Howdy! This is a transcript of a speech I gave at the Houston Democratic Socialists of America / Houston Area Progressives / Our Revolution Gulf Coast Medicare for All townhall of 7/8/2017. I sent it out to my newsletter and a cyberfriend asked me to republish it someplace a bit more shareable, so here it is!

Here’s a video of the entire thing: https://www.facebook.com/HoustonDSA/videos/1088880954545158/

I speak at 44:45, and I really recommend watching the nurse who spoke before me at 39:00 — she was fantastic and left no room for doubt in the argument that the fight for healthcare is intersectional at its core.

If you want to hear more, I was on KPFT’s Open Journal program on July 10 from 30:00–55:00. http://kpft.org/programming/newstalk/open-journal/

start at 44:45 (or, even better, 39:00)

Howdy, comrades. I lived in Houston for a few years a few years ago; I’ve been back every now and again. Yesterday I flew in to Hobby, and boy are my arms tired. I was traveling up 45 and hit scan on the radio in my rented car and hit KPFT. On KPFT, which I’ve never heard before, I heard a speech. It was a speech Bernie Sanders gave about the struggles for racial, social, and economic equality over the past 150 years. That was the entire program. They played the speech, they sped it up so it could fit the block, and at the end the two hosts said ‘In solidarity, y’all’. You live in a place long enough and you think kind of figure it out but Houston never ceases to surprise me. And it is good to be back home in Houston, Texas. All right. Y’all wanna talk about universal healthcare? All right, let’s get into it.

I’m not a doctor and I’m not a nurse — and, as far as health outcomes are concerned, that’s probably good for all of us. But I want to talk to you about universal single-payer healthcare, and why we’re told we can’t have it and what we have to accept in its place, and where that comes from, and why that’s wrong, and what we need to do to realize health justice in America.

Let’s start by describing the shape and the contours of the enemy. We live in a world in which healthcare is a commodity. That means that the futures on your heart and your lungs and the chance of whether or not you get diabetes and whether or not your memaw’s gets glaucoma before age 65 are bought and sold for profit by private companies.

You have a bunch of payers and a bunch of providers. Providers are doctors, nurses, hospitals, pharma corporations, physical therapists, or the dude behind the counter at Walgreens’. Payers are organizations like insurance companies to whom you pay a bunch of money; they, in return, they can use some of that money to pay for your healthcare costs should you ever need it. Not a lot of folks need to use healthcare in a given year — half of all healthcare costs come from 5% of the population. But when it happens, providers provide healthcare, payers pay for it.

In this world that we’re told we have to live in, paying for healthcare is very complicated. See, not all payers pay the same price for the same healthcare — some insurers pay more, some insurers pay less, and some insurers won’t pay anything at all and pass the bill back to you instead. Whoops.

The thing is, healthcare costs have been rising. They’ve been rising literally since we began measuring them in the 1880s, faster than inflation. Now, providers aren’t necessarily clean here. A lot of hospital CEOs find ways to charge more for the same procedures year after year, and a lot more people are getting chronic conditions, things like diabetes and asthma — and the good thing is people that get chronic conditions are living longer, which is nice. But this all leads to an increase in price.

And this scares the bejesus out of everyone involved, particularly the payers. Payers, insurance companies, are interested in finding ways to mitigate rising costs. Sometimes that means refusing to pay for claims — you’ve all heard horror stories. Before the ACA, it meant that payers might refuse to insure people who were sick or had a chance of getting sick — y’all know the phrase ‘preexisting conditions’.

But still this wasn’t driving costs down. There’s a fear that if you make getting healthcare cheap or affordable or even free, people might use it. And that’s hard to make a profit off of.

So we invented the bad guy. The bad guy is this thing, this idea of ‘consumer driven healthcare’. Let me run you through that.

It’s the idea that you should make consumers — which is just libertarian for “people” — pay more for the costs of their own healthcare. If you make someone pay more for their CAT or pay more for their MRI or pay more for their surgery, they will, according to this ideology, turn into ‘smart shoppers’ and will ‘shop around’ and ‘find the best prices’ and won’t seek unnecessary care and this will drive prices down long term.

Now I know this sounds like a joke, but a lot of very serious people took this idea very seriously for a very long time. In fact, it’s the foundation of our contemporary healthcare system — it’s why your annual deductible might be more than your entire savings account. I’m guessing a lot of the folks who came up with it have never been poor and sick at the same time.

All of this builds kind of an isolationist, atomized, and frankly pretty lonely worldview of what healthcare can and should be. It treats being sick, or being poor, or being [able to get pregnant], as a self-inflicted sin. It means that if you get hit by a car, or you give birth to a baby prematurely, or you get rabies or something, you’re on the hook for your own costs, it’s your own responsibility. Because it’s a matter of personal accountability.

And if that accident or that illness or that pregnancy forces you into a lifetime of crushing debt or medical bankruptcy so that a hospital, a pharma company, and your insurer can turn a profit, well, tough. That’s your problem. Shouldn’t have been hit by that car. Try being born rich next time, idiot.

And so we’re told that this is just the way things are, and this is just the way things have to be. We’re told that universal healthcare is a pipe dream, that capitalist, corporatist domination of our bodies and our health is natural, normal, inescapable, and irreversible; that single-payer will “never, ever” happen in America — and that’s just the Democrats speaking.

Man! Wow. That’s a bleak worldview, huh! Here’s the thing: it’s a big load of horseshit. And you know it’s a big load of — I’m sorry, I said I would only swear once. You know it’s a big load. I’m going to tell you why and you’re going to know the answer before I tell you what it is. Are you ready?

OK, me too. Thank you to the one person who was ready. The rest of you have like four seconds; I’m going right into it.



Back in the 70s and 80s there was an experiment called the Rand Health Insurance Experiment. This was back in a mythical, legendary time I wasn’t alive for, before we had things like copays and coinsurance and deductibles, which are what the experiment wanted to test. What happens if you make folks pay for more of their own healthcare? I don’t really make Powerpoints so I’ll spare you the charts and get into the middle of it.

Turns out, people who can already afford healthcare aren’t that affected by needing to pay [a little bit] to somebody to get their healthcare. That makes sense. But people who can’t afford to pay these costs don’t seek care. I don’t mean emergency care; if you get hit by a truck or you get cancer or whatever you’re still going to go to the hospital; you’re still going to go to the emergency room. No, no, I mean people who can’t afford to pay for healthcare who are then forced to pay for healthcare don’t get primary care. They don’t get preventative care. Because we demand they bear the burden of expensive healthcare costs they turn their bodies into ticking time bombs until they have a heart attack at their jobs. Consumer-driven healthcare only benefits the people who seek to profit from our bodies.

But there’s a happy opposite, and it’s real, and it’s attainable. Everyone benefits when accessing care is affordable and easy. Delivering care — being a doctor, being a nurse, comforting the afflicted, diagnosing, treating — that’s all complicated. Paying for healthcare; that’s really simple.

A lot of this hinges on the idea of the “universal risk pool.” That sounds kind of wonky but it’s pretty simple; I’ll run you through it.

A risk pool is how many people pool their resources together in order to pay for the healthcare costs of other people in the pool.

Because most people are healthy, the larger the pool, the easier it is to weather the cost of someone getting very sick or needing a lot of care, right? If one person gets, you know, needs healthcare in the given course of a year, it’s a lot easier to pay for it when you’ve got 300 million people sharing the cost than if you’ve got a thousand people sharing the cost.

Insurers are examples of risk pools, but they’re small and they’re fragmented. One hospitalization, one really weird accident, one premature birth, can drive costs up for everybody — which is why your premiums go up 30% year over year. The largest risk pool of all is the universal risk pool — the federal single-payer.

So let’s build it. Maybe we extend federal programs that already exist. Maybe a little thing called ‘Medicare for All’.

Because once you have a universal risk pool and a federal single-payer you can use it to do a lot of pretty cool things. Let’s go through those.

One, you can drive down costs. Almost all medical costs in America are set as a function of Medicare. If Medicare has a larger, healthier risk pool, its overall per-person costs go down, right? And therefore it has the leverage to compel providers to offer fair prices for care. And as a federal entity using public funds, it’s not going to siphon fifteen percent of its revenue away as profit — like a private insurer.

Two, federal single-payer lets us disentangle employment from healthcare. That’s right! What kind of job you got, or who your employer is, or whether your boss is cool or if your boss sucks should not dictate whether you are eligible to receive healthcare. It cruel that the poorest among us are coerced into remaining in unsafe or unjust working environments from fear of losing healthcare; it is crueler still that the healthcare of their children is shackled to the quality of their parents’ employer. That is not the America I demand to live in.

Three, because the federal single-payer; the federal actor bears costs of providing care — paying doctors, paying nurses, home health aides, etcetera — and bears the costs of not providing care — the hellworld where everyone gets sick and dies at the same time — it can finally be a tool for realizing actual health justice. Medicare for All is the starting point. It is not the goal.

If your population is sick and they are dying because they don’t have a place to live, then housing is healthcare, and you build housing to bring healthcare costs down.

If your population is sick because they don’t have access to healthy food to eat, that doesn’t cost seven bucks for a carrot or whatever, then food is healthcare, and you provide them with affordable food options to bring food costs down.

This is the actual work of health justice, and this better world can be ours!

There is solidarity in the moral community of universal healthcare. It gives my life meaning to help others, and it it is my honor and privilege to assist in the care of people around me, even if it’s just through my taxes. Those who say that, “I don’t know why I should pay for someone else’s pregnancy” have no moral ambition and no backbone. The evolution of American private insurance is rooted in this cruel, libertarian ideology of “individual accountability,” atomized personal isolation, the consumer-driven healthcare movement. It is unconscionable, it is barbaric, and it must be exorcised from our national myth.

Wow! I got real angry now.

Which is a more inspirational vision of America, right? That insurance is little more than a form of future-income loss protection, or is it the idea that healthcare is the people of our nation of plenty banding together to take care of each other? The consumer-driven market approach to healthcare is a relic of the past, like a spooky ghost, and we don’t need to carry it with us. We don’t need to bring it forward.

So why stop at Medicare for all? Medicare has no lifetime out-of-pocket limit and it has 20% coinsurance, which is why privately-run Medicare Advantage plans exit, which are just a way for private insurers to defraud the government using public money — whatever, we don’t need those. Medicare for All is a good rallying cry, a clear vision, and a helpful framework — but let’s not let that framework get in the way of ambitious policymaking. We need a universal single-payer plan with no lifetime limits, no out-of-pocket expenses, and easy access for everyone from coast to coast, plains to gulf.

In this country we let a third of families go unable to pay for housing, food, or heating because of medical costs. In Texas we condemn tens of thousands of the uninsured poor people to pour into free or low-cost clinics not to get treated but to just to wait to die. And all because our politicians lack the conviction, the courage, and the moral ambition to try anything else.

So what do we do? Yeah, I’m mad too. So how do we win? By coming to events like this. By talking to our friends, neighbors, and families — and not just at Thanksgiving. 55% of Americans want some kind of single payer program, and that number rises every day.

Because single-payer is moral. Single-payer is necessary. Single-payer is achievable. So we must demand it of our local officials, and we must demand it of our state reps. We must demand that here in Texas we permit the simple decency of expanding Medicaid to the people in need around us. And if we don’t have any candidates who will fight for single payer, we gotta make some ourselves.

I want to thank my brothers and sisters at the Democratic Socialists of America, Our Revolution, the Houston Area Progressives, I want to thank [IBEW] Local 716. Solidarity now, solidarity forever. Solidarity, y’all.