Benjamin Day and Stephanie Nakajima of Healthcare-NOW break down everything you need to know about the social movement to make healthcare a right in the United States. Medicare for All!
Benjamin Day and Stephanie Nakajima of Healthcare-NOW break down everything you need to know about the social movement to make healthcare a right in the United States. Medicare for All!
COVID-19 "Long Haulers”: Our System is Failing Them
Chelsea has had 66 doctor appointments to manage her enduring coronavirus symptoms, which are appearing in almost every system of her body. She discusses the support group that she started to connect people struggling with the physical, mental, logistical, and financial struggles of COVID long haulers. The experience has turned her into a Medicare for All supporter; listen to her reflect on what it looked like to see people struggle with poor or limited healthcare access.
Stephanie and Ben pause to express their outrage at the Democratic Party Platform rejecting Medicare for All by a vote of 125 to 36. This is less support than the same motion received during the 2016 election year, even though a majority of Democratic voters in every single state backed M4A during the primaries.
The Democratic convention is a highly scripted affair, and the vote is a result of Biden refusing to give ground on Medicare for All - even in the face of a pandemic that is making employment-based healthcare a death sentence. The Platform also voted against expanding Medicare to ages 55 and up, as well as even allowing states to implement their own M4A plans. The DNC: a true profile in courage during a national health crisis!
This episode, for Medicare's 55th Anniversary, we invite our guest Chelsea Alionar, who is a COVID-19 "long hauler" - the term for people suffering from long-term symptoms of COVID-19, who are being completely failed by our healthcare system. Chelsea has suffered from a staggering range of COVID-19 symptoms: migraine headaches, cough, fever, rashes, impacts on her nervous system, lost sense of smell and taste, loss of hearing, tachycardia (rapid heart rate), arrhythmia (heart rhythm problems), insomnia, fatigue during the day, blurry vision, short-term memory... the list goes on. Other people have had GI symptoms and even worse. Living with these long-term symptoms - particularly memory issues and fatigue - has made it extremely challenging to continue working.
Chelsea has had 66 doctor appointments and hospital visits since the start of her symptoms. Fortunately Chelsea works for the Oregon Health Authority as a medical auditor, and has fairly good insurance coverage. In her job, Chelsea pours over medical charts, and understands standards of care that providers are supposed to meet, which makes her as well equipped as possibly anyone to navigate the health system.
However, Chelsea works closely with the "Long Haul Covid Fighters" - an international support group for COVID-19 long haulers - and she feels the healthcare system has let down 99% of them. In particular, Chelsea highlights the challenges faced by people who suffer from COVID-19 symptoms, but do not get a positive test (which she refers to as a "golden ticket," enabling you to get better coverage and care).
20 percent or more of COVID-positive patients receive "false negative" test results - that is, the test fails to detect the coronavirus - even when they are tested multiple times and are symptomatic. Chelsea hears from many long haulers that, without a positive test, you cannot get sick leave from their employer, and you cannot get your care covered by insurers or the government.
Chelsea reports that COVID long-haulers in the South are being hit particularly hard. She has one friend who feels she can't tell her story about suffering from COVID-19 because her family is Republican, and does not believe in coronavirus. Many other long-haulers also don't feel comfortable telling their story publicly, because coronavirus has been politicized, and they fear public backlash (as well as backlash from their family).
Does Chelsea support Medicare for All?
Solidarity Forever: a Labor History of Medicare for All
Mark Dudzic, National Coordinator for the Labor Campaign for Single Payer, joins us again to take a deep dive into the recent history of Medicare for All organizing within the labor movement, including the political calculations made during the failed Clinton health reform push, the changing landscape for unions through the Affordable Care Act, labor’s role in the creation of the center-left Healthcare for America Now (HCAN), and the direction labor is moving in the Sanders/Biden era.
Ben kicks things off on a rant. Recently diagnosed with gout, which leads to extremely painful inflammation in the joints Ben was warned by his doctor that the miracle drug that treats gout inflammation - colchicine - could come with massive copayments of hundreds of dollars. How? Colchicine is one of the oldest medicines in recorded history - described in Egyptian medical texts from 1,500BC, and used by the ancient Greeks to treat joint pain!
Colchicine has been widely available and prescribed by doctors at low prices for generations now, but in 2009 the FDA decided to give the patent rights for colchicine to one pharmaceutical company, which drove all the generic manufacturers out of the industry, and prices rose by more than 2,000 percent. Ben now has trouble accessing a drug that was readily available to Aristotle and Christ. Good job American healthcare!
With that rant over, we bring back our guest Mark Dudzic, national coordinator for the Labor Campaign for Single Payer to do a deep dive on the history of the Medicare for All movement, and labor's role.
Mark starts by pointing out that in the U.S., the linking of healthcare to our employment was an accident of history coming out of WWII. When wages were frozen during the war effort, the labor movement effectively pushed for and massively non-wage benefits - including healthcare coverage - for workers in the U.S.
However, the promise that Roosevelt made to implement an economic bill of rights following the war, including establishing healthcare as a public right, was never realized. Instead, a serious attempt by Truman to pass national healthcare in the late 1940s was defeated by Southern Democrats to protect structural racism in the healthcare system, and that was followed by a decade of red-baiting and anti-worker legislation.
During the entire postwar period, the official policy of the labor movement was to fight for a national health plan, until the 1990s. However, the late 1980s and early 90s marked a huge health crisis - huge losses in healthcare coverage, and surging prices. Bill Clinton ran on healthcare in 1992, and tasked Hillary Clinton with implementing health reform. However, the Clintons early on ruled out a single-payer system, taking the approach that Democrats need to coopt market-oriented policy from Republicans, and they promised to develop a universal healthcare plan with all the benefits of Medicare for All without taking on the healthcare industry.
Mark describes the Clinton reform as a classic example of bargaining against yourself, and predictably the healthcare industry took all of the concessions that were offered to them, demanded more, and then ultimately opposed and defeated the bill in the end anyway. The bill was dead on arrival, and it wasted a couple years of the Clinton administration's political capital.
The Clinton reform was also a turning point for the labor movement. The official policy of the labor movement had been supporting national health insurance for decades. Entering 1992, though, the AFL-CIO very narrowly - by a vote of 5-4 - decided to endorse the Clinton healthcare plan and retreat from Medicare for All organizing.
Labor and Medicare for All, Part I
Mark Dudzic, National Coordinator of the Labor Campaign for Single Payer Healthcare, talks about his experiences as a union president that led him to become a Medicare for All activist. He answers our questions about the conflicts in the labor movement over Medicare for All that played out in the presidential primary, the Supreme Court decision in Janus vs AFSCME, COVID-19 and the Democrat’s COBRA proposal, and more.
On the pod today, is our special guest Mark Dudzic, National Coordinator of the Labor Campaign for Single Payer Healthcare!
Mark got into this movement originally as the president of an Oil, Chemical, and Atomic Workers union local in New Jersey, which struggled more and more to bargain healthcare benefits for workers. After learning about Medicare for All, the union embraced taking healthcare off the bargaining table as a core issue.
Today, Mark sees Medicare for All as THE central issue for building a just world for working people.
Stepping back just before coronavirus struck, M4A was the #1 issue in the Democratic presidential primaries. One of the most common attacks coming from Biden, Buttigieg, and Klobochar was that M4A would "take away" unions' workplace insurance. Mark was stunned by the explicit celebration of our crazy system linking healthcare to employment - which means you can lose your healthcare when you lose your job, or if you go on strike, or if you get sick. (He wrote up his response in an article titled "Employment-Based Health Care Is an Anchor around the Neck of the U.S. Working Class.") He suspects this messaging was developed by cynical PR experts playing on peoples' fear of losing the access to healthcare they have. Similar messaging is being targeted at seniors: raising the fear that if everyone has Medicare, seniors' Medicare will be taken away or undermined.
The good news? Mark argues this fear-mongering against Medicare for All simply did not work this primary election cycle. In every state Democratic voters favored M4A, regardless of who they voted for - even in the face of attacks from many of the leading Presidential candidates.
What does it look like for union and non-union workers in other countries that have a Medicare for All type system? Mark says we are the only country where workers essentially have to beg their employer for healthcare coverage, and it significantly undermines their power and leverage over key workers' rights - we are also the only country without guaranteed paid leave, guaranteed due process on the job, etc. Workers waste so much of their bargaining power on healthcare here, it has a tremendous impact on other working conditions.
What about the Las Vegas Culinary Union, which on the eve of the Nevada primaries took a run at Bernie Sanders's support for Medicare for All, implying it would "take away" their union health benefits? Mark says this was a watershed movement for organized labor. The Culinary Union is a really good union - through decades of struggle, they've succeeded in lifting a primarily immigrant, low-wage group of workers into the middle class. In part because of this history of activism though, Culinary Union members rejected anti-M4A messaging from their leadership, and by all evidence voted overwhelmingly for Bernie Sanders, and in support of M4A. This was a real wake-up call for union leaders around the country.
Now our favorite topic: coronavirus! The current pandemic has the potential to completely transform the conversation around Medicare for All with workers and unions. Mark notes that we have really seen here a collapse of the employment-based healthcare system. 27 million workers have likely lost their health insurance,
The Longterm Care Crisis in the United States
We talk with Linda Benesch of Social Security Works about the state of longterm care in the United States - the skimpy coverage provided by public programs like Medicare and Medicaid, the outrageous costs, the for-profit corporations running the vast majority of our nursing homes, and the people - the 70% of Americans who will eventually need longterm care - who are left behind. We explore how Medicare for All would finally establish longterm care as a right and ensure our dollars are spent on care rather than profit.
Ben & Stephanie reflect on police violence and systemic racism in the U.S. - how insane we appear from the rest of the world, and how racism in healthcare probably kills more people than racism in the criminal justice system, but has far less visibility.
We turn to Linda Benesch, Communications Director at Social Security Works, to talk about long-term care (LTC) in the United States (we got an incredible window on long-term care in Denmark last episode). Linda highlights that, although we think of long-term care as a service for seniors, almost half of people in the U.S. who need LTC are under the age of 65 living with a disability. The disability rights movement has also played a leading role nationally in advocating for LTC.
If you need long-term care and don't have a family member to care for you for free, your options are very bad. Nursing homes cost $100,000 per year on average - as Linda says, this is really a 99% vs. the 1% issue, since almost no one can afford that without a national LTC plan. Since only Medicaid (and not Medicare) covers LTC, and you have to be poor to qualify for it, to get LTC you will need to sell your home, sell your car, spend down your savings, everything you've worked your whole life for, to make yourself poor enough for long-term care.
Remember that study from the last podcast where you'll need to save over $240,000 for medical and LTC costs to retire at 65? Woops - Linda tells us that's only for medical care, and won't help you with LTC expenses. To retire with dignity in America, you essentially have to be a multi-millionaire.
Why does LTC cost so much in America? For-profit companies and private equity firms are rampant in the long-term care system, and they profit by driving up prices on the one hand and squeezing staff (paying them poverty wages, understaffing) and slashing services for their clients. On top of this, Medicaid drives people into nursing homes, even for people who could be autonamous and functional receiving home-based care for less.
The Medicare for All movement has been increasingly embracing the movement for comprehensive long-term care. Rep. Jayapal's Medicare for All bill in the House would cover all long-term care with taxpayer dollars, free at the point of service - much like Denmark! It would also remove the bias towards providing LTC in facilities like nursing homes, and prioritize home-based care.
Only something on the order of 7% of people have any private long-term care insurance, so - unlike universal medical care - there is no massive private insurance system that defenders of the system can try to defend. How does anyone defend our system of LTC? Linda says they don't have to - the conversation is mostly out of sight & out of mind, and is kept there intentionally.
Time for a change!
We close with a smack-down of AARP, the group supposed to be advocating for seniors in the country, which is deeply compromised by corporate partnerships and income from health insurance and LTC companies.
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Longterm Care in Denmark vs the United States
Stephanie’s father-in-law, a Danish citizen, is currently moving into assisted living just outside of Copenhagen. His flat is only $1,000 per month, and the home help and rehabilitation he’ll receive is totally free of charge. We wondered about the differences between the U.S. and Denmark’s longterm care system, so we invited a special guest to join this episode: Jon Kvist, a professor at Roskilde University and expert on Danish social welfare systems. We talk about how the Danish longterm care system works and contrast it to what is covered under Medicare and Medicaid here in the United States.
Depending on the state, anywhere from 40% to 60% (or more) of coronavirus deaths in the United States are taking place in long-term care facilities such as nursing homes [note: Ben incorrectly said 50 to 60% on the podcast]. This is due, in part, to our terrible system of long-term care (at least as bad as our medical care system!).
Stephanie's father-in-law is being transitioned to an assisted living facility. Fortunately, he's Danish, where long-term care is covered as a right - just like healthcare. His only expense will be roughly $1,000 per month for rent of his new apartment.
We introduce a special guest to the program: Jon Kvist, a professor at Roskilde University, and an expert on the long-term care system in Denmark.
First things first: What is long-term care (or LTC)? "Long-term care generally refers to non-medical care (ie, custodial care) for patients who need assistance with basic daily activities such as dressing, bathing and using the bathroom. Long-term care may be provided at home or in facilities that include nursing homes and assisted living."
Who gets access to long-term care? Here in the United States, almost no one. Medicare - our public healthcare program for seniors and some people with disabilities - incredibly does not cover long-term care! Most people have to get LTC through Medicaid - which means making yourself poor.
Professor Kvist tells us that Denmark has a universal system for long-term care. If you can demonstrate a need for long-term care, it will be covered largely for free - so it is purely needs-based. LTC in Denmark is run at the local level, so it varies somewhat by "municipality" - although the richer municipalities redistribute their funds to the poorer municipalities.
By European standards, the Danish government spends a lot on LTC - almost 3% of their total economic spending. But as Professor Kvist points out, if you don't cover LTC publicly, a lot of care will be paid for privately OR provided informally by family members - particularly women are forced into this role.
American couples are supposed to save over $240,000 for long-term care and medical costs alone if they want to retire by age 65. How much does the average Dane have to save for retirement? "Close to $0" says Professor Kvist. When you retire in Denmark, you will be taken care of, with the understanding that you will pay into the system when you are healthy and working.
The good news for Americans? Ben is only $240,000 short of his retirement savings goals! Ben asks about Danish refugee status for Americans who can't afford to get older in the U.S. - and Professor Kvist says that we're welcome!
Another problematic feature of the American long-term care system is what's called "institutional bias": in many states, Medicaid is required to cover institutional LTC (meaning LTC at nursing homes, or assisted living facilities), but does not cover LTC provided in people's own homes, which is cheaper, provides a better quality of life,
New Sanders/Jayapal bill: the Healthcare Emergency Guarantee Act
Next week, Medicare for All lead sponsors Sen. Bernie Sanders and Rep. Pramila Jayapal will introduce a bill that will authorize Medicare to fully cover medical costs for the uninsured until we have a widely available vaccine for COVID-19. The bill would also provide wrap-around coverage for everyone on public or private insurance. We contrast this bill to the other two healthcare proposals competing for a place in the next relief package. The Koch brothers are trashing Medicare for All with a new healthcare campaign. Health insurers continue to make a profit, but are still crying for help from Congress.
Burglers broke into the Healthcare-NOW office this past week! They stole loose cash and trashed our non-profit. If you're able to help us with our moving costs, you can donate here.
Back to the Medicare for All movement! Congress will soon be taking up a "CARES 2" relief package, and the million-dollar question: will there be any relief for the millions of people losing their health insurance (because they lost their jobs)?
There are now three Democratic proposals, but it's unclear whether any healthcare reform at all will be able to make it through the Senate (which is a shocking prospect).
We're fans option #1: the "Health Care Emergency Guarantee Act," which will be filed by Senator Bernie Sanders and Representative Pramila Jayapal. This would empower Medicare to cover every U.S. resident, until a vaccine for COVID-19 is widely available. Every uninsured resident would be covered, and Medicare would also cover co-pays and deductibles for everyone with private or public health insurance. This would achieve the access goals of Medicare for All, but not yet eliminating private insurance - that would have to come next for the program to be sustainable.
Contrast this with option #2: the "Worker Health Coverage Protection Act," which is being championed by Democratic leadership, including Nancy Pelosi. This bill would 100% subsidize the premiums for COBRA - this is the law that lets some workers stay on their previous employer's healthcare plan, if it still exists.
There is also a new proposal, option #3: the "Medicare Crisis Program Act," filed by Reps. Pramila Jayapal and Joe Kennedy. This would enroll all of the recently unemployed (since the pandemic) in Medicare, although you would still have to pay most of Medicare's co-pays and deductibles (up to 5% of your income). We like this plan better than the COBRA subsidies: way more people would be eligible, and it's not a giveaway to for-profit insurance companies. But it does still leave out the previously uninsured, and the co-pays and deductibles could be worse than COBRA coverage for workers who had really good healthcare previously (like some union members).
Now that we've summarized all of these Democratic bills, bad news: it's unclear whether the Senate will agree to any health insurance relief at all. Senate Republicans have signaled that they want to extract all sorts of concessions (liability reform, tax cuts) if they agree to even things like aid for states and municipalities. Democratic leadership in the Senate have a list of priorities, but healthcare isn't one of them. Is it possible that 30-40 million people will lose their health insurance - during an unprecedented health crisis - and Congress will do nothing? Sadly, yes: it's possible.
Next up, the Koch brothers are getting in on the healthcare game: the Koch-funded Americans for Prosperity have launched a national healthcare campaign. They're saying their plan is the anti-Medicare for All proposal, but they mostly want to deregulate prescription drugs and other provider regulations...
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Sorry to say goodbye
I’ve listened to every episode and in some cases learned something new. I was always aware of the correspondents support for Bernie but was able to overlook the bias. However, now that Bernie has withdrawn from the presidential race, the bias has turned to snarkiness and I just can’t take it. If I hear that the show regains an objective focus on and advocacy for M4All I may consider a return.