In her 68 years, Rebecca Littlewood, of Sequatchie, Tenn., had never attended a political town hall meeting, never posed a question to her congressman and never known a time when so many Americans were so uproariously engaged in an issue -- until now.
"People are starting to really pay attention to what's going on, and I think it's a good thing," said Mrs. Littlewood, who last week went to a town hall meeting on health care reform with Rep. Lincoln Davis, D-Tenn.
The prospect of reform has spawned hope, anger, fear and at times bewilderment among everyday consumers of health care.
President Barack Obama has pledged to pass broad health care reform by the end of the year, aiming to control burgeoning costs in the more than $2 trillion health care industry while extending insurance coverage to the 46 million uninsured people in America.
Concerned people found an outlet for their emotions at town hall meetings with their legislators this month. While most recognize a need for some kind of change, most view any reform proposals through the lens of their own experiences, according to a national polling director. And they face steep barriers in distinguishing myth from reality in the health care debate.
About 46 percent of people surveyed in an August poll described themselves as "confused" about health care reform, said Mollyann Brodie, director of public opinion and survey research for the nonprofit Kaiser Family Foundation, a private foundation focused on health care.
"There isn't a single (finalized) bill yet. There's really, honestly no way of knowing how these bills will affect individual families yet, but with all the contentiousness in the debate, I think it's easy for people to start feeling insecure in how they might fare in any legislative outcome," she said.
Misinformation and uncertainty are rampant, even for those genuinely trying to evaluate reform proposals, said Dr. Ken Ellinger, a political science professor at Dalton State University and self-described "progressive Democrat."
"The myths and distortions and lies are out there, and they're being reported even in the mainstream media. I feel sorry for anybody who's actually trying to get the truth," he said.
Crafting a reform plan acceptable to everyone is a tall order. The legislative process makes passing bills on any issue, let alone one as big as health care, a huge challenge, Dr. Ellinger said.
"You got to get all your ducks lined up in a row and the stars have to align to change the status quo," Dr. Ellinger said. "We are talking about one-seventh of the economy here. The default option is going to be, 'Better the devil you know than the devil you don't know.'"
Formulating an opinion
For most people, a central factor in their outlook on health care reform is their personal experience, Ms. Brodie said. A lot of insured Americans are generally satisfied with their health insurance, she said.
"The average person doesn't need their health insurance really in the course of a given year," she said. "It's only when they have some sort of big health challenges that they really see whether their policies are generous enough to cover and protect them."
Within their first year of marriage, Chrissy Willocks and her husband, Elliott, both 25, were struck by major medical problems -- in her case, a benign, operable brain tumor and in his case, a major seizure leading to a diagnosis of epilepsy.
Without health insurance through Mrs. Willocks' employer, Rhythm & Brews in downtown Chattanooga, the couple would have faced $200,000 in medical expenses compared with the $13,000 in out-of-pocket costs they ended up paying.
For Mrs. Willocks, the experience has solidified her belief in universal coverage, at least at the catastrophic level, and her support for the public option in health care reform.
"I do feel like it's a social responsibility to protect people from the catastrophic," the law student and restaurant server said. "If we had gone bankrupt, those costs would have been passed on to the taxpayers."
Some supporters of broad reform argue that private insurers' rising premiums must be reined in through competition from a government-run public insurance plan known as the public plan or the creation of regional or state insurance exchanges that would give individuals, not just employers, a choice among private insurers' plans.
Family premiums for employer-sponsored health insurance grew 119 percent between 1999 and 2008 and could increase another 94 percent to an average $23,842 per family by 2020 if growth continues, according to a study by the Commonwealth Fund. The New York-based private foundation supports independent research on a broad range of health care issues.
Lorraine Miller-Roberts, a Summerville, Ga., resident, said a public option is necessary to inject competition into the system and to keep insurance companies "honest."
"Right now insurance companies are not highly regulated as to what they can do," said the 57-year-old artist, who has private insurance. "Because someone had a pimple 20 years ago, they can drop a policy. ... Just as the (U.S.) post office has competition with UPS and with FedEx, I don't see any disharmony there. It just gives people other choices. And UPS is not going out of business."
Vietnam War veteran and Hamilton County resident Robert Miller, 67, is adamantly opposed to the public option, which he fears would undermine the benefits he receives through the Department of Defense under Tricare.
Mr. Miller said the administration's proposals are "just one more federal takeover that we don't need."
President Obama emphasized earlier this month that health care reform will not affect eligibility for or benefits through the Department of Veterans Affairs or the Tricare program of the Department of Defense, according to the American Forces Press Service.
Proposals to bring millions of uninsured Americans into the health care system should be accompanied by efforts to bolster the number of doctors and nurses to treat the new patients, Mrs. Littlewood said.
"They have no plans anywhere to increase the manpower and the facilities to take care of all these extra people," she said. "There's no way you can dump more people into an existing program with the current facilities and expect everyone to have the same access they have now."
The cost of reform, which under the House's health plan is projected to increase the federal deficit by $239 billion over 10 years, is incomprehensible to many.
"We can't afford to do this," said Randy Bidwell, of Chattanooga, 52. "We're already broke."
But the cost of delaying reform is more worrisome to others who favor the passage of legislation this fall.
"I want this plan to go through so badly," said Mildred Parker, of South Pittsburg, Tenn., who characterized reform as a moral imperative. "We've got to take care of the poor. (Opponents to reform are) for the big companies, the big man. ... They don't know what a hard time is, and they don't want to help anybody else."
Some health care consumers have been taken aback by the divisiveness of the issue.
"It gets pretty ugly. ... If you voice that you are for health care reform, people accuse you of being in favor of death panels to kill your Granny," said Lisa Winfree, 39, of Rising Fawn, Ga., referring to former Alaska Gov. Sarah Palin's widely debunked assertion that the Obama administration's reform proposals would lead to government panels deciding to withhold health care for those deemed "unproductive."
Mrs. Winfree said she supports reform that would expand Medicaid to cover those who are now uninsured.
"It's like there's no room for calm, rational discourse on it on either side," Mrs. Winfree said.
The spread of "demonstrably false" claims about health care reform are a replay of reaction to now-Secretary of State Hillary Clinton's efforts to pass health care reform in the 1990s, Dr. Ellinger said.
"Some critics are asking (questions) in good faith and they honestly fear and honestly believe what they're saying about the potential harm of any changes, but clearly many of the critics are playing a cynical game," he said.
The reform debate didn't hit home for Mrs. Winfree until her husband, Anthony, was laid off from his job at a heavy machinery company in January and the family lost its employer-subsidized insurance.
Mr. Winfree was diagnosed with multiple sclerosis two years ago, and his 5-year-old daughter was diagnosed with Crohn's disease at age 2. A federal subsidy has helped them continue their insurance coverage through COBRA, but the Winfrees are at a loss about what to do when that subsidy runs out in November and they're left with a $1,000 monthly premium.
Despite his precarious situation, Mr. Winfree said he is a staunch libertarian and opposed to reform that would increase government involvement in health care, even though it could ensure his own access to health insurance.
"It causes me a great deal of conflict because I'm in essence arguing ... against my own self-interest," he said. He takes issue with the current health insurance system that insulates health care consumers from the cost of care and that would use his tax money to provide coverage for others who aren't taking responsibility for their health.
"In a perfect libertarian world," he said, market forces would naturally rein in exorbitant costs for procedures such as his MRI scans, which are today impossible for him to afford without the help of insurance.
BY THE NUMBERS
National health care spending in 2007: $2.2 trillion ($7,421 per person or 16.2 percent of the nation's gross domestic product)
Average family health insurance premiums in 2008:
* Tennessee: $12,302 (20.3 percent of average family income)
* Georgia: $11,659 (16.1 percent of average family income)
Source: U.S. Department of Health and Human Services, The Commonwealth Fund
In a recent survey, 58 percent of people with insurance surveyed are either "extremely satisfied" or "very satisfied" with their plan and 30 percent are "somewhat satisfied." Eleven percent were "not too satisfied" or "not at all satisfied."
Source: 2009 Health Confidence Survey conducted by the Employee Benefits Research Institute
KAISER FAMILY FOUNDATION POLL
A monthly public opinion poll conducted in August found:
* Fifty-three percent of Americans said it's "more important than ever" to take on health care reform, compared with 62 percent in October 2008.
* Forty-two percent said we cannot afford to take on health care reform now.
* Sixty-one percent of Republicans, 11 percent of Democrats and 36 percent of independents say they would be worse off if health reform passed.
* Forty-five percent of Americans think the country as a whole would be better off if Congress passed health care reform, compared with 59 percent in February. 34 percent think the country would be worse off, compared with 12 percent in February.