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.

Just this Monday, we celebrated Martin Luther King Day, a tribute to one of the great leaders of the movement for racial justice – but something that often gets forgotten in the flurry of MLK quotes that become memes this time of year is that equity in healthcare was a crucial part of King’s vision. Throughout his career in activism, he often stated his conviction that “Of all the forms of inequality, injustice in healthcare is the most shocking and inhuman.” Sadly, over 50 years after his death, racial inequity in healthcare is even more shocking and inhuman. Today, we’re joined by public health expert Walter Tsou to do a deep dive into the horrifying world of racial health injustice, how we got here, and how we make real change.

The show is joined on MLK Day by Dr. Walter Tsou – past president of the American Public Health Association and former health commissioner of Philadelphia! Gillian asks how Walter dedicated his life to health access and health equity. When Walter graduated from med school he stumbled into a job at a public health clinic in West Philadelphia that treated patients lacking private insurance or the money to afford medications, which gave him his first window into the deep economic, racial, and health divides in the U.S. This launched his career in public health advocacy.

Walter served as the Health Commissioner of Philadelphia from 2000 – 2002, and to him the most stark racial inequity he had to deal with was the gap in infant mortality – black infants at that time were 2.5 to 3 times as likely to die before reaching age 1 than white infants. Walter looked up the most recent statistics in preparation for the podcast, and the number had barely changed. The traditional way that states are pretending to do something about infant mortality is to create an Office of Equity contained inside their Department of Health that has maybe two staff people. To make a real difference in infant mortality, Walter says, you have to tackle the largest social determinants of health – education, job opportunities, housing, transportation, and so on. Two or four people in an Equity Office aren’t going to make a difference – it’s window dressing.

On top of this, Walter says, the U.S. has abandoned most of its community health work, which was widespread under LBJ’s Great Society programs after WWII, when community nurses would go into communities and address social determinants of health.

Gillian backs up to share some of the big-picture distressing findings from the Commonwealth Fund’s scorecard on racial equity in U.S. healthcare:

Walter highlights that the history of racism in U.S. healthcare, including the infamous Tuskegee syphilis experiment on black men, meant that when COVID struck, communities of color generally had less trust in the medical system and the opinions of medical experts, in addition to being more impacted by social determinants of health.

How would Medicare for All impact racial inequities in healthcare? It would be a huge step towards leveling the playing field, but it’s not a solution by itself – there is a huge concerted effort needed to guarantee equal access to health services, and M4A would also not in itself address social determinants of health (education, housing, environment, etc) that have such a profound impact on whether we get sick or injured in the first place. Ben points out that our current healthcare system is linked to the job market, where most people get their health insurance, and if you don’t get healthcare through your job then it’s linked to your access to money, to purchase insurance on your own. This means that any racism in the job market has an impact on your healthcare coverage, and any racism in access to money and financial security also impacts your healthcare coverage. Medicare for All would at the very least de-link your health coverage from these other systems, which are deeply marked by racial inequities.

Walter closes by talking about how the tide within the physician community is turning towards support for Medicare for All, as doctors face more and more barriers to treating patients. A younger generation of doctors is leading the charge within the American Medical Association and state medical associations.

Our podcast manager is Angelique Davis, our researcher for this episode was Sophia Simeone, and our audio editor was Christian Brandt!

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 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!

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?

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:

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?

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?”

Answer:

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?”

Answers:

People have always said that anything cool that disrupts the status quo isn’t feasible. But:

Dinner Table Notes:

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!

Open enrollment. Deductible. Coinsurance. HMO. Indemnity plan. If you’re listening this far, you probably have a migraine already. Understanding the language of the health insurance industry, let alone selecting a health insurance plan, can be confusing, frustrating, and disheartening. But never fear – we are here to give you a crash course on everything you need to know about your insurance plan. No need to scroll through Healthcare.gov’s Health Insurance glossary and risk throwing yourself out the window…

We want to give you some tools here to understand what you’re choosing when you pick a healthcare plan, but no one but you really knows what’s best for your health, so (for better or worse) we aren’t going to give any actual advice here about what healthcare plan to pick. 

Also, all health insurance kind of sucks, so you will probably get screwed no matter what you pick. Basically, we’re going to try to decode all the mystifying language that the insurance companies use to disguise the ways they’re going to screw you so at least you’ll be able to anticipate how you’ll get screwed.

Names

Whether you get health insurance offered by your employer, or you have to buy insurance on your own in an exchange or on healthcare.gov, or you have Medicare and you are looking at one of the privatized Medicare Advantage plans, you’re going to be choosing from a series of plans that have totally incomprehensible names and acronyms, so let’s start by breaking down the how the name of the plan itself will tell you something about how your insurer is going to screw you.

Generally the first part of an insurance plan’s name will be the name of the insurer (like “Blue Cross” or “United Health”), then you MIGHT get a word that says who is paying for the insurance plan (if it’s a “Group” plan that means an employer is paying for it, an “Advantage” plan is a privatized Medicare plan), and finally there will be an acronym that only 0.005% of people in America understand – and those are the generally people making money from the plans. These acronyms will be something like HMO, HSA, PPO, EPO, or my personal favorite “GTFO” – the “get the fuck out of here that can’t be a real plan” plan!

Indemnity Plans (“Open Choice” or “Open Network” plans): are the opposite of managed care; you could use any doctor or hospital, there are no networks, no review of care or pre-approvals, no claims denials. These were the plans that virtually everyone had prior to the 1980s, and plans that virtually no one has today except maybe the extremely wealthy. In 1978, 95% of people had indemnity plans, then that dropped to 71% by 1988, and by 1998 it was down to 14%. Today, only 1% of workers have indemnity plans.

Indemnity plans are the opposite of managed care – you can see any doctor or hospital you want, there Today, you probably wouldn’t even want an indemnity plan, because the modern versions usually only pay a percentage of the cost of your care, leaving you with the rest and massive bills.

Health Maintenance Organizations (HMOs) represent only 12% of insurance plans today, so after taking over in the 1990s, old school HMOs are going the way of the dinosaurs. HMOs usually limit coverage to doctors/providers who work for or contract with the HMO (“in-network”). It generally won’t cover out-of-network care except in an emergency. HMOs can also be limited by location, meaning you might have to live or work in a certain area to be eligible. 

Exclusive Provider Organizations (EPOs) are a new catch-phrase that are appearing more and more often, but they are VERY similar to an HMO, and you should think of them the same. In fact, that survey that only 12% of workers have HMO plans includes EPOs under the same category. EPOs often have larger networks than HMOs, and unlike HMOs, they don’t require referrals to see specialists – as long as the specialist is in their very limited network.

Preferred Provider Organizations (PPOs) are the dominant type of health plan in the United States today. 49% of workers are currently covered by PPO plans. Like HMOs and EPOs, PPOs have a network of providers. However, unlike HMOs and EPOs, PPOs will still cover out-of-network providers but at a higher cost, – i.e. the plan gives you a better deal and takes on more of the cost if you use providers in its network. You can see specialists and out-of-network doctors without a referral.

Point of Service (POS) is another uncommon type of plan – only 9% of workers have POS plans. The main difference with a POS plan is that they usually offer national coverage, if you’re someone who travels a lot, but if you go to an out-of-network provider anywhere in the country – big surprise coming here – you’ll be absolutely screwed with how much money you have to pay. Gillian’s dad had a spicy name for this type of insurance. 

Health insurance exchange categories

Just to make it extra confusing, plans in the exchanges are also categorized into 4 “metal categories” based on cost and quality of coverage, ranging from bronze (shittiest plan) to platinum (rich people plan). Those who buy individual insurance plan on the exchange (or marketplace) have to choose a metal level.

Bronze plans have the lowest monthly premiums, highest costs when you need care, and huge deductibles each year.

Silver plans have a “moderate” monthly premium and “moderate” costs at the point of care. Deductibles are lower than a Bronze plan. Some Silver plans come with “cost sharing reductions” or “extra savings” for some households.

Gold plans have a high monthly premium, low costs when you need care and low deductibles.

Platinum plans have the highest monthly premiums but pay the most when you need care.

What to look out for in the small print:

Summaries (or Schedule) of Benefits (SOBs) this case that isn’t a reference to the CEOS of your insurance company. In insurance lingo, SOB is is where you find the deets about what is and isn’t covered.

Premium: The amount you pay to your insurance company monthly to maintain your health insurance. Premium amounts vary along with deductibles, co-insurance, and other aspects of the plan; if other aspects of the plan are more expensive (like a high deductible) then premiums will be lower.

Deductible: The amount that you are responsible for paying out-of-pocket per year. Whenever you pay for health care services, it goes towards your total deductible for the year. After you hit your deductible, the insurance company should be covering the rest of your costs. 

HDHP with HSA (High Deductible Healthcare Plan with a Health Savings Account) A high-deductible plan can be any of the plan types listed above – EPO, PPO, HMO – provided it has a deductible of over a certain amount determined by the IRS. (As of 2023, a “high deductible” is at least $1,400 for an individual and $2,800 for a family). Insurance companies that provide high deductible plans will set up Health Savings Accounts, which allow members to set up an account where they deposit pre-tax dollars from their paycheck in order to cover medical expenses.

High deductible plans can leave you open to massive costs, depending on how high the deductible is. People with high deductibles often behave the same way as uninsured people: they delay and skip care because the cost of meeting their deductible is so high it could bankrupt them to seek care. This is also why you will find clinics andhospitals very full at the end of the year: all those people who have met their deductibles rushing to get care before their deductible reset at the first of the year.

Co-insurance: Did I say that the insurance company will pay for the rest of your costs after you hit your deductible? SIKE. A lot of the time, it won’t. On many plans, once you hit your deductible, co-insurance kicks in, meaning that the insurance company will begin covering a certain percentage, but not all, of your expenses.

Co-insurance out-of-pocket max: The maximum amount of co-insurance money that you have to pay on your plan in a given year.

Maximum prescription and out-of-pocket max: This is the total amount of co-insurance you have to pay out of pocket plus your deductible. In the biz they call this your “annual exposure.”

Co-pays: A fixed amount you pay for a doctor’s visit or a specialist’s visit. Can vary based on the type of provider or service. Can also vary based on whether or not you’ve met your deductible (they usually go down at that point)

Election tier: Plans have “tiers” depending on whether you are electing to cover yourself, yourself and a spouse, yourself and children, etc. Commonly the “tiers” would be “individual,” “Individual plus family,” “individual plus children,” “individual plus spouse”

Plan year: the “plan year” is 12 months from the date of effective coverager (when your coverage kicks in). Deductibles can either apply to a calendar year or a plan year.

COBRA: If you become ineligible for a health insurance plan that you are a dependent on (common examples would be turning 26 or getting a divorce), the payor on the plan can elect to keep you on as a dependent and pay an additional amount 

What are our takeaways here?

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.

SOURCES:

The health plan categories: Bronze, Silver, Gold & Platinum | HealthCare.gov

Consumer Guide to Understanding Health Insurance | Mass.gov

Health insurance and Obamacare te rms | healthinsurance.org

HMO, PPO, and EPO – What’s the Difference and Why Does It Matter? – CalPERS PERSpective   

Managed Care: MedlinePlus

Data Resources | CMS

The Most Common Types of Health Insurance | Northwestern Mutual

Publication 969 (2022), Health Savings Accounts and Other Tax-Favored Health Plans | Internal Revenue Service   

If you’ve ever had an experience with the American healthcare system, you’ve probably walked away thinking, “Why can’t we have nice things? Or even basic human things??” We get stuck on gurneys sitting in ER hallways, waiting hours for care; we skip other basic needs like food and housing to pay for the healthcare we can’t skip; or we wait for months for preauthorizations from our health insurance and referrals from our doctors. Of course, for the super rich you don’t have to endure any of these humiliating experiences, and they have developed some new, expensive ways to get the healthcare they need when they need it. So put up your pinkies and throw on a monocle – today we’re doing a deep dive into the lifestyles of the rich and famous to find out: just how fancy is concierge healthcare, and can the rest of us get some?

Let’s start with concierge primary care, the latest trend in fancy healthcare! What is concierge care?

Some concierge plans (also called Direct Primary Care) work with existing insurance – those are the cheaper ones ($600-1000/year, aka Hyatt Care). Some you actually pay a flat fee that covers all your services. Those are the really expensive ones, which can run from $2400 to $30k per year!

But what do you get for your money?

Now there are more than 1,500 Direct Primary Care practices across the country, and 1 in 5 of the top 1% buy concierge physician care.

We’re also seeing some hospitals, like Ben’s local mega-hospital Mass General, offering “Concierge Medicine.” They have dedicated concierge physicians who see fewer patients and are more accessible, available by phone or email 24 hours a day, seven days a week. You also get your own health coach and a dietician.

Do you need to maintain insurance? Yes. At Mass General, your $10,000 membership fee covers a high level of “service” and “access” but not the cost of the medical care you need. Your insurance plan will cover the actual services provided by the concierge physician. That means $10,000 on top of your premiums, co-pays and deductibles.

Outside of the exorbitant cost, are there downsides to concierge care? You betcha.

But when rich people get to the hospital, don’t they get treated like the rest of us? Nope. Big hospital donors often get to skip the line in the ER and get VIP status. They get fancy luxury suites with fine gourmet dining, high thread count sheets, and suites with custom cabinetry. They also get the best nurse to patient ratios in town, with some luxury units assigning each patient their own nurse who has no other patients, 24/7.

These luxury units can be dangerous though. When the hospital is more concerned with pleasing the patient than providing the care they need, it can result in “VIP Syndrome.” There’s anecdotal evidence that because some patients want to stay in their luxury accomodations instead of being moved to a specialty or more intensive unit due to their condition, they don’t get the kind of care they need, which can lead to worse outcomes or even death. At least one study suggests that higher patient satisfaction is correlated with worse outcomes.

VIP syndrome can lead caregivers to overtreat patients with unneccesary expensive tests, or undertreat them by avoiding upsetting or painful procedures or tests. This can lead to terrible consequences. A 2016 story from the Boston Globe described a prince with “ties to Middle Eastern royalty” who was diagnosed with a drug-resistant infection, but objected to his providers wearing protective gear around him. Instead of following hospital protocols, they made an exception to make him happy, putting his and their health at risk. There was also an investigation into the amount of painkillers he was administered, and other examples of exceptions made to hospital policies to please the prince.

Another obvious downside is that this kind of VIP care is unethical to treat patients differently based on wealth or status. And treating those VIPs better takes resources away from “regular patients” who already struggle to access care and providers.

Doesn’t it seem like some of this stuff is just the kind of decent healthcare we should all have? Shouldn’t we all have access to the care we need when we need it, including providers who have time to spend with us and hear our concerns, hospitals that prioritize our comfort and treat us with respect, and the ability to get care without a health butler to handle all the complexities of referrals and prior authorizations? We at Healthcare-NOW believe we all deserve nice things, and that’s why we won’t stop pushing for Medicare for All.

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.

Just over a month ago we lost Bob Barker, the man who taught us all about the brutal nature of capitalism one pricing game at a time. Now, thanks to the Inflation Reduction Act, the federal government is going to be playing a role in determining the prices for some of our favorite products. No, we’re not talking about cars or family vacations to the Bahamas – we’re talking about the prescription drugs that keep us alive! As the Biden Administration enters its own Showcase Showdown with Big Pharma, we’re taking a full episode to break down what that means and whether the result will be prices we can actually afford.

Our first (and only) contestant is Alex Lawson! He 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. Alex’s organization played a critical role in moving the Democratic Party (mostly!) away from efforts to cut Social Security, and has been shifting the momentum towards expanding Social Security. Social Security Works is also a key ally of ours in the national fight for Medicare for All!

Alex, come on down!

Alex starts by telling us about the time he took a camera to PhRMA’s (the Pharmaceutical Research and Manufacturers of America) office the day of the Inflation Reduction Act signing ceremony. He conducted person-on-the-street interviews, asking if they knew PhRMA spent hundreds of millions of dollars to keep Medicare from being able to negotiate drug prices, and if they had any messages for the folks in the building? Most of the responses were of the “f-you PhRMA, we got you!” variety.

PhRMA has literally never lost until the Inflation Reduction Act was passed. Even though it’s modest, Medicare went from having no authority over drug prices to the authority and mandate to find the fairest price for certain drugs is a huge loss to the industry.

Alex wants listeners to understand that this win is as simple as it sounds. Who buys the most drugs in the world? Medicare. Why doesn’t Medicare tell the pharmaceutical companies what they’re willing to pay? This is called the Maximum Fair Price. No other peer nation doesn’t have some kind of negotiated standard for drug prices.

While our guest and hosts would prefer that Medicare be allowed to negotiate the prices of all drugs used by beneficiaries, PhRMA was successful in limiting the Inflation Reduction Act drug provisions to only apply to ten pharmaceuticals. (Still, pharmaceutical companies are suing to block the implementation of price negotiations.)

Negotiating the prices for only ten drugs may seem like a drop in the bucket, but the cost of those ten drugs alone make up a huge amount of Medicare’s spending on Medicare Part D. And in coming years Medicare will be able to negotiate over ten more drugs, and so on. This will squish the most excessive profiteering of the pharmaceutical industry and deliver savings of $9 or $10 billion dollars a year.

We give President Biden credit for taking an aggressive stance against PhRMA to finally make good on an evergreen Democratic campaign promise to lower drug prices. But we also give ourselves some credit. First there was the debate in Congress in 2019 over HR3, the Lower Drug Costs Now Act. Advocacy by groups likes ours resulted in the House passing a robust bill that would have dramatically lowered drug costs. Then in 2021 both Healthcare-NOW and Social Security Works fought hard to win major expansions of Medicare in the Build Back Better bill (we were on track to win a lot more than prices for ten drugs). But Senators Joe Manchin and Kyrsten Sinema tanked the whole bill in the Senate.

Those two battles led us to the Inflation Reduction Act aiming high from the start, and resulting in a bill that will make a big impact on drug spending by Medicare. The Build Back Better fight was brutal, and we lost, but we named what we wanted: vision, hearing, and dental coverage for Medicare; long term care coverage; negotiated drug prices. We lost then, but we aimed high, so when we finally got across the finish line with the Inflation Reduction Act, we achieved a lot. It’s not everything, but it’s a remarkable start.

A few years ago Florida, under Ron DeSantis, asked for permission from the federal government to import drugs from Canada, where they are cheaper. Trump was also developing a national version of this policy to let Canada negotiate drug prices for us. They both knew the political popularity of lowering drug prices, but didn’t want to take on the pharmaceutical industry.

Drug importation policies show up at the state level, where some non-profit groups sponsor bus trips to Mexico or Canada to buy cheaper prescription drugs, and the state government of Utah actually pays for public employees’ flights to those countries because it is still cheaper than paying full price in the United States. (Your shownotes writer is reminded of an independently wealthy U.S. Senator who spent his entire Senate salary on bus trips to Canada for seniors to highlight the issue of high drug prices; that Senator went on to win two more statewide elections before retiring.)

It’s unfortunate that we continue to spend so much energy focusing on imports from Canada, whose drug prices are the second highest after the United States. As more states try to address drug prices by importing, ultimately the “solution” of importing drugs from Canada won’t be sustainable; pharmaceutical companies will eventually raise prices for Canada too. The real answer is to go to the source and negotiate prices on our own.

We’ve all heard PhRMA’s claim that if we negotiate lower drug prices, they won’t have enough money to do research and development on wonderful new life-saving drugs. Alex tells us that is completely false, and in fact, pharmaceutical corporations only “invent” rip-offs of existing drugs (“me too” drugs) using the U.S. patent system to extract maximum profit. Our current system doesn’t incentivize the companies to do R&D on drugs with the greatest public health benefit; it incentivizes looking for drugs that will deliver the greatest private gain. The real research is primarily paid for by the U.S. taxpayer, not the pharmaceutical companies.

U.S. Senator Bob Menendez (D-NJ), a “Pharma Darling,” was just indicted on federal bribery charges. Menendez is known taking loads of money from big pharma and in return almost single-handedly killing pharmaceutical price reforms like drug price negotiations. He’s hardly the only member of Congress to take funds from the pharmaceutical lobby. But over time, healthcare justice advocates have made the pharma label so toxic that some Democrats are turning down those contributions and there aren’t many Pharma Darling Dems like Menendez anymore.

We’re excited about the impact Medicare drug price negotiations will have on the power dynamics in Washington and on seniors’ wallets. This leads us to dream even bigger about the true transformation we could achieve with full Medicare for All.

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.

With all the threats facing our country – climate change, a predatory economy, corporations buying our elections, and the overt move towards fascism among the far right – you would think that politicians would be laser-focused on the existential crises descending upon us. But instead, politicians in the US are devoting a considerable amount of their energy these days to an all-out assault on the rights of transgender people. Although the war on trans people has taken many forms, from bathroom bills to restricting school curricula, one of the most chilling is the denial of basic gender-affirming healthcare. Now, in places like Texas, elected officials have gone even further by targeting healthcare access for the most vulnerable trans folks – trans kids. In this episode, we’re joined by one El Paso family and a local gender-affirming care doctor who are fighting back!

Our guest today is Lori Edwards. Lori is the Director of the Intergenerational Rainbow Link at Borderland Rainbow Center in El Paso, Texas, an organization that provides a number of services to queer people in their community. Lori is a mama bear to her two trans/gender fluid teens, as well as any person who finds themselves in need of a mama bear nearby. She has a BSNS from Purdue Global, is a certified Mental Health Peer Specialist and pulls from backgrounds in both emergency medicine and education to function as a Jane of all trades who’s ready to tackle the unexpected. As an El Paso native, Lori returned to the borderland with her husband to raise their children close to family.

Liana, who is Lori’s daughter, is a 16-year-old trans girl who loves gaming, singing (rapping in particular) and is a student athletic trainer at her high school. She is also a Girl Scout and local advocate for LGBTQ rights in her city. Along with helping the family foster for a local pug rescue, she loves spending time with her 2 cats, 2 pugs, and 4 fish.

Dr. Toni Marie Ramírez is a family medicine physician with several years of experience in gender-affirming care. She received her undergraduate and medical school degree from Brown University and trained in family medicine at the Santa Rosa/UCSF family medicine residency in Northern California. She was born and raised in Socorro and moved back to El Paso in 2020 to be with family. Her work is strongly grounded in social justice and equity, valuing the power of community empowerment.

As a family medicine physician and gender-affirming care provider, Toni shares that those entering the medical field with the intention to provide and contribute to the health and well-being of a community, quickly realize that the healthcare system is not set up for this. We pathologize what is outside the norm in this colonized world and the medical community ignores the healthcare disparities of the trans community. Her 10-year experience in providing care has shown that it is astonishing how little medical providers know about gender-affirming care.

Gender-affirming care is not part of the curriculum in medical school, let alone residency. This allows medical providers to uphold this gender binary in medicine. Starting from the very beginning, our socialized aspects infiltrate the way medicine is practiced and taught. When it comes to the access aspect that comes from that, physicians are already not educated enough to provide such care. We live in a world that is very binary and the reason why there are so many disparities is not because of anything innate to trans or gender-diverse folks, but because of the transphobia that exists in the world and the transphobia that exists in medicine.

Sometimes people don’t access care because of a fear of discrimination or outright denial of care. Even in a progressive area of California, where Toni practiced, there are so many barriers to accessing care: (1) for feeling safe, (2) there was only one gender-affirming clinic in the entire county, (3) the insurance companies and the cost of seeking care. In California, there’s a law that insurance companies must cover gender-affirming care. That being said, there are loopholes around this and Toni spent a lot of her time talking with insurance companies and explaining to them the operations were medically necessary. Even in the most progressive places, we’re seeing constant barriers to access to care.

Transphobia in the marketplace from employers prevents trans folks and queer folks from getting good jobs that have good benefits and insurance coverage. Any transphobia we see in hiring just in the economy translates into discrimination against trans and queer folks.

On June 2 (just in time for Pride month), Texas Governor Greg Abbott signed a bill into law that would ban gender-affirming care for trans youth. Without some kind of judicial intervention (which I know we are all hoping and praying for), the law will go into effect on September 1. For Lori and Liana, the worries about the law started in February of last year, when Gov. Abbott and Ken Paxton put out their opinion letter telling CPS to investigate her and her husband. They specifically wanted to call them unfit parents and that they were abusing Liana.

Liana was very young when everything first started happening and we were rolling out of COVID. Liana slowly started thinking “Wow, I don’t have a future”. To look at kiddos who have that thought process makes everything impossible including setting goals. As a mother, looking at your kid and saying “Hey, we’re gonna get through it” when the internal monologue is “Texas doesn’t want me to get through it”, it is very hard to maintain grades and social relationships and to set goals. S.B. 14 was the biggest slap to their face and wanted to testify in Austin as soon as they found out.

Toni shared that the law has impacted adult patients she sees even though it does not directly affect their care. They are fearful and appropriately paranoid about what the next steps will be for them in Texas. Kids could just be the first line of attack because they are more vulnerable than adults. There are several bills that may directly impact gender-affirming care for all ages in the future if they pass.

At Healthcare NOW, we train our activists who have been impacted by the healthcare system how to tell their story publicly, which is 100% needed if we want to win social change but can be very challenging, and emotional labor, and you can put a target on your back for criticism.
Liana and Lori have both been really brave and vocal about defending trans kids. Liana spoke out for the first time publicly at an El Paso Matters interview, where it felt awkward for her at first but after she realized that a lot of people would look up to her words and use them for guidance or information it became easier.

We have been fighting for many years to make sure that if we were to win Medicare for All, healthcare for trans folks wouldn’t be left behind. This year, the Medicare for All bills were reintroduced in the House and Senate, and for the first time, we were able to get explicit language into the bill that would guarantee access to gender-affirming care at the national level and make sure those services are covered for everyone, regardless of income or zip code.

Lori explains that this kind of change would be life-changing for her family. If M4A were to pass it wouldn’t be an issue of where she lives or how much she makes because she would be able to
Provide for her daughter. It would be amazing not just for Liana but for the entire community and to be able to see her 16-year-old not have to carry the weight on her shoulders and worry about insurance.

Toni shares that M4A would be life-saving for so many people. If she could change anything about our healthcare system it would be (1) our food systems and (2) having universal coverage and M4A is the best way to do that. M4A means safety and equity because when gender-affirming care is denied or thought of as cosmetic and is not included very specifically in these aspects it allows the narrative that it’s wrong, dangerous, or questionable to continue. Coverage is a validation that gender-affirming care is medically necessary.

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.

Almost every patient in America has had a frustrating experience in a hospital setting where we feel like we’re on a medical conveyor belt that moves WAY too slowly. We sit for too long in a waiting room; then our nurses or doctors speak with us very briefly; we might feel more like we’re filling out an online survey than we’re being listened to; then we might have more waiting; and then we’re pushed onto the next specialist or appointment too quickly. Of course some patients experience FAR worse disasters in hospitals. As patients, we know that something dysfunctional is going on, and it leads a lot of people to distrust their medical providers, and avoid healthcare altogether. But nurses, doctors, and other medical professionals themselves know that behind the scenes, they are being pushed to the brink by hospital corporations, and not really allowed to treat their patients to the best of their abilities. So today we’re going to focus on one of the most crucial behind-the-scenes hospital policies behind patients’ bad experiences: staff-to-patient ratios. 

Our guest today is Gerard Brogan, RMN, RGN, RN. Director of Nursing Practice at California Nurses Association/National Nurses United. Gerard has over 40 years experience as an RN. He has practiced nursing in the USA since 1984, before joining the California Nurses Association in 1994 as a Nursing Practice Representative.  He is the Director of the Nursing Practice Department for the California Nurses Association/ National Nurses United.

Gerard has extensive experience in nurse-to-patient ratio legislation, having been a part of the successful campaign to establish nurse to patient ratios in California and subsequent experience in seeing the efficacy of the ratio law.  He serves as an educator for the organization, teaching classes to nurses on a variety of  topics relevant to health care in general and  the scope  of nursing  practice  and patient advocacy in particular.

Most of us will be patients at some point, so unsafe staffing practices in hospitals will have an impact on us or our loved ones. Studies show you have a lower risk of death, higher risk of poor outcomes, and a higher chance of re-admission if your hospital has adequate nurse staffing and your care is guided by providers’ professional judgement. Sadly, in a for-profit healthcare system care decisions are made based on more on their budget impact.

You’ll recognize unsafe staffing when you see it: things like long wait times, or feeling like a number instead of a whole person because your nurse doesn’t have enough time with you. The nursing profession takes a holistic approach to care, looking at the entire person and the factors that contribute to their health; that takes time, which the healthcare industry doesn’t want to give nurses.

Improving nurse staffing levels has been the #1 priority of nurses unions (and most unorganized nurses too) across the country for more than a decade. Gerard tells us that nurses are ethically and legally obligated to be a patient advocate and provide optimal care. When that can’t happen due to the business interests of the employer, healthcare workers experience moral distress. (Rather than “burnout” which implies an individual, personal defect, Gerard uses “moral distress” to determine the suffering that happens when nurses are constrained by forced beyond their control from providing the care they should.)

There has been a sea change regarding nurse staffing over the last several decades. When Gerard began his career, staffing was “impeccable,” he had professional autonomy and the institution’s respect of his professionalism. In the 1990s when the Clinton’s healthcare reform attempt failed, “let the market decide” became the dominant narrative in healthcare. Corporate interests descended on healthcare to make a buck and nurse staffing began to decline.

Non-profit hospitals seem like they would be less driven by the profit motive and more concerned about safe patient care than their for-profit counterparts, but Gerard tells us that sadly there is no difference. For-profits generate profits, while non-profits generate what’s known as “excess revenue.” They all play by the same playbook: they see nurses as their largest labor cost, and being a female-dominated profession, they tend to devalue nursing work and see it as a target for cuts.

Over the last few decades we’ve seen the leadership of hospitals change from primarily physicians to primarily people with MBAs. Their priorities have changed from safe care to being more efficient and growing profits. Nursing has suffered under these efficiency schemes, like the Toyota Lean Management model, which treats patients like widgets and nurses like factory workers, with no room for the humanity of either.

Gerard shares that we should have been prepared for the COVID-19 pandemic, with a preparedness and response plan laid out by the WHO years ago, yet the profit-driven healthcare system didn’t value the lives of workers or patients enough to devote resources to preparation. For a lot of healthcare workers, the pandemic was the final straw. Nurses made great personal sacrifices to meet their social responsibility to patients during the pandemic, but the employers failed to meet their responsibility to their workers.

With so many nurses unwilling to work under these conditions and leaving the bedside, the industry is crying about a nursing “shortage.” There are actually 4.4 million licensed nurses in the U.S. but only 3.3 million are working. Instead of creating working conditions that nurses would want to come back to, the employers – who will never let a good crisis go to waste – are proposing cost-cutting measures like “team nursing” and “gig nursing” as solutions to the “shortage” they created.

It costs somewhere between $45,000-80,000 to recruit, orient and retain a new nurse; it’s a terrible business decision to force nurses to work in unsafe, short-staffed hospitals until they eventually leave the bedside. The best way to retain nurses and attract new ones is to improve staffing levels. The best illustration is to compare turnover rates: in Texas, nursing turnover rate in 2017 was 21.7%; in California (with a highly unionized workforce where the legislature approved staffing ratios in 1999) the turnover rate was 3.2%.

Opponents of safe nurse staffing legislation claim that if implemented, patients would suffer and hospitals would be forced to close their doors. According to Gerard, there is no evidence to back up these claims. Hospitals didn’t close, wait times didn’t get longer, patients didn’t suffer more. In fact, California has seen declines in mortality and improvements in patient outcomes since implementing statewide staffing ratios.

Medicare for All would make a huge difference to nursing and the care patients receive. Aside from the fact that nurse-to-patient ratios are part of the federal Medicare for All legislation, the savings from a single payer system would allow the healthcare system to devote more resources to clinical staff, research, and other improvements to 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.

Today we bring you behind the scenes into our office at Healthcare NOW. Just like the TV show The Office, we have our hijinks and wacky characters, including some very smart interns! They have prepped some of their burning questions for this episode.

First, from Intern Noah from Boston College:

In your opinion, what is the most effective way to organize/advocate for Medicare for All? 

Talk to one person, then another person, and then another! It doesn’t start with money, marches, or celebrity endorsements (though if Oprah wants to support M4A, she should give us a call!) Those feel good, but without authentic relationships and networks, they don’t make change. Unfortunately there are no shortcuts in organizing; we have to build the power ourselves.

Do you have any funny stories from an experience meeting a member of congress?

Gillian remembers meetings with former Republican U.S. Senator from Massachusetts, Scott Brown. Unfortunately all Senator Brown cared about was how the policy she was advocating for affected Dunkin Donuts.

Gillian fondly remembers the time former U.S. Congressman Barney Frank told her that her hometown in New Jersey smelled bad. He also told a room full of constituents “the only thing that marches on Washington put pressure on is the grass in Washington, DC.” Epic one-liner that we don’t necessarily disagree with. (He already supported M4A so it was all good.)

Intern Gulmeena, a public health student asks:

When we talk about Medicare for all – are we thinking of a system with government run hospitals and government employed medical professionals? Do you think such a concept garners resistance or are people open to that paradigm shift?

One of the most common attacks on M4A is to call it “socialized medicine.” Very few countries actually have real socialized medicine, where insurance is public, all healthcare facilities are owned and operated publicly, and the healthcare professionals are public employees. In the United States, Medicare for All legislation does not socialize the facilities or professionals. By focusing on the payment mechanism, it would give the government a lot of power to reign in the worst parts of for-profit healthcare. Ben notes he has seen a poll showing a majority of Americans support socialized medicine, so who knows, maybe that’s the future of the movement.

Would Medicare for All include long term care for the elderly such as nursing homes and hospice?

This has been a debate within our movement for a long time. Both M4A bills include long term care. The House version is more generous and comprehensive. The Senate bill would cover home-based long term care but not institutional. Currently most people get long term (which also includes care for people with disabilities) care through Medicaid, the healthcare program for the poorest Americans; this forces patients to spend down all their assets to qualify. Medicaid also has an institutional bias: it’s much more likely to cover care in residential settings rather than homes, which is usually more expensive. If you’re interested in advocacy around this issue, check out Caring Across Generations.

Intern Ioanna (who hails from Greece, a country with universal healthcare):

Considering that you have been a part of the movement since before Medicare for All was introduced by Sen. Sanders in 2017, how did you first hear about single payer healthcare, and what drove you into the movement at a time when it was not getting much or any (?) media attention?

Back in the day of phone books and print newspapers, Gillian learned about universal healthcare from Ben! When her own employer-provided healthcare left her underinsured, a friend in the finance field told Gillian “if your job doesn’t give you good health insurance, that’s capitalism’s way of telling you that your job isn’t important and maybe you should get a new one.” Learning about Medicare for All convinced Gillian it’s actually ok to expect to have a rewarding job and healthcare.

Ben learned about universal healthcare when he lived in England, and learned about the American movement for single payer at an in-person job fair, which led him to apply for a job with MassCare.

What could be done to get more support from academics (economists, sociologists, public health professionals, etc.) in advancing the movement? Existing research seems to show that there would be many gains for the federal government and the American public, so why aren’t more researchers advocating for it?

Gillian (a former adjunct professor) thinks that we’re currently seeing academics becoming more radicalized, and we may see them in the streets more. One of the things that works against us is that academics in the U.S. are under attack; for example, in many states “anti-woke” laws limit their ability to teach. Traditionally academics have felt like they should be distanced from the world as impartial observers. As they’re learning that their impartiality won’t save them, maybe we’ll start seeing more of them taking action.

Ben notes that a large segment of academics are unorganized, exploited workers like graduate students and non-tenured, part time professors without benefits. The basic answer to why they’re not involved is because we haven’t organized them yet; in fact big groups of unorganized workers give the movement more potential activists to tap into. (As efforts to form unions by these groups pick up steam and success, these workers are naturally going to be organizing around healthcare issues when they bargain their first contracts.)

Intern Lucy from Tufts University asks:

What do you feel like is the hardest part of running this organization? How do you prevent from getting burnt out?

The hardest part for Ben is fundraising. Healthcare-NOW depends primarily on individual small donors, which can fluctuate dramatically from year to year. Healthcare-NOW’s donations also follow the political cycles; when single payer champions run for national office, they stop giving to us and start giving to them. It’s tough and stressful, and if you want Ben to sleep better at night, please chip in a little bit to support this important work!

A lot of non-profits work their employees to death, and think that they’ll do it happily for “the cause.” Ben and Gillian organize volunteers to help build power, and avoid working themselves to the bone as much as they can.

What is something Healthcare-NOW has achieved that you feel proud of?

Ben is proud of how far the movement has come since he began at Healthcare-NOW 10 years ago: more activists, more local grassroots groups, record numbers of legislative co-sponsors. He’s also proud that Healthcare-NOW has taken on the role of elevating the people most affected by the healthcare system, rather than the policy wonks who led the movement in the past, who may not have been directly impacted by the healthcare system.

What are some common misconceptions about the work you do?

Ben and Gillian are the only employees of Healthcare-NOW, so they basically do everything from bookkeeping to building grassroots power. Gillian’s mom doesn’t know what she does, she just doesn’t want Gillian to get arrested.

What are some smaller action items people can take to support the movement (i.e. what are some of the most accessible aspects of supporting this movement for people who feel as though they may not have the time or energy to devote a lot of themselves to it?

We don’t usually ask people for a big commitment at the start; as a first step, go to the website and sign up for the email list to get in the loop, and tell your healthcare story to help build the movement. Talk to your people! And it’s quick and easy to donate to Healthcare-NOW if you’re able.

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.