A man passes out in church. An ambulance is immediately summoned, and he’s taken to the nearest emergency room where he is treated and discharged. But the real stinger in this story is the $1,633 bill he receives for the seven-mile ride to the hospital.
All this really happened. What’s more, as the Philadelphia Inquirer’s Sarah Gantz reported in her investigation, it could happen to any one of us.
The TriHampton Rescue Squad said the man owed the money because that ambulance company was not part of his insurance network. Health insurance companies often sign contracts only with particular ambulance services – it’s their “network” system. Insurance then backs you up only if you take the ambulance in your own network.
The only trouble is, most of us, when unconscious, don’t look over our health insurance contracts to find out which ambulance service to call.
This is only one way that Americans are terribly vulnerable under an arbitrary and capricious health care delivery system. Medical bills can lead you to personal bankruptcy. Forty-three percent of low-income Americans go without medical care because of costs. Americans are more likely to die from health care delivery system failure than people in almost any other wealthy country.
The system that’s supposed to protect us leaves us vulnerable, but few people get mad at systems.
Making our vulnerability real
Vulnerability is also our condition in relation to gun violence. In the past decade we’ve seen mass shootings in schools, a movie theater, a gay nightclub, a church and many other places. After short bursts of indignation, the energy usually shifts back to policy advocates who take it to the system level. Yet, again, few people get mad at systems.
Most of us return to the denial that allows us to live our daily lives. Denial helps us function when there’s no campaign to join, no ability to take direct action with a chance of challenging the entrenched status quo.
What re-awakens our concern is when the vulnerable have faces, and we hear their stories. We feel their passion and remember “that could be me or my friend or my family.”
What the teenage survivors of the Marjorie Stoneman Douglas School shooting in Parkland, Florida, did was to become the faces and voices of the vulnerable. Their direct action (die-ins, marches, school walk-outs) inspired urban teenagers to take a public stand against the gun violence they face in their neighborhoods. In multiple places around the country, an informal cross-race and cross-class coalition is forming against gun violence, led by the teens who are willing to let their faces and passion be seen and felt.
In Florida, where state government has a history of being under the thumb of the gun lobby, a short campaign brought some policy change. Clearly, the teens are onto something. Whether they will retain their feisty independence and be supported by adults with resources or instead be co-opted by lobbyist insiders is an open question.
The vulnerable are everywhere in our health care system
As bad as gun violence is in the United States, the chance of your life being seriously impaired by the U.S. health care “delivery” system is even greater than you getting gunned down. People die in the United States for lack of adequate health care at higher rates than in comparably wealthy countries, even though people pay much more for health care in the United States than those countries.
The extra we pay reflects profit and waste. The CEOs of 70 of the largest health care companies cumulatively earned $9.8 billion in the seven years after the Affordable Care Act was passed.
A market-based health delivery system is so obsolete that most industrial countries gave up theirs many decades ago. The system leaves us highly vulnerable, but – to say it again – few people get mad at systems. As the Florida and inner city teenagers know, what arouses people’s energy is faces, voices, passion. What channels that energy effectively is nonviolent direct action campaigns.
The extraordinary opportunity for Medicare for All is that the vulnerable ones are everywhere: People who, in distress, were “taken for a ride” on an ambulance and are still paying the bill; people who were charged in one hospital twice as much as for the same service in another; people who were denied the treatment their doctor recommended; people who needed to choose between paying the rent or keeping up with their meds; and people who resorted to crowd-funding to pay for what would already be taken care of in Denmark.
When I gave the keynote for a Medicare for All conference in 2017, I heard about a new public health problem: doctors burning out. We already have fewer doctors per capita than the Nordic countries. Even though the conference attendees knew more than I did about our system’s failings, I found the indignation channeled into polite policy advocacy. There was little enthusiasm for adding to advocacy a direct action wing that would use proven campaign strategy principles to build a movement that could win. I found myself wishing I’d brought some gun control teenagers along.
The majority wants Medicare for All
Just as with gun control, a majority of Americans want Medicare for All according to a Kaiser Family Foundation 2017 poll. Even a majority of Republicans told pollsters in 2017 that they want more governmental spending on health care.
Advocates on both issues want us to take comfort in the minority of the minority party who are willing to try what the majority of Americans want. On both issues, the power realities are against them. The good news under these conditions has always been people power; even a quick look at the Global Nonviolent Action Database reveals hundreds of cases where the power structure opposed reform but was forced to give way to campaigns using nonviolent direct action.
Comparing the issues of gun control and Medicare for All suggests another way in which the single-payer forces have a big opportunity right now. The opposition to gun control is not only coming from the economic elite – the usual opponent of progressive change. There is also a substantial and passionate grassroots opposition to major gun regulation. That base was built over time and will not erode quickly. The struggle would be easier if we were only taking on the gun manufacturers and the National Rifle Association.
By contrast, whatever popular support there has been for the medical-industrial complex is eroding: the disappearance of community hospitals in rural areas, insufficiency of medical professionals to provide service to vets and others, inability to control costs including medications, the demography of aging boomers stressing the system even more. Reasons keep growing – including among Trump voters – for a health care system that will actually work for their families.
The beauty of strategizing around a Medicare for All campaign is not only the combination of system failure and widespread support for a just alternative, but also that there are so many targets for campaigning. The civil rights movement used multiple targets to generate many campaigns: public accommodations, schools, voting, housing, hiring. A more recent example is the environmental movement to shut down coal mining, with campaigns targeting power plants, barges, terminals for overseas loading and banks.
The medical-industrial complex is similarly many faceted. Each facet deserves its own campaign, and there are tactics that can be quite useful for targeting the pharmaceuticals and drugstores, private health insurers and private hospitals – not to mention the investors.
Successful campaigns will feature faces of the vulnerable with whom we can identify, bold and passionate action, and a movement-building strategy of nonviolent direct action campaigning. The Medicare for All lobbyists may initially oppose such dynamic campaigning, but in the end they will be happy because, at last, they will represent real people power.