It’s that time again folks… time for a Mailbag Episode! We reached out to our whole audience and all our supporters to find the pressing questions on everyone’s mind. Or at least we would have if Gillian hadn’t been too busy eating turkey to email our list. So instead, Gillian reached out personally to some of our superfans (anyone in her contact list who had previously admitted to listening to the show once) to find out what they wanted to hear from us. And here we are, with questions about everything from Ronald Reagan to elder care to dinner table conversation from some of our favorite stans!
Question from Liam Meyer in Massachusetts:
“Maybe discuss this on your podcast: Facing Financial Ruin as Costs Soar for Elder Care – The New York Times.”
“You could also talk about elder care and how wildly fucked up it is. One especially galling bit is how Medicaid is basically built to just ignore cognitive stuff. Almost all metrics are about physical health so, like, if someone’s grandpa **could** theoretically cook and shower themselves (ie, “He can stand up and walk, he still has hands!”), Medicaid says it all good even if grandpa doesn’t know where the shower is, leaves the stove on all the time, and continually eats spoiled food.”
Answer: “elder care” is a vague term that mooshes together lots of kinds of care for seniors. But “long-term care” is better defined, and has been a major focus of ours in recent years, needed not only by older folks but anyone with a physical or mental disability that means they need help with day-to-day living. Most of us will need long term care at some point in our lives.
What’s wrong with the U.S. long-term care system?
- We don’t have one!
- Very few people are insured for long term care
- Medicaid covers the vast majority of long term care services – you have to be or become poor to qualify (except in California, where Medicaid asset limits will be eliminated starting January 1, 2024!) We’ve heard many stories of people who have had to sell homes or farms, affecting their whole family, in order to become eligible for Medicaid.
- Institutional bias: Medicaid will pay for long term care in a setting like a nursing home, but not home-based care which is cheaper and better for quality of life.
Check our our long term care episode for much more.
Questions from Geri Katz in Minnesota:
“Have you listened to the 1961 Ronald Reagan Speaks Out About Socialized Medicine LP? Why has the AMA historically opposed single payer?”
Answer: in 1961, before Medicare passed and before he was elected Governor of California, Reagan was a washed up actor talking about how “socialized medicine” would ruin our country. He sounds like a ghoul: “One of the traditional methods of imposing statism or socialism on a people has been by way of medicine. It’s very easy to disguise a medical program as a humanitarian project. Most people are a little reluctant to oppose anything that suggests medical care for people who possibly can’t afford it.”
Reagan was paid by the American Medical Association (AMA) to deliver this speech, which was printed on an LP so you could host a house party with your socialism-hating friends. The AMA has a long history of opposing healthcare reform, such as:
- In 1948 when Truman proposed a national healthcare program – which was supported by an estimated ⅔ of americans – the AMA decried it as socialism and used member dues to fund a political campaign against Truman’s plan.
- After passage of Civil Rights Act in 1964, the AMA continued to allow medical societies to discriminate against physicians of color.
- The AMA has been involved in campaigns against Social Security, Medicare and Medicaid.
- The AMA is a scam! According to Dr Linda Girgis, “Perhaps the biggest example of how doctors lost their trust in the AMA is the way they are funded. With less than 20% of US doctors paying membership dues, it is apparent they secure funding from other sources. One of their biggest streams or revenue is their profits from selling billing coding, insurance, and other products. Most doctors disagree with the CPT-10 billing transformation. Yet, the AMA continues to profit hugely from selling these products despite our protests. Clearly, doctors’ opinions have been shoved under foot in their quest to drive profits.”
- The AMA only represents about 15% of physicians.
There’s some exciting organizing within the AMA to rescind the organization’s opposition to national healthcare. The membership is split but the student wing, the AMSA, recently passed a resolution calling on the AMA not to oppose single payer.
Question: “Do hospital mergers and acquisitions ever work out for the community? Could M4A put the breaks on healthcare consolidation?”
We started going down a rabbit hole on this one, so we’ll do a whole episode on this in 2024!
Question: in your opinion, who is the most evil healthcare profiteer of 2023?
- Ben’s initial answer was UnitedHealth, which is being sued for using artificial intelligence to automatically deny claims, but the truth is that most insurance companies are doing that. Let’s call the AI industry the villain of the year.
- Gillian is most pissed off at Texas Governor Greg Abbott, who signed into law a ban on gender affirming care for trans youth. He’s not technically a healthcare profiteer, but he’s a political profiteer who is collecting countless political points from the far right for taking away healthcare from vulnerable children.
- Ben gives an honorable mention to PhRMA (Pharmaceutical Research & Manufacturers of America) – the umbrella lobbying organization for the pharmaceutical industry – for suing the Biden administration for trying to negotiate drug prices under Medicare.
Question From Walter Tsou: Who are your healthcare heroes and why?
Answers: Gillian’s are Larry Kramer & the founders of Act Up, the AIDS advocacy organization that began in the 1980’s. Act Up was made up mostly by members of the LGBTQ+ community who took militant grassroots action to draw attention to the epidemic. Lots of Medicare for All activists came out of the AIDS advocacy movement.
Ben’s are Dr. Jack Geiger & the founders of the first two community health centers in the country, launched in the 1960s in Mound Bayou, Mississippi and right here in Boston, Massachusetts on Colombia Point. If you haven’t seen “Out in the Rural” – it’s a short documentary that is must-watch stuff for health justice advocates. The premise of the first community health centers was that it was ridiculous for medical providers to just treat patients’ symptoms when they showed up to a hospital or clinic, when often those symptoms were caused by poverty, by lack of work, lack of money, poor sanitation, inadequate or no housing, and structural racism. Or in the words of Geiger: “the idea that you stand around in whatever circumstances laying hands on people in the traditional medical way, waiting until they’re sick, curing them and then sending them back unchanged into an environment that overwhelmingly determines that they’re going to get sick.” So the Mississippi health center for example created a workers co-op that would allow their patients to own and run their own agricultural operations, creating jobs and income; they had a massive sanitation program installing toilets in patients’ houses and communities; they’d hand out prescriptions for food that their patients could cash in at local markets. Again in the words of Jack Geiger “We have been able to enter and to do things under the general umbrella of health that would have been much harder to do if we’d said we were here for economic development or for social change per se.”
Question: How do we overcome the fear that the crappy plans we have would be somehow better than government funded single payer?
Answer: This is the fear mongering they use whenever we get closer to passing something. But we know that no one likes their health insurers, or their insurance. We’ll need to do a lot of inoculation against this: Medicare gets rid of your insurance and replaces it with actual care. We know they’re going to lie, and we just have to be prepared to have even more one on one conversations about the truth. We’ll probably have to spend money to advertise too.
Question from Katie Worth in Texas:
“We had dinner with our cousin’s new boyfriend and he brought up that the French eat SO MUCH BETTER than Americans that they live three years longer than we do even though “we have the best medical care in the world here!” Naturally I launched into a heated lecture about how we actually don’t have the best medical care in the world except maybe for people who are extra rich, and in fact our crappy medical system is likely more to blame for our shorter lifespan than anything we eat, but his eyes glazed over immediately and he changed the subject as soon as he could. Do you have advice about how to respond to dumb bullshit in a way that won’t alienate our cousin’s new boyfriend?”
- The French don’t live longer than the U.S. because of their food (although it’s really good food) – they live longer because they have a significantly lower infant mortality rate than we do here in the U.S. When people die before they’re one year old, that brings down overall life expectancy a lot.
- BUT ALSO: the very low life expectancy in the U.S. probably is not due primarily to our shitty healthcare system. If you want an amazing read, pick up “The Status Syndrome” by Michael Marmot, which is about the huge body of research that has shown the primary driver of life expectancy and health outcomes is our social status and our position in the social hierarchy. More equal societies have better health outcomes and longer lives. The U.S. is one of the most unequal developed countries, in addition to being virtually the only one without universal healthcare, so it’s easy to get these two things mixed up when we’re looking at outcomes.
Question from Emily Mason in Massachusetts:
“Over the holiday, my more-moderate-with-age Uncle in law took the time to explain to me that while Medicare for All is great as a concept, it doesn’t make sense with the current political infrastructure surrounding healthcare, so we should forget it as an idea. What are some good talking points to fire back with other than ‘stop thinking like a boomer?'”
“Can you please just prepare an arsenal for me to argue with my snake oil salesman of an inlaw?”
People have always said that anything cool that disrupts the status quo isn’t feasible. But:
- Popular support for Medicare for All right now is around 69%. That’s more popular than The Civil Rights Act in 1964 (61%), Same Sex Marriage in 2015 (60%), and Medicare in 1964 (61%). Folks said those things were politically unfeasible too, but because they were popular and folks organized around these popular ideas, we won. We are many. They are few.
- We hate this the most when elected officials say this. They’re the ones who literally decide if the laws pass or not!
- Ask someone dying because they can’t afford medical treatment how feasible the current system is.
Dinner Table Notes:
- Always lead with the heart, not the stats
- Personal stories are more effective than data
- Avoid saying “I hope your family dies first”
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