I am an ICU nurse at University of Chicago working on my masters in nursing at Purdue University Northwest. I have worked in nursing homes, Long Term Rehab, Hospice, and Emergency rooms in community and university settings. I have studied healthcare reform in school and on my own time and have been a single payer advocate for years. I work with my good friend Dr. Philip Voerhof who is an attending pulmonary critical care doc at U of C and on the national board of Physicians for a National Healthcare Policy, and we are working with to build a national strategy for radically restructuring healthcare in the United States to ensure equal access and health care justice.
I am super excited by the amount of energy that is being poured into Single payer advocacy, but many do not seem to grasp how complicated the problems of stitching together our fragmented system of healthcare fiefdoms is going to be.
I believe that no plan to fix healthcare in the US is going to work without a comprehensive plan to drastically expand the number of health care professionals, including primary care providers, general surgeons, Emergency Room docs, and Ob/Gyns available to the public. Nurse practitioners, nurse midwives and physicians assistants seem to be nowhere near this debate and we will need a way to ramp up education of MDs as well as these advanced practitioners while ensuring they are distributed and working throughout the vast swaths of under-served healthcare deserts throughout both rural and urban America. The same goes for other support professionals such as pharmacists, physical therapists, mental health professionals and technicians. Comprehensive funding for students will have to be brought on to break the chains of student debt that pulls MDs into high paying specialties and incentivizes revenue maximizing behavior. I work with young MD’s fresh out of school and the bitterness about student debt and the crushing realities of caring for those who must make healthcare decisions in the light of personal economics has made many of them ready to shift to new forms of healthcare delivery. To those who would resist us, to paraphrase Aneurin Bevan, we may have to “stuff their mouths with gold”.
Resources will have to be diverted from “healthcare cathedral” hospital construction to localized clinic systems in a big way. A national trauma care fund should be founded to build level one trauma care that everyone can reasonably access within the “Golden Hour”, as well as similar programs for stroke and cardiac centers.
Pharma will have to be broken, either through rigorous anti-trust action, medicare negotiations, or outright nationalization. The generic manufacturers should be nationalized to ensure that no critically important drug is on shortage (when I brought in the list of over 100 drugs on shortage to our working group meeting people actually left kind of frightened).
But the problems are familiar to anyone paying attention or personally affected by a health problem.
The issue of the strategy to fix it all seems to be stuck grinding away stuck somewhere between first and second gear. I suspect that Healthcare reform strategy will be a very contentious issue given the tone that the online discussion has taken over the past weeks.
We need to radically shift the narrative surrounding our health system and fixing it, while finding points of leverage that we have not noticed yet.
I have proposed within our working group some new tactics for the healthcare fight.
1) We need a Universal Healthcare pledge modeled on my favorite Leninist Grover Norquist’s Tax policy pledge so we can begin to identify friends and allies, as well as our enemies. Every politician in Washington and at the state level must go on the record in favor or opposition to a policy proposal that has majority support in the US. Until we know where people stand how can we pressure anyone?
2) We need to encourage militant healthcare themed direct actions, record and publicize stories of how healthcare in America is failing all residents, we need to hold intensive education events for internal and external consumption, and we need to be showing up at town halls, calling politicians, and generally calling out those who don’t support us while praising and supporting those who do. Key constituencies will be young doctors, nurses, nursing home assistants, labor orgs, the uninsured, and everyday people who are by all polling extremely anxious about the state of healthcare delivery in the United States.
3) Finally, on messaging, we need to invert the neo-liberal narritives that have surrounded these debates in the past.
4) We should keep the idea of a march on Washington on the table, but not before 2020, when we will be needed to put pressure from below on either a neoliberal democratic administration (hello president Zuckerberg!), or support a left populist administration in their struggle against the neoliberal centrists in congress, or worst case scenario put pressure on a 2nd Trump administration with hopefully enough left populists in congress plus terrified self interested neoliberals to present a plan to Trump that is effectively “an offer he can’t refuse”