Every day I learn of a new horror of the American healthcare system

This piece was published in my book Lockdown in Hell World.

It’s March and it’s sunny and quiet in my old neighborhood. Too quiet except for the birds. It feels like there’s a blizzard outside that you can’t see.

Toward the end of February which is the first time as best I can tell I personally acknowledged the existence of the coronavirus I sent out a tweet that went viral: “I like how the experts on TV say if you think you have coronavirus call your doctor ok lol let me just get my doctor on the phone the thing you can do.”

Around fifty million Americans have donated to a crowd-funding campaign for medical bills or treatment according to a survey by the National Opinion Research Center at the University of Chicago. This may or may not be related to any problems we’re experiencing at the moment in July as 5.4 million people have lost their job-provided health care insurance last I checked.

The survey also found that “an estimated eight million Americans had started a campaign for themselves or someone in their household and more than twelve million Americans had started a campaign for someone else.”

“Although more people gained insurance coverage with the Affordable Care Act,” they wrote, “crowdfunding for health care expenses is becoming more common because Americans still cannot afford their out-of-pocket costs— deductibles, copays, or coinsurance—their coverage notwithstanding. Medical bills remain the number one reason Americans file for personal bankruptcy, according to a 2019 City University of New York-Harvard study. When asked who is responsible for paying for care for those who cannot afford it, a majority of Americans (60 percent) believe the government should as opposed to health care providers, charities, and family and friends.”

In late July the Democrats’ platform committee voted against including support for Medicare for All.

I’m so fucking sick of being told people like me and presumably you if you are reading this book are too angry about healthcare. If anything we aren’t yet angry enough.

A recent study from Yale researchers says we’ll actually save money—and lives—under Medicare for All.

“Although health care expenditure per capita is higher in the USA than in any other country, more than 37 million Americans do not have health insurance, and 41 million more have inadequate access to care,” they write. “By contrast, a universal system, such as that proposed in the Medicare for All Act, has the potential to transform the availability and efficiency of American healthcare services.”

Not only would it literally cost less than what we pay now but “ensuring healthcare access for all Americans would save more than 68,000 lives and 1.73 million life- years every year compared with the status quo.”

Just as the pandemic was kicking off I spoke with a former nurse who worked for years in Texas and California because she genuinely wanted to help people. What she found instead was an insurance bureaucracy dedicated to extracting wealth from the bodies of the injured and the sick and even more exasperating for her doctors who were willing to manipulate that system to enrich themselves. After working for a particularly malicious surgeon she decided she could no longer in good conscience be a part of that system.

“Nurses are truly nurturers,” she told me. “I don’t think we would be nurses if we weren’t, but the healthcare industry does something to you. It’s become a black void of greed and corporate shills who have no regards for the sanctity of life. I could no longer do a job I loved because I believe in compassion, selflessness, and solidarity with my fellow humans, you know?”

“I’ve told a patient who had just been diagnosed with terminal lung cancer that their insurance company would not pay for treatment because they themselves were not deemed viable,” she told me. “I’ve told women with breast cancer their insurance has denied a second mammogram for being medically unnecessary. I’ve told parents who were barely hanging on to hope that their insurance was not in-network so we would be sending their child six hours away to another, less qualified facility.”

Despite personally living a life that could be destroyed instantly with a bad healthcare break like most of you I also live the relative life of a king compared to millions in this country. It’s simply unjust and it disgusts me that people doing ok like me seem to care more about the millions being crushed today as we speak than the people who are doing very well like all of the rich cable news personalities and untouched Democrats who think better healthcare is akin to installing a Communist dictatorship. Not only before the pandemic, they still think that right now!

Dealing with the right is one thing but it’s real fucking grim and demoralizing having to contend with so many “on the left” who don’t think better things are possible and don’t seem to even want to try. I get that coming from the rich TV people they have their own class interests to protect but I don’t understand the average person who goes to bat for the status quo.

The thing that bothers me the most just as the pandemic has made evident the evils of our current system is this: You can literally just say you want the best and most just outcome for whatever issue at any time. A lot of people don’t seem to get that. It’s free! You do not as an individual have a limited reserve of justice aspiration coupons to redeem. You’re not managing a fantasy football team or whatever where you can only draft one tight end. You can ask for the fucking moon or you can simply ask that our country accept a little bit more social democracy. You don’t have to think Well how will we pay for it? you don’t have to think Hmm will the other side be mad at me for wanting this? you don’t have to think about what the voters of a lawmaker in a purple state might want you can just say THIS IS FUCKING CRAZY AND WE NEED TO MAKE THINGS BETTER. You can say it ten thousand times in a row. And then when enough of us are saying it the politicians will have to listen or it’s their ass.

Countless hours of watching cable news pundits has convinced the average person they have to think like a savvy politics insider who knows how the game is played and that always means hamstringing our aspirations for progress before we even get to the bargaining table. You don’t have to do that shit man. It’s not your job to worry about that shit. You don’t have to see Chuck and Nancy caving in to the Republicans’ demands on unemployment insurance in the middle of a historic devastating plague with millions out of work and millions infected and say ah well they are doing their best.

The only conclusion I can draw from people who aren’t demanding that things can and should be better is that they don’t particularly care if things get better or not because things are already fine enough for them.

But maybe there are other ways to improve healthcare (or whatever) people will say maybe we just need to go a little slower and not make such radical leaps all at once they say and to them I say “more likely to work” and reasonable process arguments are always always always a way of forestalling progress. It’s a condescending appeal to fake reasonability and a lie that says we’ll get to your shit eventually just hold on and to that I say no go fuck your mother. It’s also how we end up with a mostly invisible candidate in the form of Joe Biden at a time when we are uniquely situated for real change.

I’ve said this before but as a reminder all of you fucking worms who aren’t all in on eliminating the predatory health insurance industry today are going to lie and pretend you were all along at some point when retrospect makes it seem insane.

Whether it’s climate change or healthcare or the pandemic or any of the other dozens of crises we’re facing there are always going to be people who are paid very well to tell you that we just have to chill out and let progress wind its slow meandering course. They’ll say it’s too expensive or that the rules must be followed and the choice we have is whether to stand there over a dying man’s body afraid to do anything to help because it might cost too much of a rich person’s money to do so or to fucking take what we want because it’s already ours.

Ok wait I lied the first time I tweeted about the virus was the day before the doctor one. I said this: “I will never contract nor die from the famous virus COVID-19 better known colloquially as the coronavirus.” Back then it seemed ok to joke about.

Shortly before that Alex Azar the U.S. Secretary of Health and Human Services and a former pharmaceutical lobbyist and the vice president of Eli Lilly & Co. was at a hearing refusing to commit to Congress that any vaccine eventually developed for the virus would be made affordable for all Americans. “We would want to ensure that we work to make it affordable,” he said. “But we can’t control that price because we need the private sector to invest.”

After the tweet about calling your doctor took off dozens of readers wrote in to me to confirm the absurdity of it. Here is a small sampling of what they said.

• I don’t have a doctor. I have an urgent care clinic I can sit in for five hours coughing till I see a nurse practitioner who tells me to go home and drink fluids.

• I haven’t had a “my doctor” since I was last able to qualify under my mother’s workplace insurance so that would be some fifteen plus years ago. Frankly the idea of having a doctor you regularly see is an alien concept at this point.

• If you can’t get the doctor on the phone, just take a helicopter to your family’s wing at the local hospital.

• This is why I just love it when people are like “we can’t have Medicare for All because other countries have to wait forever to see a doctor!” I had to wait six months last time I wanted to see my PCP for insomnia and when I did her literal words were “I don’t know. Try chamomile.”

• For most of us it’s “call your nurse line and get referred to an emergency room.” Having a doctor you can call seems like a fucking myth.

• When I went into urgent care for bronchitis, the nurse practitioner told me “after you finish the round of antibiotics, follow up with your PCP.” “You . . . you are my PCP.”

• I’ve been to my doctor’s office four times in the last year and have not seen my doctor. I think he might have died and the staff is covering it up.

• Laughing because I have never spoken to LET ALONE met my doctor. I have one and they just send me nurses when I make appts. This shit is COMICAL.

Back in February when I still had hope I went to a number of Bernie Sanders rallies and at one in New Hampshire I stood there with my hand raised like nerd for a half hour because I wanted to ask him something along the lines of: When we all hear these stories about people’s lives being crushed under the weight of the predatory for-profit healthcare industry in this country the very natural response at least for me is that that is fucked and we have to stop it. So many other people see it and think Eh that’s not my problem. You cannot legislate empathy I wanted to say. So how at long last do we convince anyone to care about other people?

I never got a chance to ask though. No one else since then has come up with an answer.