A great piece of health policy news, and some excerpts from Health Justice Now

Hello friends,

I have two things to talk about today -- one is hype as shit, the other is about my book. Let's get into it.

I. QUEBEC VACCINE COUNSELORS
II. EXCERPTS FROM HEALTH JUSTICE NOW
III. TOUR SCHEDULE

I. Quebec and Vaccine Counselors
Here is a short and sweet story from our friends up north. I learned about it from this article, which I'll summarize here. 

Quebec is home to some of the planet's most brutal (and most problematic) black metal, and it's also home to a good number of people who don't get vaccinated. Canada's nationwide vaccination rate ranges from 69% to 91% among two-year-olds. 82% of high-schoolers in Quebec have been vaccinated for measles,compared to 88% nationally. That's much lower than we'd like—95% vaccination is the standard for "herd immunity." And as vaccination rates drop, even after a measles outbreak in 2011 and a measles scare this year, the province wanted to find a way to change course.

People who don't vaccinate their kids come in two flavors: hard-line anti-vaxxers, who understand that vaccinations are worse than chemtrails and grapeseed oil combined; and vaccine skeptics, who (understandably) look up vaccine information online or on TV and come away with conflicting impressions. Not wanting to hurt their kids but unsure what to do, they defer their choices until inertia takes over. The latter group, it was reckoned, was saveable.

Except doctors are pretty ill-suited for this line of work. Doctors have limited time; they can be kind of brusque; they are not good at being patient and kind listeners. So Quebec hired a few dozen social workers as "vaccination counselors,"  who would visit new parents immediately after delivery and hang out in the neonatal unit. They'd ask, "oh, have you considered vaccinating your child," they'd answer questions, they'd provide data, and, most importantly, they made it clear that they respected the parents' choices and autonomy. The kind of slow, gentle, empathetic compassionate labor which makes real, tangible differences in population health.

How real? How tangible? In the hospitals studied, vaccination rate increased from 72% to 87%.

That's incredible! This is the illest shit on earth! I want to be wrapped in this like a shroud. I want to be buried in this.

Here's why it's cool. It represents the quad-kill of health interventions, to me

• Public funding of
• Social workers, doing
• Compassionate labor, which
• Improves population health, bigtime

Isn't that hype? Here's where I get mad about it: this could never happen in the United States under our current healthcare model. Never! There's simply nobody who has the incentive or capability to work on a population-wide initiative like this. Private insurers don't bear the long-term cost of vaccination noncompliance, so they're not going to invest in this. And even if they did—that would mean creating a bunch of disjointed processes, which differ from insurer to insurer and create another interaction between patients and the insurers they don't want to hear from. We could subsidize a bunch of vaccination counselors through public funding, but that means we would ultimately just be subsidizing the incompetent private insurance industry for work they're unwilling of attempting and, so long as they prioritize profit, are incapable of doing.

Insurance companies only care about the healthcare costs you incur while they're insuring you. Because you're likely to change insurers in the future, and eventually (god permitting) go on Medicare, they feel no pressure to provide you with care that keeps you healthy in the future--or which keeps a large population of people healthy. And we know what achieves these goals--social workers, nurses, home health aides--the people whose work is the tedious business of being empathetic to people in need. And because this work is not profitable; because it is slow; because it does not get immediate results; this work is utterly devalued. Nurses are seen as expendable warm bodies on which to dump overflow physician work instead of the backbone of the hospital.

The valuation of compassionate labor, the pursuit of population health, the prioritization of being kind to people—these things are fundamentally incomprehensible to our health finance model. This is a future that is denied us by private insurance. This is a better world which has been stolen! 

II. Excerpts from The Book
My book is out now (please buy it!). Before publication two excerpts were published, and now here they are. "Try Before You Buy"

THE TRANSFORMATIVE POTENTIAL OF SINGLE-PAYER, in The Outline

HOW WE WIN, in Splinter

Wow!!

III. TOUR SCHEDULE

Yippee, I'm going on tour. Here's a cool flyer my friend Rory made. 
You can also find this schedule here.

That's all! Thank you!!