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    Black voters in Georgia want affordable access to healthcare. Will Kamala Harris win them over?

    Around 4am last Christmas Eve, Kuanita Murphy’s father suddenly became short of breath and briefly passed out. Without a medical facility nearby, Murphy had to drive him 45 miles east to Albany, Georgia, to the Phoebe Putney memorial hospital. The only hospital in their small town of Cuthbert, Georgia – Southwest Georgia regional medical center – had closed down three years earlier due to financial strain from failing infrastructure and an increase in uninsured patients.After waiting for several hours, Murphy’s dad was finally admitted at noon into a hospital room for internal bleeding and a restricted heart valve. While he eventually underwent lifesaving surgery, Murphy said that he would have received treatment faster had Cuthbert still had a hospital.“He had some pain dealing with his chest and the anxiety of not knowing exactly what was going on with him,” Murphy, the editor of Rural Leader magazine, said. “That made it worse off than it probably was, not knowing and having to wait.”Hospital closures are top of mind for Black voters throughout Georgia, since it’s one of 10 states to reject Medicaid expansion. On Wednesday, Kamala Harris launched a two-day bus tour through south Georgia that will culminate with a rally in Savannah on Thursday afternoon. “Campaigning in this part of the Peach state is critical as it represents a diverse coalition of voters, including rural, suburban and urban Georgians – with a large proportion of Black voters and working-class families,” the campaign said in a statement.Since 2013, 12 hospitals have closed down in rural and urban areas throughout the state, according to the Georgia Hospital Association. In 2022, two Wellstar Atlanta medical centers closed in the Atlanta metro area, where more than two-thirds of the 4,281 emergency room patients were Black, according to 2019 data from the private, non-profit Wellstar Health System cited by the Atlanta Journal-Constitution.In Murphy’s eyes, the shuttered medical facility where she was born 49 years ago has served as a rallying cry before the upcoming presidential election. The city’s residents, she said, want to “back a candidate that is going to support Medicaid expansion, or affordable access to healthcare”.Murphy, like most residents in majority-Black Cuthbert, has long voted Democrat. Although Joe Biden won Georgia in 2020, the first Democratic presidential candidate to do so since 1992, the Republican-led state legislature has rejected expanding Medicaid coverage to more lower-income adults. The Biden-Harris administration has long urged all states to expand Medicaid – a legacy that health policy experts predict Democratic nominee Harris will continue if she becomes president.Throughout her vice-presidency, Harris has discussed the need to expand Medicaid coverage for postpartum mothers from two to 12 months after giving birth. “We also must work together to call on Congress to advance other components of our Build Back agenda, to expand Medicaid in every state,” Harris said during a speech in 2021. “People live in every state, that’s the logic.”Floundering healthcare facilities might stay open if they have received Medicaid reimbursements for patients who otherwise couldn’t pay their bills, according to health policy experts. As they gear up for state and federal elections, healthcare advocates and community organizations say they want Georgians to vote for candidates who prioritize affordable and equitable access to healthcare.Bobby Jenkins, the Cuthbert mayor, believes that the state’s hospital closures could drive voter turnout there. “That’s a way of engaging people in the electoral process to get them to understand this is a direct impact of your vote, or it could be a consequence of your lack of voting,” he said. Case in point, Jenkins said, is that Biden-Harris’s 2025 fiscal year budget includes “Medicaid-like” coverage to people in states that haven’t expanded the program. Meanwhile, Donald Trump sought to repeal Medicaid expansion and supported work requirements for people to qualify for free government healthcare during his presidency.‘Our governor said no, which is crazy’According to surveys and canvassing sessions, access to healthcare has remained the most pressing concern only behind the economy for Black and brown communities over the past two years, said Kierra Stanford, the lead community health organizer for the non-profit New Georgia Project. At ice cream teach-ins and public meetings, Stanford tells residents that hospitals could stay open if state and federal leaders expanded Medicaid. While the group is nonpartisan, they encourage voters to research candidates’ stances on healthcare.Healthcare redlining, which Stanford defined as “the deliberate managing of healthcare resources in Black communities”, has led hospital systems to divest from historically marginalized areas. “It’s an ongoing trend,” Stanford said, that “has been exacerbated by not expanding Medicaid”.In May, Stanford held a public meeting with 30 attendees in East Point, Georgia, a majority-Black city south-west of Atlanta, to discuss the connection between hospital closures and the state’s refusal to expand Medicaid. A few days later, the New Georgia Project packed the public comment period of an East Point city council meeting to share their concerns about access to healthcare.On the state level, the New Georgia Project releases a voting guide to alert voters of pressing healthcare concerns before elections. Eventually, they plan to roll out a scorecard that shows the state politicians who didn’t vote to expand Medicaid. On the national level, Stanford explains to voters: “Georgia has literally been offered the funds, but our governor said no, which is crazy.”“I try to tell people that the money that’s being taken out of your check for federal taxes,” Stanford said, “you’re paying for healthcare for people in California, for people in these other states that have expanded Medicaid.”Hospital closures hit Black rural communities the hardest, said Sherrell Byrd, executive director of Sowega Rising, a Georgia-based non-profit focused on coalition-building and rural revitalization. “When a hospital closes in rural areas, it’s much more devastating than in urban areas, because it’s like a black hole,” Byrd said. “It takes out a whole subset of the economy side of the community.”It’s common for residents to drive up to an hour or to cross state lines to access hospitals. The organization encourages rural residents to speak to their legislators about their healthcare access concerns, but Byrd said that politicians have not shared any steps they have taken to solve the issue.“That’s where people start to be frustrated, because year after year, they still don’t have hospitals,” Byrd said. “And so that’s when people become disenfranchised.”Hospital closures are top of mind for Medlyne Zamor, a Rockdale county voter who was previously unconcerned about candidates’ healthcare platforms. She didn’t see the need to expand Medicaid and thought that the state would benefit from funding other institutions. However, after a spate of hospital visits due to fibroids in 2022, Zamor met other patients who had been personally affected by the closures. Some of them had needed to wait several months to see specialists. That opened her eyes to the issue, she said: “When I saw how the hospital closures … impacted them in the community, it definitely made me shift my vote to expansion.” Now she only votes for candidates in state and federal offices who support Medicaid expansion.As a result, Zamor began volunteering at the New Georgia Project, where she hosts events to inform Georgians about the lack of access to healthcare. She also addresses the issue by phone banking, sending out email blasts to residents and writing senators. “These hospital closures, not only does it affect the nearby citizens,” Zamor said, “but also it affects the workers, and it affects the [remaining] hospitals, too.”State and federal politicians hold the power in slowing down the closures by extending healthcare coverage to lower-income adults, “relieving fragile hospitals from providing free care to uninsured patients”, said Laura Colbert, the executive director of the non-profit Georgians for a Healthy Future. “After that, state and federal leaders should work together to slow consolidation among hospitals and other investors, which can accelerate some rural hospital closures.”Congress members have stepped up to save Cuthbert’s healthcare system after its only hospital closed four years ago. The city plans to establish a new hospital after recently receiving nearly $12m in federal funding. The Randolph County Hospital Authority is currently working with an accounting firm on a feasibility study to ensure that the facility stays in the community for good. More

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    Trust in US institutions has ‘never been lower’ – here’s why that matters

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    American psyche: a new series exploring the angst at the heart of the US election

    She was sentenced to prison for voting. Her story is part of a Republican effort to intimidate others
    Americans don’t have much faith in America right now. Or at least not in its institutions.In 2022, a Gallup poll found that Americans had experienced “significant declines” in trust in 11 of 16 major US institutions. The supreme court and the presidency saw the largest drops in public confidence – by 11% and 15%, respectively. Trust also fell in the medical system, banks, police, public schools and newspapers.Things didn’t improve in 2023: a follow-up poll found that levels of trust remained low, with none of the scores “worsening or improving meaningfully”.Public confidence waxes and wanes, but these numbers are notably bleak. Trust in institutions has “never been lower”, confirms Jeffrey Jones, a senior editor of the Gallup poll and the author of the 2022 report.This mistrust is not a one-time blip, a rough patch in an otherwise happy relationship between a country and its people. According to polling experts, it is partly the result of a decades-long effort by political leaders to erode public confidence in institutions such as science, media and government. And the consequences are serious. Not trusting the forces that govern their lives is detrimental to the health and wellbeing of individuals and communities, and makes the country less prepared to face a major crisis.“Trust is the grease that oils the gears and makes things work,” says Dr Marc Hetherington, professor of political science at the University of North Carolina at Chapel Hill. “Without it, everything is more difficult.”But how did we lose this trust in the first place? And is there a way to get it back?With the exception of a couple of surges, the US “has been in a really low-trust environment since the 1970s”, says Hetherington.At that point, public confidence in institutions started to fall. Part of this was a natural leveling out. After the second world war, trust levels had been “extraordinarily high”, Hetherington says. “Probably anomalously so.”And part of it was due to the simple fact that – after the civil unrest of the 1960s and the energy crisis followed by stagflation of the 1970s – many Americans felt the government just wasn’t performing very well.But there was another force at play. Around this time, the Republican party became “the anti-government party”, Hetherington says. “There was a lot of political hay to be made from actively saying negative things about institutions, and it helped win elections.”By 1984, the Republican party’s official platform condemned government overreach. “Not every problem cries out for a federal solution,” it read.Over the next few decades, there were spikes of trust – usually during sunny economic times, like in the middle of the Reagan administration or at the end of the Clinton presidency. There were also spikes that arose from crises, like the months following 9/11.View image in fullscreenBut overall, trust trended downwards. “For the last 20 years, confidence has been depressed,” Jones says. He notes two major drops. The first during the second term of the George W Bush administration, when average confidence dropped 10%, and the second from 2019 to now, when average confidence dropped another 10% (save a brief spike during the early days of Covid).Numbers can feel abstract. But the effects of low public confidence are very concrete for both individuals and communities.“As individuals, we rely on institutions to sustain various aspects of our lives, whether we realize it or not,” says Keanu Jackson, a licensed social worker and therapist in New York City. Trust gets undermined when people feel like the institutions they rely on are not concerned with their wellbeing, he says, adding that when it happens, it can lead to “feelings of disillusionment, increased anxiety and stress, identity confusion, and a decreased sense of stability”.Constantly questioning the organizations that govern our lives is exhausting. “Having institutions that we trust is an easier lift for us cognitively,” says Dr Lynn Bufka, deputy chief of professional practice at the American Psychological Association. If someone feels that they have to double-check government guidance, news reports and medical directives, it wears on them and leads to a greater sense of uncertainty and anxiety.Low public confidence can also suggest “a lower collective sense of who we are”, Bufka notes. If Americans don’t have a shared understanding of how institutions represent them and what they can depend on, that may lead to greater splintering between groups. “That can potentially lead to anticipation of more general conflict, which at minimum would put you on edge,” she says.On a larger scale, the effects can be even more devastating. And perhaps they already have been, Hetherington says.Consider the Covid crisis. “Government was responsible for carrying out whatever ideas scientists thought were best practices,” he says. But significant mistrust of both the government and the science made many Americans treat official health guidelines with suspicion, if not outright rejection. “The ramifications of that are pretty clear. Probably tens if not hundreds of thousands of unnecessary deaths happen in the US,” Hetherington says.Is there potential to turn it around? Experts are torn.Jones says he is not optimistic that there will be a reversal in the mistrust trend anytime soon. In the past, he says, moments of economic prosperity have buoyed public trust, but he’s not sure that can happen any more. “Even when the economy’s good, there’s still economic angst,” he says.Hetherington says that, given how unwilling both major political parties seem to give each other any credit, he doubts “whether it’s even possible” to have a meaningful surge in trust. “I’ve come up with lots of problems and too few solutions,” he admits.Bufka is more optimistic. Leaders can rebuild trust with their public, she says. In the American Psychological Association’s 2023 Stress in America report, 59% of Americans said it is stressful that “politicians aren’t talking about things that are most important to them”.So, Bufka says, leaders need to speak on issues that matter to people. “Are [officials] talking about the things that are important to the people they represent? Does the news focus on things that are important to the average person?” Doing this, and explaining how and why they are making decisions, makes a big difference, she says.“Institutions have some opportunity to make change here, and it’s important for those who have power to think about what it is they could do,” she says. “It often comes down to transparent and honest communication.” More

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    Who profits from blood plasma donations in the US? Politics Weekly America podcast

    Kathleen McLaughlin has a rare chronic illness and needs regular treatments using people’s blood plasma. She started researching the US blood plasma industry a decade ago and has written a book, Blood Money, about what it says about class, race and inequality.
    This week, she speaks to Joan E Greve about what she’s learned about the for-profit blood plasma industry
    • How to listen to podcasts: everything you need to know

    How to listen to podcasts: everything you need to know More

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    ‘Lives are at stake’: hacking of US hospitals highlights deadly risk of ransomware

    ‘Lives are at stake’: hacking of US hospitals highlights deadly risk of ransomwareThe number of ransomware attacks on US healthcare organizations increased 94% from 2021 to 2022, according to one report Last week, the US government warned that hospitals across the US have been targeted by an aggressive ransomware campaign originating from North Korea since 2021. Ransomware hacks, in which attackers encrypt computer networks and demand payment to make them functional again, have been a growing concern for both the private and public sector since the 90s. But they can be particularly devastating in the healthcare industry, where even minutes of down time can have deadly consequences, and have become ominously frequent.The number of ransomware attacks on healthcare organizations increased 94% from 2021 to 2022, according to a report from the cybersecurity firm Sophos. More than two-thirds of healthcare organizations in the US said they had experienced a ransomware attack in 2021, the study said, up from 34% in 2020.Ransomware attacks on healthcare are particularly common in the US, with 41% of such attacks globally having been carried out against US-based firms in 2021.“The current outlook is terrible,” said Israel Barak, CISO of Cybereason. “We are seeing the industry experience an extremely sharp increase in both the quantity and level of sophistication of these attacks.”Ransomware hacks have caused major healthcare disruptions, including delayed chemotherapy treatments and ambulances being diverted from a San Diego emergency room after computer systems were frozen. In 2021, a lawsuit filed by the mother of a baby who died in Alabama alleged the first “death by ransomware”, blaming a 2019 hack of a hospital for fatal brain damage of the newborn after heart rate monitors failed.‘We are not ready’: a cyber expert on US vulnerability to a Russian attackRead moreThe possibly devastating consequences for medical facilities may be one of the reasons hackers have identified them as a high-profile target. “The North Korean state-sponsored cyber actors likely assume healthcare organizations are willing to pay ransoms because these organizations provide services that are critical to human life and health,” said the advisory from the Cybersecurity and Infrastructure Security Agency (CISA).CISA and others advise hospitals against paying ransoms, but providers often feel they have no choice, said Barak. In 2021, 61% of healthcare organizations that suffered a ransomware attack paid the ransom – the highest percentage of any industry sector.“When lives are at stake, it makes the decision very easy,” Barak said. “These attackers have identified medical organizations as very, very good targets because they are more likely to pay.”Attacks are typically carried out by private groups of criminals, experts say: in the third quarter of 2021, 30% of ransomware attacks on healthcare entities were carried out by Conti, a crime syndicate thought to be based in Russia, according to an industry report from cybersecurity firm BreachQuest.But the North Korea incident revealed last week is just the latest state actor to orchestrate ransomware attacks on health care organizations after the FBI revealed in June it had thwarted an attack from Iran on a Boston Children’s hospital.Underfunded hospitals hit by Covid squeezeThe healthcare industry has been hit by a perfect storm of factors that have escalated the ransomware problem, experts say: patient information is increasingly being digitized as hospitals struggle with small internet security budgets.In 2009, the Obama administration passed a bill requiring all public and private healthcare providers to adopt electronic medical records by 2014, resulting in a massive migration of paper patient records to online systems. But today, just 4-7% of the average healthcare provider’s annual IT budget is focused on cybersecurity, the BreachQuest study said.“Healthcare providers have gone through massive digital transformation in a very short amount of time,” said Hank Schless, senior security expert at the cybersecurity firm Lookout.The move was accelerated by the pandemic, he added, as more providers shifted to telehealth to connect with patients during lockdown and hospital staff were stretched thin by the influx of sick and dying patients.CISA has advised a “3-2-1 backup approach” for healthcare entities, including saving three copies of each type of data in two different formats, including one offline. But the agency’s advisory to hospitals is “somewhat unhelpful”, said Vincent Berk, chief security officer at the cybersecurity firm Quantum Xchange, offering generic recommendations about securing data with little clear path to doing so.“The issue with this attack, and any other ransomware attack, is that the cure doesn’t really exist,” he said. “In other words, if it happens, it is already too late.”Legislators are attempting to fill in those gaps. In May, Senator Patty Murray of Washington led a hearing on strengthening cybersecurity in the healthcare and education sectors, saying that the US “needs to address cybersecurity attacks and ensure they are treated like the national security threat they are”.“These kinds of challenges don’t just cause major headaches, lawsuits, and expenses for hospitals,” she said. “They put patients in danger. They undermine our national security. And in some cases they even cost lives.”In March 2022 the Senate introduced a bipartisan bill called the Healthcare Cybersecurity Act, which would direct CISA and the Department of Health and Human Services (HHS) to collaborate on a plan to bolster cybersecurity measures among healthcare and public health organizations.Those measures would include cybersecurity training to employees of health organizations and authorize studies from CISA to identify risks in the industry. It is unclear when the bill is set for a vote, but experts say such legislation is more urgent than ever.“There’s zero deterrence right now,” Barak said. “Until we find a more effective way to tackle this issue, I am afraid the outlook is not looking good.”TopicsHackingHealthcare industryData and computer securityCybercrimeUS politicsUS healthcarenewsReuse this content More

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    Guess what the three Democrats blocking lower medication prices have in common? | David Sirota and Andrew Perez

    OpinionUS politicsGuess what the three Democrats blocking lower medication prices have in common?David Sirota and Andrew PerezA bill in Congress would allow Medicare to use its bulk-purchasing power to negotiate lower drug prices. Big Pharma is not pleased Mon 20 Sep 2021 06.25 EDTLast modified on Mon 20 Sep 2021 11.21 EDTThe three conservative Democratic lawmakers threatening to kill their party’s drug pricing legislation have raked in roughly $1.6m of campaign cash from donors in the pharmaceutical and health products industries. One of the lawmakers is the House’s single largest recipient of pharmaceutical industry campaign cash this election cycle, and another lawmaker’s immediate past chief of staff is now lobbying for drugmakers.The threat from Democratic representatives Kurt Schrader (Oregon), Scott Peters (California) and Kathleen Rice (New York) comes just as the pharmaceutical industry’s top lobbying group announced a seven-figure ad campaign to vilify the Democratic legislation, which aims to lower the cost of medicines for Americans now facing the world’s highest prescription drug prices.At issue is House Democrats’ initiative to let Medicare use its bulk purchasing power to negotiate lower prescription drug prices. That power – which is used by other industrialized countries to protect their citizens from exorbitant prices – has been promised by Democrats for years, and party leaders have been planning to include it as part of their sprawling $3.5tn infrastructure reconciliation effort.On Wednesday, Schrader, Peters and Rice helped vote the measure down in the powerful energy and commerce committee, blocking the legislation before it could come to the House floor for a vote. Even if the bill were to ultimately make it to the floor through another committee – which remains a possibility – Democrats have only a four-seat majority that allows them to pass legislation, so they can’t afford to lose any more votes.“I understand that the pharmaceutical industry owns the Republican party and that no Republican voted for this bill, but there is no excuse for every Democrat not supporting it,” said the Vermont Senator Bernie Sanders after the vote.The trio of Big Pharma Democrats are jeopardizing a plan based on HR 3, the Elijah E Cummings Lower Drug Costs Now Act. The Congressional Budget Office has said the drug pricing legislation, named for the late Representative Elijah Cummings of Maryland, would save the government $456bn and “reduce prices by 57% to 75%, relative to current prices” for various medicines.The measure would direct federal health regulators to negotiate prices of 25 high-priced drugs in the first year of implementation and 50 drugs in subsequent years, and the new negotiated prices would be available to both Medicare and private insurers.Polls show that the idea of allowing Medicare to negotiate drug prices is wildly popular – to the point where swing-state Republicans and swing-district Democrats, and even former President Donald Trump, have expressed support for it.Schrader and Peters are among the two biggest recent Democratic recipients of pharmaceutical industry donations, according to OpenSecrets. The pharmaceutical and health products industries are collectively the second biggest donor to both lawmakers over the course of their careers, giving them almost $1.5m in total. Peters is the House’s top recipient of pharmaceutical industry donations in the 2022 election cycle.Big Pharma doesn’t want us to expand Medicare. We have to fight them | Bernie SandersRead morePeters and his family were worth an estimated $60m in 2018, making him one of the wealthiest lawmakers in Congress, according to OpenSecrets. His wife is the president and CEO of Cameron Holdings, an investment firm whose portfolio company provides manufacturing and packaging for pharmaceutical companies.Schrader’s net worth, meanwhile, was pegged at nearly $8m. The Oregonian reported in 2008 that he received “a quite large inheritance” from his grandfather, who was “vice president and director of biochemical research and development at Pfizer” – the drugmaker whose political action committee is now Schrader’s third largest career donor.The congressmen on Tuesday offered their own drug pricing proposal, which would allow Medicare to negotiate prices only under limited conditions, such as when a company no longer has exclusive marketing rights on an older drug but there are no competitors. That proposal was also backed by the Democratic representative Stephanie Murphy (Florida), the co-chair of the conservative Blue Dog Coalition, who is the House’s fifth largest recipient of donations from the pharmaceutical and health products industries.Earlier this year, Peters’ campaign saw a surge in donations from pharmaceutical company executives after he organized a letter with nine other Democratic lawmakers informing the House speaker, Nancy Pelosi, that they opposed HR 3. Schrader and Rice co-signed the letter.It’s worth noting that Peters, Schrader and Rice all voted in favor of HR 3 in the previous Congress. Politico wrote in May that Peters “said he cast that vote knowing it had no chance of becoming law at the time. He said he supported it only to ‘start a conversation about lowering the cost of prescription drugs’.”Rice, Schrader and Peters have seats on the House energy and commerce committee, which is writing the party’s prescription drug plan, and they used those positions to help block the measure there on Wednesday, preventing it from moving to the floor.Last December, House Democrats’ steering committee voted to put Rice on the energy and commerce panel instead of the progressive New York representative Alexandria Ocasio-Cortez.On Tuesday, Rice explained that she opposes the drug pricing measure because “I do not support advancing policies that are not fiscally responsible and jeopardize the bill’s final passage.”Schrader’s longtime top aide, Paul Gage, left the congressman’s office earlier this year, according to Legistorm, and quickly started lobbying for Pharmaceutical Research and Manufacturers of America (PhRMA), the powerful Washington drug lobby.Gage has been lobbying Congress on drug pricing issues and HR 3, according to ethics records. PhRMA raised more than $500m in 2019, and the organization is one of the top lobbying spenders in DC.On Wednesday, PhRMA announced it is launching an ad campaign against House Democrats’ drug pricing efforts. “Politicians say they want to negotiate medicine prices in Medicare,” one ad warns. “But make no mistake: What politicians mean is they’ll decide which medicines you can and can’t get.”The Blue Dog Coalition’s political action committee has been making monthly payments to a consulting firm led by the coalition’s former communications director, Kristen Hawn.Hawn is also a partner at the bipartisan public affairs firm ROKK Solutions, which has worked for PhRMA.
    David Sirota is a Guardian US columnist and an award-winning investigative journalist. He is an editor-at-large at Jacobin, and the founder of the Daily Poster. He served as Bernie Sanders’ presidential campaign speechwriter
    Andrew Perez is a senior editor at the Daily Poster and a cofounder of the Democratic Policy Center
    This article was originally published in the Daily Poster, a grassroots-funded investigative news outlet
    TopicsUS politicsOpinionUS CongressPharmaceuticals industryHealthcare industrycommentReuse this content More

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    Like millions of Americans, I can never leave my spouse. I’ll lose my healthcare | Jessa Crispin

    OpinionUS healthcareLike millions of Americans, I can never leave my spouse. I’ll lose my healthcareJessa CrispinMy access to doctors is tied to my husband – and his access is tied to his employer. Land of the free indeed Fri 23 Jul 2021 06.17 EDTLast modified on Fri 23 Jul 2021 07.03 EDTIt was around the second dose of fentanyl going into my IV bag that I stopped trying to control how much all of this was going to cost. I had been arguing with every decision the caregivers at the emergency room were making – “Is this Cat scan actually necessary or is there another diagnostic tool?” “Is there a cheaper version of this drug you’re giving me?” – and reminding them repeatedly that I was uninsured, but either the opioids in my bloodstream, or the exhaustion of trying to rest in a room next to a woman who, given the sounds she was making, was clearly transforming into a werewolf, forced me to surrender.Why is a 108-year-old resorting to GoFundMe to pay for home care? | Ross BarkanRead moreI walked out of there four years ago alive, yes. And, as the doctors and nurses kept reminding me, if I had waited another 48 hours to discover I didn’t actually have the magical ability to self-diagnose and self-treat serious problems with Google and herbs, I might have gone septic. But all said and done, I was also walking home to a $12,000 bill, which was approximately half of my annual income as a single woman.It took me several years of hardship, contributions from my friends and the assistance of the hospital’s charity program to pay off the $12,000.Then, last month, it started again. I was at home. I turned my head a little, the whole world started sliding away from me, and I crashed to the floor. I tried to crawl back into bed, insisting, “It’ll pass, it’ll pass.” My husband, on the other hand, was raised in a country with compulsory public health coverage, so his first instinct upon something weird happening isn’t to lie down for 48 hours and see if it goes away. He immediately started plotting the route to a hospital on his phone.I was back, but this time I was married. The whole hospital visit cost us $30, including the prescription. Everything was covered by his insurance. That’s when I realized I can never divorce my husband.The first emergency room visit might have been an anomaly – a freak health problem that the nurse explained as “sometimes these things happen”. The intense vertigo was the result of the deterioration of the condition of my ears. It has been a problem since childhood, one left in “let’s wait and see what happens” condition until a weird virus last year – yes, I was the big idiot who caught a debilitating non-coronavirus virus during a coronavirus pandemic – forced me to a doctor, who discovered significant hearing loss and structural damage that will require lifelong treatment and intervention.As a freelance writer who has tried and failed for years now to get a real job with real benefits, the costs of the surgeries and hearing aids and other treatments the doctor sketched out as part of my future would be suffocating. But almost all of it is covered by my husband’s insurance, making my health and ability to access healthcare dependent on his presence in my life.While I convalesced from the virus last year, I watched the discussion about health insurance take over the Democratic primary debates. I had little hope that the bright, sparkly Medicare for All plan championed by candidates like Bernie Sanders would be made reality. But still I despaired of the excuses other candidates made for why they did not support guaranteed coverage for all. It angered me to see Amy Klobuchar, Pete Buttigieg and the eventual winner, Joe Biden, defend their plans to largely maintain the status quo – a system in which employment and marriage determine access to healthcare – as though they were protecting our “freedom” to “choose” coverage that was right for us.The coercions built into American social welfare programs limit freedom, not preserve it. People who are not financially independent are forced to maintain ties with family members who might be abusive or violent unless they want to relinquish their housing, healthcare or other forms of support. And as outlined by Melinda Cooper’s Family Values: Between Neoliberalism and the New Social Conservatism, the dismantling of protections like food and financial aid in the 80s and 90s had the express purpose of increasing familial obligations in the name of “duty” and “responsibility”. Single parents seeking public support for their children’s wellbeing now had to first seek assistance through their partners, no matter how fraught or harmful those relationships might be. While politicians spoke of “strengthening families” and repairing the social fabric, one of the consequences of these policy changes was to limit the ability for people to make the basic decisions required to live the lives of their choosing, unless they had the money that in this country is our substitute for freedom.It’s not just unhealthy families we are stuck in: a Gallup poll revealed that one in six Americans stay in jobs they want to leave because they can’t afford to lose their health benefits. Politicians on both sides claim to support innovation and entrepreneurship, but the cost of healthcare is a huge barrier for many, and something that could be easily resolved with a public option. It’s almost as if we believe people who are sick, unlucky or not blessed by inherited resources deserve to have their choices constrained and stay trapped in perilous circumstances. (That last part is a joke. We Americans definitely believe this.)We have a Democrat-led Congress and a Democratic president, yet there is no public option or significant overhaul of our broken health insurance system on the horizon. As a result, when my husband got offered his dream job at an emerging non-profit startup, one so new that when the offer was made they could not yet offer health benefits, he hesitated. There would be a gap in coverage, of indeterminate length, and there was still that $12,000 emergency room visit in recent memory.In the end, simply by luck, the startup found a way to enroll employees in a health program that left us with only a one-month gap in coverage. I am lucky to be married to someone I like, who I am not afraid of, who I do not want to leave. This hasn’t always been the case for women in my family, or even myself in my 20s. For now, and for the foreseeable future, my access to doctors is tied to my partner, and his to his employer. Land of the free indeed.
    Jessa Crispin is a Guardian US columnist
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