By Timothy Faust
This can all feel like so much. It feels like so much to me! I sit to read or write and the waves batter me and my body feels like a towel, wet and crumpled on the floor; I fall inside myself and wish for some angelic comet to plunge into my house and gently, quietly lift us all from this national suffering. But I don’t think that’s fair of me to do. It’s not very kind to indulge in nihilism when other people have even more at stake. What do you do? How do you tilt against the grotesque squalor of the world?
My answer begins with single-payer. Single-payer won’t solve all of the problems we’ve talked about in the previous section of this book. It won’t even solve most of them: it won’t build the houses, it won’t feed the people, it won’t bring jobs or money back to rural areas. But that’s all right, in a sense— no program can, not all at once. What single-payer can do, I believe, is serve as a ladder we can climb, all together, into a better world. A properly designed single-payer program is one titanic step toward making people safe in their own homes, in their own bodies. It is a reprieve from our continual fucking-over by the structure and stricture of private insurance. And it is a method of finally demanding accountability from a state that permits (or even encourages) the sins that cause mass suffering—and the medical inequities they produce.
It’s not a hard sell. Single-payer isn’t that complicated (the real complicated shit is the various bureaucratic coping mechanisms invented to respond to the inadequacies of private insurance!) and most people like it already. More people will be drawn to it once they learn what it means and how it fits into the nooks and crannies of their lives. Most doctors and nurses like it, both because they’ve seen the devastating consequences of uninsurance among their patients and because they’d like to avoid the grating bureaucracy of trying to get paid by insurance companies.
The people who tend not to like single-payer are people who wouldn’t like anything that didn’t make them money: the insurance companies it would replace, plus the pharmaceutical, device, and hospital CEOs whose profits might be cut into by the rise of a larger, stronger, payer. Then there’s the powerful people who generally benefit from human suffering: the abusive boss who wants to make sure you can’t quit your job; the abusive husband who wants to make sure you can’t quit your relationship; the CEO who enjoys being able to cut benefits while knowing his workers can’t strike for fear of losing insurance; the lizardlike politicians who find it useful to first advance policies that let rich people plunder their districts, then blame poor people, people with disabilities, and people of color for the resulting scarcity.
These problems are not new in America. We’ve been suffering needlessly for generations. We continue this suffering because, at every conceivable opportunity, our politicians, our policy-makers, the CEOs who mine us for profit—have decided to pursue moderate, subdued, pragmatic, and useless policies. They have had every opportunity to help and have refused. They must be left behind. They’ve started coming out of the woodwork, and they’ll continue to do so for the next few years. They’ll have “responsible solutions” for “new American healthcare.” They’ll smile and go on TV and say they’re very concerned about all these problems whose structural causes they, personally, have benefited from. They will reach out to take our hands, tenderly and piously, and whisper, “This really is the best we can do right now,” as they jam them in the garbage disposal. So they’re out.
We will have to turn to each other.
This is all to say that the work of health justice is not siloed. Housing work, healthcare work, anti-carceral work, disability liberation—all share health equity in their articulations of a better world. This and only this, I think, can bring about single-payer, and, beyond it, health justice. We have seen that movements for universal healthcare that are led from the top down have not succeeded.
Yet through this massive mobilization—and only through this massive mobilization—this is a fight we will win. Single-payer is already a wildly popular idea among the people it affects. This is not a radical proposition. We are simply discussing a basic principle of fairness.
After all, we all come from nothing. We are all fashioned from a formless and shapeless place. We have been thrust through the maw and born into a world that is arbitrary and unequal in its allocation of suffering. And yet instead of affording each other the basic dignities of being human, we have developed this bizarre system of American health in which one’s suffering is one’s own responsibility, in which empathy is vestigial and unnecessary. We have atomized suffering and, in turn, assigned blame for suffering to the people who suffer it.
I have seen such naked suffering inflicted in my American name. I have seen neighborhoods ripped apart by the unrepentant, unyielding bloodlust of capitalism. I have seen families torn limb from limb in the service of extracting profit. I have seen the dehumanizing machine all at once and felt despair. For me it is heinous to feel complicit, through my simple existence in my only and horrible home, in the mass immiseration and annihilation of those against whom the whole rotten weight of the world is stacked.
This is intolerable to me. I hope it is to you, too. And so I hope you join me in saying: enough.
Not in our name may this America persist. May we root ourselves not in fear but in love—love for those who suffer around us, as we, too, will one day suffer—and from that love, may we cultivate the fury by which this cruel machine can be destroyed.
My friends—single-payer is moral. Single-payer is necessary. Single-payer is achievable. Solidarity now, solidarity forever.
For an expanded version of these excerpts:
About the book, “Health Justice Now,” and how to purchase it:
Video: Tim Faust: Beyond Single Payer (45 minutes):
By Don McCanne, M.D.
Timothy Faust’s new book, “Health Justice Now,” provides an excellent description of the injustices inherent in our current health care system and the reforms that we can achieve with single payer as the springboard. But he doesn’t stop at single payer. He goes on to discuss the social and structural determinants of health as part of the broader overview of health justice.
Faust is very well versed in health policy, whereas his very different communication style you might find refreshing in comparison to the typically nerdy PowerPoint discussions that many of us at PNHP have been delivering. The video (link above) includes some topics covered in his book.
So which audiences might resonate with his style and rhetoric? Young adults, particularly with a sophomoric bent, might find that his approach clarifies some of the fundamental issues of health justice. Because of his smattering of profanity and the complexity of the topic, it would not be suitable for most young children, but, even there, it may give their parents some ideas with which they could communicate health justice concepts to their children and friends and especially nonbeliever friends. It might be very useful for those confused or misled by the prevailing rhetoric supporting expansion of the Affordable Care Act or supporting the option to continue with private insurance plans, with or without a public option – rhetoric that inappropriately rejects the model that really does work: the single payer version of Medicare for All. It might also be useful for audiences who are already sold on single payer in that it may add to their catalogue of sound bites and explanations of health policy concepts – concepts that some may otherwise find to be particularly mundane. Staid, conservative libertarians may find the rhetoric and references to socialism off-putting, but that is an audience that remains quite resistant to the single payer message anyway, though, who knows, maybe this could be a spark that awakens a sense of health justice that this group seems to lack. In sum, almost all audiences could benefit from his message, in spite of or because of his unique style and rhetoric.
I would emphatically recommend watching the 45 minute video (this weekend might be a good time) so that you have a better idea of his style and message. Then buy his book, and, above all, share it with others. We need to spread the word, and this can be an effective tool.
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