sense of responsibility to humanity, not just projected military might. Here's another area where we need to lead: in Darfur, the genocide is effectively supported by the Sudanese government. We need to be on the right side of that. Because if the world believes we are committed to the greater good of humanity, the world will follow. But when we do not, as the current administration has not, the world will not follow our lead.

Thanks all around, and it is over.

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I thought the presentation was somewhat disjointed and did not flow well. Some of that is nice, certainly answering questions in that manner, rather than delving into an obvious stump speech makes it seem more like a personal interaction. But when the subject of the day was health care, I thought it should have flowed better. Not that I could have gotten an answer, probably, but I would also want to know what the sources were for the numbers that are being used.

In general, Senator Edwards made a good impression. Of course, I have seen him before when he came through four years ago, so there s an element of familiarity with his style of speaking and with his charm. I am still quite uncommitted. We certainly could do worse than to have him as our candidate, especially with a strong VP candidate.

Cross-Posted at Daily Kos.