Mailbag Episode! Spilling the Tea with Ben and Gillian

This week Ben and Gillian take questions from YOU, our listeners, and Medicare for All activists around the country. We got some really great questions submitted over the past week, and some very saucy questions as well – well done listeners!

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Show Notes

Question from Susan Udin in NY:

“I was in the hospital a few weeks ago for 2 days. I went due to symptoms of stroke (aphasia) on instructions of my doctor’s office. When I got home, I discovered a statement in my discharge papers that I hadn’t actually been “admitted”. I was just there “for observation.” Then a few days after that, I got a letter from Highmark, my health care non-provider, that they deemed the stay and the tests not to have been due to an emergency and were thus not going to pay the costs.

My questions: Who profits from such non-admissions? Can Highmark get away with not paying? Are the hospital and Highmark in cahoots?“

ANSWER: Many insurance companies deny a huge percentage of hospital admissions; they are the ones profiting in this case. The hospital is actually the loser in this scenario; this denial means they’re not getting paid. You do have the right to appeal. (Additional detail from your friendly show notes writer: observation status can be especially problematic those covered by Medicare.)

Question from someone in MN:

“I am disabled and I have Medicare. I also need to have supplemental health insurance and prescription drug coverage. The total cost for Medicare and my other healthcare coverage is over $7,000 a year. My gross annual income is $20,000. It is very hard to live on what is left of my income after paying for Medicare and the supplemental insurance and prescription co-pays I have. Medicare is not good insurance unless you are very healthy or have a sizable income. As it is now, I don’t think Medicare for all would be a good deal for most Americans. It sure is not a good deal for me!“

ANSWER: the Medicare for All bill doesn’t just extend Medicare as it currently exists to all Americans. It expands the benefits and fills in all the gaps mentioned in the question. No premiums, no or very small co-pays. The person asking the question wouldn’t be paying $7,000 a year for Medicare under the bill we’re supporting. We want to make Medicare better and expand it to everyone.

Two questions about protecting Medicare for All:

Question from Jan in CO:

“How can we convince the public that Medicare For All will be different and not fall into the hands of the political party currently in office who would like nothing better than to prove how wrong it is for the government to make the rules around healthcare?  I’ve heard that services would be determined by a board of experts and patient advocates, not politicians; but who would be responsible for appointing these experts on the board and who would be selected as a patient advocate?   I love and advocate for M4A, but am having the same worries about politicians owned by special interests on both sides of the aisle.”

Question from James in IL:

“Will M4A be such that members of Congress and their families will have the same coverage as me and my family such that they will make it be the best that it can possibly be?  Will there be any people in charge of it (like CMS) that can distort it like CMS does now?  Can M4A be kept free of corruption, confusion, and consternation?”

ANSWER: If you look at the other countries with universal healthcare, there are often attempts to undermine and privatize their systems. It is a constant fight for all of them to maintain or expand their public systems. While we wish that passing the bill would mean we could retire from healthcare activism, we will have to keep fighting. The good news is that it’s far easier to preserve an existing program with hundreds of millions of recipients than it is to win a whole new system. Once the system is in place, we’ll have to protect it, but it will be very hard for our opponents to eliminate it.

Question from Alex:

“Do countries with universal healthcare run into significant shortage problems, or are the systems generally well-equipped?“

ANSWER: If we continued our current spending but switched to Medicare for All, we’d cut out a lot of waste like profits, administration, CEO bonuses, etc, and we would be able to put those funds into healthcare services. Since the U.S. spends more than any other industrialized nation on healthcare, that means we would have a lot of actual healthcare resources in a Medicare for All system. Other countries make budget choices that may result things like shortages and waits. For example, a lot of the horror stories about wait times in Canada come from the 1980s, when Conservatives there slashed spending on their healthcare system. If you underfund the system, you will have shortages. We have shortages and waits in the U.S. too, but they’re caused by prioritizing services based on their profitability.

Two questions about incremental reforms – do they help or hurt?

Question from Mary in PA:

“Do you think the Affordable Care Act helped or hurt the fight for healthcare for all?”

ANSWER: Both. The ACA was a setback in that we spent more to cover more people but didn’t challenge the healthcare industry in any way. So while more people got access to health insurance, we did nothing to address the high cost of care. It was positive in that the ACA passage created a narrative that we were moving toward a more universal healthcare system. The Medicare for All movement has exploded since the ACA, so there’s more wind behind our sails. But the model of letting the healthcare industry sit at the table and make decisions is a failure we can’t repeat.

Question from Heather in MA:

“Here’s an organizing Q…How do we keep the momentum going for M4A when we keep having to direct our attention and energy to an ongoing series of tangential attacks? E.g., DCEs/ACO REACH. This attack on traditional Medicare was an existential threat to Medicare and the M4A movement did right by focusing its resources and power on this issue. But these kind of drip-drip-drip assaults keep pulling us from the primary organizing we need to do to move M4A forward. Of course, all these attacks are related…but how do we keep our eyes on the M4A ball while having to deflect and regroup after every individual attack?

ANSWER: It’s a balancing act. We have to stay focused on our long term goal, but we also have to do what we can when people are suffering or at risk right now. We have periodic surges in our movement when healthcare is in the news and at the top of the agenda. We also have lulls no one is talking about healthcare and there’s no legislation moving. Even when healthcare is at the top of the agenda for the wrong reasons (for example, when the GOP had the White House, the Senate and the House and their first priority was repealing the ACA) we saw a huge surge in support for Medicare for All. So, playing defense against attempts to roll back healthcare gains can actually help us grow the movement while we’re fighting off the immediate crisis.

Question from Kevin in OH:

“What opportunities do you see to organize across constituencies in the fight for M4A? I feel like coordination with the Debt Collective around medical debt could be fruitful, as well as organizing with the employees of insurance companies and other medical offices – has any of this been pursued before?  What seems most promising to you?”

ANSWER: Gillian shares the pulpo (Spanish for octopus) model of organizing she learned while working on a banking campaign with international unions. If you try and catch an octopus by one leg, the octopus will yank off that leg and swim away. If you want to catch an octopus, you have to rope all of its legs at once and bash its head with a hammer. (Bet you never thought you’d hear that sentence in a healthcare podcast.) In the organizing context, this means pressuring a target from multiple directions: in the legislative arena, regulatory agencies, and organizing among the workers. So, yes, we should consider including workers from all sectors in our constituency. Ultimately our constituency has to be centered on the people hurt the most by the current system including people with disabilities, BIPOC, lower income people and so many more who have to be with us for us to win.

Question from someone (unattributed):

“I plan on going to the Healthcare Now conference in April, is there going to be anyone there who is organizing for the March for Medicare for All (M4M4All) in July?”

ANSWER: the folks organizing that event have a very different strategic approach than we do. If you want to learn more about why we don’t favor throwing people into national marches as a strategy, check out the episode “Do Marches and Rallies Work?” So, the issue of the March won’t be at the forefront of the conference.

And one final question from a hater, Thomas Cox in Florida:

“Why, after many efforts on my part, is Healthcare Now still ignoring the elephant in the room?

Common health care financing mechanisms embedded in Medicare/Medicaid, and private health insurance transfer insurance risk to health care providers, making those health care providers de facto health insurers and claims agents for their patients. As small, inefficient health insurers they have no alternative to reducing the quantity and quality of care they plan to provide to avoid losses and insolvency.

I have offered my book (Standard Errors: Our Failing Health Care Finance Systems and how to Fix Them) for free repeatedly  in which I describe exactly how this all happens, and yet you waste your time and effort distracting people from the root causes of the disaster unfolding in our country’s health care system.

Wasting my time sending me emails that further convince me that your are wasting people’s time and are part of the problem – not the solution.”

ANSWER: As organizers, we have a lot of research and evidence about what moves people and what doesn’t. Detailed, wonky policy arguments don’t move people to action. Think back to any successful movement, are any of your vivid impressions of those movements related to policy or legal arguments? Nope. We remember the people who had their lives ruined by inequities making moral calls to action. So that’s what we do.

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