Political Economy of Medicare for All
Political Economy of Medicare for All
A round up of Death Panel episodes examining the popular, proposed, health-finance reform through a political economy of health lens
Today the House Oversight Committee held a hearing on Medicare for All, which means that our favorite subject to cover on Death Panel has bubbled back up to the top of the discourse again. Because we heard and saw so many of our least favorite Medicare for All one liners today—here is a round up of just some of our extensive Medicare for All coverage on Death Panel as well as an important note on systemic anti-fatness and policymaking, analysis of which is not included in these episodes but is currently in the works.
Below I’ve divided up some of our most popular Medicare for All episodes into the following categories:
How are we going to pay for it?
Why Federal Universal Single Payer (FUSP) not State Single Payer?
Medicare for All and the Social, Structural, and Spatial Determinants of Health
Disability Justice Means M4A Needs In-Home Services and Supports (IHSS) and Long Term Care (LTC)
Balancing Long Term Goals and Immediate Reforms
Health Care Workers on Medicare for All
What About an American National Health System (NHS)?
How Media Framings Impact Policymaking
Issues with our Current System
(Shout out to Death Panel listener Chris Willcox who testified on the first panel, ending with “Medicare for All now,” and Death Panel guest Jamila Michener who testified on the second panel and was truly a force to be reckoned with during the question portion.)
What’s Missing from Death Panel’s M4A Coverage: How Can We Use Medicare for All to Undo Entrenched Anti-Fatness
Fat studies has informed a lot of my thinking this last year, and we have not done an episode that makes this explicit so I wanted to make sure to include some fat liberation perspectives highlighting just one aspect of why it is important to center fat people in our health care policies when conceptualizing reforms like Medicare for All. If we are fighting for reforms then we also must use those reforms to leverage goals of liberation—such as using health finance (e.g. single payer) towards the elimination of policies that were instituted as cost saving measures by private insurance companies which force doctors to collect data like BMI, which is used to ration care based on body size and leads to a trove of misleading (and bad) research which mistakenly claims a correlation between larger bodies and medical neglect leading to worse outcomes is instead a causal relationship of destiny.
As public health researcher and fat liberationist, Monica Kriete, explained: currently, we “essentially have a system where BMI is used to funnel “deserving” bodies toward real care and ‘undeserving’ bodies toward iatrogenic harm for profit.” Simply changing the payer through switching to a single payer system—i.e. changing who pays for the care—does not de facto eliminate this dynamic. We run a major risk of repeating harms of the current system if we do not interrogate how stigma and harm are reproduced at a structural level and then refuse to allow these practices to move forward.
How are we going to pay for it?
M4AW2:06 – Nathan Tankus & Marshall Steinbaum on How to Pay for Medicare for All
Economists Nathan Tankus and Marshall Steinbaum join us to discuss the biggest red herring argument leveraged against the single payer movement: how are you going to pay for it? We discuss what this question distracts from, how the answer is actually quite simple, and the number of ways a single payer system would have profound macroeconomic benefits.
Nathan Tankus is Research Director at the Modern Money Network and the author of the publication Notes on the Crises. Marshall Steinbaum is an Assistant Professor of Economics at the University of Utah and Senior Fellow at the Jain Family Institute.
Federal Universal Single Payer (FUSP)
M4AW01:09 – Tim Faust on Winning Federal Universal Single Payer
We sit down with Tim Faust to talk about how we win Medicare for All. Tim Faust is the author of "Health Justice Now: Single Payer and What Comes Next".
Medicare for All and the Social, Structural, and Spatial Determinants of Health
M4AW2:03 – Arrianna M. Planey on Medical Geography and the Surplus Population
Arrianna M. Planey joins us to discuss the how the distribution and rationing of healthcare in the United States is closely tied to property relations, systemic racism and ableism, and capitalist market frameworks.
Arrianna M. Planey is a medical geographer and an Assistant Professor in the Department of Health Policy and Management in the University of North Carolina Gillings School of Global Public Health.
M4AW2:04 – Justin Feldman on Police Violence And Social Murder
Justin Feldman joins us to discuss the how state violence operates as a public health vector and how the politics of medicalization and data production interact with the carceral system.
Justin Feldman is an epidemiologist of social inequality and state violence and a Health & Human Rights Fellow at the FXB Center for Health and Human Rights at Harvard.
Disability Justice Means M4A Needs IHSS and LTC
M4AW1:05 – Steve Way on Long Term Care and Bernie's Disability Platform
We sit down with Steve Way to discuss the crisis of long term services and supports (LTSS) in American healthcare, his support of Medicare for All, Bernie's Disability Rights platform, and his own battle with New Jersey Medicaid over home care hours.
Note: The day before this posted, there was a major update to Steve's case. Bea reached Steve over the phone to briefly provide some context at the beginning of the episode. The original interview begins at 05:25.
Bernie's Disability Rights Platform (1/31/20)
We discuss the Bernie Sanders campaign’s statement on disability rights from January 2020.
Sick Note: Fighting for Disability Benefits
In a guest post for Sick Note I detailed my experience with Social Security Disability Insurance, and how that taught me the need for a single payer program like Medicare for All.
“My experience with disability, both when I was on private health insurance and now on Medicare, is why I think we need a single payer system and so much more if we want to truly commit to the pursuit of health and protection of the vulnerable. Without this, we’re leaving people to die.”
Balancing Long Term Goals and Immediate Reforms
M4AW2:05 – Dean Spade on Mobilization and the Limits of the Law
Dean Spade joins us to discuss building the movement for single payer, how the fragmentation of our social welfare systems is used to demobilize us, and how Medicare for All would help build solidarity to fight future struggles.
Dean Spade has been working to build queer and trans liberation based in racial and economic justice for the past two decades. He works as an Associate Professor at Seattle University School of Law.
M4AW1:07 – Michael Lighty on Why This Time Is Different
Michael Lighty joins us to discuss lessons from his more than 25 years as part of the struggle for single payer and health justice in the United States.Michael is Health Care Constituency Director for the Sanders campaign and former Policy Director for National Nurses United (NNU).
Health Care Workers on Medicare for All
M4AW1:03 – Vivian Negron on 37 Years of Billing Private Insurance
We speak with Vivian Negron about how medical billing has changed over her 37 years working as a medical receptionist, and the absurd hoops private insurance companies make her jump through on a daily basis.
M4AW1:08 – Dr. Victoria Dooley on Health Justice
Dr. Victoria Dooley joins us to discuss racial and economic justice through single payer, her experience in a small family practice and doing her medical residency in Flint, Michigan, and how our current health care system punishes patients and caregivers alike.
Dr. Dooley is a family medicine doctor and 2020 National Surrogate for the Sanders campaign.
M4AW1:01 – Dr. Adam Gaffney on Redistributing Care
We speak with Dr. Adam Gaffney about the redistributive potential of a single payer health system and his work with Physicians for a National Health Program.
Adam Gaffney is the most recent past president of Physicians for a National Health Program and a pulmonary specialist at Cambridge Health Alliance / Harvard Medical School.
What About an American National Health System (NHS)?
M4AW2:02 – Adam Gaffney on the Pandemic and a National Health System
Adam Gaffney joins us to discuss how the pandemic has highlighted the need for Medicare for All and more comprehensive coordination of healthcare resource distribution.
How Media Framings Impact Policymaking
M4AW2:01 – Libby Watson on How Media Get Healthcare Wrong
Journalist, Libby Watson, joins us to discuss how the way the press frames healthcare stories obscures systemic problems with our healthcare system, and the issues with limiting our demands to incremental reforms. Subscribe to Libby's publication Sick Note at sicknote.co
M4AW1:02 – Libby Watson on Dark Money
Libby Watson joins us to discuss attitudes in Washington towards single payer, the influence of corporate-backed groups like the Partnership for America's Health Care Future, and how untenable America's current health care system is.
Issues with our Current System
UNLOCKED: A Death Panel History of Medicare (07/05/21)
We survey the extremely messy history that led to the passage of original Medicare, the role private insurers and other industry groups played in its creation, and some of its unintended consequences we live with to this day.
A Nightmare on Medicare Advantage (10/22/21)
We discuss the Biden administration's newly narrowed ambitions for its Build Back Better bill, including the assertion that negotiations over the healthcare provisions are now "holding it up," and the surprising possibility that Democrats might, finally, do something about privatized Medicare plans.
Teaser - A Death Panel History of Socialized Medicine (9/7/20)
Subscribe on Patreon and hear the full episode here: www.patreon.com/posts/41353907
In this Labor Day special, we take a look back at the fight for national health insurance in America from the 1920s into the 1970s. Eugenicists, industry groups, paternalistic wonks, this one has it all.
More on What’s Missing from our Existing Death Panel Coverage of Medicare for All:
The beginning of this round up features a statement from public health researcher and policy expert, Monica Kriete. I wanted to provide some more background on why I felt it was so important to mention that this topic is not well represented, (e.g. in the way that a disability justice perspective is), and reassert my commitment to including crucial analysis like Monica’s in our lens for evaluating and discussing health finance policy going forward.
I have an automated tweet set up to go out every day at 7:59am ET that says “Here's a daily reminder: if you don't support Medicare for All—you want disabled & poor people to die. If ur asking "how are we going to pay for it?"—you want disabled & poor people to die. If you bet M4A won't happen—you want disabled & poor ppl to die.” You can’t convey values or a full policy platform in a tweet, this is intended to be polemical and to the point—but it’s vagueness has actually led to some really generative discussions which has given me such valuable insight into what aspects of Federal Universal Single Payer (FUSP) are currently under-theorized, contradictory, inadequate, or unconsidered.
Recently, Monica replied to this automated tweet to add a very important point, which I had only recently begun to consider in my own thinking of what kind of policy framework we truly need in the last year since after the recording of our second Medicare for All Week.
This is a crucial point. Ability to pay as a metric for rationing care is not the only thing that could be changed by passing a policy like Medicare for All—it all depends on what is in the actual policy or not. Monica is so right about this, and the discussion which follows is what made me sure I needed to spend some significant time rounding up a little bit of background on this if I was going to send out a round up of our Medicare for All coverage.
I am not ashamed to admit that I am still new to learning from fat studies scholars and fat liberation activists—since reading Sabrina Strings’ book Fearing the Black Body: The Racial Origins of Fat Phobia in 2020 and doing work around health care facility spatial/environmental accessibility, I realized how crucial learning from fat liberation was to strengthening my approach to disability justice.
Monica’s full statement, which outlines part of a conceptual framework theorized in collaboration with fat activist, Ali Thompson: “if BMI is all but meaningless (it is) and weight loss treatments don’t work reliably to improve health (they don’t), we essentially have a system where BMI is used to funnel “deserving” bodies toward real care and “undeserving” bodies toward iatrogenic harm for profit.” What follows is some further context, it is important to note that BMI is just one aspect of analysis here—there is much to undo if we aim to strip anti-fatness from health care.
As Medicare for All Week participant Dr. Victoria Dooley pointed out recently, insurance companies are pretty pushy about this stuff, codifying anti-fatness into their systems and structures of mandatory data collection. Often times arguments in favor of Medicare for All, many of which I’ve made myself, point to the ways that a Federal Universal Single Payer System could give researchers much better data, showing us a picture of the United States that many assume we already have (we don’t). If Medicare for All is to replace private insurance, then it cannot reproduce these same harmful systems.
It is crucial that when replacing our systems of extractive and carceral health finance, we do not reproduce these frames, values, ideologies and dynamics that made the system so extractive and carceral in the first place.
Also, I cannot recommend Mikey’s podcast Unsolicited: Fatties Talk Back enough, it’s co-hosted by Da’Shaun L. Harrison, who I interviewed for Death Panel about their recent book Belly of the Beast: Anti-Fatness as Anti-Blackness.
That’s all for now, to support the work we do on Death Panel, become a patron at patreon.com/deathpanelpod.