Wade Rathke: Chief Organizer Blog » healthcare

Enforcing Adequate Medicaid Cover for the Poor

dine — Sun, 14 Aug 2011 19:20:15 +0000

New Orleans Reading the report was one of those Sports Center “come on, man!” moments. This couldn’t be true. The top Democratic were filing an amicus curia (friend of the court) brief with the Supreme Court to try to overturn the Obama Administration’s efforts to allow cutting the standards of health protection under Medicaid for the poor by various states. Furthermore, this was no rouge group but heavy hitters like Nancy Pelosi, Henry Waxman, Harry Reid, and Max Baucus. They were joined in similar amicus briefs by former health officials, civil rights groups, the AARP, and others. What the heck?!?
Here’s the problem. The feds sent a truckload of money to the states and in California where this case arose the number is $20 billion. The states have to pick up between 25 and 50% of the costs with the feds on the long end of the stick for 75 to 50% depending. In the crushing domino fall of the USA economic meltdown not surprisingly the poor would be first in line for a beating. States in dire straits whack down on their Medicaid spending to save money by cutting the standards of care giving themselves a break and finding a friend on the other side of the deal in the federal government which therefore also saves on its share, leading Obama, the health care coverage so-called advocate, to pop the poor hard. Reimbursement rates get cut when this happens, so doctors feel the system and the poor not only have diluted coverage but no providers either.
Robert Pear of the New York Times is on this beat and cites the other problem which is the requirements of the law:

“Federal law says Medicaid rates must be ‘sufficient to enlist enough providers’ so that Medicaid beneficiaries have access to care to the same extent as the general population in the area.”

In other words the law is clear that you cannot discriminate in health care coverage, the decisions of life and death, against the poor.
The Obama Administration, seeking the cowards’ cave, argues that enforcement of that unambiguous standard should be the “exclusive responsibility” of federal health officials. The Congressional caucus and anyone else caring two cents about the 55,000,000 who are covered under Medicaid, know that the feds simply do not have the resources or bureaucracy to police all of the standards in 50 states down to the nap, so they want poor people to be able to sue California and others when they are chumped and cheaped out. In past presidential administrations such lawsuits were not greeted with universal cheer, but they were recognized as having a vital role in securing the standards of health care and protecting the poor.
What is the political equation which makes it acceptable for the Obama Administration to aid and abet discrimination against the poor and encourage by passivity killing them with neglect?

New Study: Health Insurance Saves Lives of Poor

dine — Thu, 07 Jul 2011 16:03:13 +0000

New Orleans This should be the least surprising news since you learned that sugar tastes good, but now there is actually statistical proof from a drug-trial-like study that when the poor have health insurance by damn their health improves! I’m not sure having hard proof will change any minds or votes among lawmakers but at least in the grand debate about health insurance there will now be no pretense that voting to limit or end health insurance for low income families will put blood on your hands, because it will be killing them. Ok, maybe I’m overreaching, because that will only be clearer once the second phase of the study is completed, but it is pretty obvious where it’s going at this point, so be ready for that, too.

A study “The Oregon Health Insurance Experiment: Evidence from the First Year,” by a baseball team full of academics (Amy Finkelstein, Sarah Taubman, Bill Wright, Mira Bernstein, Jonathan Gruber, Joseph P. Newhouse, Heidi Allen, Katherine Baicker, The Oregon Health Study Group) was published by the National Bureau of Economic Research this week and reported by Gina Kolata in the New York Times. In 2008 the professors jumped on the once-in-a-lifetime policy disaster and statistical goldmine. Oregon had approved a statewide healthcare Medicaid plan for low income families but did not have the dollars to put the whole show on the road. In a novel, random solution, the state held a lottery and chose the 10,000 winners, who received the insurance, from the 80000 odd folks who were eligible and therefore equally poor. The profs then surveyed the winners and measured the outcomes compared to the losers. It is important to note that Oregon was able to provide insurance to everyone in 2009.

According to the Times:

“Those with Medicaid were 34 percent more likely to go to a clinic or see a doctor, 15 percent more likely to use prescription drugs and 30 percent more likely to be admitted to a hospital. Women …were 60 percent more likely to have mammograms…20 percent more likely to have their cholesterol checked…70 percent more likely to have a particular clinic or office for medical care and 55 percent more likely to have a doctor whom they usually saw.”

There was also a 25% increase in the numbers who said their health had improved to good or excellent, and “they were 40 percent less likely to say their health had worsened….”

Bam! Debate over about the benefits of the poor having full health coverage is over! Yes, people will use it, get better, feel better, and have less medical debt.

Couple this study with the finding I discussed yesterday on the number of people killed annually by inequitable access to services, including health, and this ought to be open and shut on what is indisputably a life-and-death decision.

Who’s ready to have their vote counted now?

Let’s Really Investigate the Doctor Business

dine — Thu, 09 Jun 2011 13:34:05 +0000

New Orleans A bi-partisan group of US Senators, led by Orin Hatch (R-UT) has asked for an investigation of physician-owned-distributorships (POD) and the lack of safeguards preventing docs from unnecessary surgeries utilizing devices that enrich them because they are distributors for manufacturers. A study Hatch released indicated these PODs are legal in 20 states now and seem to be triggering a spate of risky and redundant spinal and orthopedic surgery. I can only say, “Right on!” and then, “Don’t stop there!”

I am equally suspicious of doctors that display, advertise, and then recommend, i.e. prescribe, supplements and vitamins in their offices as part of treatment and care in order to fatten their pocketbooks even though there may be cheaper and generic alternatives. When I hear that such doctors are not processing insurance claims for their patients to me that is a neon flashing warning light that these are pocketbook doctors rather than medical doctors and the only pain they are alleviating is whatever you may have had by sitting on a wallet with too many dollar bills. They clearly know that their “vitamins” will not be covered by insurance nor is it likely that most of their care will be, and they are therefore simply involving themselves in predatory practices on their desperate patients. Perhaps that example is too easy to stop, but the point is that no one is really regulating doctors now but their own medical boards and that is no regulation at all.

There have long been warning signs on doctor owned and investor owned hospitals and whether or not they are within miles of the Hippocratic Oath of “doing no harm,” especially when it comes to separating out the patient’s best interest from the doctor’s self-interest. The problem remains that doctors are making the referrals to hospitals where they practice, so the patient becomes a “captive market” and anytime that happens, abuses are going to proliferate.

Even as future healthcare is being debated, there’s no reason for the Senators, feds, and states not to step up and do the jobs they should be doing of providing some public accountability and protecting the public from health care predators wearing white coats. It’s a life or death matter!

Mr. President Don’t let Healthcare Coverage be Taken from Healthcare Workers

dine — Mon, 16 May 2011 20:03:48 +0000

Obama signes Healthcare Reform Act

Tegucigalpa Before dawn in Honduras with the birds still loud and the sun still just a rumor, I was writing a petition for Local 100 members (www.unitedlaborunions.org) to be able to get out through our leaders and stewards throughout Louisiana, Texas, and Arkansas to demand that President Obama, DHS, Congressional Representatives, Senators and just about anyone who might listen would say no to the industry’s efforts to try and get a waiver from finally providing their workers healthcare under the coming law. Reading the morning papers on-line, I was amazed at the gall and the bitter irony of healthcare industries trying to deny healthcare workers basic health insurance.

We represent a number of nursing home workers employed by different companies throughout Louisiana and Texas and community home workers providing similar health care support for the developmentally disabled in Louisiana, Arkansas, and Texas. These are hard working, caring workers doing the jobs that families cannot do and that companies often pay little for them to do, despite the essential nature of the service. It has long been an embarrassing blemish in our state and federal reimbursement systems that so much of these industries have been privatized under companies for whom profits are foremost and care is somewhere down the line, and the workforce often amounting to more than half of the care cost is always last on the list.

Reading the article in the Times of the nursing home association and the former governor of Kansas (is it a coincidence that the current head of DHS in DC is also a former governor of Kansas?) and its attempt to get a waiver from the President allowing them to not have to provide the now legally required healthcare for the millions of industry workers who currently provide healthcare but do not enjoy any healthcare themselves, was to put it mildly disgusting and enraging. The gall!

Workers even in unionized homes such as hours are above minimum wage but still in sight of minimum wages with starting levels only a dollar or two above $7.25 and sometimes as little as $0.50 cents above. When we first organized facilities in Louisiana almost 30 years ago they were all minimum wage, no vacations, no sick days, no holidays, no nothing, and certainly no health are or pensions. Now with a union they are above minimum wage by a good number of steps, have regular raises and protections, do have vacations, do have sick days, do have holidays, but still don’t have any health insurance (or where they do have something it is so far out of their reach financially that it is almost an insult to claim it in the contract), and of course pensions courtesy of the Social Security Act.

It is unimaginable that the President or anyone recognizing the plight and paradox of healthcare workers without healthcare would even countenance for a minute giving a waiver, but in these days and times, nothing is certain. As I write this, we are still writing the petition so we can post and circulate, but don’t hesitate to give a call and/or send a message to the White House and your elected representatives that doggone, don’t approve a waiver: healthcare workers have to have healthcare, too!

Rave Reviews for ACORN International in Dharavi

dine — Wed, 13 Oct 2010 12:55:03 +0000

From the National Geographic article featuring ACORN International ragpickers.

From National Geographic Article

Mumbai Vinod Shetty, ACORN India’s Director, and I had been meeting for hours along Juhu Road at the Sip ‘N Munch going through our work list of what needed to be done on campaigns around remittances, the Commonwealth Games, and multi-national food contractors and their labor law violations. We had discussed the great progress of our Dharavi recycling center. He had told me the good news that Joseph Campana’s project for us of producing a book that would support our Dharavi work finally had a publisher in Harper-Collins-India. We had talked about the prospects for acquiring a set of scales and a crushing machine to be able to raise the prices for our plastic recycling and increase our waste pickers wages. We had checked the dates and filings on our paperwork for the ACORN Foundation (India). We had discussed our efforts to repackage and sell products being produced in Dharavi for Diwali and other festival dates to our school recycling partners like Eco-Mundial and the American School. We had taken notes for reports owed to our friends at BCGEU and SEIU. There were a lot of items ticked off the list.

Finally at that point Vinod pulled out a staff of glossy magazines and newspapers with almost a blush. The magazines ran the gamut. One was the Clean India Journal which focused on environmental progress for companies, contractors, and others in India and featured our work in September in a piece called, “Waste Matters for Green Workers” about our ragpicker organization in Dharavi. Another in a the “green” issue of an upscale fashion monthly called Jade and style magazine was entitled “Green Heroes: Ragpickers or City Savers?” (Access both on our website at www.acorninternational.org) Later he forwarded me another piece published on several websites by a Londoner which was not quite as gushing but referred to our ragpickers as “invisbile heroes” in http://www.chinadialogue.net/article/show/single/en/3790-Invisible-heroes-of-Dharavi. An article distributed for school children in a “weekly reader” style publication called Robin Age also contained a recent feature.

Looking quickly, the Jade piece by Sugatha Menon ended with the lines:

Ragpickers in the Dharvi Project

As I write this story, a message pops
in my mailbox, the US ambassador
to India is visiting Acorn’s waste
segregation center today… paucity of
time doesn’t permit me to go for the
event, but I sincerely wish for many more
mighty oaks for this Acorn.

Wow! Feeling the love in Bombay! What a pleasure to read for a beaten down veteran of the USA based searches like me which are dominated by right wing zealots, conspiratorialists, and general haterators. Why doesn’t Google search worldwide for me?!?

Reading the Clean India Journal, I couldn’t believe what I was reading. A straightforward and accurate overview caught my eye:

Laxmi and several others form the recycling clan of Dharavi. And, they are all part of Acorn Foundation (India), Mumbai, a registered charity trust affiliated to Acorn International or the Association of Community Organisations for Reform Now. Acorn International is a community based NGO working in 12 countries across the world. It has been fighting on issues like right to affordable housing, living wages, water, sanitation, education and healthcare in India. One of their projects – the Dharavi Project – Acorn aims to organise and train the ragpickers in scientific methods of waste handling, segregation and recycling. Besides Mumbai, the organisation also works to improve the lives of the ragpickers in cities like Delhi and Bangalore.

In the “Invisible Heroes” piece the last paragraphs are equally powerful by Delhi based Anna da Costa:

like many countries, especially in the developed world, India already has a skilled recycling and sorting workforce in place. “India’s recycling industry has the expertise and capacity to scale massively, but it needs to be properly valued, formalised and supported,” said Shetty as we sat in his Mumbai office. There are signs of change, “But these need to be magnified.”
I looked down at Shetty’s desk where a series of small ID cards were carefully laid out, identifying recyclers as members of the “Dharavi project”. An image of a young boy, who could not have been more than nine years old, gazed back at me, accompanied by a name in bold type: “Sameer”. For Sameer, this card is the difference between invisibility and visibility, anonymity and belonging. For India, it is a step on the long road to tackling the enormous waste challenge, and creating dignified, green jobs.

One article had such a “crush” line about Vinod that he would have to be careful showing his wife the piece.

It was great praise and a long way from building power, but as we rose it felt like progress in Mumbai for our rag pickers in this huge world capital of the poor.

Kaiser Win for SEIU, No Rerun Coming

dine — Mon, 11 Oct 2010 10:58:02 +0000

Nytimes article picture of SEIU workers celebrating with workers coming into work.

Mumbai The results of the Kaiser decertification election or what Steve Greenhouse with the NY Times calls the largest single-company private sector election since Ford Motor more than 60 years ago, were an old foot stomping, ass whipping blowout for SEIU. The scorecard was conclusive: 18290 or 61% to 11364 out of 43000 eligible voters. The results were predictable for lots of reasons, and in fact I had called this on September 2nd’s blog.

So, will there be a rerun election as Sal Rosselli and his remaining band of dissidents has called for? Will the California labor wars finally be over now for SEIU? Should they be? My answer to all of these questions will be NO.

First, let’s talk about the prospects for a rerun election. A friend of mine who has organized in the Los Angeles area for decades mentioned to me a couple of years ago that the current generation of organizers doesn’t understand “NLRB organizing,” because for years – and for good reasons! – the emphasis and success when it has come has been in non-Board work. Well, the first thing to remember about the NLRB is that it may be ostensibly about worker rights, definitely it is not about union rights, and by virtue of policy and mission it is all about collective bargaining. To the degree there are well meaning bureaucrats embedded in the bowels of the NLRB still, they really, really believe in the value of collective bargaining to achieve labor peace and to protect and advance the interests of workers and their employers.

Here you have a situation where the following is true:

Kaiser health care has been union for decades and has been in fact an innovator in pro-union policies and programs.
Kaiser declared it was neutral in this internal dispute.
Kaiser’s labor relations people and legal people deal with all branches of the NLRB across the state of California all the time. They know the folks, and they know the game.
Kaiser and SEIU bargained a contract that was approved overwhelmingly by the workers only short months ago and now Kaiser workers have decidedly decided to stay with SEIU.
There are less opportunities for company unfair labor practices in a mail ballot election than with manual elections, because the company can’t drive the turnout, which is why unions in normal situations love mail ballots. In a manual election company release would have driven the vote over 95% rather than the 75% in this contest, but this was too big for the NLRB to supervise that way, so lower vote and less chance for company interference.
The breakaway folks will file objections, why not, they have nothing to lose. It doesn’t cost money and delays the announcement of defeat for a couple of weeks, and in Rosselli’s case it give him someone else to blame for the defeat: Kaiser and the NLRB. But it won’t matter even if there were some violations of the Act, the Board will see it as de minimus – to trivial to matter. The vote count will be enough for them, but all of these piece together will be enough for the NLRB not to worry much about calling the game over and letting the dissidents file appeals as the clock runs out.

In this case the NLRB will only be doing the dissidents a favor by not ordering a rerun. Rosselli can gripe, but it wont’ matter, so it’s the perfect situation for the dissidents. He says they have some elections up coming with SEIU. He needs to keep waving the flag until they take it out of his hand, and that’s never going to happen.

The worst thing that could happen to Rosselli would be an NLRB rerun election. If he were lucky (unlucky?) the NLRB would order one maybe 12 months from now, maybe more, depending on the number of appeals to get there. Every month that goes by is letting SEIU deepen its strength in the workplaces of Kaiser. Another 6, 12, 18 months, and they will be even more impregnable. A mail ballot election like this totally favors whichever side can do the GOTV and turnout its supporters. Looking at the numbers, almost as many voted with their feet to not vote at all as voted with the decertifiers. Any rerun would also be a mail ballot. This was the high water mark for the dissidents, and they are a long way from dry land and sinking further.

Rosselli knows this, too. He whined to Greenhouse that they had filed with a majority 18 months ago to try and get this election (the long delay is one of the reasons they lost), but now they got beaten almost 2 to 1. That’s the way it works with the NLRB. I once filed (25 years ago) at a shipyard on a unit of about 400 with 80%, and lost 2 to 1 by the time of the election. The dissidents have now proven that their best number is 11,000 workers, which is very respectable, but it won’t increase, it’ll decrease over time. Rosselli can keep firing spitballs, but the workers on the floors for the most part will say, “ok, let’s live and let live” and go on and focus on the job and the boss. It’s toast.

There won’t be an election. If the NLRB called one, the dissidents would have to block and then pull the petition. If not the loss will be even larger the next time. Kaiser is a classic case of “all over but the shouting.”

So, will there be labor peace?

No. It’s in no one’s interest. The cause of the dissidents attracted a lot of support. Many of the Rosselli themes resonate and no matter how long suffering SEIU may have been in private, it played its public hand in a crude and bullying fashion sufficient to alienate much of the California labor movement, which contrary to most places, still has a labor movement, and a lot of the liberal-left, which is bigger in the Bay Area than anywhere else in the country. Rosselli will continue to be a homeboy who has spent 30 years and more in the state and been there for a lot of people and in a lot of fights when it mattered, while SEIU will be the colonial occupier from DC.

SEIU may be starting to understand this at least a little. Local Kaiser workers emerged during the election as the spokespeople for the campaign and as the observers in the election, which is smart and the way it should be. The organizers who had to win the election undoubtedly forced their voices to be heard. Now they will need to be heard again, rather than the union bureaucrats. To take the local out of trusteeship, they need to allow local leaders to emerge and win, rather than anoint the viceroys from the international. New leaders would be able to define a new era for the future: Californians for a California local union. They would be able to bring real labor peace and even reach out to Rosselli and say, hey, it’s time.

This is where the internal politics of SEIU and the external needs for the labor movement in California may diverge in unsatisfactory ways. A lot of very good organizers and leaders, many of whom have been uprooted as part of this, will believe that they should get the nod or have been promised pieces of this pie. Dave Regan, the executive VP, who has managed this mess on the ground for SEIU, and is a future President of SEIU in waiting, should weight in for more “local” content. Mary Kay Henry, the current President, has been through these wars before. She knows the local has to go local, and is not bound by the old deals, nods, and promises, so for the sake of the whole labor movement, especially the California labor movement, hopefully she will let local leaders emerge to the top of this huge local and give it a new chance.

Rosselli isn’t going away, nor should he. There’s room for his local in organizing California healthcare workers. The density is higher there, but way less than it needs to be. He’s got 5 or 6000 members so that’s a million or more in dues per year without having to pay per capita to anyone. He’s smart and disciplined and driven. He can build something bigger.

Greenhouse had a funny quote in his story the other day: “Dave Regan, the S.E.I.U. official who leads the local placed into trusteeship, said that with this defeat, the rival union would be short on resources and should close down. “It’s time to admit you have failed,” he said. “They need to look in the mirror and say, ‘It’s time for us to stop this thing.’ They have no future as a health care union in California or elsewhere.” He added that his union was reaching out to those who had voted against it.”

In the excitement of the victory, it’s probably natural to wish away the opposition, but it’s not necessary and it’s not a winning strategy. Even in the geography of the giant 1199 on the East Coast, CWA has several strong locals of hospital workers in upstate New York that do a fine job. AFT has an affiliate of nurses and others around Philly and New Jersey which has a reputation for excellent leadership and organizing. SEIU has always known jurisdiction was determined by whomever did the best organizing, yet even after the multi-year Change-To-Win disastrous attempt to assert jurisdictional hegemony unsuccessfully, it seems SEIU is still not on message in California, and it needs to be.

The way to deal with Rosselli and his small upstart union is to learn to live with it and prove the superiority not in the statements but in organizing and representation in the workplaces. Sal will still get something out of this fight, even if it’s not what he wanted. He and his operation on the ground will end up making SEIU a better union in California, and given the fact that SEIU is by far the largest union in California and has so much of its membership nationally there, that’s actually pretty important. At the end of the day, Sal will have to settle for reform from the outside and SEIU will have to learn the lessons being taught over recent years.

Eventually we’ll all be the better for it.

Healthcare Hijinks: Catholics, Rockefeller & Repubs

dine — Fri, 18 Dec 2009 16:10:39 +0000

Buffalo Driving through neighborhoods on first the east side and then the west side of Buffalo was a reminder of what happens in America when your issues fall to the bottom of the pile. The impact of deindustrialization was an ever present scar even when we found the occasional still operating Wonder Bread or Milk Bone plants, steam still moving into the frigid air from the smokestacks. There were beacons certainly. Rehabs of some low-slung plants into office space, the rebuilding of the Armory, the work done by Extreme Makeover, and signs, some painted and some peeled and falling, that signaled areas where city supported block and civic associations reigned supreme.

Even the bright spots crept through some clouds when we would pass massive new school construction blocks away from huge shuttered parochial facilities with fences flapping in the wind. Bill Covington, an old colleague from the HOTROC organizing drives in New Orleans, was my guide and mentioned there were 11,000 abandoned houses in the city now. Each one entailed $10,000 in costs to demolish. The city had announced a multi-year plan to tear down 500 per year. Gulp. That would be 22 years of demolition while the inventory would continue to grow and communities would be living with permanent scars.

I was reminded of Professor Ken Reardon’s conversation with me in Sicily about his efforts to build a center at the University of Memphis to address the crises of mid-sized cities and their future. I had heard these stories in Springfield, Massachusetts recently and now Buffalo, New York seemed like deja vu. More than an institute is needed though. The isn’t an organizing plan yet, and that’s work work and thought.

Talking about Citizen Wealth that evening to a great group of hardy souls, the frustration kept arising around healthcare and the slow and fragile development of any progressive legislation. There’s no happiness in Mudville. We may be close to getting something on healthcare, but no one is talking about “winning” anymore.

Today’s papers were discouraging. To reach of Senator Sanders being thwarted from even trying to have a debate about something better is disheartening. To reach the role of the U.S. Catholic Conference’s willingness to hijack any hope for reform around what now seems to be their single issue (abortion) and to realize that a great, historic advocate for the poor and downtrodden has beyond myopic is depressing. It isn’t hard to feel the gloating of the Republicans over the success of their “kill reform” at any price strategy. What the heck?!

But, just like Buffalo there are still strong rays of hope, though perhaps more mirage than reality. Seems that more than one can play the amendment game, and Senator Rockefeller from West Virginia had two great cards on the table according to the story in the Times:

“Senate Democratic leaders said they would probably accept two contentious proposals by Senator John D. Rockefeller IV, Democrat of West Virginia. One would increase the powers of a proposed new agency to limit the growth of health spending, including payments to hospitals.

The other proposal would require insurers to spend a specified share of premiums — at least 85 percent — on clinical services and activities that improve the quality of care. This would, in effect, limit the profits of insurers.”

Hope springs eternal!

The Cash Fueling the Crowds

jstuart — Sun, 09 Aug 2009 15:56:59 +0000

Dauphin Island The biggest threat to a democracy is the latent fear of the people, which allows politicians, policy makers, and special interests to conspire to deprive them of any ability to impact events through voice or vote. We are deluged by evidence today.

Here’s one from a political scientist quoted in the Times:

“We’re living in the era of the viral town meeting,” said Ross Baker, a political scientist at Rutgers University who once worked as a Senate aide. “I remember back in the ’70s getting identically worded telegrams in the thousands. What’s happened now is the technology of protest has metastasized, and it threatens to overwhelm the relationship between members of Congress and their constituents.”

Professor Baker doesn’t comment on the ineffectiveness of such communication or protest, though it is implicit in his remarks, nor does he clarify what he believes is the “relationship” of elected officials to citizens, though one gathers he wants some distance to it.

Another professor from Princeton in another article in the Times commenting on the robustness of the local meetings was similarly confused:

Accusations of phony grassroots campaigns — “Astroturf,” in Washington argot — also are not new. When Richard Viguerie, the conservative strategist, pioneered the use of direct mail to raise money in the 1970s, he quickly came under attack for creating “the impression of a mass uprising when there were organizers behind it,” said Julian Zelizer, a historian at Princeton University.

But last week’s “town brawls,” as the news media dubbed them, do seem to represent a shift. Instead of each side’s holding rallies and protests, the activism seemed directed personally at lawmakers, with the aim of overwhelming them. Mr. Kratovil, the Maryland Democrat, opposes the health care legislation moving through the House. But he was unable to get his point across, he said. “They simply want to yell when you talk.”

Some might call it democracy in action, but there is a risk. If the pattern continues, lawmakers could grow suspicious, refusing to believe that their encounters with voters are genuine.

“When a politician can’t tell what’s grassroots and what’s Astro, that’s dangerous,” Mr. Zelizer said. “In the long term, that could undermine the potential of grassroots mobilizers to change things. At a certain point, it’s crying wolf. No one is going to believe it’s real.”

If elected officials cannot judge reality at their base, then isn’t it fair to say, that they should neither be politicians or re-elected.

Frank Rich, the op-ed columnist for the Times seems to see it more clearly than the good professors. It’s not really about people and the grassroots, but about money being funneled from the healthcare special interests. And for all of the hullabaloo about “fake” protests, there should be real protests about this kind of cash register politics and the politicians that are practicing it.

As Democrats have pointed out, the angry hecklers disrupting town-hall meetings convened by members of Congress are not always ordinary citizens engaging in spontaneous grass-roots protests or even G.O.P. operatives, but proxies for corporate lobbyists. One group facilitating the screamers is FreedomWorks, which is run by the former Congressman Dick Armey, now a lobbyist at the DLA Piper law firm. Medicines Company, a global pharmaceutical business, has paid DLA Piper more than $6 million in lobbying fees in the five years Armey has worked there.

But the Democratic members of Congress those hecklers assailed can hardly claim the moral high ground. Their ties to health care interests are merely more discreet and insidious. As Congressional Quarterly reported last week, industry groups contributed almost $1.8 million in the first six months of 2009 alone to the 18 House members of both parties supervising health care reform, Nancy Pelosi and Steny Hoyer among them.

Then there are the 52 conservative Blue Dog Democrats, who have balked at the public option for health insurance. Their cash intake from insurers and drug companies outpaces their Democratic peers by an average of 25 percent, according to The Post. And let’s not forget the Democratic Senate Campaign Committee, which has raked in nearly $500,000 from a single doctor-owned hospital in McAllen, Tex. — the very one that Obama has cited as a symbol of runaway medical costs ever since it was profiled in The New Yorker this spring.

Something like healthcare reform with clear benefits of millions should be easy to understand at the level of basic national values. Fear of the people and the filter of money distorting what politicians are allowed – or willing – to hear are threatening any claims we might have to democracy, not a couple of rowdies and robust dissent at town hall meetings.