When Barack Obama is inaugurated this month, his transition team will present him with suggestions on reforming health care from thousands of people across the country, including more than 200 who convened recently in Columbia.
The campaign organization the president-elect built is still at work, using vast e-mail lists to mobilize people who want to take part in transforming vital programs like health care by braving a cold holiday weeknight to put their thoughts down on paper.
"How refreshing is it that a campaign that is successful wants to listen to its supporters' ideas?" County Executive Ken Ulman told the standing-room-only crowd that turned out Monday night at the Florence Bain Senior Center in Harpers Choice.
Ulman, Del. Shane Pendergrass and county health officer Dr. Peter L. Beilenson conducted the meeting, which was part of a national effort by the Obama team to build enthusiasm for change by asking supporters to hold hundreds of meetings on the issue.
At the same time, the gatherings are intended to help build momentum for congressional action later this year. Former South Dakota Sen. Tom Daschle, Obama's choice for secretary of health and human services, attended several of the meetings, though not the one in Howard County.
Pendergrass said the issue is not a partisan one, despite the Democratic origins of the meetings. Ulman's office invited elected Republicans, though only GOP County Councilman Greg Fox arrived briefly toward the session's end, Fox said. Republican State Sen. Allan H. Kittleman said he was unable to attend because he was out of town but commended the effort to solicit ideas.
"This certainly is a notable endeavor," he said.
Republican Del. Warren E. Miller said he was busy with family and could not attend. But he said he was suspicious of the meeting, which he thought sounded more like a rally than a policy event.
"Whenever I think about [health care reform], I think of socialized health care, which I don't agree with," he said.
Pendergrass said party affiliation doesn't matter.
"I think there's a role for everybody in this process," she said. "The people getting sick are not Democrats or Republicans. The people getting sick are Americans."
Pendergrass said she believes Obama has the ability to foster a consensus and make change happen: "What's political about this is that with the change in administration, there's a will to reinvent the health care system."
The 90-minute event was organized in one week, with thousands of e-mailed invitations sent. Attendees were divided into groups that discussed seven questions. The summarized results were sent to the transition team the next afternoon.
Among those who attended were doctors, lawyers, insurance experts, legislators, retirees with expertise in health care, hospital lobbyists and ordinary citizens, as well as former Obama campaign volunteers.
Tom Flynn, who once headed a civic group in North Laurel, described a health care problem that several in his group said they, too, have faced - a grown child too old for family insurance but without a job that provides health insurance.
To afford treatment for a chronic condition, Flynn said, his son needs a job with benefits, but he can't get one until he gets the treatment he needs - a circular predicament many face.
Beilenson summarized the problems with four words - access, quality, cost and prevention.
The first question asked participants to name the biggest problem in the current system.
In one group, Jack Day said the main problem is that 50 million people across the nation are uninsured. Dr. Seth Eaton, a primary care physician, noted waste, high costs and a lack of preventive programs. Ron Carlson, a health care consultant, pointed to behavioral health, including smoking, poor eating habits and lack of exercise.
Frank Chase, a retired federal Medicare worker, said he had a more basic issue. "I dispute the idea that there is a system. At present, it's a fiasco," he said. "We've got to create one, and we don't need insurance companies to accomplish that."
Obama's plan would keep both employer coverage and insurance companies involved in health care while trying to reform the worst aspects of both.
That approach didn't please some.
"Employer-based coverage is part of the problem," Day said. "Obama's made a big mistake backing that."
Employers aren't expected to provide car insurance, another person suggested, so why health insurance?
But Eaton said that a complete transformation is unlikely. "It's too radical a step now, given the political situation," he said.
His wife, Karen Bonnie Eaton, a retired health management attorney, argued that employers should remain key players because of their ability to negotiate better terms for people needing insurance.
All kinds of ideas were discussed, even taxing behavior like watching TV to make people exercise more. That suggestion got no support.
Pegeen Townsend, a lobbyist for the Hospital Association of Maryland, said primary care physicians should be paid more to encourage better care and more practitioners.
Seth Eaton said his practice can't afford to offer health insurance to his employees' families, which is distressing.
"It's like the cobbler who can't provide shoes for his workers," he said.