On The Debacle We Loosely Call Healthcare





[The following is excerpted from my new book Don’t Think Of A Republican – How I Won A Republican Primary As A Lefty Progressive And You Can Too, which recounts the rhetoric and strategy of satirical candidate H.F. Valentine’s unprecedented 2022 primary run. See the whole book here.]


Beginning of H.F. Valentine’s Carter Community College speech


I had someone on the campaign trail ask me the other day, “Mr. Valentine, why are you only harping on the insurance companies? Why not the drug companies too?” And I said, “Because everyone already knows the drug companies are awful. It’s such a given nowadays, you hardly even have to make the point.”


But after I said it, I thought, “Ain’t that some shit? The companies that we rely on to provide us our medicine when we’re sick, people just assume they’re going to prey on us through advertising, gouge us at the cash register, and lobby against any other beneficial treatments that they either can’t control or profit from.”


That’s the given in America. That’s where we’re at. That the modern pharmaceutical industry is more akin to weapons manufacturers. Weapons manufacturers aren’t interested in peace, they’re interested in war. They’re not interested in getting to a place where the world needs less weapons; they want to sell more weapons and more weapons and more weapons. And while we are certainly fortunate to have made the advancements we’ve made in treating illnesses we would otherwise be at the mercy of, the business ethos of our drug makers has advanced far beyond our interests. Between companies less interested in finding cures than they are finding diseases and companies that actively addict us, indeed treating us worse than any street dealer ever would, we’re at a place now that we need legislation and the courts to protect us from the companies that make us our medicine. That’s where we’re at.


And the Congress still hasn’t done anything about it. Like they have no power. Or maybe they just don’t have any interest.


They sure as hell didn’t have any interest when they let a former healthcare lobbyist write key provisions of the Affordable Care Act.


Speaking of, here’s how much of a joke our healthcare debate has been over the past two generations.

At the end of the 1980s, the ultra-conservative Heritage Foundation came up with the individual mandate as an alternative to a single payer system. The individual mandate would go on to become part of Romneycare, only to then be borrowed for what would go on to become Obamacare. For which, the Republicans immediately began suing to get rid of the individual mandate.


In the long run, the only thing that any of them could agree on is that we just can’t have a single payer system. We just can’t have what the rest of the industrialized world has.


And here we are, over ten years after the Affordable Care Act was passed, also known as Obamacare, and the most recent epidemiological study from the Lancet shows that a single payer system like Medicare for All would prevent over 68,000 unnecessary deaths a year, and it would cost less.


Let me repeat that. Because we have the system we have right now instead of a single payer system that would cost us less, 68,000 people a year have to die unnecessarily. That’s like losing the amount of people we lost on September 11th about every two and a half weeks for an entire year, every year.


And why? Because we just can’t have any challenge to our sacred Insurance Companies. Companies that created the crisis we were in, when the solution they sold us was the Affordable Care Act. Companies that subsequently carried on their chicanery to the crisis we’re in right now. Companies that, I might add, provide you and I literally no healthcare. That’s right. They don’t provide anything. We could streamline the pooling and payment of healthcare dollars, like the rest of the industrialized world does, and the only real difference would be that there’s no longer a multi-billion dollar middleman to pick our pockets and deny us coverage. A multi-billion dollar middleman that is seemingly ok with an extra 68,000 deaths a year.


Are you ok with that? Are we ok with that? I know I’m not. Sadly, the most powerful people in our country seem to be ok with that.


Nancy Pelosi is quite possibly the politician most responsible for us not getting a single payer system. Yet Nancy Pelosi knows about the Lancet study. She knows about the 68,000 people a year. But, evidently, she seems to be ok with that.


Mitch McConnell doesn’t even want the Affordable Care Act, which at least mandated coverage for pre-existing conditions. Which, if overturned, would mean even more than 68,000 unnecessary deaths a year. But, evidently, he seems to be ok with that.


And it’s not just those two; it’s the majority of our elected representatives in Washington that seem to be ok with that. And I can say that they’re ok with that with quite a bit of confidence because the fix is so easy. It’s just doing what every other industrialized nation in the world does, and spending less in the process.


Am I just crazy? The priorities here seem a little out of whack. Maybe I should ask you. What do you think is more important? Saving corporations that literally do not provide healthcare or saving the lives of over 60,000 people and spending less in the process?


Somehow, this is still a debate. Of course, we know the reason why it’s still a debate. It’s a debate because there’s someone else who seems to be ok with that.


I said before that Nancy Pelosi was the most responsible for keeping us from getting a single payer system. But I believe she would not be able to keep us from getting it if it were not for the help of the media. A media who parrots bullshit talking points from the insurance industry and the politicians they bribe.


From NPR to Fox News, whenever Medicare for All is brought up, it’s almost like they’re obliged to ask how it would be funded. They ask this question as if they don’t know the answer. As if they don’t know how it’s funded in every other industrialized nation in the world that spends a fraction on healthcare while actually covering everyone. They act as if they don’t know this.


But here’s the thing. They do know this. These aren’t yokels who’ve never been to town before. These are affluent journalists and media professionals who have traveled and seen what it’s like all over the world. They know the answer to these questions. And the only reason why they ask them is in the hopes that you don’t know the answer. Because here’s the other thing. They don’t tell you the answer. They don’t tell you how Canada’s system works; they don’t tell you how France and Germany’s systems work, how it works in Scandinavia or Taiwan. They know it, but they don’t tell you.


Instead, they leave it an open question. And if they do offer an answer, the answer is always that it will mean raising people’s taxes. As if they don’t know what premiums are. As if they don’t know what copays are. As if they don’t know what deductibles are. As if they don’t know what out of pocket maximums are. And who knows, maybe they don’t know. Maybe they’re all so rich, they don’t even pay attention to the bills that stress normal people the fuck out. But you know who does know. You know. You know what premiums are, and what copays are, and what deductibles are, and what out of pocket maximums are, and what all these add up to. And what you need to know, the only thing you need to know, is that in a single payer system, you would never have to worry about any of those ever again and you would never have to worry about whether or not you’re covered. You would only pay your taxes, and the portion of your taxes going toward healthcare would be less than what you paid before. No more bills. Just automatic coverage.


But they don’t tell you that. Corporate media will never volunteer that information. They would rather pretend that it’s a debate. As if any of us prefer paying more for getting less.


It’s like when they ask people, “Are you ok with Medicare for All if it means losing your current insurance?” And then they go on to talk about this as if anyone in this country actually likes their policy. Are they glad they have coverage? Absolutely. But do they like the millions of miles of fine print they could never wade through to find out if they’re going to wind up with a medical bankruptcy even when they have coverage? Hell no. These people act like we love having to worry about going bankrupt, that we love paying more and getting less. They act as if we should be thankful for it.


Otherwise, they would frame the question, “Would you be willing to give up your current health insurance plan if it meant you would be automatically covered with even better insurance – and pay less?” Or how about combining all the facts, and asking, “Would you be ok with far better healthcare coverage if it meant paying less money and ensuring 68,000 extra people don’t die this upcoming year?” Or how about asking voters, “Is keeping a worse plan worth the 68,000 unnecessary deaths this system results in each year?”


Ask yourself. Why don’t they frame the question like that? It would be completely true; the facts are not even challenged.


That’s why I say that they’re ok with the deaths. Because you can’t even imagine them framing a question like that. They won’t volunteer the deaths, they won’t volunteer the number of bankruptcies, over half a million a year. They won’t volunteer the hassle and the anxiety and the injustice that each and every one of us has experienced as a consequence of the current system.


They won’t volunteer it because they’re ok with it. And if anyone in the media would like to counter this assertion, there’s a simple way for you to prove that you do care. And that’s to be honest in the framing of your questions. Quit acting like we don’t know our own situations. Quit acting like the deaths don’t matter, or the bankruptcies don’t matter, like we don’t matter. Quit acting like you’re just ok with it.


I ask again, are you ok with that?


I’m not.


My opponents like to call me all kinds of names: Democrat, Socialist, Communist, Anarchist, whatever. But what they don’t like to call me is an advocate for universal coverage. What they don’t like to call me is an advocate to have the best and most efficient healthcare system in the world, because we can. What they don’t like to call me is a politician who believes it is immoral and unacceptable in the richest nation in the world for people to have to second guess going to the emergency room because they’re afraid it might bankrupt them. What they don’t like to call me is a politician who believes it is immoral and unacceptable that even one person should die in the richest nation in the world because they do not have insurance or they have inadequate insurance, much less 68,000 people a year dying for this reason. My opponent will never call me that kind of a person.


I’m advocating for a single payer system, because anything less is immoral and more expensive. Let me say that again. It is immoral. And it is more expensive.


It’s bad enough when something is immoral but it is cheaper. That’s atrocious on its own. But when something is immoral and costs more, costs much more, what argument is there to keep it? When it is more expensive to be immoral, what argument do you have left?


If Nancy Pelosi won’t say it, I will. If Mitch McConnell won’t say it, I will. If the corporate media won’t say it, I will.


The system we have is immoral, and it is more expensive. It results in 68,000 unnecessary deaths a year, and over half a million medical bankruptcies.


And if my opponents don’t like that, they can call me any name they like. Because I don’t need to call my opponent names – when I can just call them someone who is ok with that.


H.F.’s Note:


Running in a Republican primary, it’s always advantageous to have handy some kind of criticism of top Democrats. And on the issue of healthcare, the criticism was forthcoming.


I don’t think it can be stressed enough how disingenuous and dangerous the Democrats’ take on healthcare has been over the last decade. Not only did they not learn their lesson, but Barack Obama himself intervened in the 2020 Democratic primary at a time when the candidate running with Medicare for All, a single payer system, as his main policy plank, was ahead in the primary. And he intervened to ensure that that candidate did not win. Barack Obama did that. Now, you can argue it’s because he didn’t think that Bernie Sanders could win. But that means you believe he thought Joe Biden was a really strong candidate, the same Joe Biden he tried to dissuade from even running.


Barack Obama knew about the Lancet study when he made sure, once again, we didn’t get a single payer system. Just like Nancy Pelosi knew about the Lancet study when she, in the same election year, dismissed even the thought that we could have a single payer system. I would contend that the key obstacle in the Congress to Medicare for All was never Mitch McConnell. It was Nancy Pelosi. It was Nancy Pelosi who was sent out to kill even the Public Option in 2009. And here we are, three presidential elections later, talking about the possibility of a half-measure public option being the best we can hope for.


This isn’t insignificant. It’s everything that is wrong with the Democratic Party. And for any of my critics who think it’s unfair for me to pick on Barack Obama or Nancy Pelosi when it comes to the Herculean task of getting Medicare for All past the Republicans in Congress, I would remind you that they passed the Affordable Care Act using Reconciliation, which bypassed normal Republican opposition. Republican opposition wasn’t the issue. Moreover, with the hype of hope and change Barack Obama rode into the White House on, he could have done anything he wanted to in those first two years. Voters were not just ready for serious change; they expected serious change. And now, over a decade later, we still see thousands and thousands of people dying every year unnecessarily.


You don’t really believe they thought giving the insurance industry even greater control over our healthcare system was the just thing to do, do you? If so, I offer you the following quote.


“I happen to be a proponent of a single-payer universal health care program. I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its gross national product on health care, cannot provide basic health insurance to everybody. And that’s what Jim is talking about when he says everybody in, nobody out. A single-payer health care plan, a universal health care plan. That’s what I’d like to see. But as all of you know, we may not get there immediately. Because first we’ve got to take back the White House, we’ve got to take back the Senate, and we’ve got to take back the House.”


That wasn’t Bernie Sanders. That was then State Senator Barack Obama, before he indeed did take back the presidency, the Senate, and the House.


Not satisfied? Then how about these beauties?


“By reasons of security, by reasons of savings. Savings that spring also from the simplicity of the program, savings which spring from early intervention, people seeking and receiving healthcare earlier in the game, so that they don’t have more costly healthcare and hospital stays, everything points to Mr. McDermott’s bill (the McDermott/Conyers single payer bill). It is interesting to see how under scrutiny, when people really take the look at these bills, how brilliantly the single payer plan stands out… I join my colleagues in requesting from the committee the opportunity for this bill to be considered as a substitute under the rule. It has support in my community. It has support across the country. It has support in the Congress. I hope it does on this committee as well.”


“I remain a staunch and ardent supporter of the McDermott/Conyers bill. One of the principles of the single payer bill is universal access… but for access to be universal it must be affordable… I will join with my colleagues here in working to see that the plan that the Congress passes contains as many of the provisions of single payer as possible, that it does not foreclose on an eventual single payer, and that it does not throw up obstacles to states easily establishing their own single payer.”


No, that wasn’t Nina Turner. That was the 1990s version of United States Congresswoman Nancy Pelosi.

They knew single payer was the only real solution. And whatever happened to them between then and now is a perfect example of why so many Republican voters think the Democrats are full of shit.


The problem is these voters often abhor the arms of hypocrisy while snuggling up in the arms of cruelty. The Republicans tried with every fiber of their political being to repeal Obamacare, with no serious replacement. Meaning the predominant real benefit that made Obamacare worth a shit, that being the coverage for pre-existing conditions, would have been gleefully done away with if the Republicans had their way. Which would have led to even more deaths, far more deaths, than the 68,000 I cited from the Lancet study.


That’s why, all throughout my race, I repeated the slogan “I’m not telling you something you don’t already know.” It’s something voters knew. And they knew it because my opponents, by party affiliation, by donor affiliation, had to quite vocally tow the same line against real universal coverage, against even the half measures of Obamacare.


And because it was something everyone already knew, I was able to use that knowledge to illustrate just how much disdain the other candidates had for the voters. How furious these candidates were that their party hadn’t been able to scrap what little protections Obamacare had offered and reinstitute a system that once again denied the voters coverage based on pre-existing conditions.


I then did something that far too many lefties can’t bring themselves to do. I met Republicans where they are. I appealed to their sense of national pride and told them I didn’t want to be just as good as the rest of the industrialized nations. I wanted to be better. If we have the resources to have a superior system, why shouldn’t we? Why wouldn’t we?


The one advantage we had, the one silver lining in us showing up late to the party, was that we could take the best from all the other countries, and leave behind the things that weren’t working, to make a plan that would be the envy of the world.


It doesn’t matter if we’re last. We can still be Number One. In fact, it’s only because we’re last that we can ensure we become Number One.


Republicans like talking about being Number One. Why not prove it?


And why not let a Republican lead that charge?


The key to making this a winning issue was not to come out the gate trying to convince a Republican voting base, who’ve been consistently told by their elected representatives that universal coverage is some kind of communist plot, that a single payer system was the way to go. The key was to meet them where they were. And where they were was being woefully underinsured while shamefully overcharged. Where they were was wanting to have a better system, indeed wanting to be Number One. Where they were was wanting to beat up the Democrats.


So I implored them to ask, “Why do Republicans cede better healthcare to the Democrats?


What if we could finally get real universal coverage and it was a Republican that made the difference, and it was your district that could forever stake claim on that victory?”


I told them if they really wanted to stick it to Nancy Pelosi, then make it a Republican Congressman, your Republican Congressman, the one who would go down in history for doing what she had the power to do but never had the guts to do.