Gearing Up for the DSA Healthcare Fight Part 2
From a critique of DSA momentum’s flawed notions of a grand March on Washington, now watered down to a “national day of action” I will turn now to the state of healthcare in America, and what I think we will need to do to fix it.
What then is to be done to shatter the healthcare consensus in the United States? How do we shift from a defensive crouch to an offensive spring? Why would you listen to anything I have to say about an issue that has vexed reformers since the beginning of institutionalized medicine in the US?
At 19 years old, I was struck down by a sudden attack of Inflammatory Bowel Disease. I lost 60 pounds over the course of a month because eating became an excruciating experience and I had up to 20 episodes of bloody diarrhea a day. After I was diagnosed, I began preliminary treatment, which did nothing to cure my illness. I had to leave work, I had to withdraw from my community college, I had to move home with my parents. I vividly remember trying to walk up stairs before my hospitalization, clothes barely fitting, and blacking out, only able to feel the sickening thud of my body crumpling at the foot of the basement stairs. I had lost so much weight that my father could pick me up and carry me out of the basement to get ready for the trip to the hospital.
Once I was admitted into Cleveland Clinic, I was presented with a choice, and a unique calculus in the industrialized world that Americans are faced with when they enter any medical facility.
I was seen by two sets of doctors, and presented with two very different options. I could undergo a series of major surgeries, which would probably cure me for life, or I could try a medication that may cure me, but I which would need for the rest of my life and which cost thousands of dollars per treatment. I was incredibly lucky to have insurance, but as a recent high school drop out, and generally as a working person I knew I may not have insurance at some point in my future. Cost was a huge factor that drove me to have my large intestine completely removed, something which could have been avoided if I was a resident of France or England, where the medication I was offered is completely free for their residents. Also weighing on me was the knowledge that an uncle had a similar attack in his youth, without insurance, and was kept from treatment by doctors who knew he couldn’t pay, which resulted in his bowels disintegrating in his abdomen leading to a year spent in the ICU recovering, and later a bankruptcy over medical debt. I still remember sitting at the table, home and recovering going over all the hospital bills. Had this happened when I was off insurance, my future would have been fucked.
This experience shaped my views on insurance and healthcare to say the least.
Now I am an ICU nurse at University of Chicago working on my masters in nursing at Purdue University Northwest. I have seen how America’s health care system works from the inside, having worked in nursing homes, Long Term Rehab, Hospice, and Emergency rooms in community and university settings. I have studied healthcare reform in school and on my own time and have been a single payer advocate for years. I work with my good friend Dr. Philip Voerhof who is an attending pulmonary critical care doc at U of C and on the national board of Physicians for a National Healthcare Policy, and we are working with to build a national strategy for radically restructuring healthcare in the United States to ensure equal access and health care justice.
I am super excited by the amount of energy that is being poured into Single payer advocacy, but many do not seem to grasp how complicated the problems of stitching together our fragmented system of healthcare fiefdoms is going to be.
I believe that no plan to fix healthcare in the US is going to work without a comprehensive plan to drastically expand the number of health care professionals, including primary care providers, general surgeons, Emergency Room docs, and Ob/Gyns available to the public. Nurse practitioners, nurse midwives and physicians assistants seem to be nowhere near this debate and we will need a way to ramp up education of MDs as well as these advanced practitioners while ensuring they are distributed and working throughout the vast swaths of under-served healthcare deserts throughout both rural and urban America. The same goes for other support professionals such as pharmacists, physical therapists, mental health professionals and technicians. Comprehensive funding for students will have to be brought on to break the chains of student debt that pulls MDs into high paying specialties and incentivizes revenue maximizing behavior. I work with young MD’s fresh out of school and the bitterness about student debt and the crushing realities of caring for those who must make healthcare decisions in the light of personal economics has made many of them ready to shift to new forms of healthcare delivery. To those who would resist us, to paraphrase Aneurin Bevan, we may have to “stuff their mouths with gold”.
Resources will have to be diverted from “healthcare cathedral” hospital construction to localized clinic systems in a big way. A national trauma care fund should be founded to build level one trauma care that everyone can reasonably access within the “Golden Hour”, as well as similar programs for stroke and cardiac centers.
Pharma will have to be broken, either through rigorous anti-trust action, medicare negotiations, or outright nationalization. The generic manufacturers should be nationalized to ensure that no critically important drug is on shortage (when I brought in the list of over 100 drugs on shortage to our working group meeting people actually left kind of frightened).
This is only scraping the surface of fixing the actual delivery of care, not to mention the insanity of our insurance system.
But the problems are familiar to anyone paying attention or personally affected by a health problem.
The issue of the strategy to fix it all seems to be stuck grinding away stuck somewhere between first and second gear. This is what I want to meet with you about, or talk over the phone. I suspect that Healthcare reform strategy will be a very contentious issue given the tone that the online discussion has taken over the past weeks.
We need to radically shift the narrative surrounding our health system and fixing it, while finding points of leverage that we have not noticed yet.
I have proposed within our working group some new tactics for the healthcare fight.
1) We need a Universal Healthcare pledge modeled on my favorite Leninist Grover Norquist’s Tax policy pledge so we can begin to identify friends and allies, as well as our enemies. Every politician in Washington and at the state level must go on the record in favor or opposition to a policy proposal that has majority support in the US. Until we know where people stand how can we pressure anyone?
2) We need to encourage militant healthcare themed direct actions, record and publicize stories of how healthcare in America is failing all residents, we need to hold intensive education events for internal and external consumption, and we need to be showing up at town halls, calling politicians, and generally calling out those who don’t support us while praising and supporting those who do. Key constituencies will be young doctors, nurses, nursing home assistants, labor orgs, the uninsured, and everyday people who are by all polling extremely anxious about the state of healthcare delivery in the United States.
3) Finally, on messaging, we need to invert the neo-liberal narritives that have surrounded these debates in the past.
-Collect healthcare horror story videos to spread far and wide across social media
-Emphasize how everyone with private health insurance is effectively paying a private tax, essentially at the rate of northern European social democracies, but with worse outcomes
-Expose the contortions all of us have to undergo that severely abridge our personal freedom to maintain access to healthcare
-Highlight the outright avaricious greed of Pharma, Insurance, and certain high level providers that are stealing healthcare from us.
4) We should keep the idea of a march on Washington on the table, but not before 2020, when we will be needed to put pressure from below on either a neoliberal democratic administration (hello president Zuckerberg!), or support a left populist administration in their struggle against the neoliberal centrists in congress, or worst case scenario put pressure on a 2nd Trump administration with hopefully enough left populists in congress plus terrified self interested neoliberals to present a plan to Trump that is effectively “an offer he can’t refuse”
I have never been so upset about the state of healthcare delivery in America, yet also so hopeful that our national healthcare nightmare will be resolved.
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