Page last updated at 00:04 GMT, Saturday, 22 August 2009 01:04 UK

Rifts threaten healthcare reform

By Laura Trevelyan
BBC News

Town hall meeting in Moss Point
Emotions ran high at a town hall meeting in Moss Point

As US President Barack Obama heads off for a holiday, Democratic Party managers are left wondering how they will get his flagship healthcare reform bill passed by the autumn.

The aim is to provide health insurance for the 47 million Americans who do not have any, and drive down the spiralling costs of healthcare.

But with the Republicans likely to vote against the bill, and deep divisions in the ranks of the Democrats, getting the votes will not be easy.

Two Democratic members of Congress who characterise the splits on healthcare reform are Gene Taylor and Maxine Waters.

He is from Mississippi, she is from California, and both represent thousands of Americans without health insurance.

Ms Waters sees government intervention as the solution to the problem, while Mr Taylor believes the current plan will only make matters worse.

Blue dogs

President Obama needs the different wings of his party to reach a compromise if he is to get the healthcare reform he has promised the nation.

Emotions were running high in Moss Point, Mississippi, this week, as Mr Taylor held his monthly town hall meeting.

"Healthcare, healthcare," shouted the crowd at one point.

File photo of Gene Taylor
Gene Taylor is opposed to Barack Obama's plans

Mr Taylor has made it very clear that he is opposed to the Obama administration's plan to reform healthcare, because it costs too much.

He wants to see the inefficiencies in the existing system reformed first.

Mr Taylor is what is called a blue dog Democrat - one of an influential group of conservative leaning democrats in Congress who are deeply concerned by government spending and the spiralling national debt.

"Now everyone in this room is aware that I'm not going to vote for the healthcare plan," says the congressman, to loud applause.

Distrust of government

The Obama administration has tried to woo the blue dogs and other opponents in Congress by floating the idea of dropping government-run health insurance, known as the public option.

One constituent asked Mr Taylor if these changes will mean that representatives who said they would vote against the bill might be swayed.

It just sounds like communism, that you just have to do what they say to do if you're sick
Vicky MacArthur
Healthcare reform opponent

"Tweaking here and there's not going to change my mind," came the response.

Mr Taylor's district is predominantly white and blue collar.

It is the most Republican area in America to vote in a Democrat.

Mississippi is one of the poorest states in the Union, and life expectancy is the lowest in the country.

Distrust of government runs deep here.


At the Bethel free health care clinic, set up in the aftermath of Hurricane Katrina, which devastated Mississippi's Gulf Coast, people without health insurance are treated by volunteers.

The centre is funded by donations.

Dr David Clippinger, who has retired from general practice after 50 years, gives up his time to work here two days a week and treat the patients.

David Clippinger
David Clippinger works two days a week at the Bethel free clinic

"A lot of nights after I've put in a hard day's work here I have trouble going to sleep at night worrying about these people, just wondering if they're still alive the next morning," he told me.

"I pray for the president every night that he and his congressmen will come up with a plan to help everybody."

In the clinic I spoke to Vicky MacArthur, who has come because she needs medication to keep her blood pressure down.

She lost her health insurance when she became unemployed.

I asked Ms MacArthur what she made of the government's plan to help Americans like her.

"There's no way the government is going to provide a service like this," she told me.

"This clinic is run by people who care. I can just picture people standing in lines, you don't get to pick who your doctor is.

"It just sounds like communism, that you just have to do what they say to do if you're sick."

'Ridiculous' costs

In California, it is a very different story.

The visceral opposition in Mississippi to extending the role of government is in complete contrast to the feeling among Democrats here that government is the answer.

Congresswoman Maxine Waters, who represents a district in southern Los Angeles, has long campaigned for healthcare reform.

File photo of Maxine Waters
Maxine Waters says any bill must contain the public option

But now the moment has arrived she is nervous about the compromises the White House seems prepared to make.

"I am worried about President Obama," she told the BBC.

"I know that he's under a lot of pressure and that he wants to get a healthcare bill and I know that he's been working hard to try to work with the blue dogs and reach across the aisle.

"There comes a point where you have to say I can't go any further."

LA Democrat Marci Valner, who has a daughter with autism and a mother suffering from Parkinson's disease, says health insurance is out of control.

"I think the cost of a medication is ridiculous. My mother pays $800 a month out of her own pocket for her medicine," she says.

Ms Valner worries about people who cannot afford their medication - do they just die, she asks?

Marci Valner
Marci Valner says the cost of medication is too high

Ms Waters is one of a group of 100 members of Congress who call themselves progressive Democrats.

They were all very alarmed when the White House floated dropping the idea of the public option, a government-run health insurance option which would compete with the private sector and drive down costs.

When it was suggested that co-operative groups could perform the same function, Democrats on the left were furious.

Ms Waters says the healthcare bill must contain the public option.

"We can't support a bill that's a band-aid, that does not get at the real problem, that does not challenge a system that's left 47 million people uninsured," she says.

That leaves her poles apart from Mr Taylor, illustrating a deep divide in the Democratic coalition that is threatening to undermine the flagship reform of the president's domestic agenda.

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