The strength of the American Solidarity Party will always be our passionate defense of our four principles of respect for life, social justice, environmental stewardship, and a more peaceful world. However, it can also come from how we respectfully argue our positions on other issues that challenge our communities. Here, ASP member Maria Reynolds-Weir offers some thoughts on the need for healthcare reform.
by Maria Reynolds-Weir
Naomi’s Story: The Case for Single-Payer Health Care
Naomi almost made it to her thirty-third birthday. On the day she died, her sister Leah set up a memorial “Medicare for All” fund in her honor because Naomi had spent too many of her precious few days figuring out how her health care would be paid for.
In the fifty-seven months that Naomi lived with colorectal cancer, she’d counted the songs and stories sung to her two children, the trips taken with her husband, and those taken to visit family and friends. She’d counted her surgeries, but not the troubles she faced in order to leave her husband with as little debt as possible, because she was grateful. Her health care had been mostly paid for thanks to the Affordable Care Act, imperfect as it is. Love, a strong support system, and reliable health providers help cancer patients—and other patients—stay stronger to fight their diseases longer. Naomi might not have lived as long if she had taken the advice of the social worker on her treatment team.
“You could consider divorce.”
Her social worker had advised her and her husband, Andy, in seriousness, to consider divorce. Ever the dark humorist, Naomi joked that she should get thrown in jail instead. “I could also find some fentanyl and sell it. They have to treat me in prison,” she said. Fentanyl wasn’t hard to find in Jackson, Michigan, where she lived when the ten-centimeter tumor nearly killed her. The year was 2013. A gastroenterologist diagnosed her on Valentine’s Day. She took short-term disability after two “shrinkage” chemotherapy sessions over the next few months. Once the surgical phase began, when she lost the primary tumor and added an ostomy, she realized she had less than ten years left, none of them as a full-time long-term wage earner in her home.
Naomi and Andy’s economic outlook had only begun to brighten in 2012, when she finally landed a job with benefits that included health insurance for the family. They’d been struggling with college debt (“Go to college! It will pay for itself!”) and a clunker that got her a mile down the road to work and back, but not much further. Not long after her first surgery, while living with an ostomy, Naomi realized she’d never be able to work full-time again. She rode out short-term disability and was fired for health-related reasons just as the January 1, 2014, open enrollment of the ACA kicked in. Already swimming in tens of thousands of dollars in medical bills, she spent her waking hours between chemo and radiation trying to sign up for a plan on the overloaded ACA websites.
Naomi discovered that there would be no ACA plan that was affordable, because of Michigan’s implementation of the plan. Conservative leaders across the US had thrown sticks into the spokes of the plan as it rolled out. The only help came from her social worker, who had said, “You could divorce Andy on paper. He’d probably need to move out for a while, in case your situation were investigated. You could keep the kids to show your need. Later, maybe he could move back in.” It was advice she gave to a number of couples, a common strategy because prison, where she could sue for complete treatment, was hardly practical for a church-going mother of two preschoolers.
“At least they have to cover a pre-existing condition now.”
After months of fighting for a solid plan, the hospital’s financial staff found a Medicaid program in Michigan that would cover her. So, Naomi signed up. While her kids ate lunches of Pop-Tarts while watching Blue’s Clues and jumping on the couch, she spent hours trying to sign herself and her kids up for care. Some days (like when she discovered her four-year-old son’s Social Security number and identity had been assigned to another child) felt like full-time administrative days.
“Bankruptcy. That’s what I think when I hear cancer.”
Naomi’s father, husband, mother, kids, siblings, and Naomi herself all worked for two years to remodel the bottom half of a sprawling Frederick, Maryland, home where Naomi, Andy, and the kids would soon live. The week Naomi went on hospice, they moved into the three-bedroom apartment. They’d relocated from Michigan to Maryland, where Andy would find viable employment—a job with future growth and real benefits, which Jackson could never offer—and where Naomi’s family could do more than schedule trips to cook, clean, and help with kids while Naomi slept through the ravages of radiation and chemo.
In the nearly five years Naomi lived with cancer, she had dozens of tumors removed, an ostomy put in, a reconstruction on the end of her colon, then the ostomy reinstated because she was nearing death weekly due to dehydration. Even with Andy’s benefits, Naomi had to stay on Medicaid. When she was well enough, she was expected to work. She couldn’t keep a job. Even with her six siblings and parents donating time, money, and child care, the bills piled up. Even with the ACA, Naomi spent precious days—when she had the energy—calling her provider to find out why her doctor’s chemotherapy regimen was “experimental and not covered” even though she was using standard drugs, just in alternative combinations.
In the living room while discussing the recent diagnosis of a fellow church member, Naomi’s father pinched his forehead, tears in his eyes, and answered the question, What do you hear when you hear the word cancer? with: “Bankruptcy. That’s what I think.” But he also heard socialized medicine when his kids enthusiastically supported the ACA, and even when his other daughters marched in the Women’s March with signs in rainbow letters that said, “The ACA saved my sister’s a——.”
A mainstream conversation?
On the day she died, Naomi’s father stayed silent while Naomi’s sister Leah sat cross-legged on the couch, calling out progress as she set up her “Medicare for All” fund. In the 2016 election, Naomi’s father had sworn off anything linked to Bernie Sanders. As a transplant to the East Coast and a Rust Belt Republican, he sweats the word socialism while his kids insist, “We need a single-payer plan.” After the funeral, the “Medicare for All” fund raised a chunk of change. Now, his children promote universal health care and debate which iteration will inspire the masses and shift the national opinion. Andy makes appearances advocating for “Medicare for All.” The siblings sport T-shirts for the brand.
In 2018, Naomi’s father nearly lost his job when his long-time employer, Sears Holdings (which owns both Sears and Kmart), filed for bankruptcy. He mentioned longingly how he’d like to retire promptly but had to wait. “Maybe when we get universal health care,” he let slip. He’s been subject to the willy-nilly labor-related dealings of his company and tied by necessity to the paternalism of employer-based health care for his entire life. He’s got the résumé and smarts to join a startup, but he and his wife are aging. Naomi’s disease, colorectal cancer, is ordinarily an older person’s disease, as are hypertension, diabetes, and the other cancers that lurk in their family histories. They, like so many American workers, can’t shell out the money for an individual health insurance plan. What’s affordable is not viable unless you’re a healthy twenty-something with a high risk tolerance.
Senator Mike Braun of Indiana, where Naomi was born and raised, recently called out the paternalism of insurance companies and health-care providers. He proposed a solution that will hold these entities responsible for opaque cost sheets and prioritizing profit margins before people.
Health-care providers need to offset the unpaid bills of those who are either underinsured or uninsured, so they often charge patients two or three times the cost of goods or services. The average worker with insurance gets a few negotiated breaks, but the costs of emergency-room visits remain obscenely high because it’s the only place where the poor can get health care. The poor often don’t have access to clinics or offices in their area. The poor often don’t have access to employer-based health insurance if they do work, and most do. The poor don’t have sufficient, if any, coverage even if they work. The system reeks of inefficiency.
Braun says it is the paternalism of the system that is causing problems, but which part of the system is most at fault? Insurance companies? Employers? The working class and mid-level professionals are overwhelmed but skeptical. When they bear testimony to the favors and trinkets that drug and device companies hand out to court hospitals and physicians, they sense their own skepticism and feel questions prick the backs of their necks. It stinks of paternalism at best, and sycophantism of the powerful at worst.
The land of confusion.
We live in a culture of conspiracy and implication. Causation and correlation get confused. Too many commentators fill the airwaves with too little information. On the perimeters, gluts of raw data and information presented in academic jargon obfuscate the issues. No wonder we succumb to the idea that our little voice doesn’t matter. We can’t change the system, we think. It’s too big. But we can, if we give ourselves permission, if we speak our concerns, if we ask our questions, if we call our representatives.
Since the inception of employer-based health insurance (during World War II, when companies courting employees from a tight labor force realized that for a few dollars, folks could visit a doctor a certain number of times, arranged by your employer, thank you very much), Americans have also fretted over socialism and communism. We conflate the two, treating them as synonyms. While post-WWII Great Britain exchanged the paternalism of company-based health insurance for a national health system (the National Health Service), American workers trusted that they’d mostly get good jobs with benefits. We trusted companies to value people as an asset worth honest, fair investments like pensions and health insurance. People over profit, we thought. We trusted that to be the American way.
It’s not working out.
If a worker has the education or opportunity to work full-time for a company that offers benefits, she is seeing the loss of or a higher cost for those benefits. According to data from the Kaiser Family Foundation, health-insurance deductibles have gone up over 200% since 2008, with premiums up 55%, but wages are only up 26%, and inflation is far lower, at 17%. Furthermore, plenty of people work multiple jobs without benefits, or are caregivers for kids or the elderly, or don’t have a local employer who offers health insurance. With the passage of the Emergency Medical Treatment and Active Labor Act (EMTALA) in 1986, the United States government decided that health care is a kind of right. If a person shows up at an emergency room, she can’t be turned away if she needs services. The outcome is that a whole class of citizens has nowhere to go for health care except the most expensive place in town. If they can’t pay, the hospital will have to shift the costs somehow to those who can. Hence, we have an inequitable, inefficient, opaque system. It’s ripe for profiteers to trade shiny favors for overpriced goods. It’s a network full of holes and gaps.
Why can’t it work out?
Companies and government-based employers can no longer afford pensions. They can’t afford insurance. Annually, they negotiate plans in which deductibles rise, contributions rise, and services and providers are limited. Spouses are dropped. Individuals place their children in Children’s Health Insurance Programs (CHIP) for coverage. They forego care, stress out, avoid preventative self-care options, and can’t find the time or information to count their own costs. Even with the ACA covering more people, the coverage may not be better or affordable. It depends on the state and its politicians who hold the power to make the options viable or prohibitive.
Who’s being paternalistic?
If Senator Braun says that it is health-care providers in the system who are being paternalistic, we might push back on that. He also points out that he, as a business owner, set up a program that worked for him, rather than for his employees. That’s a form of paternalism. He and other leaders decry a national health care, single-payer, or universal system as governmental paternalism. When that critique falls on deaf ears, they trot out the word “socialism” to besmirch the idea. It could be as easily framed as good citizenship, a civic duty, a humane part of our national identity and unity that we the people create a system that has fewer gaps, fewer profiteers, and acknowledges what we already practice, albeit poorly.
Providing access to health care is right. Letting people die between emergency-room visits is no more humane than leaving them in poorhouses untreated for acute diseases—the option of the pre-industrial era.
Also, providing universal health care is just fiscally smart in the long run. We are already paying for medical care for our poor brothers and sisters, but not as fellow citizens united. Single-payer health care will cost more in taxes, but these can be investigated and negotiated. The provision of some procedures will raise moral dilemmas, but other nations have found a way.
The United States prides itself on its leadership and innovation. In the area of health care, we have some housekeeping and catching up to do. The health and welfare section of the American Solidarity Party platform calls for “[d]iverse efforts across this country to secure universal health care access, affordability and outcomes, including single-payer health initiatives, healthcare cooperatives, and hybrid systems at the state and national level.” Naomi’s family would agree.
Naomi is a real person. Everyone in this country probably knows a “Naomi”; the particular circumstances might be somewhat different, but her reality is universal.
Maria Reynolds-Weir writes, teaches high school, lives near Indianapolis, Indiana, and is a clergy wife passionate about serving the least of these in word and deed. She serves on the board of Raise and Restore, an urban ministry, and Achaius Ranch, which ministers to youth. She’s contributed to Relevant Magazine, The Handmaiden (an Orthodox journal for women), the Kurt Vonnegut Memorial Library’s So It Goes, and the anthology Enduring Love. Her poetry has won the Laurie Mansell Reich Poetry Prize and has appeared in Poetry South.