During the first two rounds of Democratic presidential debates, no topic received more attention than health care. In the two-night face-off in June, discussions of health care and immigration occupied the most airtime; in the July debates, the attention to health care expanded, when it was the only subject that all 20 candidates received time to discuss. The focus was almost entirely on whether Medicare-for-all is sustainable. That has led to some grousing online that health care, while important, was getting too much attention. Nothing could be further from the truth.
In “Health Justice Now,” author and activist Timothy Faust has written the best concise explanation of why the United States needs single-payer health care — and needs to widen the definition of health care itself. Faust has experience in the health-insurance industry as a data scientist and in government by helping to sign people up for Obamacare. In other words, he has lived in the two bellies of America’s health-care beast: in an industry “in which the question of ‘Who gets to receive healthcare, and when?’… is determined by private profitability,” and in government programs that, while improved by Obamacare, remain woefully inadequate.
Faust’s summary of the problems with the U.S. health-care system will be familiar to all. Americans pay more than peers in other developed countries for worse health-care outcomes. Thousands of people die every year because they don’t have health insurance. Mental health is covered essentially in name only. And the current multi-payer system has had decades to solve these problems, without success.
The good guys in this industry are hard to find: “Most of these cost increases occur because hospital CEOs, pharmaceutical companies and device manufacturers keep finding more and more ways to charge more money for the same procedures … and no private insurer can stop them,” Faust writes. The same MRI procedure at the same hospital can vary in cost by hundreds depending on the insurer. In California, a hospital stay for an appendectomy can cost anywhere from $1,500 to $182,000, with little or no connection to the patient’s health. And the current market system underpays primary-care physicians, Faust says, which “exacerbates health inequities in rural or poor areas” and creates doctor shortages precisely where they are needed most.
Rather than largely just reviewing current system’s flaws, as other similar books have done, Faust then affirmatively makes the case for a single-payer system, such as a House bill introduced by Rep. Pramila Jayapal (D-Wash.) and a Senate bill from presidential candidate Sen. Bernie Sanders (I-Vt.). Such a system, Faust writes, would include “comprehensive coverage, including medical, vision, dental and long-term care for all people … that is free to receive with no cost-sharing.” It’s affordable — even the conservative Mercatus Center estimates that the measure would lower Americans’ health-care expenditures by $2 trillion over 10 years. It expands health-care access, including helping save or reopen primary-care clinics in rural areas where loss of profitability has led dozens to close. And it would markedly improve the lives of tens of thousands who would finally have health insurance.
Other options have their flaws. A Medicare buy-in or “public option,” as proposed by several more-centrist Democrats, Faust writes, “doesn’t do anything about the skyrocketing cost of treatments.” European models like the Netherlands’ system still leave people struggling to afford insurance premiums. “All of these programs — from Medicare buy-ins to the Dutch model — might be better for some people than what we have in America,” Faust says, “but they continue to leave behind those people who we are already leaving behind.”
Finally, Faust argues that the health-care debate needs to expand to what he calls “health justice,” which recognizes how closely health care is tied to what are too often seen as separate policy areas. When “black mothers die during childbirth at over three times the rate of white mothers,” fighting racism and sexism is health care. When millions can’t afford necessities such as food and housing, fixing inequality is health care. When prisons are the largest “provider” of mental-health resources in many cities — yet function less as hospitals than as “warehouses for the mentally ill” — criminal-justice reform is health care. So in some sense, those who complained about how much time health care was getting in the Democratic presidential debates didn’t realize just how much time it was really getting.
If Faust’s book has one weakness, it is the comparatively short shrift he gives to how the United States politically gets to single-payer and health justice. As models, Faust cites the AIDS and disability rights movements of the 1980s and early 1990s, and more recently the grass-roots-driven ballot initiatives expanding Medicaid in Idaho and Maine. In both cases, the details aren’t much more than “many people worked hard, and succeeded.” The vagueness is hardly a surprise, though, because while we might not know exactly what a health justice movement will look like, we do know it will come through the broad archetype of a grass-roots movement.
That might seem almost redundant: Of course something like Medicare-for-all wouldn’t happen without popular support. Health care affects too many people to be overhauled otherwise. But it’s a truth that two candidates understand: Sanders, with his talk of a “political revolution,” and Sen. Elizabeth Warren (D-Mass.), who has begun talking more about a “grass-roots movement” to beat wealthy interests. The sooner the rest of the Democratic field understands that, and the sooner the country moves toward health justice, the better.