Whatever, Mary.

I saw this on Friday, but didn't get around to writing something about it until today. Since then, of course, many other bloggers [1] have covered it by now. But when a Democrat says something like what Sen. Mary Landrieu did on health care reform [2], I can't help chiming in even days later, if only because there can't be enough voices in the choir on this.

Look, I know southern Democrats have a hard row to hoe. They're smack in the middle of the hot, crowded, dark heart of a lot of political madness [3] right now, and trying to hold on to a shot at getting re-elected. They are, if you will, trapped in an asylum that the inmates have now taken over. But when they say things like this, you have to wonder if they're making their way towards the exits or making themselves comfortable in the middle of the madness.

"I believe in the private sector," Landrieu said [4], in reference to giving Americans consumers a choice of a public option. "I don't believe in government running every program for everybody," she added, doing her best impression of a Republican.

Asked specifically about polling data showing the public option with strong national support, the conservative Democrat added, "I think that when people hear 'public option,' they hear 'free health care.' Everybody wants free health care. Everybody wants health care they don't have to pay for. The problem is that we as government and business have to pick up the tab, and as individuals. So I'm not at all surprised that the public option has been sold as free health care. But there is no free lunch."

I have only one response to this: Whatever, Mary.

People want “free health care”? What people are you talking about? Are you talking about the 26.9% of Louisiana residents who are uninsured [5] — according to the Gallup-Healthways Well-Being Index —making Louisiana one of the ten states with the highest percentages of uninsured? Are you talking about the more than 3,000 Louisiana residents [6] whom the Remote Area Medical [7] team provided with medical care back in January 2007? (Remote Area Medical, originally founded to bring medical services to remotes areas of the globe now spends most of their its delivering health care to people who can’t otherwise get it, right here in the U.S. You can see some of the faces of the Louisianans they helped in 2007 here [8]. They also delivered “free health care” to Katrina victims in 2006 [9].)

Are you talking 18.8% of Louisianans who are also living in poverty [10] — again, making Louisiana one of the ten states with the highest percentage of people living in poverty? Those numbers — the percentage of people who are uninsured and the percentage people living in poverty — correspond with one another pretty well, especially when you consider that some of the uninsured don’t meet the definition of poverty, but can’t afford health insurance and thus have no access to health care.

As the Institute for Southern Studies [11] points out, it’s no coincidence that the list of states with the highest rates of poverty among their populations corresponds closely with the list of states with the highest percentages of uninsured residents. The correspondence applies to suffering as well as statistics, Senator.

A majority of the country’s poorest states are located in the South, and most of the poverty in the South is located in rural areas. In this sense, it is no surprise that states with substantial rural populations have ranked highest when it comes to the percentage of people living in poverty: Mississippi, Louisiana, West Virginia, Alabama, Arkansas,Texas, South Carolina, Oklahoma, New Mexico, Kentucky, Tennessee, and Georgia. Most of these states have also ranked highest when it comes to the least insured. As Facing South reported [12], when divided by region, the greatest populations of uninsured in the United States are mostly likely to be found in the South (18.2 percent).

Researchers continue to link higher mortality rates to lack of insurance. As Facing South reported [13], having no health insurance means an early death to almost 45,000 people in the United States annually, according to the American Journal of Public Health. Studies also link a lack of insurance to greater health risks, such as hypertension, poor management of chronic illness, and reduced likelihood of receiving preventative and primary care — all issues disproportionately impacting rural populations in the South.

Studies show that rural populations in the South are dying at higher rates than urban populations. Death rates in rural areas are not declining as fast as in non-rural parts of the country, and death rates in the South are also not declining as fast as other regions of the country. The Daily Yonder recently analyzed data [14] from the Economic Research Service and found that the gap between the death rates in rural and urban America has been increasing since 1990. [emphasis mine]

At least they continue to be well served by politicians like yourself.

Yet, when it comes to policy change, rural areas are caught in a particular hard net. Many of these areas are represented in Congress by members who have been most resistant to the Obama administration’s push for health care reform and a government-run public option. These politicians — including Republicans and “Blue Dog” Democrats — represent districts with the largest percentage of people who don’t have health insurance.

A new report [15] by the Urban Institute analyzing uninsurance across congressional districts in the United States illustrates this point. The report finds that rates of private coverage are lowest in districts that have higher poverty rates, which tend to be concentrated in the South and West. The report notes that uninsurance remains most serious in districts with low rates of private coverage.

The report shows that the states and districts that would benefit the most from the passage of health reform are in rural areas and the South (see chart below). Simply put, some of the biggest opponents of health reform in Congress come from districts — such as ones in Texas and Florida — with the highest rates of uninsured residents.

(Much can be said [16] and has been said [17] about why the highest level of opposition to health care reform exists in the states with the greatest need for health care reform, and where people would benefit the most from reform, but that will have to wait for another post.)

Instead of speaking up for those Americans in your own state who can’t afford health care but desperately need it, you all but called them undeserving “free loaders,” joining the grand tradition of heretofore mostly conservative politicians and pundits who said the same of the Louisianans who couldn’t afford SUVs to drive themselves out of the Katrina’s path of destruction [18]: those who can’t afford it (health care or disaster rescue) don’t deserve to get it. But you didn’t stop there.

The problem is that we as government and business have to pick up the tab, and as individuals. So I’m not at all surprised that the public option has been sold as free health care. But there is no free lunch.

Whatever, Mary.

You think we’re not paying now?

• Tell that to the 700,000 Americans who go bankrupt due to medical bills [19] each year, accounting for 62% of personal bankruptcies [20].
• Tell that to the uninsured who pay $30 billion for health care [21], paying a greater percentage out of pocket than the uninsured, for a lot less care than the insured.
• Tell that to the people who paid their premiums only to be dropped by their insurance when they got sick [22].
• Tell that to the people who lost their insurance when they lost their jobs, and face an avalanche of health care costs [23].
• Tell that to the 25 million underinsured [24], who can’t afford better insurance policies, and thus pay for limited insurance and the medical care it doesn’t cover.
• Tell the insured who are bankrupted by health crises [25].
• Tell that to the 17.4% of American households struggling to pay for care, and either postponing or delaying medical care [26] as a result.
• Tell that to Americans whose health care costs are set to rise by 9% in 2010 [27].
• Tell that to the 160 million workers whose out-of-pocket costs jumped 34% from 2004 to 2007 [28], and jumped another 10.6% over the past year [29].
• Tell that to the families who already pay an extra $1,000 a year in premiums to cover the uninsured [30], not to mention picking up the tab for the underinsured [31].

That’s reality, Senator. Maybe you’ve only encountered Americans who want “free health care,” just like John Boehner hasn’t met any Americans who support the public plan [32] — somehow managing to miss the 56% [33] to 80% of Americans who support a public option [34]. You know, the ones who just want “free health care.”

And here’s some more reality: We are already paying. Health care costs are set to top $8,000 per person this year [35]. The uninsured are straining our hospitals and emergency rooms [36], and the economy is driving more and more Americans into public health coverage, as they lost the jobs and the coverage those jobs provided.

We are already paying. But we’re not getting what we pay for [37]. We devote 16 percent of our gross domestic product to health care, yet we lag behind other nations in care. We rank 29th in infant mortality, 48th in life expectancy, and 19 (out of 19 countries) in preventable deaths. We lag behind other nations in treating chronic illnesses [38].

We are already paying. We are paying more for a health care system that doesn’t serve the health of fellow Americans or the health of the nation very well. We pay $2.4 trillion on health care every year [39] — two-and-a-half times more than most other advanced nations. This year we’re likely to hit $2.5 trillion [40], if we haven’t already. Yet, we get far less value for our money than our five leading economic competitors: Canada, Japan, Germany, the United Kingdom and France — all nations that, though their systems differ, manage to cover all of their citizens.

So Americans are basically “freeloaders” who want “somebody else” to pay for it? The same Americans who are already paying in myriad ways for our failing health system? The same Americans who are already paying for the generous plan that lawmakers like you enjoy [41]?

Americans don’t want “free health care.” We want affordable coverage. We want to know that the insurance coverage we’ve paid for will be there when we need it, if we or a loved one falls ill. We want health care that won’t bankrupt us if we get sick. And we don’t just want it for ourselves. We want it for our communities and our country, because we understand that we all pay the cost of not having health care for all. And that cost is only going to get steeper.

And you think people just want “free health care” and want “somebody else to pay for it,” when too many of us don’t have coverage, can’t get care, and we’re all paying the price for it? If you don’t get that by now, it’s only because you’re working hard at not getting it, instead of standing up for Americans — including Louisianans — who are suffering in the current system.

In spite of all the above, you still can’t do that?

Whatever, Mary.