Medicare for All Benjamin Day and Stephanie Nakajima - Healthcare-NOW

Usually we spend our time on this podcast talking about our for-profit healthcare system and why we need to make healthcare a public good, but in this episode we’re taking a detour into another privatized American system that should be public: our railroads! Just like in US healthcare, private companies are falling asleep at the switch on managing our railroads, and just like in the healthcare system, the failure of big corporations is costing money and lives.







Today, we’re joined by Michael Paul Lindsey (who goes by Paul, or Railroad Refugee on Tiktok) a locomotive engineer for 17 years. Paul is a Steering Committee member of Railroad Workers United, a huge inter-union labor caucus of railroad workers from across the country that is fighting both for Medicare for All and for making our country’s railroads public. We’re going to talk about the parallels between these two fights, why railroad workers support Medicare for All, and why we think everyone who’s passionate about Medicare for All should also get excited about establishing public railways in this country!









https://www.youtube.com/watch?v=qrNWHItT6iw

























Show Notes







RWU has been a supporter of Medicare for All for some time because railroad workers have so much trouble keeping decent healthcare while the rail companies try to gut benefits and use healthcare as a bargaining tactic against workers. Like other corporations, railroads use the increasing cost of healthcare benefits to cut into the other pay and benefits earned by railroad workers. They consistently shift more of the cost onto the workers, while claiming the benefits are so rich they can't also provide workers with paid sick time or better time off benefits.







Railroad workers, like so many other Americans, are locked into their jobs because they need the health insurance. In countries with a national health plan, workers have the basic economic freedom to leave their job if they don't like it, without worrying about healthcare. Those workers have better negotiating power because the employer can't hold healthcare over their heads. But in the U.S. railroad companies - and most large corporations - have more control over their employees because their families depend on employer-provided healthcare.







Most Americans aren't very aware of railroads and commercial rail. But commercial rail is integral to the entire modern economy. A recent example in California illustrates rail's reach into our economy: Union Pacific wasn't delivering sufficient amounts of grain to Foster Farms, one of the largest chicken and turkey producers in the country. Foster Farms was days away from having to slaughter millions of chickens. Union Pacific blamed congestion, and shortages of locomotives and workers for the delays, while in fact they had cut their own resources relentlessly to buyback stock shares. Only after the Feds ordered Union Pacific to increase grain shipments was the problem resolved.







So while many other industries depend on rail for their very existence, the railroad companies' focus on stock buybacks reduces their capacity to deliver goods, potentially wiping out entire industries. , reducing the capacity of railroads to deliver goods. Ultimately, taxpayers make up the difference because the cargo has to be delivered by trucks on the publicly subsidized highway system.







It's important to know more about an industry with so much control over the economy. For most of American history railroads have been privately owned. However when there wasn't enough capacity to support the war effort during the First World War, the U.S. temporarily nationalized the railroads, investing heavily in upgrades at taxpayers' expense.

Virtually all Americans know that our healthcare system is broken and that it’s working against us. But who is the villain in this story? Who is responsible for maintaining this healthcare system, and using it to profit off of patients? If we had to round up the usual suspects in a lineup, we’d probably end up with health insurance companies and big pharma. But what about hospitals? Many people like the nurses and doctors who care for them, and associate hospitals with those care-givers. But are hospitals equally responsible for the crazy costs of health care, for our poor access to care, and for the medical debt that is like a ball & chain on our personal finances? A new documentary sets out to answer this question. It’s called “American Hospitals: Healing a Broken System,” and our guest today is Wendell Potter, who is associate producer on the film.









https://www.youtube.com/live/6uLfGZE26lo

























Today's guest Wendell Potter is the former Vice President of Corporate Communications for the health insurance company Cigna. In 2008, he resigned, hung up his pitchfork for good, and became one of the industry’s most prominent whistleblowers, testifying against corrupt practices in HMOs before the U.S. Senate. Since then, he has become a prominent advocate for Medicare for All and universal health care.







Gillian starts by noting that we usually ID health insurers and Big Pharma as the worst actors in our healthcare system, the "villains" behind our dysfunctional system. She asks Wendell, should we add hospitals to the list?







Wendell says YES, hospitals are part of the rogue's gallery specifically because of price gouging - charging far more than they should, and more than hospitals in countries with Medicare for All are allowed to. Hospital prices bear no relationship to the cost or quality of the medical services they're providing, and many hospitals charge as much as they can get away with. They get away with it because they face much less scrutiny from employers, from Congress, the states, and even from advocates.







How do they get away with this? Unlike insurers and pharma, hospitals are part of our communities, they develop one-on-one relationships with their legislators and non-profits in their area.







Ben asks Wendell to tell us more about the principle crime hospitals are guilty of - price gouging - and how specifically does hospital pricing work? Hospitals charge whatever they can get away with, so even in the same zip code you'll find hospitals charging wildly different prices for the same service, like an MRI. Insurance companies have not been able to negotiate these prices down because some of these hospitals are so big they can't be left out of insurance plans, and in rural areas there might be only one hospital with absolute bargaining power. Moreover, insurance companies don't care that much about hospital costs - they're more than happy to pass those on to the rest of us in the form of higher premiums.







If you have insurance, when you get a hospital bill you'll probably see an enormous $ number that represents the alleged "price" of the service you receive, then you'll see a very marked down price that your insurance actually paid, creating the impression that your insurer has negotiated a massive discount on your behalf, sometimes 60% lower or even more. If you DON'T have insurance you might get that massive bill without a discount. Wendell explains that these huge hospital list prices are completely fake. Hospitals know that these prices will be negotiated down, and almost no one will actually pay the list price, so the game is to set that number as high as they possibly can to let insurers look like they've won something. If you're uninsured you are in the worst positio...

If you missed our annual Single Payer Strategy Conference, it's your lucky day. Today we share a conference presentation all about the impact of Private Equity on healthcare (spoiler alert: it's not good.) Our guests are Eagan Kemp, Health Care Policy Advocate at Public Citizen; Rachel Madley, Health Policy Advisor to Medicare for All Act chief author Representative Pramila Jayapal (D-WA 7); and Robert Seifert, Senior Fellow at Americans for Financial Reform.









https://www.youtube.com/watch?v=y0w0pV8EvYE

























Show Notes







Eagan talks about Public Citizen's recent report (with an emphasis on recent PE acquisitions and areas of concern, including end-of-life care, home health care, traveling nurses, reproductive care, and Medicare Privatization/ACO Reach)







Robert Seifert on AFR’s recent work in the space (depending on whether you want to present on the broader topic of PE in health care, you could definitely go before or after me)Rachel (as I think folks will be most excited to hear from her and be most likely will stick around for it) on Rep. Jayapal’s Healthcare Ownership Transparency Act and any other PE stuff she wants to raise.









https://www.citizen.org/news/action-on-predatory-private-equity-in-health-care-needed-stat-says-public-citizen/

When kids turn two or three years old, they learn to tell what is called a “primary lie,” which is lying without much sophistication or awareness of how the listener will perceive the lie (hint: you completely failed to fool your parents). But when we turn four, we learn to tell “secondary lies,” which take into account the listener’s likely reaction, and are more plausible. When we turn seven or eight we learn to tell “tertiary lies,” where we also make sure our lie is consistent with surrounding facts. But not until you’ve asked your legislator to support Medicare for All have you experienced the apex of deception: you walk out knowing they didn’t agree with you, but you’re not sure if they disagree with you, or whether you’ve learned anything about their position on the issue! So today we are here to talk about “legislative pushback,” or evasion, or avoidance - basically the whole playbook of tactics that legislators employ to land between “yes” and “no.”







We are joined by Eagan Kemp and Vinay Krishnan today. Eagan is the Health Care Policy Advocate at Public Citizen. He is an expert in health care policy, including single-payer systems, and he previously served as a senior policy analyst at the U.S. Government Accountability Office.







Vinay Krishnan is the National Field Organizer for the Center for Popular Democracy. We know him as an organizer, but he’s also a writer of fiction and non-fiction, and an attorney based in Brooklyn, NY.









https://www.youtube.com/watch?v=N2-A6ubjVII

























Show Notes







Medicare for All bills have not yet been introduced in the 118th Congress, the session that began in January 2023. Healthcare-NOW and our allies are starting our drive to gather co-sponsors BEFORE those bills are introduced. We expect the Medicare for All Act to be reintroduced before June in the House, and hopefully around the same time in the Senate.







We aren’t as dumb as Fox News conservatives like to make us seem, so we know that there isn’t a great chance to pass M4A this session, but it’s important to keep the momentum going by getting new cosponsors on the bill. Our past success in gaining co-sponsors has been due in large part to citizen lobbyists asking, pressuring and demanding their elected officials sign on.







If you've never called your Senator or member of Congress, we have a guide! https://www.healthcare-now.org/makethecall. Some calls will be easy if you're lucky enough to be represented by die-hards like Senator Bernie Sanders (I-VT) and Representative Pramila Jayapal (D-WA-7), the chief sponsors of the bills. But for many of the rest of us, our elected officials are wishy-washy, or even reluctant to sign on to M4A, so our guests give us some strategies for these conversations.







Before we get into the objections, we want you to know you don't need to be a policy or health economics expert to talk to your elected officials. If you've been victimized by the American healthcare industry, you're an expert.







While we've heard some wild reasons for not supporting M4A, most objections fall into a few basic categories:







Downplaying the importance of co-sponsoring the bill









"Medicare for All is just a slogan that's not going anywhere so I don't need to engage"







"I'm not on a committee of jurisdiction so I can't co-sponsor"







"I'm on a committee of jurisdictino so I can't co-sponsor"







"I'm in leadership so I don't co-sponsor bills"









Strategy: these answers tell you that the suffering of people in their district isn't important enough for them to take action.

Back in 2008, the TV show Breaking Bad asked a question that is still on a lot of Americans’ minds: How far would you go to pay for medical care? In Breaking Bad, the main character ends up building a meth empire to pay for his cancer treatment, which is a solution we don’t necessarily endorse, but you do what you have to do.







Today we’re going to be talking about real life (slightly less dramatic) examples of the lengths folks are forced to go to these days to navigate our for-profit healthcare system. From TikTok to Go Fund Me to class action lawsuits and appearances on the Dr. Phil show, ordinary people may not be selling meth, but they are turning to public platforms to get the care they need.







We are joined today by Jill Parkinson, who recently went viral on TikTok talking about her own health care horror story and is channeling that experience into Medicare for All activism!









https://www.youtube.com/watch?v=QS1dCAqcvb0

























Show Notes







Jill tells us her healthcare story, which begins with long-undiagnosed stomach pain since she was a teenager. In 2021 the pain got so bad that she went to urgent care. Diagnosed with endometriosis, Jill had two surgeries. She reports she did “everything right”: got marketplace insurance, paid her premiums, and paid the full amount of her deductible and out of pocket max of $7,500 upon checking into the hospital for surgery.







Following the surgery, she needed to immediately begin taking a prescription to prevent more pain and surgery yet again. She faced an epic runaround with her insurance company, the specialty pharmacy, and the hospital. Once she sorted that out, she assumed insurance would cover the full cost of the prescription, because that's what insurance is supposed to do! Even though she had met her deductible, she ended up paying $1,500 out of pocket for the prescription, and still didn't get it on time.







So Jill took to TikTok, and went viral within hours.









https://www.tiktok.com/@jillfrance/video/7197882383864220974









The responses to Jill's video elicited lots of advice and comments:









never pay up front or even pay at all.







Use Mark Cuban’s Cost Plus Drugs.







Getting drugs from Mexico or Canada. (Northwest Pharmacy Canada priced the same drug at $300.)







People told me to get a lawyer or call state authorities.







Go to the manufacturer’s website for a discount. (This drug was $1,600 and the max that the manufacturer will take off is $300, making it $1,300.)







"It’s Obamcare’s fault”







Ask for a grant.







“Karen as hard as you can. Karen harder than you ever have Karened in your life!!”







“Hang in there, medicare is freaking awesome.”







“This is why I can’t quit my job. My insurance is too good.”







“People with no money just don’t get surgeries. We just die and the world continues on.”







“When I had my son (my 3rd c section) the registration woman told me that if I didn’t pay my copay before leaving, I wouldn’t get to take my son home.”









Would you rather have a literal pain in the ass or have a pain in the ass lawsuit? Next our hosts and guest play Would You Rather: the Healthcare Edition. Ben tells the story of Christopher McNaughton, who finally found a treatment that changed his life–but insurance company decided he wasn't worth the cost.

2013 was a big year -- we had just survived 2012 (the year the Mayans thought the world was going to end), we were all doing the Harlem Shake on Vine, and -- most importantly -- our regular co-host Ben Day became the Executive Director of Healthcare NOW, the nation's leading Medicare for All advocacy organization. In this episode, Gillian interviews Ben about the past decade in the movement for healthcare justice, revisiting the highs, the lows, and the weird in-between shit!







Like a lot of folks, Ben Day began his journey to Medicare for All activism as a patient. He was a graduate student in Labor Studies in his 20s when he developed a panic disorder that put him in the hospital and racked up his medical bills. He was so outraged by the experience of getting hung out to dry by the for-profit healthcare system that he decided to change course and spend his life fighting to bring down the system!







Back in 2006, when Ben started as an organizer with Mass-Care, the Massachusetts campaign for Single-Payer Healthcare (This was before the term Medicare for All was commonplace in public discourse.), Massachusetts had just passed "Romneycare," a package of healthcare reform laws that became the model for the Affordable Care Act ("Obamacare"), so Ben got a preview of how trying to reform the system without eliminating the private insurance companies can go VERY wrong, resulting in limited networks and other industry tricks to keep profits high.







Of course, even with that insight into how reform unfolded in Massachusetts, Ben and other single-payer healthcare activists were marginalized and dismissed as naive radicals throughout the years of debate leading up to the 2010 Affordable Care Act, as moderate Democrats consolidated their efforts into demanding the policy non-solution that refuses to die: the public option. That ended badly both for advocates of the public option and advocates of Medicare for All, who lost out in the final version of the bill, but it was a positive development for private insurers, who now had millions of new customers lining up at their doors!







By the time Ben came to work for Healthcare NOW in 2013, the whole country was mired in the backlash from right wing Republicans fighting tooth-and-nail to "repeal and replace" the Affordable Care Act, which had become a political symbol of the Obama administration. Ben explains that this was a turning point for the healthcare justice movement, as regular people who hadn't been involved with politics before stood up at town halls and listening sessions across the country, not just to defend the ACA, but to push legislators further and demand Medicare for All.







Since then, we've seen massive growth in support for Medicare for All, and thanks in-part to Bernie Sanders, Medicare for All has been the top issue in the past two presidential elections, and Healthcare NOW is working with thousands of activists throughout the US to make Medicare for All a reality in our lifetimes. Ben speculates that even though we still have a fight on our hands to win, there are enough of us now that we won't be marginalized or dismissed in the debate about healthcare ever again!







Want to help us celebrate Ben's 10-year anniversary and make sure we get Medicare for All in a timely fashion so he doesn't have to do this job for another 10 years? Make a donation to Healthcare NOW today!