The debate in Washington over healthcare reform seems to be missing an important voice: the public. Where are the crowds of people demanding better healthcare? Where are the voices of those who have healthcare horror stories to tell? Where is the grassroots effort to define the problem adequately?

Sadly, I have no answers to those questions. I suspect, if anyone bothered to find out, the answer would be: "They're busy working at their jobs, terrified they'll be fired and lose what health insurance they've got."

So far the Washington debate over healthcare reform has been moving steadily away from the reality most Americans face. The average American has much more concrete concerns than the political gamesters on Capitol Hill seem to appreciate right now. People are concerned with things like: "Will I lose coverage if I lose my job?" and "Will my insurer drop me like a hot potato if I get really sick?" and "Why are insurance companies allowed to get between me and my doctor and dictate what treatments I receive?" or even "How will I ever be able to afford insurance, as my company doesn't offer it?"

Those questions seem to have been bulldozed in the debate inside the Beltway. Nobody, to be blunt, seems to be defining the problem in real-world terms that people can relate to. The big fight right now is over a "public plan" and what, exactly, that will mean. If you just listened to the politicians on the issue, you'd think it was a fairly contentious issue with the general public. You would be wrong. NBC and the Wall Street Journal just released a poll showing exactly the opposite. They asked [Page 25 in the PDF of the full results]:

In any healthcare proposal, how important do you feel it is to give people a choice of both a public plan administered by the federal government and a private plan for their health insurance -- extremely important, quite important, not that important, or not at all important?

A whopping 76 percent replied "extremely important" (41%) or "quite important" (35%). Only 20 percent answered "not that important" (12%) or "not at all important" (8%). This shows almost a four-to-one general approval for a public plan.

There's an even-more astounding poll out from Lake Research, which breaks down the results by party affiliation. Of the 73 percent support they found in general, 79 percent of independents supported a public plan option, 77 percent of Democrats, and (the astounding part) 63 percent of Republicans also favored the public plan. Bob Cesca has links to this poll, as well as others which show similar results.

In other words, people in red states get sick, too. Even states with Blue Dog Democrats have people that not only get sick, but also get really sick of the way they are treated by their insurance company (if they're lucky enough to have insurance, that is).

Unfortunately, Congress hasn't exactly gotten the memo. The "public option" is being ripped to death in various committees right now, by elected officials who are quite obviously out of touch with the mood of their constituents. Perhaps it's those boatloads of money the healthcare industry shovels into campaign re-election funds? Just a thought....

So where is the public's voice in all of this? President Obama has held a townhall meeting and given a speech in the last week, but he cannot win this fight alone. Where are the horror stories from average Americans splayed all over the television screen? Where is the spirit of public theater? Where, for that matter, is Michael Moore (who knows a thing or two about public theater, and about the healthcare debate)?

Horror stories aren't that hard to find. The Bob Cesca piece I cited earlier is titled: "'My Face Was Ripped Off' and Other Arguments for a Public Option," and spotlights a dandy example -- the story of a woman who had her face ripped off by a bear, and then had to fight her insurance company to pay for her medical care.

These stories are quite common (although not all involve spectacular details like getting mauled by a bear). There are, literally, millions of these stories out there. So why are they not being heard from? Where is their place at the table?

The American Journal of Medicine published a study recently which shows the scope of the problem Americans face [PDF version of the entire study]. From the first page of this study:

Using a conservative definition, 62.1% of all bankruptcies in 2007 were medical; 92% of these medical debtors had medical debts over $5000, or 10% of pretax family income. The rest met criteria for medical bankruptcy because they had lost significant income due to illness or mortgaged a home to pay medical bills. Most medical debtors were well educated, owned homes, and had middle-class occupations. Three quarters had health insurance. Using identical definitions in 2001 and 2007, the share of bankruptcies attributable to medical problems rose by 49.6%.

. . .

As recently as 1981, only 8% of families filing for bankruptcy did so in the aftermath of a serious medical problem. By contrast, our 2001 study in 5 states found that illness or medical bills contributed to about half of bankruptcies. Since then, the number of un- and underinsured Americans has grown; health costs have increased; and Congress tightened the bankruptcy laws.

In other words, it's not that hard to find people badly affected by our current healthcare system.

Unless you're a politician, I guess.

Think of how this would re-frame the debate for everybody: have some committee call a hearing with the heads of the biggest health insurers in the country. Have five people per company step up to the microphones and detail how they were screwed by that company. Then ask the CEOs to their face: Why did this happen? Press them on the issue: What will the healthcare reform plan which the insurance industry backs (whatever that happens to currently be -- co-ops, whatever) do to change this situation? If the answer is "nothing," then throw out their plan and start over.

The public does not need to be educated that there is a problem with healthcare in America today. Washington politicians, apparently, do need to be educated on the severity and scope of the problem. Otherwise they wouldn't be talking about half-measures and weaseling out of doing the right thing in the hopes of reaping more healthcare industry dollars for their campaign chests. The organization Change Congress has shown how easy it is to use the leverage of public opinion and public shame against these Democrats (Blue Dogs and others).

The public's voice needs to be heard in this debate. If the people lead, the leaders will follow. But if the people never get heard, then the leaders will pull an enormous bait-and-switch, and we'll get a Potemkin victory -- a "healthcare reform" bill that gets signed among cheers and smiles, and which does little to solve the actual problems of our healthcare system.

To put it in medical terms, we don't want passage of a healthcare reform bill to be like the old joke: "The operation was a success. The patient, unfortunately, died on the table."

-- Chris Weigant