Medicare for All

The United States is unique among industrialized nations. Lucky for us, we can accumulate medical debt! Most industrialized and some developing nations have national healthcare programs that guarantee care to their residents. But we in the richest nation in the world have the freedom to get insurance through the free market, and go into debt when it doesn’t cover the care we need! USA USA USA!

According to the Kaiser Family Foundation (KFF), while over 90% of Americans have health insurance, we owe at least $220 billion in medical debt. Approximately 14 million people owe more than $1,000, and about 3 million owe more than $10,000. When the debt is cast more widely to those who have put medical bills on their credit cards or borrowed money to pay them, KFF found that 41% of adults have healthcare debt.

According to the US Census Bureau in 2021, Black and Latinx households are disproportionately affected by medical debt.  

Today we’ll dive into the topic of medical debt: who has it, who profits off it, and what can we do about it? 

What causes medical debt?

Believe it or not, our freewheeling use of the healthcare system is not to blame. In the US medical debt is caused by the high prices charged by hospitals, pharmaceutical companies, and insurance companies. While most industrialized nations have some means of controlling prices, in the United States the healthcare industry sets prices more or less however they want. As a result, according to a nationwide poll in 2022, over a five year period more than half of US adults report going into debt because of medical bills. 

Debt is preventing Americans from saving for retirement, paying for college, or buying a home. 

The 2022 poll found that 1 in 7 people reported being denied care due to unpaid bills. Two-thirds of those polled reported putting off necessary care due to cost. 

This is all despite the Affordable Care Act expanding insurance coverage to more Americans than ever before. Insurance companies increasingly shift costs onto patients, with higher deductibles and more claim denials. According to the 2022 KFF poll, 61% of insured Americans had medical debt in the previous five years. 

What makes medical debt so dangerous?

We know health systems are denying care to patients who have unpaid bills. And we know people put off care so they don’t incur more debt. Those barriers to care make us sicker, and they disproportionately impact people with higher rates of chronic conditions. The Commonwealth Fund found that 54% of people with employer coverage who skipped or delayed care reported getting sicker; 61% in individual market plans and 63% with Medicare reported the same. A 2024 study published in the Journal of American Medical Association found that medical debt is associated with higher mortality and premature death.

What happens when you can’t pay your medical debt?

When you think about all the real people on the end of those medical debts, that makes it all the harder to swallow a fact that gets relatively little attention in the broader conversation. Medical debt collection is a for-profit business. In many cases, non-profit hospitals sell debts to for-profit medical debt collections agencies. Some health systems even operate their own for-profit debt collection arms. Think of it: They set the prices for their services as high as they want, and on the other end of the equation, they’re making money off debt collection. 

Dr. Luke Messac of Brigham and Women’s Hospital testified at a July hearing of the Senate Health, Education, Labor and Pensions Committee that he learned that his and many other hospitals as well as collection agencies report sick, vulnerable patients to credit bureaus, garnish wages, seize bank accounts, and seek warrants for their arrest. And again, we have to highlight the evil practice of hospital systems that restrict patients from getting needed follow-up treatment until their debt is paid. 

These are not just a few bad apples. Aggressive debt collection tactics are widespread: a KHN investigation in 2022 examined billing and financial aid at 528 hospitals across the country and found: 

Medical debt doesn’t always go on your credit rating: Unpaid medical debt that is sent to collections can be reported to credit bureaus after one year, then remains on your credit report for seven years. As of a rule that went into affect April 11, 2023, medical debt can only impact your credit rating if it’s over $500. CPFD’s new rule would prevent debt of any amount from appearing. 

WATCH: If you need a moment of levity, a few years ago, John Oliver did a segment about the “grimy business” of debt collection.

How do we fix this?

Until we have a Medicare for All system that takes the profit motive out of healthcare, controls prices for care, and gives patients access to treatment with no cost at the point of delivery, we will continue looking for new and creative ways to help people survive in our messed up healthcare system. Fortunately, many Americans and even some of our elected officials are good at coming up with creative ways to help each other in times of crisis. Some solutions would be relatively simple for Federal, state or even local governments to enact:

Charity Care Eligibility: We have to hold non-profit, tax-exempt hospitals responsible for providing what’s known as “charity care.” In exchange for their tax-exempt status, non-profit hospitals are supposed to provide care and help patients determine if they’re eligible for free or reduced cost care or Medicaid. One problem is that charity care standards are vague; as a result, KFF found that charity care costs represented 1.4% or less of operating expenses at half of hospitals in 2020. Another barrier to access is that hospitals make applying for this kind of assistance overly complicated, something a patient in a health crisis rarely has the capacity to do. One solution is for the IRS to use existing authority to allow hospitals to verify patient income in real time, so they can access financial assistance or Medicaid. Hospitals could use software that’s widely available to “cut off medical debt at the source” and ensure that eligible patients receive assistance when they walk in the door for care. But they aren’t currently required to do this by federal law.

Buying and Forgiving Medical Debt: We’ve all contributed to GoFundMes to help people with medical bills by now. Another way to crowdfund medical debt: for ten years, an organization called Undue Medical Debt (formerly known as RIP Medical Debt) has offered Americans an easy way to buy up and forgive other people’s medical debt for pennies on the dollar (without lining the pockets of a corporate crowdfunding platform). Any individual can buy up medical debt for pennies on the dollar and go to sleep at night knowing they helped ease the burden on a fellow American.

Taking that idea to a new level, some cities and counties like St. Paul, Minnesota and Wayne County, Michigan have used federal ARPA dollars to buy up the medical debt of some of their residents. St Paul, MN with a population of just over 300,000 erased $100 million in medical debt for 43,000 residents. We know that when debt is erased, especially for lower-income families, that leaves more money for rent, groceries, and the other things needed to lift people out of poverty. While this doesn’t address the root cause of medical debt,

Medical Debt Cancellation Act of 2024: In May of this year, Representatives Ro Khanna of California and Rashida Tlaib of Michigan, and Senators Bernie Sanders of Vermont and Jeff Merkley of Oregon introduced legislation to eliminate $220 billion in debt, wipe it from credit reports, and limit the accrual of future debt. The bill create a grant program within the Department of Health and Human Services to to cancel medical debt, prioritizing vulnerable populations and debt owed to safety net hospitals. 

Consumer Financial Protection Bureau rulemaking to remove medical debt from credit reports: A proposed rule change by Biden Administration/Consumer Financial Protection Bureau announced on 6/11/24 would prevent almost any medical debt from appearing on credit reports. 

State Efforts: according to a 2023 Commonwealth Fund analysis, 20 states have financial assistance standards, and 27 have community benefit standards. The strength of these standards vary, as does eligibility to receive financial assistance, but several states have robust protections:

The Republican plan: Surely Donald Trump and JD Vance have a plan to address this crisis. Just kidding. Literally nothing comes up if you Google their names plus medical debt. 

Conclusion

Medical debt is a shameful part of our broken healthcare system. Relieving medical debt isn’t the solution. It is the right thing to do to relieve millions of Americans from immediate stress and hardship so they can focus on their health. But the real solution is a national health plan with price controls for providers based on what it costs to provide care, and low-to-no cost at the point of care, so patients can get care when they need it, without worrying about the debts afterward. With the patchwork of limited protections and relief on top of a system that allows unfettered profiteering by the healthcare industry, medical debt will continue to be a problem for Americans until we address the PRICE of care. Until then, we’ll keep you posted on mutual aid efforts that help Americans survive our healthcare hellscape.

Do you have a story about the way your community is coming together to support people who need healthcare? Please share it by emailing us at [email protected].

Don’t forget to like this episode and subscribe to The Medicare for All Podcast on  Apple Podcasts, Google Podcasts, or your favorite podcast platform!

This show is a project of the Healthcare NOW Education Fund! If you want to support our work, you can donate at our website, healthcare-now.org.Don’t forget to like this episode and subscribe to The Medicare for All Podcast on your favorite podcast platform!

Usually on the Medicare for All Podcast, we talk about people who want healthcare but can’t get it, but today we’re talking about people getting healthcare they have specifically refused: folks who have been involuntarily committed. For plenty of our listeners, the idea of being held against your will at a psychiatric institution feels like a nightmare from another time – something out of gothic fiction or horror movies set far in the past. But for folks struggling with mental illness in 21st century America, the terrifying prospect of psychiatric commitment is alive and well. In fact, a 2020 UCLA study found that in the 25 states where they actually keep data on this, the numbers of involuntary psych detentions have been sharply rising in recent years. Today, we’re joined by two experts in this dark corner of our healthcare system to talk about why so many people are getting committed and who is reaping the benefits.

Originally from Massachusetts Jesse Mangan has experienced a few different psychiatric hospitalizations and has spent over two decades struggling with the impacts of those experiences, so now he produces a podcast about mental health laws called Committable.

Rob Wipond is a freelance journalist who writes frequently on the interfaces between psychiatry, civil rights, policing, surveillance and privacy, and social change. His articles have been nominated for seventeen magazine and journalism awards. He is also the author of the 2023 book Your Consent Is Not Required: The Rise in Psychiatric Detentions, Forced Treatment, and Abusive Guardianships.

Jesse shares how he came to have so much (unwanted) expertise in psychiatric commitments, and how he turned that experience into a podcast, Committable. He was involuntarily committed and held longer than the standard of care dictated, past the date his insurance ran out. He was finally discharged with no real discharge plan and a big bill.

Rob tells us he’s been writing about mental health for a couple of decades. He says that the media typically portrays people who have been committed as really out of touch with reality, but he’s found that they’re far more like the rest of us. He watched his dad – who had no history of mental illness – go through a catastrophic health crisis that led to a depressive episode. Rob tells us that his dad was held and treated against his will for months. This happened in Canada where healthcare is guaranteed, so it’s a more complex problem than just enacting the right financing system.

A lot of people tend to think of psychiatric commitment as a barbaric tactic from the bad old days – like Nurse Ratchet in One Flew Over the Cuckoo’s Nest – but this is obviously a practice that continues to this day. It’s more common now for people to be held for a few days, rather than months or years on end. We only have data on these commitments from 25 states, but they show that these kind of commitments are rising dramatically.

Jesse explains that due to disability rights activism and investigative journalism, a number of federal cases in the 1970s established some basic due process standards for patients. At the same time the mental health system became increasingly privatized and our understanding of mental health changed dramatically. The expense of due process became a factor – as soon as a case reaches a court hearing, private providers become more likely to release the patient because of cost. State mental health laws have given a lot of authority to law enforcement and providers to detain patients on an emergency basis without a due process check until the point the facility wants to hold the patient beyond the emergency period (in many states 72 hours). The justification for holding these patients are often very vague and broad, posing a risk to many Americans.

Mental healthcare in this country isn’t a clearly defined system. Providers are often driven to be more conservative about holding patients because of a fear of liability if they don’t. The profit motive is certainly involved, but there are other motives as well: it’s widely accepted that forced treatment helps and is good for the patient. There’s also a social tendency to isolate people we deem dangerous from the rest of society.

Jesse highlights that we spend a lot of public resources on the court process for outpatient commitment as well. There are some resources that are only available to people on a court order, which incentivizes family and clinicians to seek a court order to get those resources. Advocacy on behalf of people with mental illness tends to be dominated by families and groups with more “respectability” leading to a generally paternalistic approach to mental health laws.

Because the US doesn’t have a federal healthcare system of any kind, those of us in the Medicare for All movement tend to attribute a lot of failings to that patchwork of coverage. Rob tells us that the same critiques (“chaotic” and “patchwork”) happen in Canada because systems are run provincially. The real elephant in the room is that there’s no evidence to support involuntary mental health treatment. There’s nowhere in Canada or the US where outcomes of involuntary commitment are tracked. Money is thrown at whatever the advocates or healthcare corporations claim will work, without any scientific evidence informing a consistent standard of care across the country.

Jesse also notes that there are interactions between the mental health system and the criminal justice system that Medicare for All won’t solve. In many cases patients are committed in order to restore their competency to stand trial (rather than to restore them to wellness). As soon as they are restored to competency and relased from the mental health facility, they are returned to the criminal justice system where they won’t receive treatment and may deteriorate again. Financing won’t solve mass incarceration and perverse incentives for treatment.

While we continue to advocate for Medicare for All, in order to make mental healthcare truly equitable, our guests stress that we need to make sure the system covers more than just medicalized treatments, and we need to…

Q6: This seems like one of those problems with US healthcare that M4A can’t solve on its own – as we fight for universal healthcare, what other changes do we need to be fighting for to make mental healthcare truly equitable?

Don’t forget to like this episode and subscribe to The Medicare for All Podcast on Apple Podcasts, Google Podcasts, or your favorite podcast platform! This show is a project of the Healthcare NOW Education Fund! If you want to support our work, you can donate at our website, healthcare-now.org.

If there’s one thing everyone is talking about these days, it’s JD Vance’s affinity for couches. But if there are two things everyone is talking about, it’s Vance’s couches and Project 2025. You may be wondering, what is this mysterious project, and what does it have to do with me? Well, it turns out, a lot! Project 2025 is the right-wing map to a terrifying future, and if its proponents have their way, the future of healthcare is especially grim. Today, we’re doing a deep dive into what this thing is and how it could change healthcare as we know it.

Gillian Mason, Healthcare-NOW’s Executive Director, has read Project 2025 so you don’t have to. P25 is the brainchild of the Heritage Foundation, the think tank founded in 1973 because conservative businessmen thought Richard Nixon was too liberal (remember that Nixon created the EPA and advocated for a better national health plan than Obamacare, so they weren’t all wrong). They really hit their stride during the Reagan administration when they wrote his policy playbook, which they called the “Mandate for Leadership” — Reagan implemented or initiated about 60 percent of the 2,000 policy changes they recommended. They do this Mandate for Leadership report now every presidential cycle, and it’s been pretty influential whenever a Republican wins.

These people are unabashed fascists. We use that term a lot kind of casually but these guys literally fit the Merriam-Webster Webster dictionary definition: “a political philosophy, movement, or regime that exalts nation and often race above the individual and that stands for a centralized autocratic government headed by a dictatorial leader, severe economic and social regimentation, and forcible suppression of opposition.” The Heritage Foundation’s whole deal is consolidating all authority in the office of the president so he can implement severe economic and social regimentation based on nationalism and barely-veiled-when-it’s-not-just-blatant racism.

Project 2025 It’s the “Mandate for Leadership” for this election season, so it’s supposed to be a template for Trump’s next four years. Although reading Project 2025 would make you think it was a room full of monkeys at typewriters type situation, it was actually written by a room full of Trump’s cronies. Hundreds of people contributed to writing and researching this thing, and a hefty percentage were former Trump appointees and employees of the administration.

Also, VP pick JD Vance just wrote the foreword for an upcoming book by Kevin Roberts, the head of the P25 team. Vance has also been a mouthpiece for some of the wilder shit in P25.

Trump claims he really doesn’t know much about P25. But it’s still worth talking about because COINCIDENTALLY it turns out that a lot of his policies are the same as the ones in P25.

The Premise: The liberals in Washington, in cahoots with Chinese Communists and the  “totalitarian cult known today as ‘The Great Awokening’” have put “the very moral foundations of our society are in peril.” (This is not an exaggeration— it’s literally all on the first page)

P25 has 4 main goals:

All the recommendations are laid out systematically according to the different areas of the federal government they want to control (The Executive Office, Department of Homeland Security, Intelligence Services, Media Agencies, etc.) We’ll mainly be focusing on healthcare today but context is important so here are a few highlights of what they’re planning to give you some flavor:

So what do these policy geniuses have to say about healthcare? Their overall goals are:

So our takeaways: ever since the GOP tried to overturn the ACA, they haven’t had a coherent health policy. Project 2025 really doesn’t move the needle. It’s mostly culture war nonsense that does not project any kind of vision of what they want to see in the future. While most opinion polls show that healthcare costs are still a major issue for American voters, they don’t touch on the topic in Project 2025. They would privatize all of our public programs, making more profits for insurance companies and putting fewer resources into patient care.

Don’t forget to like this episode and subscribe to The Medicare for All Podcast on Apple Podcasts, Google Podcasts, or your favorite podcast platform!

This show is a project of the Healthcare NOW Education Fund! If you want to support our work, you can donate at our website, healthcare-now.org.

It’s our 100th episode folks, and we are celebrating the only way we know how – by sharing our predictions of the grim, apocalyptic future that surely awaits us if we fail to get our healthcare system together! That’s right, we’re talking about the next pandemic, and if experts are right, it’s coming sooner than we think. In addition to several somewhat less familiar pathogens on the rise this summer, COVID is back, and this time it’s FLiRTy. Today we’ll go into some of the outbreaks currently threatening to explode into our next global disaster and explore how prepared our for-profit healthcare system is to keep us safe. Spoiler: It isn’t.

This emerging new pandemic situation is pretty serious, and more people should be taking it seriously. Forbes healthcare reporter Alex Knapp called this: “Hot Virus Summer.”

First, COVID is up! Again! It’s important to point out that COVID never really left – in 2023 75,000 people died from COVID 19, nearly 1 million were hospitalized, and plenty of people are still suffering from Long COVID. Now we have the new FLiRT variants — sexy! There are almost 34,000 new cases per week globally. 

Next up: Bird Flu, which has historically tended to infect birds, is evolving and has begun to infect mammals. For now, that mostly means livestock – so far 129 dairy herds in 12 US states. As far as animals are concerned this is already a pandemic – it’s impacting industries all over the world and could cause shortages of meat and dairy. You may be panicking: IS OUR CHEESE SAFE? Don’t worry, most commercially available dairy products are pasteurized, which kills the virus. 

There have, however, been three cases of the virus in humans reported in the US. Around the world, more than 50% of people infected with Bird Flu die from the virus. All three of those people in the US worked on farms in direct contact with birds and livestock, and right now the CDC is just limiting their warnings about Bird Flu to folks who also work in close contact with animals. BUT, scientists are warning that at any time the virus could mutate and become transmissible between humans, at which point, we would be facing epic disaster. 

How likely is that to happen? In August 2023, Dr. Michael Greger said of Bird Flu, “The question is not if, but when.” 

In addition to COVID and Bird Flu, Mpox (fka Monkey Pox) is having another moment, as is West Nile Virus, so there are a lot of ingredients in the virus stew we’re cooking.

So the best indicator of future outcomes is to look at how we’ve fared in similar situations in the past. Luckily (or not), the 2020 COVID outbreak is still fresh in some of our minds. You may remember that we, as a country, were not particularly well-prepared. For one, our profit-driven healthcare system creates disparities of access and care, which were exacerbated by the pandemic.

Also, we don’t have a truly cohesive public health program in this country. Health departments in various counties, municipalities, and states work largely independently of each other, so there was little to no coordination on surveillance and testing. We had to rely on private companies for important preventative measures like PPE and, most notably, vaccines (the research and development for which were PUBLICLY FUNDED with our tax dollars.)

During pandemics, a lot of people stopped going to healthcare facilities for elective procedures and surgeries – the real moneymakers for the for-profit healthcare system. That led to layoffs of staff at the same time that patients who desperately needed care struggled to get it. In countries with a national health system, hospitals don’t lose money if people stop going; they have a fixed amount to cover the operating expenses based on past history. So you don’t see mass layoffs and shrinking of the healthcare workforce when they are most needed.    

So if we were to do the whole pandemic over again – and it looks like we might, what preventative measures should we be advocating for?

Don’t forget to like this episode and subscribe to The Medicare for All Podcast on Apple Podcasts, Google Podcasts, or your favorite podcast platform!

This show is a project of the Healthcare-NOW Education Fund! If you want to support our work, you can donate at our website, healthcare-now.org. 

It’s the most wonderful time of the year! For activists in the movement to make Medicare for All a reality, this is the week when we gather to plot, scheme, and kvetch. Welcome to the 2024 Annual Medicare for All Strategy Conference, “Healthcare Beyond the Ballot Box,” organized by Healthcare NOW! For those of you who are attending the conference right now, you are getting a sneak preview of our Very Special Conference Episode!

Since our theme this year is about what happens to Medicare for All in an election year — and beyond — we wanted to invite some of our favorite policy people with their fingers on the pulse of what’s happening in DC to help us sort out what’s happening with healthcare on Capitol Hill and what role we can play to get some justice out of DC in the coming year!

powerpress

Our guests are Eagan Kemp and Alex Lawson.

Eagan Kemp is the health care policy advocate for Public Citizen’s Congress Watch division. He is an expert in health care policy and served as a senior analyst at the U.S. Government Accountability Office prior to coming to Public Citizen.

Alex Lawson is the Executive Director of Social Security Works, the convening member of the Strengthen Social Security Coalition— a coalition made up of over 340 national and state organizations representing over 50 million Americans. 

With one of our major candidates being a guy who is solidly against Medicare for All and the other being Trump, is 2024 a bad federal election cycle, or the worst federal election of our lifetime, and why? Alex puts a positive spin on it: we are closer to M4A with a Biden presidency than any other Democratic presidency. He’s definitely not a M4A guy, but all his other economic policies are based on Sanders-esque populism, rather than Obama-esque neo-liberalism. We’ve seen Biden enact serious corporate reform in several sectors, and in a second Biden administration, taking on corporate greed and sociopathy in health insurance is on the agenda. On the other hand, we know exactly what’s at stake with another Trump presidency, driven entirely by profit for his billionaire friends.

Eagan notes that there has been movement on Medicare in recent years, including die-hard GOPs shying away from talking about cuts to Medicare until after the election. At the same time, we’re seeing Biden moving more toward the M4A movement and the folks trying to expand and improve traditional Medicare. We’re seeing insurance companies running scared, feeling the pressure from our movement in a way they haven’t before.

Alex notes that Biden’s economic vision contains a lot that Medicare for All folks can work with. Our movement worked hard to expand Medicare to include vision, hearing, and dental, which was ultimately included in Biden’s Build Back Better plan. We didn’t get that, but we did get prescription drug negotiations, which is a huge part of improving Medicare before we expand it to everyone. (Go back and listen to another episode where we were joined by Alex to discuss prescription drug negotiations for more details.)

We’ve also seen a lot of good work against Medicare privatization, via Medicare Advantage, and that solidarity has moved the ball a lot – more than ever before to restrain private insurance companies. We didn’t just give up when we knew Biden wouldn’t sign M4A; we pivoted to expanding benefits and reversing the privatization with a lot of success.

Eagan found a silver lining in – of all places – the subject of private equity in healthcare. He thinks we’ve passed the peak of PE ravaging healthcare, and they are now backing off the healthcare sector in part because of increased pressure from the DOJ, FTC and HHS. That’s due to pressure from doctors, patients, and whistleblowers.

Eagan also notes that the Trump administration pilot of throwing seniors in traditional Medicare into private relationships with providers. Our movement worked with seniors to fight that off, and get the Biden administration to curtail the scariest parts of the “Direct Contracting Entities.” Alex credits FTC Chair Lina Khan for challenging corporate power and winning, in a way the FTC hasn’t in decades. Next up the FTC is teeing up UnitedHealth and their massive monopoly. Industry is scared. The movement is putting on the pressure, the agencies are getting wins and the media is starting to pay attention.

Ben says we’re seeing a significant shift in Democratic strategy around healthcare reform, away from the ACA model of just giving more money to private insurance, and toward taking on the industry and cutting off some of their income streams.

When we look at issues like prescription drug negotiations or curbing Medicare Advantage where we’ve gained some ground over the past year, it’s been due in large part to activists increasing the pressure. Public Citizen is working on M4A resolutions, seeing more excitement especially in southern states.

Alex says politicians are lagging indicators (they don’t start reflecting public opinion for a while after a shift happens) and he’s noting that even some are finally ready to accept that privatizing Medicare is ripping us off and killing people.

Another big shift is on the issue of the age of eligibility for Medicare. Not long ago we were fighting off attempts to raise the age to 67. Now President Biden is talking about lowering the age. Biden continues to feel the pressure on healthcare andhas resulted in some real progress.

We talk about the good, the bad, and the ugly post-election scenarios. Good would be a Democratic trifecta (there’s a path, if you squint a little) where we could make a lot of progress toward expanding and improving Medicare. In the Fair column would be another Biden presidency with a divided congress, in which case our movement will have to continue to work on executive actions the president could take. Ugly would be a Republican trifecta, which will immediately mean huge corporate tax cuts and possibly right-wing violence like we saw on January 6. In that case, our job will be to stand in solidarity with our allies against fascism.

It’s becoming harder and harder for people – politicians and voters alike – to deny that we’re on a bleak path. There’s been a real change on the hill, driven by organized people pushing for a better future. We’re seeing real results like drug price negotiations, insulin price reform, and bills addressing medical debt.

If we want to continue the work, one of the most important things we can do is get and stay engaged with our Members of Congress, and start building relationships with the people who are waiting in the wings to run for something in the future. Get involved in local elections now, and those are the folks who will be running for Congress and President in the near future. Tell them your stories! We may never have the perfect scenario with the perfect elected officials, but we need to be ready for M4A to have a moment. Keep building so we will be as ready as we can be.

Alex leaves us with the story of Eugene V. Debs. Socialist and labor leader Debs ran for president and lost several times (1904, 1908, 1912, 1920), but was all lost for his pro-worker priorities? A little over a decade after Debs’s final loss, Frances Perkins and the New Dealers essentially put forth his whole platform and got it done during the Roosevelt administration. If we don’t win M4A, don’t throw up your hands and give up. Keep laying the foundation so we’re the ones who are ready when the time comes.

TL;DR: organize, organize, organize.

If you’d like to hear more presentations from the 2024 Medicare for All Conference, visit the Healthcare-NOW Youtube channel!

Don’t forget to like this episode and subscribe to The Medicare for All Podcast on Apple Podcasts, Google Podcasts, or your favorite podcast platform! This show is a project of the Healthcare NOW Education Fund!

This show is a project of the Healthcare-NOW Education Fund! If you want to support our work, you can donate at our website, healthcare-now.org. It’s end-of-year giving season, and thanks to a generous matching gift from the United Steelworkers Union, every dollar you give will be doubled, so please make your way to our website and chip in!

We are in the middle of a resurgence of organized labor in the US. From Amazon workers to auto workers and grad students to baristas at Starbucks, everyone is getting in on the action! One of the big reasons workers are so hot to get that union card is because of… you guessed it, healthcare! Today we’re going to be talking union healthcare plans – how they work and how workers have managed to use collective bargaining to resist the national erosion of healthcare access. Most importantly, we’re going to take a deep dive into why, even with better healthcare, unions have been leaders in the fight for Medicare for All, and how they might save the rest of us from corporate healthcare hell.

Our guest Jim McGee has spent his entire career working in union health benefits, starting with the Plumbers and Pipefitters local he belonged to in Harrisburg Pennsylvania. For the past 20 years, he has been the administrator of the health benefits plan for Amalgamated Transit Union Local 689. He’s on the steering committee for the labor campaign for single payer healthcare, and he’s joining us today from Bethesda, MD.

Jim educates us on the two types of union health plans:

Typically both those options sound a lot better than what your average non-union worker is getting from their employer, though they are still subject to same rising costs and economic pressures as every other health insurance plan.

Given that union members are more likely to have health coverage than non-union workers, it’s interesting that unions have been at the forefront of the movement for Medicare for all. Many unions come from a rich progressive tradition that looks past the short term to the long term value of guaranteed healthcare for all workers. Jim also shares that the unions that are more exposed to competitive pressure in their environment are more likely to be supportive of Medicare for All. This is especially evident in less urban areas where locals are facing more non-union competition.

Jim notes that throughout his career, healthcare has been #1 cause of strikes. Taking it off the table would not only benefit the workers, it would benefit their entire community. Small businesses and non-union employers that offer poorer or no healthcare benefits to their employees often stay afloat on the backs of the unionized employers in their community that do offer good health benefits; this is an inquitable and unsustainable system.

Speaking of strikes, graduate student workers at Boston University are on strike right now over healthcare benefits among other things. Not only would Medicare for All take health insurance off the negotiating table (making more room for workers to bargain for pay, safety and other benefits), it would take away a the ability of employers to weaponize health insurance to break strikes; solidarity can crumble quickly when the employer stops paying those premiums at the first of the month.

Don’t forget to like this episode and subscribe to The Medicare for All Podcast on  Apple Podcasts, Google Podcasts, or your favorite podcast platform!

This show is a project of the Healthcare NOW Education Fund! If you want to support our work, you can donate at our website, healthcare-now.org.

The U.S. is wrestling with a massive mental health crisis – impacting young people in particular. Half of young adults and one-third of all adults report that they always feel anxious or have often felt anxiety in the past year. One-third of respondents could not get the mental health services they needed. Why? 80% say they couldn’t afford the cost and more than 60% said that shame and stigma kept them away. The shortage of mental health providers also means that care can be very hard to find, even when we try hard to find it. Usually on the Medicare for All Podcast, we focus on the stories we think you need to know about. Today we decided to scrap the show and come up with a plan to get an hour of free therapy!*

(*Not really. None of this information is intended as medical advice.)

Our guests today are Dr. Pamela Fullerton and Lindsay Baish. 

Lindsay is a therapist and an Licensed Professional Counselor (LPC) in Illinois and a certified trauma professional – and former volunteer for the podcast.

Dr. Pamela Fullerton, Ph.D., is the founder and clinical director of Advocacy & Education Consulting, a counseling and consulting organization dedicated to ensuring social justice and advocacy through equitable access to mental health and well-being services. She is a Latina bilingual Certified Clinical Trauma Professional (CCTP), a Certified Dialectical Behavior Therapy professional (C-DBT), a Certified Clinical Anxiety Treatment Professional (CCATP), a Certified Grief Informed Professional (CGP), and a clinical supervisor and consultant specializing in working with BIPOC communities, undocumented communities, immigration and acculturation, trauma, anxiety, life transitions, and career counseling. In addition to being a professional writer and speaker, Dr. Fullerton is an adjunct instructor in the Counselor Education department at Northeastern Illinois University. She is also a volunteer contributing writer for three publications and runs a nonprofit to support Latinx youth in the Chicagoland area. Dr. Fullerton consults for two behavioral health advisory boards, Sinai Urban Health Institute (SUHI) and Illinois Unidos/Latino Policy Forum, providing advice and input to assist in promoting health equity and justice initiatives for underserved communities in Illinois.  

Pam tells us that counselling is a subset of psychiatry and psychology that started as a movement for career development for veterans returning from war. The profession started helping people through life transitions puts people and their lives and livelihoods at the center.

Lindsay notes that a lot of the language of mental healthcare is used interchangeably, but there are distinctions: psychologists have PhDs and can provide therapists; psychiatrists have MDs and can prescribe medications. Counselors and therapists can diagnose but not prescribe.

Congress passed the Mental Health Parity and Addiction Equity Act in 2008 to prevent insurers from providing worse coverage for mental health than they do for medical or surgical treatment. However, mental health providers are not usually treated the same as medical doctors when it comes to insurance coverage and payments.

Historically, counselors are the newest mental health clinicians on the scene and are more limited by insurers than more established clinicians like social workers or psychologists. Insurers often only reimburse for certain therapeutic models of care (Cognitive Behavioral Therapy, for example) leaving other kinds of counseling uncovered in the midst of a crisis in mental healthcare.

Pam tells us that a big part of her job is the extra work to navigate her patients’ insurance plans, Medicare and Medicaid in order to get coverage for their care. Most Americans can’t afford to pay out of pocket for mental healthcare. Counselors just got approved for Medicare reimbursement on January 1, 2024, but Pam tells us her first application was denied, as was Lindsay’s supervisor’s. Couples and family counselors were just approved for Medicare as well.

Lindsay notes that no two insurance companies pay out the same rates, so some plans are not worth taking because the payout will be late, small, and requires hours of red tape to receive. Ben calls this “rationing by inconvenience.”

Illustrating the troubling priorities of the healthcare industry related to mental health, Lindsay shares a story about the Diagnostic and Statistical Manual (DSM), the encyclopedia of mental health diagnoses. The DSM is put together by the American Psychological Association, where panels of providers create and refine criteria and definitions for diagnoses. Those panelists are required to disclose who they have received funding from including pharmaceutical companies and insurance companies. A recent study found $14 million in undisclosed industry payments to some of those panelists, representing countless conflicts of interest.

Americans have responded in a lot of different ways to the difficulty of getting mental healthcare including millions who go to TikTok for mental health advice. On the bright side, many of us have found out we aren’t alone helping to reduce the stigma of talking about mental health. Unfortunately social media has also disseminated misinformation leading to mistaken self-diagnoses. Lindsay is actually on TikTok, talking about her specialty areas and social liberation issues in psychology, because it provides a space for some people who don’t feel welcome in the traditional healthcare setting.

Since COVID, we’ve seen the rapid growth of virtual mental health services. This feels a bit like the Uber-ization or Airbnb-ification of mental health services. In theory these platforms are great for access, but many are poorly regulated and the therapists are often not held to professional standards. The FTC found that one platform, Better Help, sold patients’ data.

One of the things we always say about Medicare for All is that it would take the business out of healthcare. What would it look like if we took the business out of mental healthcare? Currently most Americans’ insurance is tied to employment, and that plan can change due to their employer’s bottom line. There’s something particularly insidious about developing a trusting therapeutic relationship with a mental health professional only to lose coverage and having to start over finding another provider who will accept the new plan. Pam dreams of a healthcare system divorced from profit, where we can do more preventative mental healthcare and collective healing, and not wait until someone is in crisis.

Don’t forget to like this episode and subscribe to The Medicare for All Podcast on Apple Podcasts, Google Podcasts, or your favorite podcast platform! This show is a project of the Healthcare NOW Education Fund! If you want to support our work, you can donate at our website, healthcare-now.org.

We hear it over and over again – the private sector just does it better. Whether we’re talking education or healthcare or our criminal justice system, the default Republican (and sometimes Democratic) talking point is that competition in the marketplace allows the best ideas and best people (Elon Musk, lookin at you) to rise to the top and lead us to a utopian future (sponsored by Meta).

But then something wild happens like the cyberattack on UnitedHealthcare, which is causing massive fallout throughout our healthcare system over the past two weeks – so much so, that the company appears to have paid a 22 million dollar ransom to the hackers who breached their system and now the federal department of Health and Human Services has had to bail them out. That kind of thing really makes you question how anyone is still making the argument that the private sector has this shit handled. This episode, we’re bringing in special guest and political messaging expert Jordan Berg Powers to talk about how we talk about all of this stuff: public healthcare, private corporations, and how to message our way out of the corporate hellscape in which we currently find ourselves!

Jordan Berg Powers is a consultant and the former director of Mass Alliance. Most importantly, he is coming up on 30 YEARS of experience in campaigning and organizing for progressive causes and candidates. Jordan is a return guest to the podcast, first appearing in our My Big Fat American Healthcare episode.

UnitedHealthcare debacle is a little bit fun for us because we get to talk about the failures of a really shitty company, but like any healthcare debacle, there are some serious consequences. What happened here, and what does the UnitedHealth scandal look like for folks on the ground?

Starting on February 21, a group of hackers breached “Change Healthcare,” which is the largest electronic medical records and medical claims processing platform in the country. About half of all Americans’ health insurance claims pass through Change Healthcare, which was bought two years ago by UnitedHealthcare, the largest health insurer in the country.

Following the hack, Change Healthcare shut down its entire network, leading to complete mayhem in the healthcare system, which is still ongoing:

As much as we’d love to dwell on the UnitedHealthcare scandal that is unfolding, this incident really got us thinking about the broader debate over distrust of government, hatred of taxes, and bipartisan worship of market-based solutions.

Jordan explains the false dichotomy of government vs marketplace, public vs private; there is no marketplace without government. The question is, which way does the government tilt the marketplace playing field? The debate about government vs private market run healthcare isn’t productive. We should be concerned about the fact that we’re all being robbed to make rich people richer. UnitedHealthcare is owning so much of the healthcare marketplace is the result of 40 years of Wall Street profiteering at the expense of American patients and the security of our data.

Over the last 40 years the Right has been very successful at convincing Americans that the government is bad at everything. One slogan or one campaign can’t undo that. The message that does cross party lines is that we’re being ripped off.

The reason we need public programs like public education and healthcare is because they give the people oversight. Not only do they provide opportunities to the marginalized in our society, they are the only thing we can control.

It often feels like those of us who are fighting for the expansion of the public sector through programs like Medicare for All are constantly fighting the notion that government is dangerous, in part because the private insurance industry has controlled the national narrative about healthcare.

A weakness of the Left is letting the opposition frame the debate, and then trying to win the argument on their terrain. Jordan drops the truth bomb we all need to hear: you’ll always lose when you argue in good faith against bad actors. We have to control this impulse, and instead talk about our own good ideas not their dumb ones.

Another mistake we make is to fight an intellectual fight, when the Right is fighting about emotions. We need to work in the emotional state: this system is stupid, they’re stealing from us. We have to tell that story.

Ben reminds us of a report called “Parroting the Right” by Partners for Dignity and Rights, fka NESRI, which found that the health insurance industry got the entire media and polling landscape to use their framing when discussing universal healthcare. You won’t see terms like corporate-run healthcare or public insurance in polls about Medicare for All; you’ll see questions about government-run vs. private healthcare. It’s actually pretty remarkable with this biased polling language how many people still support Medicare for All.

Inside Medicare for All world we spend a lot of time talking about finding just the right words to articulate our cause. We love to talk about talking, but what we love even more is to fight about talking. One really good example is the internal movement debate about whether or not we should talk about healthcare in terms of human rights. A few years ago, Vermont nearly won single payer using rights based language. On the other side of the coin, messaging research in Minnesota found that voters had poor responses to rights-based language.

Rather than fighting about how we describe our solution, Jordan thinks that we need to get away from leading with solutions entirely; we need to take voters on the emotional journey first, before we bring them to the solution. We should start by talking about the broken system and lead people through their emotions of outrage. We need to be outside of for-profit hospital HQs and insurance giants, protesting that they’re stealing from us.

Instead of fighting about messaging and policy, what our movement needs most is people to have conversations with each other about how terrible healthcare corporations are. As fun as it is to fight amongst the choir, we need to talk to people and build the outrage. We don’t need more people who don’t know what they’re doing arguing about messaging and tactics; we need more people to talk to people, or pay someone to talk to people, says Jordan with the next great Healthcare-NOW t-shirt slogan.

Have you donated to Healthcare-NOW recently, by the way?

TL;DR: the #1 organizer question is “tell me how awful your life is.” Works in any setting, with any person: another patient in a clinic waiting room, a harried doctor or nurse, or an unorganized worker. The real “messaging” we need to worry about is the conversations we have with individuals. Instead of arguing about a hypothetical ad buy we can’t afford and won’t move the scales, work on the conversations!

Don’t forget to like this episode and subscribe to The Medicare for All Podcast on Apple Podcasts, Google Podcasts, or your favorite podcast platform! This show is a project of the Healthcare NOW Education Fund!

How much do you like this podcast? Did you learn something today? Please throw us a few bucks so we can keep providing content that helps you understand exactly how you’re getting screwed by American healthcare system! If you want to support our work, you can donate at our website, healthcare-now.org.

Occasional fistfights aside, most of our legislators make the choice to use their words when they’re angry, and a lot of those words go into public letters they write to presidents, officials, and even each other. Despite the fact that no one else in this country has written or read a letter in decades, the public comment letter is still popular with politicians, who have elevated this obscure literary genre to a competitive sport, using these letters to demonstrate their power, build alliances, and shape policy. Today we’re going to focus on one ongoing battle of letters over one of our favorite topics: the privatization of Medicare through a program known as Medicare Advantage. We’ll talk about how all the players in the debate about Medicare Advantage are engaging in that battle, and how it could impact our access to healthcare!

We’ve recorded a bunch of episodes about Medicare Advantage!

Medicare Advantage was created as a private, for-profit alternative to traditional (or public) Medicare, was the promise of lower costs… which never happened. Surprise: Medicare Advantage plans are FAR more expensive to taxpayers than traditional Medicare for covering the same person, costing taxpayers $7 billion more per year than if everyone were just covered by traditional Medicare. (source)

It’s the healthcare Joe Namath, Jimmy JJ Walker, and Big Papi are selling to seniors with big promises of coverage for vision and dental care, transportation, groceries, and more – for $0 premiums. Free shit!

Private companies drain public money to provide generally substandard insurance. These companies are exploiting a legit problem in Medicare, where many seniors are forced to pay premiums for medigap plans to cover stuff like chewing and seeing.

If you can’t afford the premiums for Medigap coverage, but you need to chew or see, you might be forced into an Medicare Advantage plan just because that’s what you can afford month-to-month. And that could be fine… until you need care and find out that the copays and deductibles are too high, there are super limited networks, or the insurance company refuses to pre-authorize your treatment.

But many of these MA plans don’t come through on their wild promises, and in fact, seniors end up being pushed out of MA and back into original Medicare when they are sick and actually need care. Private insurance companies love collecting money,but they hate paying money for the service they’re supposed to provide. Go figure! 

We put out a report about this! Taking Advantage

Who’s Who?

AHIP: “America’s Health Insurance Providers” is the trade organization for the health insurance industry. Unsurprisingly, they are big proponents of Medicare Advantage.

AHIP has written their own comment letters to CMS (the Center for Medicare and Medicaid Services) advocating for expansions to the MA program since at least 2015. Lately they also began coordinating their besties in the House and the Senate to write letters on their behalf. They claim that Medicare Advantage will expand the program to more seniors, and present some of their own research:

In 2021, 70 members of congress signed “dear colleague” letter, initated by initiated by Reps. Val Demings (D-FL), Mike Gallagher (R-WI), Marc Veasey (D-TX), and Gus Bilirakis (R-FL). 

In 2023 – 60 Senate signers – a good example of how this is insidiously bipartisan, John Fetterman signed right next to Ted Cruz

In 2024 – 60 Senators, but only 16 reps signed on to their version. That’s because of the OTHER letter, which Congresswoman Pramila Jayapal has been whipping up support for in the house.

The Good Guys

Organized resistance to Medicare Advantage is actually fairly new (last few years)! Just a couple of weeks ago a COUNTER letter was to Biden and the agencies that run Medicare calling for major reforms to Medicare Advantage and essentially pointing out that it sucks. The letter was led by three Reps – Jayapal, DeLauro, Schakowski – was ALSO signed by 70 Representatives, so suck on that AHIP! (P.S. there are 435 voting members of Congress, so most of Congress is taking the cowardly fence-sitting approach to Medicare Advantage) (source)

The letter makes four demands, one of which is already kinda sorta happening:

This last bit is particularly important, since it’s problematic to just end the MA program – this would require many low-income people to spend more to buy Medigap plans. They’d have much better coverage, but many can’t afford that better coverage. 

There will be a separate Senate letter, but we don’t have details yet. (There’s still time to ask your Senator to sign on.)

What does the Other Letter mean? It’s a show of power in a legislature where it’s difficult to put progressive policy up for a vote and actual voting ends in gridlock. Based on the numbers, we can see the tides turning on Medicare Advantage.

Remember that even though these letters are important for signaling shifts in the balance of power, the real organizing happens at the grassroots level, not on Capitol Hill.

Don’t forget to like this episode and subscribe to The Medicare for All Podcast on your favorite podcast platform! You can listen to Medicare for All on Apple Podcasts, Google Podcasts, or visit our website here.

This show is a project of the Healthcare NOW Education Fund! If you want to support our work, you can donate at our website, healthcare-now.org.

Jayapal Press release: https://jayapal.house.gov/2023/02/16/jayapal-delauro-schakowsky-lead-effort-to-reform-medicare-advantage/

Jayapal Full letter and signers: https://jayapal.house.gov/wp-content/uploads/2023/02/230216-MA-Letter-Final-with-Signatures3.pdf

AHIP press releases:

https://www.ahip.org/news/press-releases

Here at the Medicare for All Podcast, we love calling out all the bad actors in our healthcare system – greedy insurance companies, soul-less CEOs in Big Pharma,profit-hungry “non-profit hospitals”, and all our favorite villains. Mostly, we look at the ways those predators target sick people and poor people for exploitation, but today we’re looking at what happens when they start fighting each other for a bigger piece of the pie? Specifically, we’re going to explore the world of hospital consolidation – that’s when smaller hospitals merge to form bigger corporate entities who can battle it out with insurance companies to secure more of patients’ healthcare dollars! What does hospital consolidation mean for regular people? No spoilers, but it turns out that when giant healthcare monsters go at each other, much like when Godzilla took on Mothra, it’s the rest of us tiny humans who suffer!

Like every major industry in this country, healthcare is full of big corporations that will stop at nothing to get bigger, using the time-honored capitalist techniques of mergers and acquisitions to become HUGE corporations. But, of course, we live in America, where bigger is always better – what could possibly be wrong with bigger, better healthcare companies?

We start out this episode with a cautionary tale from Massachusetts that began in 1994, when two of Boston’s biggest hospitals merge to create a mega-corporation called “Partners Health,” which over the next two decades bought up… everything. This was a response to a national wave of insurance company mergers and consolidations, which allowed insurers to squeeze both patients and providers under “managed care.” Hospitals, not wanting to be out-squeezed, fought back with their own mergers, ostensibly so they could negotiate with insurance companies.

Of course, what actually happened was something much more nefarious – and secretive. In fact, we only know any of this happened thanks to the Boston Globe’s illustrious Spotlight reporting team, who dug up the truth in a 2008 article.

Basically, in 2000, Dr. Samuel O. Thier, chief executive of Partners HealthCare, and William C. Van Faasen, chief executive of Blue Cross Blue Shield of Massachusetts engaged in an unwritten agreement between the two entities without putting it in writing to avoid legal implications. The agreement involved Blue Cross Blue Shield giving significant payment increases to Partners’ doctors and hospitals, and in return, Partners would protect Blue Cross from allowing other insurers to pay less, effectively raising insurance prices statewide. This “market covenant” marked the beginning of a period of rapid escalation in Massachusetts insurance prices, leading to a significant annual rise in individual insurance premiums.

Partners used its clout to negotiate rate increases, pressuring other insurers to match or exceed the payment increases given by Blue Cross, leading to cost increases for consumers. In turn, Partners’ significant growth and influence in the healthcare industry compounded the impact of this backroom deal, leading to a substantial rise in medical costs in Massachusetts.

Partners employed aggressive tactics, resulting in major payment increases benefiting a few powerful hospital companies while leaving others behind. This led to significant payment disparities, with Partners’ flagship hospitals earning substantially more than other academic medical centers.

Partners is an outstanding example of the evils of hospital consolidation, but it’s not an anomaly. This episode was originally inspired by our friends at the Minnesota Nurses Association (shout out to Geri Katz), who last year were fighting a proposed merger of Fairview Health with Sanford Health, two giant corporations with dozens of hospitals and clinics.

Fortunately, the nurses and MN patients won this fight – merger talks were abandoned – but consolidation across the healthcare system in the United States has run rampant the past decade, with every possible healthcare corporation merging with every other possible healthcare corporation: hospitals buying other hospitals, for-profit private equity firms buying up anything they can flip for a short-term profit, insurance companies buying hospitals, retail pharmacy chains buying the pharmacy benefit management companies that exist only to negotiate with retail pharmacies. It has become almost impossible for free-standing, independent physicians to practice on their own, just as it’s become almost impossible for freestanding, independent community hospitals to survive. Whether you’re seeking care at a hospital, a physician’s office, a dialysis clinic, or a nursing home, the landscape facing patients is a shrinking number of mega-healthcare-corporations.

What are the consequences?

Generally, patients have fewer options for medical care. Between 1998 and 2021, the American Hospital Association reported 1,887 hospital mergers. By 2017, in most markets, a single hospital system had more than a 50-percent market share of hospital discharges.

Now all this negative talk about mergers might make us sound a little bit like old-school capitalists advocating for greater “competition” in the healthcare “marketplace” – but you know us better than that! Decades of for-profit healthcare in this country have demonstrated that market competition isn’t much better for patients than healthcare monopolies – it does nothing to decrease costs or improve care.

At Healthcare NOW, we’ll keep fighting to get the market out of our healthcare system altogether so we can stop talking about corporate nonsense like vertical integration and get back to focusing on health and human dignity!

Don’t forget to like this episode and subscribe to The Medicare for All Podcast on Apple Podcasts, Google Podcasts, or your favorite podcast platform! This show is a project of the Healthcare NOW Education Fund! If you want to support our work, you can donate at our website, healthcare-now.org.