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Hello and welcome to [inaudible]
In the moment. I’m your host, Ginny Palmer. It’s the third week of September, 2019 and the moments are flying by quickly here at town hall, Seattle or homecoming festival. Momentum is in full swing with events this past week from award-winning novelist Marilyn Robinson to diplomat, Samantha power to Seattle mayor Jenny Durkan. And as we approach our fourth week of the festival, we have some even more hip exciting events to add to the roster, including tough art, collective takeover. On Saturday, September 21st you had me at cello at cello concert on Sunday, September 22nd and hot takes with hot dykes, a live podcast with standup comedians, Clara Pluton and Val Negro on Tuesday the 24th and in the midst of all that entertainment, don’t overlook the critically important discussions filling our space. Naomi Klein talks about the green new deal with three Somos SCADA. Jonathan Safran Ford talks about how what we eat impacts climate change. With our in the moment, chief correspondent Steve share on the great hall stage and on this episode we get to know Timothy Faust, who will be discussing a single payer health care in the forum and if you happen to be in districts three or seven in the Seattle area, Townhall is hosting the city council debates next Thursday, September 26th if you’d like to see a full lineup of all of our events.
Check out our calendar at town hall, seattle.org single payer healthcare is a health insurance system financed by taxes that is managed and run by one entity such as the government providing essential healthcare to all citizens. There are many approaches and ideas for how this healthcare system could work in the United States, but healthcare, data scientists and activists, Timothy Faust, got on the ground to talk to people throughout the U S about health inequalities in their neighborhoods and how a single payer system could benefit all our correspondent Venice. [inaudible] Has been a journalist, reporter and editor in Seattle for over a decade. Most recently as editorial director at the Seattle globalist Venice sat down to talk with Timothy about why he’s passionate about healthcare, what he’s learned while working with the affordable care act and his new book health justice now single-payer and what comes next. So yeah, thanks for talking with me. I guess first can you talk about you know, what, what was the emphasis for writing this book? I mean, what was the need that you saw for having a book about this topic?
Sure. So I spent much of the past two years driving around talking to folks about single payer and health and equity and health justice. And one of the things that I realized is a, there’s, there’s wasn’t a good book out there and for a lay person, and I’m a consummate lay person, I’m talking about well healthcare, talking about what it is, how it operates, what insurances, why these things work the way that they do or don’t work the way that they don’t. At that single payer policy was understood. Generally it’s on the complicated, but then it was understood generally or the specific contours of, well, this thing is and how it works and how it operates or quite as fluently understood as I’m, as I might one of them to be so Polish your ass the rest of the book. And I thought this would be a good fit for it. And we’re not really much of a writer, but managed to excrutiatingly pull the words out of my head, like yanking my own teeth. I know what it was, a little book for them. And now here we go. We got a little 220 page ish bad boy that I’m rather proud of that seeks to answer Phil. Three questions. One, what do we have to, what do we want instead? And then three, what lies beyond.
Mm, okay. Yeah. So maybe can we back up a little bit and talk about like how did you come about like driving around to folks about talking about health care and the health justice system, I mean, or health justice. How did you, how did that come about for you?
Sure. I’m pretty haphazardly to be honest. I know quite a bit. I wouldn’t say no quite a bit, but I know a little bit about health policy. From my prior experience helped enroll full under ACA plans and Florida, Georgia and Texas. And then I work at an insurance company. I’m originally a true believer in ICA. I thought all this can solve all problems with Atlanta. You know, we may give given a chance to work the right way. I recall I once got into a shouting match, I’ll set a bottle with somebody. But whether or not the a snake work and I was wrong. I was super wrong. My, my goal and the time, my longterm plan was to this was back in 2015, 16. You get a job working for a state Medicaid program and do this for a few years cause I love Medicaid, especially in New York.
And then maybe you got a job then [inaudible] under a Clinton presidency and then hopefully work on single pattern in pass. And then of course, so that didn’t work out for it. Right. Intervene. And I reckon, Oh shit. Like we got a big problem here. Here’s the thing I’m really care about. I should go out and talk about it. And so I had some friends that had a podcast called Chapo trap house, really popular broadcasts. I played D and D Dungeons and dragons with one of the guys for about a year and a half. And I got them. There’ll be come on and just talk about single payer. And that was pretty popular. The same time I’m a member of the democratic socialists of America. So I happened to have a lot of folks from, from branches across the us say, Hey, would you be interested in coming to speak to us?
So I’ve got DSA locals across the U S to help put together events. I’d come and speak. And then more importantly, I’d get a chance to learn well, healthcare on the ground because healthcare is very different. And you know, Boise and Boston and Houston and Dallas and all these towns, I mean, Seattle, Seattle, and Eastern Seattle and Spokane have different healthcare needs. So I got a chance to learn more about health care in different, different parts of the U S and the specificities and contours of how health and manifests and then we’ve got a chance to put that all into a book.
Hmm. Yeah. I guess, are you finding, you know, you’ve been traveling around a lot or have you been finding kind of different reactions to the idea of a single payer in different parts of the country, like different resistance to, you know, different aspects of it and or skepticism of the idea in general?
I think there’s a lot of folks who understand they are afraid of their own bodies now. They are afraid of leaving their kids behind or they are afraid that they will be punished with a mountain of medical debt for a thing which is virtually beyond their control. But a lot of folks in just in a kind of in the middle they don’t quite know what this thing is. They’ve been told a lot of misinformation by people who profit from that misinformation. And so I’ll talk to a good number of those folks. And always eager to talk to more like listening to folks and but yeah, that’s been, I think that real that’s the real productive ground for them. Single-Payer question.
Hmm. Okay. So I guess, can you maybe describe what some of the misinformation that you’re hearing from people, like maybe some of the most common misconceptions about it and, and what do you tell them?
Sure. Well, the biggest one that gets swung around with a little hammer, you got a single pair, simply can’t afford it. That’s going to cost so much extra incremental money that we could never finance. And I have two responses to that. One of which is that, I mean, frankly, I don’t myself necessarily care about the economic arguments. I think this is a civil service, civil rights. People are, I think people want them to settle the people that live freely in their bodies. We can provide one, it’s what a government is there to do to, it’s economically proven to invest in American as hell. Every dollar spent on healthcare or the federal government typically for experts return compared to two way. And you’d have one central terminal or things like war crimes, but to, we fundamentally can afford single payer because we’re already affording it.
Right now or this year, we’re going to spend three point $9 trillion on national healthcare expenditures. You’ve got a whole bunch of steps or whole bunch of arguments. Single-Payer costs significant in the lesson, right? One single payer three year national health monitors have increased much faster than inflation once because of healthcare costs while they of control and the increased just kind of one line it’s profitable to do so. So a health go off year over year, over year we still spend four point $7 trillion eight years from now. What a single payer does is at the very least, keeps that cost flat. So there’s a large quantity of money that it saves efforts. You are not getting up left foot. Bug’s $7 trillion line two of that three point $9 trillion going right now. A full third of that is it’s considered waste either outright fraud or it adequacy of the contemporary American insurance.
Oh, half of that of that 30% is provider’s sideways. Things like unnecessary services being our price Mark. Other half of that is pay or sideways things like admin costs and efficiencies and pricing and this kind of the general and competence of the insurance industry bring prices down. So where we have this big chunk of change, we’re already hammering all contrast that to go single payer, the political economy research Institute, that’s a, our estimates are both single payer plans in Congress will cost a 10% less per year. Well Carl been now, so a 10% less to cover all people at full versus a bloated massive private carve outs and fraud waste. A pretty easy comparison for me. And what are you talking through with folks? You know, they, they tend to understand it. Some folks are concerned that their taxes will go up. I’m not to easy to fucking right now spending a lot of money, private facts to insurance companies that premiums, deductibles, copays, all that is life away.
So I think the nurse campaign’s estimate is that under their plan, a average, and I think this was docked out, if you look at the tax proposal, family of four making $40,000 a year right now spends about five to $6,000 on a health care in a given year, which is, I’m seeing them on the money. And that’s a combination of insurance, premiums, deductibles and copays. And the, under the Sanders plan, they’d spend $420 a year be a tax. But that tax is more offset by a marked reduction and their family. And on top of that you’ve got like your employer in spending, you know, 6,000 or warm $10,000 a year on insuring you cause retired employment to insurance. In theory provides the room for them to pass on that savings in the, for my higher wages and a better benefits.
Okay. And so that tax is essentially part of their income tax, right? Is that, is that kind of what the, the argument is
The actual financing models contingent upon the policy pass? Right. and like there’s a bunch of different ways one can fund the program but are still like determined upon how the policy is written. The most common one right now is an income tax, a progressive income tax that expands the higher counts of it. So people who make a hell of a lot more money. But I’ve more into the pot. But there are certainly alternative ways to finance lists or a compliment in your finances.
Okay, cool. Thank you. When I was reading the book, I did find it interesting that the last section of the book, I’m kind of focused on other social justice issues, connected to health justice, such as racism, affordable housing and gender issues. I, I was wondering do you, do you find when you’re talking to, you know, just the general public to lay people, do they, you know, intuitively find that connection between, Oh, you know, like, you know, I’ve gotten a lot of mold in my house or in my apartment, so that’s what’s making me sick, I guess. Are you finding that they, that they intuitively make that connection? You know, topics that I think a lot of people tend to shy away like intersectional topics that I think people tend to shy away from like gender issues or can’t get certain types of health care because they’re female. Yeah.
Yeah. I mean folks who got like just got mold in the walls and do get sick and see their kids get sick. They’re saying the causes of why they’re getting sicker while their kids are getting started. People on, I’m surprised to learn that they’re unsafe. Home conditions are causing illness and it’s often feel powerless or can’t do anything about it. And frankly that’s not long. A lot of them can’t do anything. I probably gotta organize where I talked about, so I kind of put a delay between social determinants of health and structural determinants of health, social determinants of health or things like housing and food and education, income and struck. But these things offer as we understand on evenly apportioned, cross the public, right? Some folks have adequate housing, some folks do not. Some folks are adequately safe at home or in their own bodies.
And some folks are not. Some folks had access to the healthcare they need and some folks don’t. Some folks have income and other people don’t. I mean I, I posited that the method of portion and these social determinants is through along the lines of things like structural racism, structural poverty, structural Pega, Patrick alcoholism like Mike McConnell wants to call it. Examples is a natal mortality. Black infants die twice. The rate of white infants. How there’s no inherent like quality of black people that mix infants die twice as often. Clearly something else is at play here. There was no racial components to County. You can take it up a few degrees less abstract. We know that for example, black man in a white man with the same symptoms of chest pain when we were in the same ability to pay or needed the same hospital will receive different kinds of care. This has been measured by it. See downstate did a study on this, a really brilliant study looking about how black men both receive worse care and receive more bad care. Little difference there. Then then wiped my arms. Like racism plays a pretty big role in how he received, how you like even literally receive help or even before you take out the intersections of inequality these things do affect how we behave in healthcare, get sick, die, et cetera.
You talked a little bit about the affordable care act, the ACA and you know, in the book also you mentioned that you were a big fan of it and actually started working in it and I was wondering, can you describe what you liked about it and kinda the reasons why you kind of left that industry?
Oh so actually still work in the industry. I gotta get, I have about $2,000 of medical costs a month, and frankly I needed the insurance. So I’m kinda, there’s a certain hiring to that. I’ve made my own [inaudible] and bargain. Honestly, nothing I say reflects my employer and certainly not vice versa. No, I mean, I, I I thought the thing would good be good. I thought the government would be a, a good actor here that like the, they had like you could channel a corporation and they could do nice lens and I don’t think insurance companies are malevolent. I think they’re just incompetent. I think they’re a inadequate to handle the task we put before them. They can’t do the right things. We, if they wanted to, they are unable to invest in the things that make a difference and all they can do is they can’t manage costs.
All they can do is scrape off their profit and pass the costs back to you. The the consumer. I mean the idea that healthcare as a commodity, that you are a consumer instead of a person I find pretty abhorrent. And I find that the justification for maintaining the insurance industry to sustain this model pretty flimsy at best. They’ve had 40 years to do the right thing. And even with the ACA, they have failed to do it time and time and time again. So there was large swats and population who just, you know, we couldn’t have targeted or shouldn’t have targeted because they weren’t eligible for the ACA. I’m not going to book my brain. I didn’t really understand why. Hey, government would actively deny care to people if it was free. Which kinda had a, a catalyzing effect in my understanding of how government works and how, you know, certain bad actors can ruin things for the bunch.
Okay. How, how do you feel about the ACA now?
Oh, it was a mass government subsidization in private industry in an attempt to coerce it completely. It’s a big part. It’s a big pint of whale. Please, please, please. How many billions of dollars we’ve got to give you. You stop being sick people off their insurance plans. That’s how I see it now. That’s not how I thought at the time. No, I mean like it’s, there’s, there’s no, like Paul on the road to Damascus conversion story. I just looked around at what I’ve been doing for a year and said, huh, have things gotten better? And the answer was no. And I couldn’t blame it on like a, you know, GOP interference or whatever. I had to say this whole thing is not working the way it ought to. What does kind of settled upon single payer is the thing that I thought a the model which made sense to me.
Okay, cool. And, and I guess, can you kind of describe your your, your ideal scenario and what would have to happen in the next you know, you can give me what the timeline is. I’m thinking five, 10 years for your plan to come about. What would have to happen?
My ideal scenario is full single-payer. Full stop. No question. That can be a transition plan or we have a couple of years where people kind of get ramped into a ramp out of the plan. We’re going to be overnight. I don’t really care. We can either make it illegal to sell insurance and compete to get single pair or we can nationalize the insurance industries and fill their mouth’s with old. I don’t really care either way. I think the latter probably makes more sense as far as what we needed to get there. I mean, we need a massive popular movement. Health reform and the has been tried in the U S many times and it’s failed every single time. Even when my well-meaning Sanders or well-meaning policy leaders or other woman people. All right, the helm, the only time health perform succeeds as when there is a large popular movement behind it.
Doesn’t need to be that large. Like think of like a, a act up act up as the HIV AIDS advocacy program that was sprung out in the 80s and they were facing a lot. There was a sitting president who said that HIV was a plague brought by God to kill gay people and that this was good. And even in the face of that, they organized, they allied with homeless people and people using drugs and people of color and poor single mothers and put together massive of mass, the top of popular movement. And they won. They won and they won and they won. They won. And I won a, I think we need similar popular movements. And I think the nice thing about health justice is it shows that you can be working on housing and so we are working with part of that, the health care movement at the same time.
Right? Not, I don’t think you want to build a singular monolithic popular movement. I think you build a, you, you win whatever you can, wherever you can. Right. You’re in Seattle. I can’t tell you what to fight for in Seattle cause I don’t know, I don’t want to be covered back. I don’t, I don’t, I want to fight over. I try to call the shots if I can say it as if there is something you think you can go forward and women because small material gains you get larger material games. This kind of like snowballing of a a victory. We will build the quilts that can win single payer and so much more beyond it.
Okay, cool. Yeah. Thank you for answering that. Like, you know, is there like an example that’s particularly egregious that you know, you don’t that you’re, that you wish people would know about?
One of the things I talked about mentioned earlier was that prices in the U S are fundamentally fake. And that sounds like a joke, but it’s not. Often prices are determined as a function of costs, right? It takes me $5 to build a gizmo. I want to pay my employees and myself, I cost $2. So at a total of seven there’s other competing giggles in the market and they’ll go for $9. So I will sell mine for eight 50 or whatever that’s I use to use costs to set a price. That’s how it works in healthcare and not at all. And so I got a couple of a couple of comparisons. I like. One is inpatient care in the U S costs 40% more than the same procedures performed in the same patients when performed in France or you’ve got a MRIs. Mris are a great example because MRIs are pretty consistent that as big tubes of printed money and one MRI is virtually indistinguishable from the, another MRI made by the same company.
So in the U S and MRI scan costs five times the same machine doing the same procedure costs in Australia. There’s no difference there. The MRIs aren’t more expensive to produce. It’s the same machine coming. It’s coming the same person that’s that they can afford to to charge five times more. So they do, I think it’s dumb or even not domestically. The, in a given a given hospital and like the literal same hospital, the literal same MRI machine who perform scans that have a seven fold cost variance, that is to say one scan might cost $200 and another scan might cost $1,400 even though it’s literally the same button being pressed to perform the literal same kind of scan. I simply, because [inaudible] prices are set as a function of who’s paying for it. If a hospital has a more powerful or dominant relationship with an insurance company, they can demand that the insurance company pays more for a given procedure.
Or if the insurance company has a particular scheme or a particular policy in which certain procedures cost more or cost less or whatever. But there was no real, like there’s no sensible approach to how a thing lets us standardize as an MRI on this cost. And if you add more competitors in the market, if you add a new hospital to a city or if you had a new facility to a region, costs go up, not down. There’s no, like this is not a market good. It doesn’t behave like a market good. In general it is, it’s a big gold rush. Big land grab. Everybody’s going for it and it doesn’t behave in the ways that we’re told to believe. Markets should behave, costs go up, prices go up, prices are invented. The, at the insulin for example now costs $400 a vial.
It costs fractions of, of honey produce costs go up simply because they can. Most famous case of that is Martin Shkreli on the pharma bro who took Dera prim, which is a, an antifungal, I forgot what it is. It’s a, it’s a, it’s a, it’s a drug used to treat infections in people that have autoimmune diseases like HIV AIDS and increase the price. Something like 17000% overnight suddenly because he could and he didn’t go to jail for it. We only went to tell because he ended the fraud in some rich people. The EpiPen now costs $500 with insurance, even though it used to cost a think 150 a couple of years ago. Like these costs increased simply because they can, not because of any kind of like sound business logic or anything. And so that’s where, that’s where the real like bankrupt in, of, of Medicare or whatever is coming from. It’s coming from bad actors in the provider side. And in the face of all this, insurance companies can’t do anything. They have no leverage. They have no tools, they have no nothing. They can’t handle these rising costs. All they can do is make you pay for more of it. The hopes that that will prevent you from seeking care, but then they have to pay for.
Okay, great. And, and I was also, I was wondering, do you feel that you go around talking to people who already kind of are sold on single payer health care? I was, I guess my, my main question is, you know, you know, for whom did you write the book, you know, D do you feel like you’re preaching to the choir when you kind of lay out your arguments here or are you, are you actually, are you reaching people who kind of, you know, are curious, want to learn more?
I wrote the book from my dad mostly. So I imagined my father as a reader and then wrote a book for him cause he’s a, he’s a nice guy who wants the best but it doesn’t know a lot about healthcare policy and doesn’t quite know how the whole kitten caboodle operates. So, okay, let’s, let’s, let’s put together a thing that he can read and understand and hopefully enjoy. And so far it’s getting the dad’s seal of approval. Five out of five dads stars with is all I can ever help for. As to, as far as like like the, the hope is that my hope is that the book of the toolkit for folks who want to talk about single payer but don’t know how folks who wants to know what this thing is, to what degree that’s successful, I don’t know yet.
The book only came out last month. So my hope is that people that come to this book talks will take the book, you can read it and carry that forward. And talking to other folks that that they talked to about and self care is a thing people do discuss. I’m sure I have a pretty skewed index on how often people discuss healthcare. But I do believe people discuss healthcare pretty frequently. So I hope people can use, they learn in this book to talk to people that they know about healthcare health office,
Timothy Faust. We’ll be talking in our forum on Wednesday, September 25th. There are still some tickets available. So if you’d like to get involved in the conversation, head to our website at town hall, seattle.org. Thank you for listening to in the moment. Our theme music comes from the Seattle based band, EBU, and Seattle’s own Barsac records. We filmed and live stream two events this past Monday, September 16th so if you’d like to watch Caitlin Dowdy discussing death or Samantha power talking about her career as a U S diplomat, check out our YouTube channel. Just type in town hall Seattle and you can access our whole library of videos and live streams. But if you prefer the medium of audio, which I suspect you might, our events will also be published on our arts and culture, civics and science series, podcasts. Just subscribe, listen, and learn. Next week on in the moment, our chief correspondent Steve share talks with author and dog cognition researcher Alexandra Horowitz about the odd, surprising and contradictory ways we live with dogs. Until then, thank you for joining us right here in the moment.