Some notes on Bernie's bill, a new podcast about healthcare & metal, Single Payer Roadtrip, Cassidy-Graham, wow!
It's been a while since I've spoken with you—in my defense, I've been busy working on fun stuff. Some of that is below.
I. HEAVYxMEDICAL podcast
II. Some thoughts on Bernie's Medicare for All bill
III. A single thought on Cassidy-Graham
IV. Single-Payer Townhall Roadtrip & other shit. (The International Single Payer's Vanthem)
V. Other news
I. HEAVYxMEDICAL podcast
My partner Kelly Jo and I have been working on a podcast, which we think we'll release every-other-week-ish. Our first one is about bundled payments and how the lack of HIV healthcare programs in the US lead to a fucked-up "carceral healthcare" program which punishes vulnerable people—specifically trans women of color in the South. Fuck!
We also discuss metal bands we like. Ep I is out now, Ep II will be out soon (I fucked up the recording quality on that one)--it's a good discussion on payment models and how insurance companies passively discriminate against people with HIV in their plan design. Ep III will come out next week-ish and be about Bernie's bill and fetal protection laws. We're very "fun".
Here's a link to our twitter, which has links to both the iTunes page and the RSS feed: https://twitter.com/heavyxmedical
II. Some thoughts on Bernie's Medicare for All bill.
It rules! I'm working on a brief essay about it, but I thought I'd offer some initial and very unpolished analysis here:
III. A single thought on Cassidy-GrahamLast Wednesday, Bernie Sanders introduced his “Medicare for All” act—a bill that would, if passed, establish a federal and universal single-payer healthcare system in America and delegate broad powers to enact it to the Secretary of Health and Human Services. The bill stands juxtaposed against a cruel summer of the GOP’s “repeal and replace” bloodlust, today represented by Cassidy-Graham, and years of mewling, milquetoast non-ideas from the mainstream Democratic Party tendency.
This is a minor, but significant victory for the popular movement which yearns for health equality in America. Though even stalwart advocates for single-payer agree this particular bill won’t pass in the next few years, its mere existence is an irreversible mark of progress in the fight for healthcare, and whether out of moral obligation or vulgar opportunism, over a third of Senate Democrats (including likely 2020 nomination-seekers) have adopted it. The story of the fight for health justice is still starting, but after decades of struggle, false promises, and corporate warfare, perhaps its prologue is finally coming to a close.
It’s hard not to be excited reading the Medicare for All act—a singularly refreshing and enthusiastic document, unequivocal in its ambition. Sanders demands:
an extensive set of essential health benefits (including abortion, vision, and dental care) for all American residents (delegating any further extension to HHS), with no out-of-pocket costs beyond $250 for prescription drugs.
fair transition for the relatively small number of displaced insurance administrative workers,
The prohibition of private insurance to duplicate services offered by the public payor—farewell to Medicare Advantage and the Medicare privatization movement,
(very excitingly) that HHS to set up standards for data collection and invest in evidence-based care guidelines for providers—joyful news for both the essential yet persistently besieged Agency for Healthcare Research and Quality and people who like their healthcare to have research validating it, and
elevates primary healthcare to its own office, tasked with measuring, analyzing, and investing in primary care, particularly for people in underserved communities.
As compelling as what the policies and programs the bill articulates are what it removes, gleefully toppling pillars of our neoliberal medical-industrial complex. Most striking among them is the removal of cost-sharing. This spits in the face of forty slow, grinding years of the “consumer-driven healthcare” movement, a term describing insurer efforts to wriggle out of increasing healthcare costs by shifting more and more of them onto individuals poorly-equipped to weather them. 40% of all insurance plans in 2016 were high-deductible plans (up from 28% in 2011).
This sums to a clear, focused vision of the future: that insurance is not healthcare, and that healthcare is something a just nation affords its citizens. The United States may be a country where Saudi princes can fly to get a heart transplant, but it remains a country in which poor men die 14 years earlier than rich men.
~~ (here's some other shit i had to write for something else on a similar topic)Critics of single-payer are quick to claim that the cost of healthcare makes single-payer impossible. This argument is made in bad faith. We already spend massive amounts of money on healthcare, but we're forced to spend it poorly—on one hand, we pay extreme unit costs (an MRI in the US costs five times what it costs in Australia) while letting hospitals overbill payers with unnecessary or unbundled care; on the other, we fail to provide essential and primary services to people who need it most.
Providing healthcare is complicated, but financing it is relatively simple. Total health spending in 2015 was 3.2 trillion dollars, of which public money represented $2.1 trillion. A little less than half of that is actual Medicare, Medicaid, or VA costs. The rest is spending on private insurance for government employees and subsidies to insurance companies and individuals via tax subsidies for employer coverage. A single-payer program removes insurers and their profit margins (plus their $200 billion in annual administrative costs) from the process by taking spending which already exists—insurance premiums—repurposing part of it to fund itself, and returns the rest back to you.
We know that Medicare can negotiate much better prices for treatment because it is a larger payer. Scale that idea up—imagine how much better things will be when we have a single payer to regulate costs more effectively across all healthcare spending! The goal is not necessarily to cut spending, but reallocate it to best serve the health needs of our whole population.
We already know the problems undergirding population health. When people don’t have access to healthcare, or when they’re forced to bear heavy costs for seeking it, they don’t see doctors at all. Their conditions compound upon themselves, and things like stage 0 cancer become stage 3 cancer; untreated diabetes turns into cardiac failure. Thus, our refusal to make care free and broadly accessible out of fear of its cost actually forces us to spend even more money down the road.
This is not a problem that single-payer healthcare solves in and of itself, but it is a problem that only a single-payer model can solve in America. Once the federal actor bears costs of providing care (paying doctors) and not providing care (the financial and social costs of widespread preventable illness), it can finally be a tool for realizing health justice. If the population is getting sick and dying because they don’t have a place to live, then housing is healthcare, and we must build housing to bring healthcare costs down. If the population doesn’t have access to healthy food to eat, then food is healthcare, and we provide affordable and nutritious food options to bring food costs down. If the population lives in fear of their personal safety—if they are assaulted or beaten at home, at work, by the police, or by their domestic partners, then safety is a form of healthcare, and we provide safe havens for the population to bring healthcare costs down.
Victory is entirely imaginable. After decades of activism, culminating in a rejection of the Republican movement to scrap the Affordable Care Act and restrict Medicaid, led by thousands of activists demanding accountability from their representatives in townhalls in states red and blue—single-payer has emerged as a policy plank in mainstream discourse. With the exception of hyperconservatives who now rail against the idea of insurance altogether, we have heard voices on both sides of the aisle speak of universal coverage as a moral imperative. Universal coverage in America—real coverage, that liberates us from medical debt and fear of preventable illness—can only be realized through a federal single-payer program.
Single payer is moral, single payer is necessary, and single payer is achievable. Single payer is inevitable if we make it inevitable together
It sucks ass! It contains the usual shit you've come to know and love from the repeal-and-replace movement, but it's also somehow much dumber and worse. It contains an explicit admission that it will increase the number of uninsured people, for example.
Cassidy-Graham insists falsely, nakedly, that it will help the vulnerable (those who are uninsured or under-served by Medicaid), though its advocates were the ones to exacerbate that vulnerability in the first place (by refusing to expand Medicaid with free money). And so now the people who chose to actively, purposefully fail their constituents and make (make, not let) them suffer—are using their hardship to advance a wave of cruelty which will harm millions more. All unnecessary. All despicable. I hope it drowns. There is so much work to do.
Republicans bear all the blame for how this happened, of course. BUT... the argument permitting state-by-state enrollment decisions (the NFIB v. Sibelius lawsuit, which determined that compelling states to expand Medicaid forced them to spend on a substantively different program than the Clinton-era means-tested welfare program they had to begin with) wouldn’t have existed if the ACA had been a single-payer program to begin with. Means-tested programs designed to identify the "deserving poor," out of fear of accidentally assisting someone unworthy (a line of logic only used on poor people, never the rich...) can only build cracks in your infrastructure. People fall through cracks. Bad guys use those cracks as leverage points.
IV. Road Trip
I like posting as much as anyone, but I think the single-payer fight can use more face-to-face conversation, so I'm hitting the road to do my part. Plus I like talking to people, and I like driving.
Here's a map of a tour from 10/10–10/27. I've added some more dates outside of this, so i'll list it below too.
If you live in one of these places, come hang out with me. If you don't live in one of these places but want me to come hang out, get together some people or talk to a local organization (like the DSA) and shoot me an email. I don't want any money, but I do ask for travel and a place to sleep.
I'm planning on doing a FL-TX and West Coast drive as well. We'll see if I manage to not fail my classes this semester.
V. Other news
Recently me and KJ went to Japan. It was wonderful. Everyone says hello.
OK! That was fun! See you
