The Campaign Spot

Bills Look Different When You Have to Justify Them to Skeptical Constituents

Kirby Wilbur, the voice of all that is right up in the Pacific Northwest, sends along this account from a listener who attended a constituent meeting with Rep. Adam Smith, D-Washington, a week ago.

I’m guessing there were +/- 150 there, and someone who usually attends told me norm is 10 to 20 – but I don’t know how accurate that source is.  Smith spoke for a few minutes then allowed questions/comments that ran over until ~12:40.  When it became apparent the tone/make up of the audience with one of the first comments (something about not paying for health care for illegal immigrants getting lots of cheers) he tried to keep a lid on things by suggesting that we not applaud to show agreement with comments.  He had some limited success but towards the end kind of gave up on that.  
There were about 10 people there in purple SEIU shirts, but the vast majority were very upset about this bill, the rush to do something, holding residual anger at TARP, the stimulus, and Cap and Trade.  I tried to count, and think total there were 6 to 7 positive comments towards the bill/process.  The remainder were against. (50-75)
…He kind of agrees that we’re rushing. He told me that there is some ‘global’ urgency, but that doesn’t mean we need to vote by July 31st.  He believes that something should be done this term (prior to 1/11) but he currently does not plan to vote on this bill this month (I know there’s a lot of wiggle room to change his ‘current’ plans) – says he knows his week  will be interesting in DC a la Pelosi’s wanting to bring it to a vote.

#more#

* He does not plan to vote for the bill in current form.  (Well, we all know that once an amendment attaches…it won’t be in the current form.)   
* Says one of his biggest problems with the bill is that there is not enough done to address the geographical disparity between payment in different areas.
* Kind of shrugged like ‘what you gonna do’ and acknowledged that some people say that if a public plan is offered, that in  time it may lead  to many more on the public plan and fewer on the private plan.  He didn’t dispute this and (of course since that’s the whole point….) just kind of accepted that if it happened … it happened.
* Said he doesn’t like, and isn’t proposing a single payer.

* Repeatedly made the point that in Canada, if you like, you can purchase private insurance (no one got around to asking … well since middle class is going to have increased taxes to pay for this, then from where are individuals going to get the money going to pay that extra insurance premium.)
* There were several “I’d have to look closely” at questions relating to abortion and taxpayer funding. 
He’s REALLY gunning to get rid of fee for service. Says that docs currently get paid more to do more (well, yes, that’s capitalism – do more – make more) and wouldn’t say it, but apparently thinks (similar to Obama’s tonsil comment) that Docs are just lining their pockets doing unnecessary procedures…

So on one hand, docs are influenced to do more unnecessary procedures by Fee for Service payment system, but he’s not willing to admit that docs are influenced by the threat of lawsuits to practice defensive medicine and use medical resources in that way.  He was pretty resistant to the concept of tort reform.

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