In 2016, 26% of the U.S. population struggled to pay their medical bills. 77% of these people struggling actually have insurance, but it failed to stop their decline into debt. And for both the insured and uninsured, the costs of care can throw their lives into disarray:
But the numbers can only capture the suffering so much. As a student practitioner in New York City’s consumer debt courts, I have seen the suffering intimately.
Bill (names changed to preserve privacy) should not have been in court. His wife Karen was in the hospital again, and he was so anxious to leave and get back to her that he kept moving in his seat. Bill is a retired electrical worker. He showed me the injury that took him out of work: a nasty scar running the length of his arm and apparently all the way to his heart when a transformer he was repairing electrocuted him. But he told me that he had thought it was okay: he had had a good union job, Karen still worked, and his kids worked hard enough to earn scholarships to college.
But then Karen got cancer. Devastating news, but unfortunately that was just the beginning. The initial treatment seemed to have no effect: they had found out too late because they could not afford the preventative, regular healthcare that would have detected it. So they sought out special care, care not covered by their insurance. By this point Karen could no longer work. They had to fly out to the treatment center. “It was awful,” Bill told me, “It was such a struggle for her to do all that travelling and it did not even work. We should have just gone to Disneyland, at least then she could have had some fun.”
It was not a lot of debt. I had certainly seen amounts much higher, especially with student loan cases. But $3,000 was no pittance to Bill and Karen. I asked if his kids might be able to help. “We’re already living with my son,” he said, “And the other one is in college. He is paying his own way, he can’t afford to help us out.” I asked Bill if they had applied for Charity Care. They had not; Bill did not even know what the term meant.
If you are a working class person who has been to the hospital in the last five years, the hospital may have stolen from you. That is because even under the current inhumane system of private healthcare, a set of state laws commonly referred to as “Charity Care” laws mandate that hospitals reduce the amount of debt for patients at certain income levels. Hospitals are supposed to inform people of these benefits and sign them up to receive them, and in New York you even have a right to appeal if you are denied when you apply. But while it is difficult to ascertain where the gap is coming from, it is certain that there is a gap and that it makes hospitals billions of dollars. The California Nurses Association decided to look into how large this gap was in their state, and they found that in 2010 it was $1.8 billion. Between 2013 and 2015, the country’s seven top hospitals increased total operating revenue from $29.4 billion to $33.9 billion, but decreased their charity care from $414 million to $272 million.
Many of the people I talk to are surprised by this: how could incentives provided by the government not prompt corporations to do the right thing? Of course, as I have written about with the Affordable Care Act, compromise with capitalists is impossible. Our government naively (or if you’re really cynical, intentionally) gave hospitals the chance to increase their profits at the expense of the poorest people in this country, and the hospitals did exactly that.
The existence of medical debt, of people like Bill being dragged into court when they should be with their sick loved ones, is an indictment of private healthcare. And the failure of charity care laws to fill the gaps, and instead enriching the hospitals, is an indictment of the neoliberal reforms that have sought market based solutions rather than giving people like Karen, the people they supposedly work for, healthcare.
The Democratic Socialists of America (DSA) passed a resolution at our most recent Convention to adopt the fight for a single payer healthcare system, Medicare For All, as our national campaign. We did so not only because of how much it would benefit the people in our communities but because it is a campaign that is taking on capitalism. And going head-to-head with an industry that easily can outspend us ten to one means there is only one way for us to win: “Winning Medicare for All will mean establishing a piece of real democratic socialism and building a broader working-class movement.”
How do we build this movement? What I have just laid out, the horrors of medical debt and the negligence of our government, is one focal point that will be key to building this movement. Because we cannot build a working class movement for Medicare For All through promises. The working class of today has already been strung along on the promise of the Affordable Care Act, and their bitter disappointment in how it failed has significantly shaped our political landscape.
Actions speak louder than words to those who have been given nothing but empty slogans for their troubles. That does not mean how we talk about Medicare For All does not matter. It is crucial, and luckily it is something we do very well, especially with our five principles of Medicare For All:
- A Single Health Program
Everyone will be covered by one health insurance program, administered by the federal government, and have equal access to all medical services and treatments.
- Comprehensive Coverage
All services requiring a medical professional will be fully covered. You go to the doctor of your choice. Dental, vision, mental health, and pharmaceuticals are all included.
- Free at the point of service
All healthcare costs will be financed through tax contributions based on ability to pay: no copays, no fees, no deductibles and no premiums. Ever.
- Universal Coverage
Coverage for all United States residents — non-citizens included.
A jobs initiative and severance for those affected by the transition to government-run healthcare.
Five points, given in accessible and concise language, that cover most of the basic questions people have about Medicare For All. But recitation of these principles is not enough.
We should also be fighting to live them in the here and now. We can prove our commitment to equal access by attending and supporting health and wellness fairs in underserved communities. We can prove our commitment to comprehensive coverage by giving our Disability Caucus a prominent leadership role and agitating around ridiculous drug price increases that unfortunately are inevitable in the current system. We can prove our commitment to universal coverage by actively canvassing in immigrant communities, like our NYC chapter is doing in the neighborhood of Sunset Park. And we can prove our commitment to healthcare being free at the point of service by fighting against medical debt.
While all of these principles are important, I believe that doing work with medical debt provides a special opportunity to actively confront the profiteering of hospitals and exploitation of the working class in an easy-to-understand dollar value. From Alabama to Washington, while the protections vary, they exist in every state (find yours here) and that means the 300+ chapters of DSA could all take on this work. And Charity Care is just one avenue: other states have laws about “surprise bills” and general consumer debt protections that can be another tool in our toolbox.
Beyond acting on our commitment to healthcare being free at the point of service, working with people in medical debt gives us an opportunity to recruit people like Bill to the Medicare For All movement. I have been doing community organizing for more than ten years, and have gotten pretty good at public speaking. But no testimony I could give on abstract principles and dry statistics will ever be as powerful as someone like Bill telling the crooked politicians in public that the inhumanity of private healthcare has devastated their family. That would be powerful to millions of working class people struggling to live in a society where life is getting worse.
I am not a healthcare expert. I did not even know how far charity care was falling short until I began to work in the courts. I am just one of the thousands of members of DSA, probably like most of you reading this, trying to find out how we can win Medicare For All. I am continually impressed by the great work I have seen done in just the last few months, from East Bay to North Texas to Washington, D.C. Our members have canvassed, distributed free flu shots, and gotten arrested protesting. I am asking all of you working on this campaign to add medical debt work to your local efforts. Doing medical debt relief work will not be the magic key to winning: but I believe from looking at the evidence here that we could use it to mobilize more than one-fourth of the population. And that would certainly bring us a lot closer to winning.
Emma Caterine is a member of the NYC Socialist Feminists, a Working Group of DSA fighting to get Medicare For All in New York through the New York Health Act. Their Fight Debt! program had its inaugural training on January 20th, the one year anniversary of Donald Trump’s election. If you’re interested in doing a program in your local, please contact firstname.lastname@example.org, and to find out more about the nationwide effort to get Medicare For All, make sure to check out the new website, which will give you information on canvassing, electoral work, media, and so much more.