I was wrong about single payer

Todd, if you’re reading this: You were right.

Steven Brill (author of Bitter Pill) helped open my eyes about American health care. Photo credit: New York Times

Do you believe health care is a right? Or a privilege?

That’s what a friend asked me all the way back in 2009 — back when I was a reliable Republican voter. We were locked in a hard-headed debate about the free market and the role of government in people’s lives. I argued at length about all the problems with our health care industry. I talked about the price gouging and the way insurance companies use the profit motive to decide whether or not you get to receive the treatment your doctor believes you need. I was, without knowing it, making the perfect argument for single payer. Yet I stubbornly concluded that “government run health care” would make all those problems worse. I convinced myself that with the right regulation, the free market system could be made better. I told my friend I didn’t know the answer, but I was CERTAIN Obamacare was not it.

So he asked me “Do you believe health care is a right, or a privilege?”

I couldn’t answer the question. I know what I wanted to say. I wanted to say the government shouldn’t be in the business of setting prices. That these terms should be negotiated between service provider and consumer. I wanted to say it’s supposed to be competitively priced and negotiated based on supply and demand — duh.

But there was a twinge of doubt in the back of my mind. And his question echoed in my head for weeks. I tried comparing it to shopping for car insurance or homeowner’s insurance (neither being particularly stellar examples of serving the consumer’s best interests). Every argument I made wound up back in the same logical trap: Not everyone drives cars or owns houses, but everyone needs to see the doctor.

That was the day the tide started to turn for me. It took a number of years and a lot more life experience to reach a new conclusion. But now eight years after that raging debate, I can say I was right about one thing: Obamacare was not the answer.

But I was wrong about everything else.

I was wrong in my understanding of what Obamacare was. I bought into the Republican lie…and there really is no other word for it, it was a deliberate, malicious lie…that Obamacare was tantamount to socialized medicine; that it was government-run health care. I bought into the Republican lie that we couldn’t afford single payer. Hell, back then I couldn’t even explain what single payer was. But it sounded like a big new government program and we were still clawing our way out of the financial crisis — I was sure we couldn’t afford it. I willfully ignored evidence of successful single payer programs around the world.

The years since have offered many eye-opening experiences. I’ve seen friends skip out on going to the doctor because they couldn’t afford their co-pays. I’ve watched people die because they didn’t have insurance and couldn’t afford the treatment they needed. I’ve donated to I-can’t-tell-you-how-many GoFundMe campaigns to cover hundreds of thousands of dollars in medical bills owed by people who had good jobs with good insurance, but still ended up left holding the bag for procedures and treatments their insurance company wouldn’t cover. And that was WITH Obamacare.

Before Obamacare, I waited tables and went 2.5 years without health insurance. The restaurant did offer an employee health plan, but even pulling double shifts and routinely clocking 80 hours a week, I couldn’t afford the premium payments on an hourly server’s salary of $2.13 with unreliable tips. It was one of the scariest times of my life. At one point I did get sick. I made my way to a cash-only clinic for people like me — people who were broke and had no coverage. I shelled out $80 for my flat-fee doctor’s consultation and found out I had an ear infection, a sinus infection, and bronchitis. I went to get my prescriptions filled and was hit with a tab of $400. The doctor prescribed a week of bedrest — but I couldn’t rest. I’d just spent my rent money on 30 minutes at the clinic and a trip to the pharmacy. I had no choice but to go back to work the next day.

That only happened to me once in those 2.5 years, but every day I lived with the fear that I would be in a car accident, or contract a more serious illness. And then where would I be?

I’m one of the lucky ones. After a few years I found my way into a new career and pulled myself out of that financial ditch. I’ve never had to worry about health insurance since. Other people aren’t so lucky, and the consequences can be dire.

Responses to Rep. Raul Labrador (R-ID) who outrageously claimed “nobody dies because they don’t have access to health care.”

There are people who’ve lived their entire lives without the security of good health insurance. They live in fear that their partner or their child will get sick and they won’t be able to take care of them. I know people with mental illnesses who have gone years without treatment or support, because their insurance plan (if they have one) doesn’t provide adequate coverage for mental health services. I’ve known friends to commit suicide, or succumb to addiction, and I was left to wonder how things might’ve been different if they had received the care they needed.

Now I find myself on the other side of the debate, and I hear people make the same tired, ignorant arguments I made years ago. Today they’ll tell you that successful single payer systems like Canada and Australia are secretly dysfunctional and on the verge of collapse. They’ll point to the problems in the British National Health Service yet fail to mention the program has been starved for funds by American-style tax breaks for corporations and the super rich. They talk about the increased tax burden of a single payer system, but they never acknowledge we’re spending trillions MORE on the system we have — a system that is designed to prevent people from getting health care. They never tell you that single payer saves us money. A LOT of money.

The lies are new. They are more subtle and less insidious than the “death panel” lies of eight years ago, but they are lies nonetheless.

It is deeply disingenuous of Democrats to pretend saving Obamacare is sufficient. While the ACA helped millions of Americans get insurance, many for the first time, millions more have seen their costs skyrocket. Businesses who provide health insurance have seen their share of the cost increase by 50%, 75%, double, or worse. Others have had to forego offering their employees health insurance at all, because rates became untenable. We cannot continue with the system we have.

But if Democrats are distorting the facts, Paul Ryan and Mitch McConnell are flat-out lying to you. Not one independent analysis of the Republican health plan concludes it will cover more people or cost less money. On the contrary, the GOP proposals will irrefutably raise rates on those least able to pay, while kicking tens of millions off their plans.

Pictured here: Paul Ryan peddling a pack of lies disguised as a health care bill.

Paul Ryan has the gall to claim his health care bill will improve consumer choice. What choice, Mr. Ryan?

If I get insurance through my employer, I don’t choose my plan — my employer does. I don’t get to choose my doctors — the insurance company does that.

The insurer decides what kind of doctors I get to see, which medications I’m entitled to have, and what kind of procedures they’ll authorize regardless of what my doctor thinks is best for my health.

How is that choice? Why is an insurance adjuster meddling in health care decisions that rightly belong between me and my doctor?

If I don’t get insurance from my employer, I have to choose between plans currently offered on the exchange at Healthcare.gov. In many parts of the country there’s only one provider, with only one plan available to me. (And lest we forget, if Paul Ryan and Mitch McConnell had their way, I wouldn’t even have that option.)

What choice do I have there, Speaker Ryan? Buy the only plan they’re selling or pray I don’t get sick?

My Libertarian friends warn of rationing health care in single payer systems like Canada. Never mind that this characterization is a fallacy, what do you think is happening in the American system? We ration health care by wealth and class. If you’re rich enough, you get all the health care you want. But if you’re not, the insurance company decides what treatment you can and can’t have — not your doctor. The poorest among us are left with the fewest options. That is the definition of rationing, and it’s designed to hurt poor and working class Americans the most.

Worse? Most of you are paying these exorbitant premiums and ludicrous out-of-pocket costs like co-pays and deductibles, only to have the insurance company work double-time to deny payment to your doctor. Every year, hospitals and private practitioners spend billions appealing denied insurance claims. Doctors are left with no choice but to eat the cost or pass it on to you. Oh hey, did I mention that insurance companies have been posting record profits under Obamacare?

“The numbers are astonishing. The Standard & Poor’s stock index returned 135.6 percent in those seven years through Thursday, a performance that we may not see again in our lifetimes. But the managed care stocks, as a whole, have gained nearly 300 percent including dividends, according to calculations by Bespoke Investment Group.
UnitedHealth, the biggest of the managed care companies, with a market capitalization that is now more than $160 billion, returned 480 percent, dividends included. An investment of $100 in the company’s stock when Obamacare was signed into law would be worth more than $580.50 today.”
Source: New York Times

We’ve created a system where a handful of executives grow rich by charging people for a service they don’t intend to provide. In any other industry, that’s called fraud.

You’ve had this happen to you. You’ve had an unexpected visit to the ER, a referral to a specialist. You’ve handed over your insurance card expecting everything to be handled, received your treatment, only to end up with a surprise bill weeks or months later.

In 2005 I had emergency surgery. I was in excruciating pain and not in a state of mind to carefully study the fine print on my insurance plan. They drugged me up, rolled me into the OR, and took care of business. Months later I received a bill from the hospital. It turns out, almost everything about my surgery was covered by my plan — except the anesthesia. Set aside the silliness that my insurance provider decided anesthesia was “elective” in the case of my operation: that bill was several thousand dollars. I was fortunate to have a good job at the time. I was single, and had no debt, so I could afford to pay that bill outright. But it’s not hard to imagine what a surprise $3500 bill would do to most families living paycheck-to-paycheck.

When I think now on what my friend asked me eight years ago, I cannot look at my fellow human beings and tell them health is a privilege available only to those who can pay.

Every person has the right to life, liberty, and the pursuit of happiness. These are the foundational values of our nation. Over the years we’ve had to refine what that means. Each time we’ve made progress, we’ve reflected on the state of our nation and asked ourselves, “Does this uphold the unalienable human right to life, liberty, and the pursuit of happiness?”

Our for-profit health care system does not live up to this standard. It is, quite literally, killing us. It’s killing patients. It’s driving companies out of business. It’s running doctors and nurses into the ground — increasingly driving them to suicide.

American health care is in crisis, and a single payer system like Medicare for All is the only sensible solution. That fact is so thunderingly obvious to me now, I am sincerely embarrassed I ever thought otherwise.

This is why, today, I am standing up for Medicare for All. I’m done with the lies, I’m done with the excuses, and I’m ready to fight.

I will be a single-issue voter in 2018, and 2020, or however long it takes. Any candidate who does not stand for single payer will not only lose my vote, they will earn 100% of my time and energy devoted to their opponents who do. In fact, I can introduce you to a few.

If you believe it’s time to guarantee health care to every American as a right, then join me. Sign up for Brand New Congress and help us elect people who will fight for your health care.

Take a stand. Take the citizen pledge to #StandUp4Medicare and let your representative know: We are coming for you.

This piece is published as part of our #StandUp4Medicare Week of Action. I recorded my own pledge video (below). Today I am tagging my representative. You can join the fun. Go to standup4medicare.com to learn more.