Financial and logistical barriers to monkeypox care can disproportionately affect patients of color. In New York City, appointments for monkeypox treatment and vaccination, distributed on a first-come, first-serve basis, have disproportionately gone to wealthy, white individuals who have better access to the health care system. The first vaccines were doled out in Chelsea, a mostly white neighborhood, during the middle of the workday on Thursday. Even when vaccines began to be distributed in Harlem (a neighborhood that is 82 percent non-white), appointments appeared to go largely to white residents from outside the community, leaving community members frustrated.
Such disparities mirror larger trends in society. Across specialties, physicians disproportionately spend their time seeing white patients, despite patients of color, on average, having higher medical needs. Due to the legacy of slavery, Indigenous genocide, xenophobic immigration regulations and centuries of racist economic policies, patients of color are more likely to be under- or uninsured, and in general, have lower incomes. Patients of color are also more likely to experience difficulties accessing transportation, or taking paid time off work to access appointments. The latter is particularly important for individuals with monkeypox, which requires prolonged isolation, and whose painful lesions can inhibit the ability to work.
We need explicitly anti-racist policies to repair these harms. Medicare for All would eliminate financial barriers to health care, and in doing so, help address the racial inequities highlighted by the monkeypox pandemic.
Medicare for All would establish a “single-payer” system, in which all U.S. residents would receive health insurance. All U.S. residents would have access to medications, doctor appointments and hospitalizations with low or no copayments. Undocumented individuals could be covered under the current House bill, as to be determined by the U.S. Secretary of Health and Human Services.
Studies show that Medicare for All would have saved 340,000 lives so far during the COVID pandemic, primarily by eliminating financial barriers to care, while saving billions of dollars annually. It’s a rare “free lunch” in economic policy, because savings under a single-payer system far outstrip the costs of expanding coverage. The U.S. spends nearly a third of all health care dollars on administration, approximately $800 billion annually, primarily coming in the form of private health insurance company overhead and profits. Medicare’s fee-for-service plan, in contrast, has 2.4 percent overhead.
Medicare for All could address racial disparities in monkeypox access by making all services free of charge, disproportionately benefiting racial and ethnic minorities. Most Americans would see their incomes rise, not only because premiums and copayments would fall to near zero, but because for the majority of Americans with employer-sponsored insurance, the potential salary that is currently tied up in insurance subsidies would be freed up.
When diseases like monkeypox disproportionately affect communities of color, the financial impact on hospital systems is not equal, reproducing structural racism. In general, hospitals primarily serving patients of color earn fewer profits, since these patients are disproportionately uninsured or covered by public insurance, which reimburses less than private insurance. This codifies a perverse financial system in which white lives are more valued than the lives of people of color.
Over the past few decades, this has also led to an arms race among health care systems, which invest in lucrative projects to attract privately insured (disproportionately white) patients, driving up the cost of care for all in the process. Meanwhile, clinics that serve people of color remain underfunded.
It doesn’t have to be this way. Medicare for All would establish a financing system called “global budgeting” that could allocate resources based on need, similar to how we currently finance fire departments. It’s a common-sense approach that aligns dollars with need. Safety net and rural hospitals, which are currently closing at record rates, would see boosts in revenue, and unnecessary or wasteful spending would be curtailed. This would be a boon for clinics which focus on lower reimbursing areas, like primary care, mental health, and yes, infectious diseases.
The early days of the monkeypox pandemic have been plagued by supply chain and logistical challenges. Vaccines remain scarce and maldistributed. Contact tracing and testing have been challenging. Medicare for All wouldn’t, in and of itself, fix all of these problems, but it would enable a national electronic medical record, mitigating logistical hurdles that result from our byzantine, multi-payer health system.
For example, in 2020, Taiwan’s lauded initial response to COVID would not have been possible without its single-payer system and national health insurance database, which streamlined contact tracing and communication.
There will be more pandemics after monkeypox and COVID-19. Narrow, disease-specific measures, such as those passed in 2020 making COVID hospitalizations free, expire with time, serving only as Band-Aids. Other incremental reforms are politically attractive, but mathematically infeasible, as they do not come with the administrative savings of a single-payer system.
There is a saying in medicine that the United States does not have a “health care system,” we have a “sick care” system. Among wealthy nations, the U.S. stands out for its uniquely reactive, profit-driven system which is disinterested in prevention. The monkeypox pandemic makes this all the more clear, and also sheds a light on structural racism in our health care system. By advocating for Medicare for All, we can build a better system, fundamentally reoriented to justice and public health, one that prioritizes people over profits and takes a necessary step toward confronting racial inequities in our society.
When most of us think of mental health care, we think of seeing a therapist once per week. But at Kaiser Permanente facilities in California and Hawaii, clinicians — including psychologists, clinical social workers, marriage and family therapists, and addiction medicine counselors — say their patients routinely wait months between appointments. Not only that: There’s no limit to the number of patients that can be assigned to one therapist.
“You’re expected to follow anybody you have seen in the last two years. At times, the number of people I have seen in the last two years has been up to 600,” Sabrina Chaumette, a Kaiser therapist in Oakland, told Truthout.
Since July 2021, Kaiser mental health clinicians in California, who are members of the National Union of Healthcare Workers (NUHW), have attempted to use contract negotiations to demand the resources they need to provide better care for their patients. But workers say management has been unwilling to budge on changes necessary to reduce their unmanageable workloads and reverse understaffing, so on August 15 — nearly 14 months after their first bargaining session — over 2,000 Kaiser therapists in California went on strike. Nearing two months, it is the longest mental health strike in history. And on August 29, 57 of their colleagues in Hawaii, also NUHW members, joined them.
Kaiser is the largest nonprofit HMO in the United States, operating in eight states and the District of Columbia. It’s the largest health insurance plan in California, with more than half the market share, and the second-largest in Hawaii. However, despite reporting an $8.1 billion profit in 2021, Kaiser staffs only one full-time-equivalent mental health clinician for every 2,600 members in Northern California and just one therapist for every 5,500 patients in Hawaii, according to NUHW. Union members say this flies in the face of Kaiser’s key marketing promise: That by offering health insurance plans and operating hospitals and other facilities under one umbrella, patients receive better and more integrated care.
“I call it the glitter cloud,” Rachel Kaya, a Kaiser therapist in Hawaii, told Truthout. “They put out into the world how they promote mental health care, how they help people thrive, and how they do fair labor bargaining. But in my field, we talk a lot about the difference between talking the talk and walking the walk.” Unlike their colleagues in California, whose contract expired, Kaiser therapists in Hawaii are still without a first contract four years after joining NUHW.
“A strike is an absolute last resort. We have made numerous efforts to compel our employer to shift our model of care to reduce dangerous delays in terms of wait times that our patients face,” Ilana Marcucci-Morris, a Kaiser therapist in California and bargaining committee member, told Truthout. According to Marcucci-Morris, the union’s last contract cycle nearly ended in a strike over the same issues, but members ultimately accepted an offer from Kaiser when it agreed to form a committee, with equal participation between union members and management, that would make recommendations on how Kaiser could improve its model of care. After that committee met for over a year and made its final presentation, “Kaiser cherry-picked one or two pieces that they liked and then dumped the rest,” said Marcucci-Morris. Before walking out, NUHW members in Northern California accepted Kaiser’s financial terms. They’re not striking over their own compensation or benefits.
“Our patients are waiting three months in between appointments and flooding the emergency room because they’re in crisis, or paying out of pocket to go outside Kaiser. That extreme moral injury is the crux of our strike,” said Marcucci-Morris. We want our patients to get better and we need the resources to help them do that.” Kaya agrees. “I just want to be really clear that the reason why we are on strike is not a financial issue,” she said. “It is absolutely a social justice issue. Kaiser being a multibillion-dollar company, yet choosing to underfund mental health care in these communities, is wrong. The entire community pays the price when we underfund mental health care.”
Marcucci-Morris likens the Kaiser model, where there is no limit on the number of patients a therapist can be expected to take on, to “a house where you have a front door that’s wide open but no windows, no side door, or back door.” In addition to forcing clinicians to work many hours of overtime on non-patient-facing work like completing and reviewing notes and connecting with other members of a patient’s care team, union members say this approach actually compels them to break the law. In addition to recently strengthened federal law, California has some of the strongest mental health parity laws in the nation. SB 221, enacted in 2021, requires that mental health and substance use patients be offered return appointments within 10 business days, unless the treating therapist determines that a longer wait time is appropriate. If an appointment with an in-network provider is not available, insurers and HMOs are obligated to arrange for outside care at no additional cost to the patient. NUHW members say state regulatory bodies have been slow to enforce the new law, and that Kaiser was noncompliant even before their strike.
“Our current contract compels therapists to break mental health parity laws on the state and federal level,” said Marcucci-Morris. When she went on strike on August 15, said Chaumette, her next available intake appointment was in mid-November.
Barbara McDonald is a single parent to two daughters with mental health challenges. McDonald told Truthout that getting her younger daughter an appropriate diagnosis within the Kaiser system took so long that she was forced to pay out of pocket to go outside Kaiser. Once her daughter did have a diagnosis of borderline personality disorder, the only treatment she was offered within Kaiser was a series of classes — which were then canceled. After her daughter was hospitalized multiple times for self-harm, McDonald paid out of pocket again to get her the treatment she needed outside of Kaiser. All told, she has spent around $50,000. “I don’t think my daughter would be alive if I hadn’t been able to provide outside care for her,” she said. “And I’m still digging myself out of a financial hole because of that.”
“My older daughter said, ‘Do I have to cut my throat to get a therapy appointment?’ She sees her sister only getting care if she escalates and hurts herself. That must feel really scary, that nobody cares unless you’re hurting yourself or threatening yourself,” said McDonald.
Chaumette said that in her experience, it’s often patients with less severe symptoms who do manage to get a referral for covered care outside the Kaiser system. “If I’m seeing somebody with depression and they’re having a difficult time getting out of bed, dressing, bathing, eating, they’re not going to have the energy to be on the phone with Kaiser fighting for an outside referral. This system disproportionately hurts the people with more severe symptoms,” she said. Kaiser also encourages therapists to keep more severe cases in-house, purportedly to better manage care for those patients, and because they might be rejected by therapists in private practice. But Kaiser’s mental health providers are so overwhelmed that McDonald questions the safety of that approach. “Even though Kaiser is dispensing my daughter’s medication, they don’t have anybody following up with her. She can go six months between meetings with her psychiatrist,” McDonald said. “That’s just dangerous.”
In California, Kaiser contracts with Medi-Cal, the state’s Medicaid program, and its failures to deliver timely care disproportionately affect people who can’t afford to go outside the system. “Any marginalized community that has been unused to advocating for itself is not going to fight the system to give them a referral to an outside provider,” said Chaumette.
These untenable conditions have therapists leaving Kaiser in droves, according to NUHW. Between June 2021 and May 2022, said the union, 668 California clinicians left Kaiser — nearly double the 335 clinicians who left the previous year. In a survey conducted by NUHW, 85 percent of those clinicians said they had an unsustainable workload, and 76 percent said their inability to “treat patients in line with standards of care and medical necessity” influenced their decision to leave.
In California, NUHW members are asking for several key changes: Up to an additional 30 minutes per day to perform indirect patient care tasks such as returning phone calls and emails from patients and communicating with other members of a patient’s care team; the ability for clinicians to stop taking new patients when they have no available appointments for new patients within two weeks; a ratio of one appointment for a new patient to every six appointments with current patients; and a requirement that Kaiser hire enough staff to comply with federal and state law. The only concession Kaiser management has offered, according to Marcucci-Morris, is an increase in indirect patient care time of just 12 minutes per day, applying to generalist therapists only, which would exclude a majority of the union. Representatives for Kaiser Permenente did not return a request for comment.
In May, the National Committee for Quality Assurance, an independent nonprofit organization that accredits health plans, placed Kaiser under “corrective action” because of its violations of national mental health standards. Two California state agencies are also investigating Kaiser’s failures to follow state mental health parity law, though those investigations are not expected to conclude until next year. “I’d like to see them hit them with fines big enough to get their attention and to make it worth it for them to turn this around, because clearly they’re only interested in the money they make,” said McDonald. “Or if they’re not going to provide mental health care, then they should just say that rather than pretending they do.”
In Hawaii, NUHW filed a complaint in November 2021 with the Department of Commerce and Consumer Affairs regarding Kaiser’s failure to address serious patient care problems. In its formal response in December, Kaiser pledged to hire 44 additional therapists. According to NUHW, the number of full-time Kaiser clinicians in Hawaii has actually decreased from 51 to 48 since then.
Chaumette says that, because of its poor practices, Kaiser faces a reputational crisis among therapists. “They are never going to be able to hire enough therapists to treat all these patients, because nobody wants to work for Kaiser,” she said. “Our reputation in the community among therapists is bad. When I tell people I work for Kaiser, their first response is, ‘You don’t do therapy.’ I think this strike has increased my reputation within our community of therapists. We’re doing advocacy in ways I’ve never done before as a therapist.”
Though roughly half of the clinicians who went on strike in California have returned to work out of financial necessity, Marcucci-Morris said support for the strike remains high — in a recent vote, 85.9 percent of union members still supported the strike. “It’s important to note what a union is. We are a collection of workers. This is not one or two people telling us what to do,” she said.
According to Marcucci-Morris, therapists who have gone back to work informed the union that Kaiser is still booking appointments for patients with therapists who are out on strike, then canceling and rescheduling them. “If Kaiser felt following the law was a priority, they’d follow our proposal,” she said. “We’re ready to negotiate around the clock to get an agreement.”
In an extended interview, acclaimed physician and author Dr. Gabor Maté discusses his new book, just out, called “The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture.” “The very values of a society are traumatizing for a lot of people,” says Maté, who argues in his book that “psychological trauma, woundedness, underlies much of what we call disease.” He says healing requires a reconnection between the mind and the body, which can be achieved through cultivating a sense of community, meaning, belonging and purpose. Maté also discusses how the healthcare system has harmfully promoted the “mechanization of birth,” how the lack of social services for parents has led to “a massive abandonment of infants,” and how capitalism has fueled addiction and the rise of youth suicide rates.
TRANSCRIPT
This is a rush transcript. Copy may not be in its final form.
AMYGOODMAN: This is Democracy Now!, democracynow.org, The War and Peace Report. I’m Amy Goodman.
Today we spend the hour with Dr. Gabor Maté, the acclaimed Canadian physician and author. He’s just out with a new book, The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture. Dr. Maté has worked for decades in Vancouver as a family physician, palliative care director, addiction clinician and observer of human health. Dr. Maté’s work has long focused on the centrality of early childhood experiences to the development of the brain, and how those experiences can impact everything from behavioral patterns to physical and mental illness. Over the years, he’s written a number of best-selling books, including In the Realm of Hungry Ghosts: Close Encounters with Addiction, When the Body Says No: Exploring the Stress-Disease Connection and Scattered Minds: The Origins and Healing of Attention Deficit Disorder.
In a moment, we’ll speak to Dr. Gabor Maté, but first I want to turn to a trailer of a documentary about his work titled The Wisdom of Trauma.
DR. GABOR MATÉ: In the U.S., the richest society in history, fully half of the citizens have a chronic disorder, such as high blood pressure or diabetes. Anxiety amongst young people is growing rapidly. Asthma and autoimmune diseases are on the rise, as are addictions. Depression is rising. Youth suicide is rising. All is not well.
JAMES: I started heroin at 26. That’s what really destroyed me. Just takes the pain away.
UNIDENTIFIED: It’s easy to want to want to escape reality completely instead of coping with it.
DR. GABOR MATÉ: And so, the question is: Can we be human beings in the midst of civilization? Because what we call civilization demands the denial of human needs.
ANNOUNCER: Please welcome Dr. Gabor Maté.
DR. GABOR MATÉ: Every human being has a true, genuine, authentic self. And the trauma is the disconnection from it, and the healing is the reconnection with it.
Why do we get disconnected? Because it’s too painful to be ourselves.
RUSSELLBRAND:* So, you’re sort of a bit like in The Matrix when Neo sees everything’s made out of numbers. You look at people, and you see all their trauma and damage.
DR. GABOR MATÉ: That’s what I see.
So, trauma is not the bad things that happen to you, but what happens inside you as a result of what happens to you.
What do you want tell me? What comes up right now?
UNIDENTIFIED: Shame.
DR. GABOR MATÉ: Thank you.
ALICIA: My father, he would spank us and take a belt to us.
DR. GABOR MATÉ: Who would you speak to about your pain?
ALICIA: Nobody.
DR. GABOR MATÉ: Yeah, that’s the trauma. In other words, by the time you were 5 years old, you were completely alone.
People are much more lonely and isolated than they used to be. Literally, it causes inflammation in the body and suppresses the immune system.
You’ve been diagnosed with prostate cancer.
TIM McCARTHY: Correct.
DR. GABOR MATÉ: In my view, people that develop cancer have a hard time expressing healthy anger.
RUSSELLBRAND: Hillary Clinton versus Donald Trump. They were two traumatized people fighting to govern a traumatized world.
DR. GABOR MATÉ: That’s exactly what I’m saying. And these are the people that our society rewards with power.
Our schools are full of kids with learning difficulties, mental health issues, that are trauma-based. But the average teacher never gives a single lecture on trauma.
We need trauma-informed medical care, trauma-informed education. If we had a trauma-informed society, we would have a society that looks much more compassionate.
JOEYCARTER: You did. You made a big difference in my life.
DR. GABOR MATÉ: Thank you for being touched.
TESSAROSE: I don’t feel like I’m a bad person anymore.
Hey! How are you?
DUANE: How are you?
DR. GABOR MATÉ: Yeah, I just want people to see the truth. Solutions arise out of people when they confront themselves with the truth, when they’re not afraid of the truth.
TIM McCARTHY: I think the biggest thing that this whole healing journey has taught me is how to be human.
AMYGOODMAN: The trailer for the film The Wisdom of Trauma, featuring Dr. Gabor Maté, who is our guest for the hour. He’s just written a new book with his son Daniel titled The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture. Dr. Maté will be appearing tonight in New York City at the 92nd Street Y. On Thursday, Democracy Now!’s Nermeen Shaikh and I spoke to Gabor Maté. I began by asking him about the pandemic and the book title, The Myth of Normal.
DR. GABOR MATÉ: So, the pandemic actually revealed to us how toxic our idea of normal has been, because it showed us the desperate need for human connection that we all have. But this is in a culture that has been isolating and atomizing individuals for a long time, where loneliness has been an epidemic for decades. It showed the noxious effect of racism and inequality, because the people who had the greatest risk for being affected by COVID were those of a lower social class and of people of color.
The normal that we came from, in my perspective, was already a toxic normal. We don’t want to go back to it, because my contention in this book is what we consider to be normal in this society is actually neither natural or healthy, and, in fact, it’s a cause of much human pathology, mental and physical. And actually, people’s pathologies, what we call abnormalities, whether it’s mental or physical illness, are actually normal responses to what is an abnormal culture.
NERMEENSHAIKH: And, Dr. Gabor Maté, you say in the book, in fact, that there are no clear lines between normal and abnormal. Could you explain what you mean by that and how you understand the spectrum along which these things lie?
DR. GABOR MATÉ: Well, the key here is trauma. Trauma is a psychological wound that people sustain. And I’m saying that in this society, most of us, because of the nature of the culture, the way we raise children, the way we have to relate to each other, the very values of a society are traumatizing for a lot of people, so that it’s false to say that some people are normal and others are abnormal. In fact, we’re all on a spectrum of woundedness, which has great impact on how we relate to each other and on our health.
NERMEENSHAIKH: And, Dr. Maté, explain how you understand, as you say in the book, that the term “trauma” has Greek origins, but that it’s —
DR. GABOR MATÉ: Yeah.
AMYGOODMAN: — come to mean something quite different. I mean, in the Greek origin, it referred to a physical injury or a physical wound. But in psychiatry, in the work of Freud, in psychoanalysis, in medical literature generally, now trauma is understood as a wound to the mind.
DR. GABOR MATÉ: It’s a wound to the psyche, to our emotional being and to the soul. And trauma is not what happens to us. People, when they think of trauma, they think usually of catastrophic events, like a tsunami or a war or parents dying or sexual or physical, emotional abuse of a child. These events are traumatic, but they’re not the trauma. The trauma is the psychic wound that we sustain. And our psychological traumas have lifelong impacts. And in my medical work, I found that psychological trauma, woundedness, underlies much of what we call disease, whether autoimmune illness or cancer, or the various mental health conditions.
And in our society, psychological woundedness is very prevalent, and it’s rather an illusion to believe some people are traumatized and others are not. I think there’s a spectrum of trauma that crosses all layers and all segments of society. Naturally, it falls heavier on certain sections — on people of color, people with genders that are not fully accepted by society, people of economic inequality who suffer more from inequality — but the traumatization is pretty general in our culture.
AMYGOODMAN: Gabor, I was wondering if you could take some time and talk about your own journey from trauma and how it shaped you, as an infant in Nazi-occupied Hungary to where you are today, and how that has influenced who you are.
DR. GABOR MATÉ: Well, you know, the first chapter of the book opens with my arrival home to Vancouver, where I live, from a speaking trip. And I’m feeling really good about myself because it was a good trip, my talk was well received, and I had a good flight home. And when I arrived back at the airport in Vancouver, I got a text from my wife saying, “I haven’t left home yet. Do you still want me to come?” And all of a sudden my mood switches. I become dark. I become angry. I become withdrawn. I become sullen. And when I get home, I’m barely even looking at her.
Now, what actually happened here? All that happened was that my artist wife, typical of an artist, was the middle of creative flow in her studio, and she forgot that her husband was arriving home at the airport. What was triggered in me, however, was the wound of a 1-year-old infant who was abandoned by his mother in an effort to save my life, actually, but the meaning I made of it is that I wasn’t lovable, that I wasn’t wanted. And even 71 years later, when this woman on whom I’m relying to be there for me doesn’t show up, the woundedness of a 1-year-old infant shows up. And that’s what my friend Peter Levine calls “the tyranny of the past.” And so, these early wounds — in my case, the sense of abandonment — could still show up seven decades later over a relatively trivial incident.
And these early wounds of ours, well, so, that’s one way that it showed up. It shows up in my relationship to my work. So, I was a workaholic physician for many decades. Why was I a workaholic? Because the message I got as an infant under the Nazis was that the world didn’t want me. And if the world doesn’t want you, one way to cope with it is to make yourself very important, become a helper, become a physician, because now they’re going to want you all the time. But that’s very addictive, because you keep trying to prove to yourself something you don’t believe in the first place, which is that you’re wanted. And so that the more people rewarded me with — either financially or with their attention or their gratitude for my medical work, the more I needed it, the more I became dependent on it. So, it shows up in so many ways. These early wounds show up in so many ways. It shows up in our relationships, in our marriages, in our relationship to our children, in our relationship to our work. It shows up in politics, as we’ve seen during COVID. So, these early wounds in my life had had wide-ranging implications, as they do in the lives of many people.
AMYGOODMAN: Now, you have intrigued us, because you said, at the time, you thought your mother abandoned you. But you, of course, now understand she was doing it to save you. Can you explain what happened?
DR. GABOR MATÉ: Sure. So, I was 11 months of age. My mother was a 24-year-old Jewish woman living under the Nazi occupation, under a viciously antisemitic fascist regime in December of 1944. And she found refuge in a safe home run by the Swiss Embassy, but there were 2,000 people living there in a home meant for 100 people. The sanitary conditions were terrible. Food was very uncertain. And I was very sick, and she didn’t think I would live. So she went out into the street and gave me to a Christian woman, a complete stranger, and asked her to take me to some relatives who were living under relatively, relatively safer conditions. Her intention was simply to save my life. And she did. But as an 11-month-old, I could only interpret that as an abandonment, because I don’t understand the conditions.
Now, who gets abandoned? Somebody who’s not wanted. So I developed this fixed belief: “OK, I’m not lovable. I’m not wanted.” Now, you don’t need conditions of war and privation and such drama to give children the sense that they’re not wanted. In this society, a lot of parents are advised not to pick up their kids when they’re crying. That’s enough to give the child the sense that they’re not wanted and not accepted. And so, I was traumatized under very — and the trauma is not that my mother gave me to a stranger. The trauma is what I made it mean, the wound inside, that I’m not lovable and not wanted.
NERMEENSHAIKH: Dr. Maté, let’s go back precisely to how you understand, and how we should understand, the event of trauma. First of all, can trauma arise from a single episode, or is it something that has to, in some form, even if not precisely the same one, be repeated? And to what extent does the fact that you cannot know the trauma when it actually occurs account for the fact that its effects endure and, as you say, show up decades later?
DR. GABOR MATÉ: Well, as your question implies, trauma can be induced in people in a number of ways. It could be a single dramatic event — the death of a parent, a tremendous loss in life, a terrible explosion. You know, it occurs that way sometimes. And those are relatively easy to identify, and then, actually, they’re easier to deal with.
But for a lot of people, it’s much more insidious and much more chronic than that. For example, certain child-rearing practices. For decades, Dr. Spock, who was kind of the guru of parenting, advised parents not to give in to the infant’s tyranny, the infant’s resistance to sleep. Now, what he calls the infant’s tyranny is the infant’s desperate need to be picked up and held by the parent. That’s just a trait that we share with all other mammals. You tell a mother baboon not to pick up their baby, or a mother cat not to respond to their child’s distress. But here in North America, we’ve been telling parents for decades to ignore their children’s cries, or, for example, when a child is angry, a 2-year-old is angry, to give them a timeout, which is to say, to threaten them with the loss of the attachment relationship that they desperately need. Those events are just as traumatic over the long term, but they’re harder to identify because they seem so normal and they don’t seem dramatic. But they do show up later on in life in all kinds of dysfunctional patterns.
NERMEENSHAIKH: And, Dr. Maté, you speak in the book about unresolved traumas. So, in the examples that you’re giving now, or indeed in the case of trauma more generally, if one can speak generally about trauma, what kinds of practices can lead, if at all, to the resolution of a trauma?
DR. GABOR MATÉ: Well, whether we’re speaking about on a social level, which we have to speak, or whether on the individual level, which is what it strikes most of us, the first thing that has to happen is a recognition that how we’re living or some aspect of our lives is not working for us, and that there’s a cause for it, which we can actually uncover by some compassionate inquiry.
And very often there needs to be a wake-up call. Now, COVID could have been a wake-up call for this culture, but I don’t think it will have worked that way. It should have, but it didn’t, because of the nature of this society to transformation. The resistance to social transformation in this culture is so deep that the COVID lessons, I don’t think, have been learned, nor will be applied. On the individual level, very often it’s an illness, whether of a depression, an anxiety, a psychiatic diagnosis, a relationship breakup or a physical illness, like an autoimmune disease or malignancy, that works as the wake-up call. So there’s got to be some kind of event that happens that says to us, “Mmm, this is not working.” We need to understand why not and need to move past it.
And once we get that wake-up call, in whatever form — and one of my intentions in this book is to help people not get to that dire, dramatic point where some significant illness has to wake them up. But once we get to the point of waking up, then we come to look to inquiry. OK, what was driving my behaviors? Why was I always driving myself on the job like as if my life depended on it? Why was I a workaholic, stressing myself? Why was I so hard on my children? What is it that makes me feel so hurt when my partner doesn’t pick me up at the airport? You know, so, then we start looking at what happened to our lives, and we find the answers in our history.
And then it’s a matter of letting go of those patterns. And that takes some kind of work, usually therapy or some kind of spiritual work or psychological work, some kind of different way of taking care of ourselves. Usually it takes some inquiry, what I call a compassionate inquiry, of looking at ourselves with real curiosity: What is causing me to live the way I’m living? And why is it not working for me?
AMYGOODMAN: Gabor Maté, your book comes out at an extraordinary time, given your topic, and I know it took you years to write. But now in the pandemic, you have, according to the CDC, hospitals reported a 24% increase in mental health emergencies for children between the ages —
DR. GABOR MATÉ: Yeah.
AMYGOODMAN: — of, what, 5 to 11. And the issue of mental health, overall, so critical at this point. You talk a lot also about loneliness. But can you start by talking about this mental health crisis among youth and the escalating suicide?
DR. GABOR MATÉ: Yes. So, The New York Times, about three weeks ago as we speak now, had a front-page article in their Sunday edition about a teenager who was on 10 different psychiatic medications. Can you imagine? Ten different psychiatic medications. And there’s been articles in The New Yorker and The New York Times within the last four or five months about the rising tide of childhood suicides. There is a vast increase in the number of children being diagnosed with ADHD, attention-deficit/hyperactivity disorder, with anxiety, depression, self-cutting, obsessive-compulsive behaviors, and so on.
Now, we can make two assumptions. Either there’s some accidental, totally unexplainable rise in childhood pathology that has no specific reason whatsoever for its instigation, or we can recognize that we live in a toxic culture that, by its very nature, affects children development in such unhealthy ways that children are increasingly mentally unbalanced and desperate to the extent that they’re cutting themselves and even trying to kill themselves.
So, we have to look for those conditions, not in the individual mind or brain or personality of the child or youth; we have to look at them in the social conditions that drive children in those directions. And unfortunately, in the public conversation around it, it’s all about the pathology and how to treat it, and it’s not about the social or cultural causes that are driving children in those desperate directions.
AMYGOODMAN: So, can you talk about how you view this, and how this — not just this country, the world can heal, especially focusing on youth?
DR. GABOR MATÉ: Well, we need to begin right at the beginning. And the beginning is actually in the womb. Now, we already know, from multiple, multiple studies — not even controversial — that the more stress there is on pregnant women, the greater the impact, even decades later, on the well-being of the infant. So, how are we looking after pregnant women? The average physician — I mean, I was trained as a medical doctor — to this day, the average physician, when they’re trained in prenatal care, they’re not trained to ask about the woman’s emotional states. They’re not trained to ask about: “How are you doing? How is your relationship? How is your work stress? What can we do to support you?” We only look after the body, and we separate the mind from the body. We know that stresses on the woman can already have an impact on the infant.
Then there’s our birth practices. In North America now, the cesarean section rate is approaching 40%. Now, modern obstetrics is miraculous in its capacity to save lives, and it should be applied about 10 to 15% of cases for the benefit of the infant or the mother. But the 40% C-section rate and the mechanization of birth — natural birth, as evolved by nature, was designed to produce a bonding experience for mother and infant, including the release of bonding chemicals that will bring them together for a lifelong relationship. When we medicalize birth, we interfere with it. We mechanize it. We create fear around it. We’re actually interfering with the mother-child bond, on which the child’s healthy development develops.
Then, in the United States, 25% of women have to go back to work within two weeks of giving birth. Now, nature would have that mom be with the child for at least nine months, usually longer, if you look at it historically. Twenty-five percent of women having to go back to work for economic reasons, for lack of social support, amounts to a massive abandonment of infants, because that’s how the infants experience it. That’s the only way they can interpret it, just the way I interpreted my mother’s giving me to a stranger as an abandonment.
Then there’s the child-rearing practices that I’ve already mentioned, of not picking up children when they’re crying, of parents being so stressed, that their stress is absorbed by the infant, that the parents’ economic, racial, social anxieties, relational anxieties, their own unresolved trauma are absorbed by the infants.
Then there’s parenting practices that focus on trying to control the child’s behavior without in any way trying to meet the child’s needs. The human child is born with certain needs, for unconditional loving acceptance, for being held, for the capacity to experience all their emotions with parental support. In this society, those needs are denied over and over and over again. And most of our children spend most of their time away from their parents, so they lose the connection with the parent. Do we wonder, then, that the child’s circuits of anxiety and panic in the brain are activated and extra overactivated? These are natural consequences of an unnatural culture.
AMYGOODMAN: Dr. Gabor Maté, the acclaimed Canadian physician and co-author, with his son Daniel, of the new book, The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture. Back in 30 seconds with him.
In the wake of the Supreme Court’s decision to overturn Roe vs. Wade, strict new abortion laws went into effect in more than a dozen states. Since then, women have reported being denied care for miscarriages, ectopic pregnancies, fatal fetal anomalies and unforseen crises, like premature rupture of membranes.
We are a nonprofit, nonpartisan, investigative news organization that wants to better understand how these laws are affecting the most intimate of health care decisions between patients and providers. Lawmakers who support the restrictions say the measures include exceptions to address life-threatening emergencies, and, in some cases, rape and incest. But many medical providers say the laws are not clear enough to account for all of the dangers that could arise during pregnancy.
These are significant policy changes and, as reporters, we are interested in learning about how they are experienced by real people. We know there are a lot of strong feelings about this issue, but we’re not looking for opinions. We’re looking for examples and insights. We are especially interested in hearing from caregivers or lawyers who work in the continuum of medical care.
If you’re in a state that tightly restricts abortion, we’d like to know more about your experiences and observations. If you are pregnant or are planning to become pregnant, what are your questions about how your state’s new laws affect your options or care? Have you had a medical conversation about what falls under the definition of “emergency” or a health threat under your state’s law? Contact us using the form below.
New survey data released Monday shows just 12% of Americans think healthcare in the United States is handled “extremely” or “very” well, further evidence of the deep unpopularity of a profit-driven system that has left roughly 30 million without insurance coverage and contributed to the country’s stunning decline in life expectancy.
The new Associated Press/NORC Center for Public Affairs Researchpollfinds that 56% of the U.S. public believe healthcare in general is handled “not too well” or “not at all well,” while 32% believe healthcare is handled “somewhat well.”
In all, just 1 in 10 Americans feel the U.S. healthcare system as a whole and healthcare for older adults are handled well or extremely well.
“The poll reveals that public satisfaction with the U.S. healthcare system is remarkably low, with fewer than half of Americans saying it is generally handled well,”APnotes. “The poll shows an overwhelming majority of Americans, nearly 8 in 10, say they are at least moderately concerned about getting access to quality healthcare when they need it.”
The survey results will come as no surprise to those who have attempted to navigate thebyzantine U.S. healthcare systemto obtain basic care, which often comes at suchprohibitively high coststhat millions each year are forced toskip treatmentsto avoid financial ruin as insurance giants and pharmaceutical companies rake inhuge profits.
The AP/NORC findings, based on interviews with 1,505 U.S. adults between July 28 and August 1, 2022, show that just 6% feel prescription drug costs are handled well or extremely well in the U.S., where pharmaceutical firms have broad authority to set prices as they please.
As for potential solutions to the country’s longstanding healthcare crises, the new poll shows that “about two-thirds of adults think it is the federal government’s responsibility to make sure all Americans have healthcare coverage, with adults ages 18 to 49 more likely than those over 50 to hold that view.”
“The percentage of people who believe healthcare coverage is a government responsibility has risen in recent years, ticking up from 57% in 2019 and 62% in 2017,”APnotes.
More specifically, the survey shows just 40% for a “single-payer healthcare system that would require Americans to get their health insurance from a government plan.” Depending on how the question is framed and phrased, single-payer — more commonly called Medicare for All — haspolled as high as 70% support.
According to the AP-NORC survey, 58% “say they favor a government health insurance plan that anyone can purchase” — a public option.
Recent research shows that a Medicare for All system of the kind proposed in new legislation introduced bySen. Bernie Sanders(I-Vt.) andRep. PramilaJayapal (D-Wash.) could have preventedhundreds of thousandsof Covid-19 deaths in the U.S. over the past two years.
“In the richest country in the world, no one should die or go into debt just because they don’t have access to healthcare,” Jayapal, the chair of the Congressional Progressive Caucus,tweetedlast week. “We need Medicare for All now.”
ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up for Dispatches, a newsletter that spotlights wrongdoing around the country, to receive our stories in your inbox every week.
Do you have an experience to share related to new abortion laws in your state? Our reporters want to hear from you. Contact us on Signal at 646-389-9881.
For nearly three decades, long before the fall of Roe v. Wade, the blond brick Building for Women in Duluth, Minnesota, has been a destination for patients traveling from other states to get an abortion. They have come from places where abortions were legal but clinics were scarce and from states where restrictive laws have narrowed windows of opportunity.
For many residents of northern and central Wisconsin, and the Upper Peninsula of Michigan, it was faster to head west toward the Minnesota border than to go southeast to clinics in Milwaukee, Green Bay or Madison. Over the years, thousands of pregnant people climbed the stairs of the Building for Women to get abortions at WE Health Clinic, on the second floor.
Treating travelers from other states is nothing new for WE Health or the other abortion providers around the state, but Minnesota’s role as a so-called abortion access island is. The state’s neighbors have either banned abortion, are poised to do so or have severely restricted the procedure.
Data kept by Minnesota shows that white people make up a larger share of those who travel from another state for an abortion than those who seek abortions in state, raising questions about whether certain groups — particularly people of color — will be able to make the trip.
The Building for Women is home to the WE Health Clinic.
(Jenn Ackerman, special to ProPublica)
According to the state’s data, Minnesota residents seeking abortions are a fairly diverse group. From 2018 through 2021, on average, 31% of patients were Black, 9% were Hispanic, 8% were Asian and 2% were American Indian; an additional 6% were recorded as “other.” White patients accounted for 44%.
But among those coming from out of state, people of color made up a much smaller percentage on average of the patient population. White people made up 75% of out-of-state patients.
Experts say some of the disparity results from the fact that the states bordering Minnesota are predominantly white, particularly in the rural areas adjacent to the state. But this also describes Minnesota’s population. So at least some of the difference could be tied to access to transportation or money to travel.
“Minnesota is going to become a haven state, but for what percentage of people that actually need our services?” said Paulina Briggs, WE Health Clinic’s laboratory manager and patient educator. “That’s a huge thing.”
Paulina Briggs, WE Health Clinic’s laboratory manager and patient educator, said the facility was prepared for the estimated rise in out-of-state patients.
(Jenn Ackerman, special to ProPublica)
When Roe was overturned in June, the small staff at WE Health Clinic was dismayed but not surprised. In fact, it was prepared to meet the estimated 10% to 25% increase in out-of-state patients.
“We’ve anticipated this for a long time,” Briggs said. “So it’s not like sudden news to us.”
While the clinicians in Duluth may have been prepared for the end of Roe, something much more unexpected happened 2 1/2 weeks later, when a district court judge delivered a surprise ruling that expanded abortion access in the state. Ruling in Doe v. Minnesota, the judge threw out measures that included a mandatory 24-hour waiting period before abortions, two-parent consent for minors and a requirement that physicians discuss medical risks and alternatives to abortion with patients. He also tossed out a requirement that only doctors were allowed to provide abortion care, including by telemedicine, and that after the first trimester, the care had to take place in a hospital.
In contrast to the tearful scenes that played out in many clinics after Roe fell, in Minnesota that Monday morning, abortion providers and their support staff celebrated. Laurie Casey, the executive director of WE Health, was behind her long, crowded desk, doing paperwork when she first got news.
“It’s like, ‘Oh my God, is this real?’” she said. “Something good happened?”
Laurie Casey, the executive director of WE Health. She and her staff celebrated a surprise ruling that expanded abortion access in the state.
(Jenn Ackerman, special to ProPublica)
Lawyers for the plaintiffs in the Minnesota case, which was filed in 2019, had expected to go to trial at the end of August. Instead, the judge granted abortion supporters a big victory, leaving intact two measures: a requirement that abortion providers collect and report data on their patients to the state, and a law that dictates the rules for disposing of fetal remains.
Minnesota Attorney General Keith Ellison, whose office represented the state in the lawsuit, announced that he would not appeal the court’s decision. Ellison also pledged that he would not prosecute abortion-seekers from other states and wouldn’t cooperate with extradition orders from outside jurisdictions.
Minnesota Gov. Tim Walz signed an executive order making similar promises.
Both officials have made abortion access central tenets of their reelection campaigns.
In these early days of a post-Roe reality, it’s not yet clear who will need these protections, though the data can provide clues.
States track demographic data on abortion differently; according to the Centers for Disease Control and Prevention, more than two dozen publicly report the race and ethnicity of patients. Minnesota is the only access island state in the Midwest that releases those numbers; the state also separates that data into resident and nonresident figures.
Illinois is projected to accept far more out-of-state patients than Minnesota, but its health department does not release statistics about the race and ethnicity of abortion patients. Kansas allows abortion up to 22 weeks, protects the right to abortion in its Constitution and reports one of the highest rates of out-of-state patients in the country, at nearly 50% and second only to Washington, D.C. But Kansas’ state health department does not combine where patients are from with demographic data.
From 2008 to 2021, 13,256 patients who live outside Minnesota received abortion care there, an average of about 950 people a year, according to the state health department. Among that population, the racial and ethnic breakdown of patients has held fairly steady.
A number of factors play into the lack of diversity, said Asha Hassan, a graduate researcher at the Center for Antiracism Research for Health Equity at the University of Minnesota.
“There’s the obvious one that might be coming to mind, which is the effects of the way structural racism and poverty are interwoven,” Hassan said.
The bridge between Duluth and Superior, Wisconsin, often crossed by out-of-state pregnant people seeking abortion care in Minnesota.
(Jenn Ackerman, special to ProPublica)
Caitlin Knowles Myers, a professor at Middlebury College in Vermont who studies the economics of abortion, added, “Obviously resources like ability to take time off, ability to get and pay for child care, etc., etc. — that obviously prevents poor women from making a trip.”
Then there is the cost of the procedure itself. In Minnesota, residents can use state medical assistance funds to pay for an abortion under certain circumstances; out-of-state residents cannot. According to Our Justice, a nonprofit that provides financial assistance for abortion care and travel to Minnesota, in-clinic abortion services can cost $400 to $2,000, depending on the gestational age of the pregnancy. A locally based telemedicine service and mobile clinic called Just the Pill charges $350 for abortion medication.
Shayla Walker, executive director of Our Justice, said her organization helps people work through the kinds of barriers to travel that pregnant people of color face every day. Undocumented patients, for instance, may not have a driver’s license or other form of identification, meaning that flying from states like Texas or Oklahoma is out of the question.
Of the out-of-state patients who come to Minnesota, residents from neighboring Wisconsin make up the vast majority. And like Minnesota and its neighboring states, Wisconsin is predominantly white: 80.4% of residents identified as such in the 2020 U.S. Census.
From 2008 to 2021, an average of 690 patients from Wisconsin received abortion care in Minnesota each year. The proportion of Wisconsinites has dropped over the years — in 2008, 80% of out-of-state abortion patients reported that they lived in Wisconsin, compared with 63% by 2021. Over that same period, South Dakota residents ticked up from 4% to 16%, and Iowa patients rose from 2% to 6%.
According to Myers, the lack of abortion providers in western and central Wisconsin likely drives the traffic across the border to Minnesota. These parts of the state are largely rural and mostly white. Wisconsin’s more diverse urban centers are concentrated in the southern and eastern parts of the state, much closer to the Illinois border.
“A lot of them are likely to end up heading south to the Chicago area,” Myers said. “The Chicago area also has a lot of providers and likely a lot of capacity. And the question for Minnesota is, if the Chicago area ends up unable to absorb an enormous influx of patients heading their way from all directions, then you would expect to see patients spilling over into Minneapolis.”
Leaders of the Options Fund, which provides financial help to pregnant people in rural central and western Wisconsin who are seeking abortions, said the majority of the money they provide is for care that takes place in Minnesota.
“Certainly it’s not that people of color don’t exist, of course,” said the group’s vice president, who spoke on the condition of anonymity out of concern for her safety. “But I think generally, the more rural we get, the more white it’s going to be.”
Of course, the data from Minnesota is backward-looking, from years when abortion was still legal, though restricted or sometimes difficult to access, in surrounding states. There are certain to be shifts in where patients travel from, most obviously North Dakota, where the state’s lone abortion clinic moved from Fargo to its Minnesota sister city of Moorhead, just across the border. And as reproductive rights supporters across the country respond to the end of Roe, abortion funds have reported huge increases in their donations, which may bring travel and abortion care in Minnesota within the grasp of more low-income pregnant people and people of color.
The first week after the Doe v. Minnesota decision, WE Health Clinic’s patients felt the impact. Casey said she was able to tell a mother that her minor daughter could receive an abortion without the permission of her long-absent father or from a judge. Briggs was able to schedule a next-day abortion, which would have been illegal before the judge’s decision.
A medical abortion kit from WE Health Clinic includes mifepristone and misoprostol as well as a home pregnancy test, lip balm, candy and other items.
(Jenn Ackerman, special to ProPublica)
At some point, a clinic worker went through intake folders and pulled out all the forms certifying that “state mandated information” had been provided to patients. They were fed into the office shredder.
Tossing out their scripts, canceling the physician phone calls 24 hours in advance, no longer going down to the county courthouse to ask judges to grant their minor patients special permission to have an abortion — all of this will save the WE Health Clinic workers hours every week.
Beyond that, the court ruling — which abortion opponents are seeking to have overturned — has the potential to increase the number of providers, as advanced clinicians like nurse practitioners and some classifications of midwives may now be able to get training, and eventually provide abortion care and telemedicine.
This pivotal moment for abortion care in Minnesota and the country at large comes at a moment of major transition for WE Health as well. Casey is looking at retirement in the coming year, which means much of the work of adapting the clinic to serve patients in a post-Roe world will fall to her staff, including Briggs.
Briggs started working at the clinic six years ago, when she was just 21. She wanted to do this work after receiving her own abortion at WE Health as a college student, an experience she found at once “nonchalant” and “empowering.”
She is troubled by the disparities in who might be able to make it across the borders and climb the stairs of the Building for Women, to receive the kind of life-changing care that she did. Just keeping the doors open does not mean the care will be equitable.
Some advocates of a publicly funded universal health care system have predicted that its creation is inevitable because of the “death spiral” of insurance costs. This term refers to the fact that as costs of insurance rise, fewer people can afford it, leading to a new round of rising premiums and out-of-pocket costs. If this cycle were allowed to continue indefinitely, it would be only a matter of time before the medical insurance industry priced its product out of existence.
In a rational world, this simple fact would lead Congress to do what every other industrialized nation has done; create a publicly funded system of universal health care either through a government-run system such as Medicare for All, or through a tightly regulated system of non-profit insurers that offer a defined benefit package specified by the government, as in Germany.
COVID-19 cases persist all over the world, causing special concern in regions where vaccination rates are low due to inequities in access to vaccines. As the pandemic continues, analyses of the global response continue to point out the dangers of the predominant multi-stakeholder driven campaigns. One of the latest in line of such analyses is a report published by Transnational Institute and Friends of the Earth International in July. It zooms into how transnational corporations (TNCs) seized the opportunity to gain more power over international institutions and expand markets during the COVID-19 pandemic.
During the launch of the report, Lauren Paremoer from the People’s Health Movement underlined that the capture of the multilateral system by TNCs and private philanthropies was already underway before the pandemic, but the extraordinary circumstances led to an unanticipated expansion.
On July 30 activists marched and rallied in Washington, DC, calling for a more humane healthcare system. Physician and Left Voice member Mike Pappas spoke at the rally about how capitalism and health aren’t compatible. Below is the text from his speech.
Hi, everyone. My name is Mike, and I’m a healthcare worker in New York City. I work at the nation’s first overdose-prevention center and at a psychedelic-medicine clinic. Before this, I worked in both a federally qualified health center and a hospital in New York. I’m also a member of Left Voice, a revolutionary socialist group with a publication that is part of an international network of news sites.
To start out — and this should be no surprise to anyone — but just in case, I’m going to be really blunt and make things real clear: our healthcare system is a piece of shit that doesn’t remotely foster health or well-being.
Once upon a time there was a company called 3M. You might recall that name because everybody loved them when they made a billion face masks during the pandemic. Remember at the beginning everybody was like, “Where are we gonna get enough face masks?! We need roughly a quadrillion and the entire US only has… seven. What are we gonna do?”
So people were wearing all kinds of weird shit on their faces. And then a few companies like 3M said, “We got it. We’re national heroes. We’re like the dudes who landed on the moon.” And I was like, “No you aren’t! You’re fuckin’ making a boatload of cash. You’re not sacrificing your life, running into enemy fire with a knife between your teeth. No, you saw that you could make a trillion dollars by pumping out face masks. Stop acting like you cured polio with a third grade chemistry set.
Nearly 17,000 monkeypox infections have now been reported across 75 countries, and the World Health Organization declared the spread of monkeypox a global emergency. Meanwhile, the U.S. has stopped short of declaring a public health emergency even with nearly 3,000 cases reported in 44 states. New York alone has reported 900 cases of monkeypox, with rollout of the vaccine inhibited by short supply. We speak to Joe Osmundson, professor of microbiology at New York University, about the queerphobic myths about the viral spread, the global inequity of vaccine distribution and more. “This should have been an easy virus to contain,” says Osmundson. “The immense frustration in our community has been watching hundreds of people get sick, not because they’re having sex, not because of their queer identity, but because they’ve wanted to get vaccinated and those vaccines have not been available.” Osmundson also describes how he helped a friend get treatment for monkeypox. His new book is Virology: Essays for the Living, the Dead, and the Small Things in Between.
TRANSCRIPT
This is a rush transcript. Copy may not be in its final form.
AMYGOODMAN:There have now been more than 17,000 cases of monkeypox infections in at least 75 countries, including the United States. Monkeypox isn’t fatal, but it can cause fever, rashes and extremely painful lesions. It’s most often spread through close, intimate physical contact. On Saturday, for the second time in two years, the World Health Organization declared a global emergency to address the spread. The last time, it was forCOVID-19; this time, for monkeypox. This isWHODirector-General Dr. Tedros Adhanom Ghebreyesus.
TEDROSADHANOMGHEBREYESUS:WHO’s assessment is that the risk of monkeypox is moderate globally and in all regions, except in the European region, where we assess the risk is high. There is also a clear risk of further international spread, although the risk of interference with international traffic remains low for the moment. So, in short, we have an outbreak that has spread around the world rapidly, through new modes of transmission, about which we understand too little, and which meets the criteria in the International Health Regulations. For all of these reasons, I have decided that the global monkeypox outbreak represents a public health emergency of international concern. …
Stigma and discrimination can be as dangerous as any virus. In addition to our recommendations to countries, I’m also calling on civil society organizations, including those with experience in working with people living withHIV, to work with us on fighting stigma and discrimination. But with the tools we have right now, we can stop transmission and bring this outbreak under control.
AMYGOODMAN:Here in the United States, the Centers for Disease Control and Prevention has reported more than 2,800 cases of monkeypox so far across 44 states, with the largest outbreaks in New York, California, Illinois, Florida, D.C. and Georgia. The White House has not declared a public health emergency, that could bolster the U.S. response to the monkeypox outbreak. White HouseCOVIDresponse coordinator Dr. Ashish Jha said, quote, “It’s an ongoing, but a very active conversation atHHS.” That’s the Department of Health and Human Services.
For more, we’re joined by Joe Osmundson, professor of microbiology at New York University, scientist, activist, author of the new bookVirology: Essays for the Living, the Dead, and the Small Things in Between. He’s featured in a newpieceinThe New Yorkerheadlined “The Agony of an Early Case of Monkeypox.”
The piece begins, quote, “On the evening before Juneteenth, Joseph Osmundson, one of my best friends and a microbiologist at N.Y.U., texted me: ‘We think Andy has monkeypox.’ Two nights earlier, our friend Andy, as I’ll call him, had spent hours hunched over in an emergency room with excruciating rectal pain, only to be refused testing. It was his third try in five days. Andy’s anal sores were internal; for patients to qualify for testing, C.D.C. guidelines required the appearance of lesions on the skin. Osmundson needed help.”
Well, Professor Joe Osmundson, that’s the opening paragraph of the piece inThe New Yorker. Tell us where you went from there. And in the process, explain what monkeypox is.
JOEOSMUNDSON:Yeah. I’ll actually start with the second part. Monkeypox is not a new virus. And this is sort of why our community has been so frustrated by the lack of urgency to get us the tools we need to care for ourselves and each other and to prevent this virus. It was discovered in 1958 in animals and was shown in 1970 to exist in humans. It’s a virus that’s related to smallpox. You mentioned earlier that it’s not deadly. It’s not very often deadly, but in this outbreak so far this year, there have been five deaths, all of them in the endemic region between Congo and Nigeria. It’s a virus that is similar to smallpox but less dangerous. But it causes pockmarks all over the body, high fever. The lesions can be in the throat or on the mouth, inside the anus and rectum. They are excruciatingly painful. And the course of infection typically lasts two to four weeks. And during this time, patients are asked to fully isolate.
So, again, it’s a pretty miserable virus, although it’s not very often deadly. The frustration has been that because it’s so closely related to smallpox, we actually, prior to this sort of explosion of monkeypox outside of the endemic region — we haveFDA-approved tests, we haveFDA-approved medications that are likely to help ease suffering, and, most importantly, we have vaccinations that can prevent infection. So we have all of the tools, and yet all of these tools have been exceedingly difficult to access, even for someone like Andy, who has a Ph.D., has friends who are working on the response. I mean, it took direct phone calls to contacts in the New York City Department of Health and in the federal government to get him tested. And then, once he was tested and presumed positive, it took another few days to get him access toTPOXX, which is, again, anFDA-approved medication that we thought would help. Once he did getTPOXX, he went, in 24 hours, from being in the most pain of his life to the pain easing. And within five or six days, all of his lesions had healed, and he was cleared to leave isolation.
So, the good news is we have the tools both to prevent infections and to ease suffering. The immense frustration in our community has been watching hundreds of people get sick, not because they’re having sex, not because of their queer identity, but because they’ve wanted to get vaccinated and those vaccines have not been available.
AMYGOODMAN:I mean, we’re here in Chelsea, New York, and this is where people lined up around the block to get vaccines, but there simply weren’t enough.
JOEOSMUNDSON:That’s right. And that, you know, the rollout in New York, has gotten a lot of criticism. And, you know, the New York City Department of Health didn’t reach out to community partners prior to that. They just wanted to get shots into arms prior to Pride weekend. They’ve been listening to us about how that didn’t go well, and they are trying to do better. They are reaching out to more community-based organizations. They’re trying to have more vaccine equity in nonwhite, less affluent communities than the Chelsea community. But, you know, they are incredibly limited. You cannot have equity when vaccine is so scarce. It’s just not possible.
AMYGOODMAN:I wanted to turn to the protest that occurred last Thursday here in New York.ACTUP New York organized an emergency march against monkeypox and government failure in New York City. This is Cecilia Gentili, founder of Transgender Equity Consulting, speaking at the rally.
CECILIAGENTILI:Sex workers are again being forced to the impossible situation of choosing between prioritizing their health or having enough money to survive. Sounds familiar. Yes. The same [beep] happened a couple of months ago withCOVID. What did the government do? Almost nothing. What is the government doing now? Almost nothing. I am so tired of getting almost nothing from the federal government.
AMYGOODMAN:Professor Joe Osmundson, if you can say what needs to happen? I mean, this weekend, you have Congressman Adam Schiff demanding that more be done. You have Ashish Jha on the weekend news shows saying they haven’t decided whether to make the — call this a national emergency in the U.S. And if it were called an emergency, what would that unleash?
JOEOSMUNDSON:Yeah, it would just increase the amount of funding and tools available. There’s a couple of things going on here. One is the scientific response, the biomedical response, that is absolutely lacking. There is no urgency. This should have been an easy virus to contain. UnlikeCOVID, unlike many other emerging threats, we have all of the tools. They are in a stockpile. The point of that stockpile is that it’s meant to be there to respond to an emergency. Here we have an emergency, and the stockpile has not been activated. We found out that vaccine sits in the stockpile in such a way that it can’t actually get into people’s bodies. And vaccine in a freezer is useless. So, we need resources to mobilize the national stockpile that we have to help us, to keep us safe, to treat us when we’re ill.
But we also know — look,COVIDis — you know, a lot of us, by now, have doneCOVIDisolation, 10 days, even five days. It is incredibly difficult. It is costly. Sometimes you miss out on work. Sometimes you have to get a hotel to isolate in. It is really difficult to do. Here we have an isolation with monkeypox that is two to six weeks. That is incredibly disruptive for people’s lives. We’ve been having to crowdfund to get people the money that they need to take time off work. We need emergency funds and hotel rooms so people can properly isolate to prevent the spread. And none of that, none of those funds and resources have been coming from any level of government.
In addition, there are essential scientific questions: Is the virus present in semen? Can we develop new tests that don’t require a skin lesion? Can we test saliva during the early-on flu-like illness? These are obvious questions. And without the proper funding, it will take too long to answer them. The ideal is we get these scientific questions answered as rapidly as possible; instead of skin lesion tests, we have really good saliva tests; if you think you have monkeypox, you can go in, get a saliva test in your flu-like illness, getTPOXXimmediately, and maybe you don’t even get an outbreak of skin lesions, or if you do, you suffer much less, and you’re much less likely to spread the virus. And just, I mean, the vaccine is the most ridiculous thing. There are people who wanted to get vaccine, and now instead of getting vaccine, they have monkeypox.
AMYGOODMAN:Professor Osmundson, this whole controversy over whether to call this a sexually transmitted disease — you can also get it just in close breathing contact, isn’t that right?
JOEOSMUNDSON:That’s right. It’s a very tricky, you know, question. And there are obviously STIs that don’t require sex to transmit them, like herpes. But I’m really worried. We’re already seeing this pushback of, “Oh, if monkeypox is anSTI, why are we seeing it in children?” — sort of, again, doing the groomer thing, implying that queer people are having sex with children. This is incredibly, incredibly dangerous.
This is a virus that commonly spreads throughout households when it’s in households. It is on sheets. It’s on towels. It’s on clothes. And we need to be aware of those nonsexual modes of transmission, so that if it pops up in a wrestling team or a massage parlor or a Broadway show where someone is handling costumes all the time, we actually — that’s on our radar, and we can diagnose it in those places and prevent spread there. I think it’s a little bit myopic to be so focused on sex and the queer community. WeAs Monkeypox Spreads, US Vaccine Access Is Pitifully Inadequate need to be curious and open to the many places this virus may spread.
AMYGOODMAN:Finally, Professor Osmundson, let’s talk about the issue of global equity. There is a severe lack of vaccine here in the United States, but multiply that many times over. Talk about the rest of the world.
JOEOSMUNDSON:This was a choice. This international outbreak was a choice. The United States government let 28 million doses of the modern smallpox vaccine,JYNNEOS, expire and get binned from the national stockpile, as opposed to being used in the endemic regions, from Congo to Nigeria, where people commonly are getting monkeypox. I was on a webinar with the head of the NigerianCDC, who laughed when I asked, “What countermeasures do you have? Do you have vaccine? Do you have treatment?” They have nothing. If in Nigeria, where there’s been an ongoing outbreak of human-to-human spread of monkeypox since 2017, if they had countermeasures there to care for this painful infection there, it’s likely that we may have prevented the international spread of this virus.
Infectious diseases show us that borders are meaningless. Viruses will spread because people interact around the world. It is our obligation to care for human suffering everywhere, not just because it will prevent us from potentially getting sick, but because human suffering is human suffering. So there is absolutely an issue with countermeasures, including vaccine and treatment globally. And capitalism does not set us up well to care for everybody. It is not a way to make a profit. But in our increasingly warming and increasingly interconnected world, we are going to see more of these crises. This is not a viral crisis; this is a crisis of late capitalism. a AMYGOODMAN:Joe Osmundson, I want to thank you for being with us, professor of microbiology at New York University, scientist, activist, author of the new book Virology: Essays for the Living, the Dead, and the Small Things in Between. We’ll also link to thatpieceinThe New Yorkerthat features Professor Osmundson.
When we come back, we speak with California Congressmember Ro Khanna about his efforts to address the ongoing infant formula crisis impacting working-class families and parents of color, to stop the price gouging. Stay with us.
The U.S. pharmaceutical industry exercised its virtually unlimited pricing power to hike costs for patients again this month as Senate Democrats made progress toward a limited deal to regulate out-of-control prescription drug prices, which are forcingmillionsof people to ration their medication or go without it entirely.
A newanalysisreleased Wednesday by Patients for Affordable Drugs estimates that pharmaceutical companies in the U.S. have raised drug prices 1,186 times so far this year, further padding their bottom lines while intensifying the already overwhelming cost burden for patients.
Patients for Affordable Drugsfoundthat between June 24 and July 5, pharmaceutical companies increased prices for 133 products. Pfizer, for instance, hiked the cost of its leukemia medication Besponsa again this month, bringing its per-vial price tag to $21,056.
“This is Pfizer’s fourth hike on the cancer drug during the Covid-19 pandemic — even as the company enjoys record-shattering profits from its vaccine,” the analysis notes.
The patient group also spotlighted Amgen’s price hikes for itsautoimmune disease drug Enbrel. The California-based firm’s price increases for the medication have exceeded even the record-high U.S. inflation rate.
Amgen’s two price hikes for Enbrel this year alone are particularly brazen given that the company has faced recent congressional scrutiny over its business practices.
“Americans are struggling with record inflation and the continued challenges of a pandemic,” David Mitchell, the founder of Patients for Affordable Drugs, said in a statement. “Yet Big Pharma continues to raise drug prices with no regard for the health and financial well-being of Americans.”
Mitchell, a patient with incurable blood cancer whose drugs come with an annual list price of more than $900,000, argued that the pharmaceutical industry’s “latest price hikes demonstrate again why the Senate must stand up for the American people and pass the comprehensive drug pricing reforms in the reconciliation package.”
“These reforms are overwhelmingly supported by Republicans, Democrats, and independents alike, and the votes are there to pass the package immediately,” said Mitchell. “We must put an end to drug corporations’ unfettered ability to dictate prices at the expense of patients.”
Earlier this month, Senate Democratsunveiled190 pages of legislative text containing their plan to require Medicare to negotiate the prices of a small subset of prescription drugs directly with pharmaceutical companies. The proposal also includes other measures to limit costs, such as a $2,000-a-year cap on out-of-pocket prescription drug payments for Medicare Part D enrollees.
But asThe American Prospect’s David Dayennotedearlier this month in a detailed look at the plan — which has predictablydrawn oppositionfrom the pharmaceutical industry — the legislation’s scope is highly restricted.
“In earlier versions of the bill, the negotiated prices would have been accessible to all insurance payers,” Dayen observed. “But in this bill, the prices are only available to Medicare recipients. Part B (for drugs given at hospitals) and Part D (the Medicare prescription drug benefit) drugs that Medicare spends high amounts on are eligible.”
“The drugs eligible for negotiation also have to be at least 7 to 11 years beyond their approval stage, meaning that there’s still an exclusivity buffer where newer drugs can charge whatever they want,” he continued. “Since no drug can get a negotiated price at launch, this is likely to lead to higher launch prices.”
Launch prices are already in the stratosphere: Research published last month showed that nearly half of all new brand-name prescription drugs launched in the U.S. in 2020 and 2021 had an initial price tag of $150,000 or more per year.
Ashley Suder, a patient in Morgantown, West Virginia who takes GSK’s Benlysta to manage her lupus, said that she’s had to spend “her entire paycheck” on her medications. That experience is all-too-common in the U.S., where patients spendfar moreon prescription drugs than their counterparts in other rich countries.
Accounting for the latest price hikes, Benlysta now carries a monthly price tag of $4,282.
“Without this drug, my immune system attacks my healthy tissue, resulting in painful inflammation that damages my skin, joints, blood vessels, and brain,” Suder said. “With the price increasing again, I worry about how I’ll make ends meet while still affording my drugs.”
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This story was co-published with ARD German TV.
In the year since the United States blocked Mexicans from entering the country to sell their blood, the two global pharmaceutical companies that operate the largest number of plasma clinics along the border say they have seen a sharp drop in supply.
In a suit challenging the ban, the companies acknowledged for the first time the extent to which Mexicans visiting the U.S. on short-term visas contribute to the world’s supply of blood plasma. In court filings, the companies revealed that up to 10% of the blood plasma collected in the U.S. — millions of liters a year — came from Mexicans who crossed the border with visas that allow brief visits for business and tourism.
The legal challenge by Spain-based Grifols and CSL of Australia relates to an announcement last June that U.S. Customs and Border Protection doesn’t permit Mexican citizens to cross into the U.S. on temporary visas to sell their blood plasma. The suit was initially dismissed by a federal judge but reinstated by the U.S. Court of Appeals for the D.C. Circuit. The drug companies’ lawyers have said in court filings that the sharp reduction in Mexicans selling blood to the border clinics is contributing to a worldwide shortage of plasma and is “precipitating a worldwide public-health crisis that is costing patients dearly.”
Many countries place strict limits on blood donations — Germany, for example, allows a maximum of 60 donations per year with intensive checkups before every fifth donation. But the Food and Drug Administration doesn’t require comparable donor checkups and allows people visiting American clinics to sell their blood twice a week, or up to 104 times a year.
The limits that other countries set on blood donations have made the U.S. one of the world’s leading exporters of blood. In 2020, U.S. facilities collected 38.2 million liters of plasma for the production of medicine, accounting for approximately 60% of such blood plasma collected worldwide.
Until now, it has been unclear how much of the U.S. blood plasma supply came from Mexican citizens, and pharmaceutical companies had downplayed border clinics’ role in meeting demand for plasma. Grifols noted in 2019 that “more than 93% of the centers [are] at a far distance from the border between the U.S. and Mexico.”
But in its recent court filings, Grifols stressed the importance of the border clinics. A statement from a company executive disclosed that at the company’s Texas centers alone, there were “approximately 30,000 Mexican nationals donating and supplying over 600,000 liters of plasma [a year].” He describes Mexican donors as “loyal and selfless in their commitment to donating plasma.”
According to a filing by Grifols and CSL, the 24 border centers run by Grifols alone account for an “annual economic impact of well over $150 million” and represent approximately 1,000 jobs.
The trade organization for the pharmaceutical companies, the Plasma Protein Therapeutics Association, has similarly reframed its arguments on the issue. In a 2019 statement, the association urged reporters not to attach any significance to “donation centers that happen to fall within areas states define as border zones.” It said then that it had no estimate of how much blood was being bought at the border or whether the amount was disproportionate when compared to the rest of the country.
But a recent court filing by the association said there are 52 plasma centers in the border zone, and “the average center along the border collects higher than average (31% more) plasma than the average center nationwide.”
Some of those donation centers were set up just steps away from the U.S.-Mexico border. Their location, court papers make clear, was part of a strategic effort to bring in Mexican donors: A memorandum written by the companies’ lawyers acknowledged that the centers were located to “facilitate” donations made by Mexican nationals, and that Grifols and CSL “have also spent ‘several million dollars in the last several years’ on advertising to encourage Mexican citizens to donate plasma in exchange for payment at the centers located along the border.” The memorandum did not specify if the ads were published in Mexico, but advertising for paid plasma donations is illegal in Mexico.
The Mexican nationals selling their blood previously entered the U.S. on what are known as B-1 or B-2 visas, documents that allow visitors to shop, do business or visit tourist sites. U.S. Customs and Border Protection had long viewed the practice of selling blood as a “gray area,” with some officials allowing short-term visitors to go to the centers while others did not. In 2021, about a year and a half after we published our 2019 story, the Border Patrol issued internal guidance that barred short-term visa holders from selling blood.
CSL and Grifols challenged that action, asserting that for 30 years, CBP had “largely allowed B-1/B-2 visa holders from Mexico to enter this country for the purpose of donating their plasma at collection centers that provide a payment to donors.” The CPB disagreed. Matthew Davies, a supervisory border security officer, told the court that selling plasma for compensation had never been a permissible activity.
On June 14, 2021, CBP sent out “clarifying guidance” that selling plasma on a visitor visa was not allowed. The announcement created chaos at the border centers. Two days later, Grifols wrote — and later deleted — a post on its Spanish-language Facebook page that said, “We are replying to the hundreds of messages asking when people with a visa can come back to donate. For the moment, the response is, you can’t.” An angry reply stated “Now, we’re no longer heroes who are saving lives. They just used us.”
Since then, donations at border centers have dropped dramatically. The pharmaceutical companies told the court that a survey of 12 centers in Texas found a 20% to 90% decline. “One particularly large center, which normally collects 5000+ donations per week, has decreased to a level closer to 200,” said the plasma association president, Amy Efantis.
Some previous donors interviewed by ProPublica said they would welcome a court ruling that set clear rules for people crossing the border to sell their blood. Genesis, a 23-year-old student from Ciudad Juárez, said she had worried about losing her visa when she entered the United States for her regular visits to the border clinics.
A current manager of a plasma collection center at the border, who asked not to be named because of the ongoing court case, said that he had to lay off about two-thirds of his employees and cut the center’s hours. “It would be good if they allowed [Mexicans] to donate again,” he said. “People are depending on this, on both sides.”
Gov. Gavin Newsom announced on Thursday that California is going to begin making its own insulin, in an effort to expand access and ensure that the people who need the drug can still afford it.
“California is going to make its own insulin. Nothing, nothing epitomizes market failures more than the cost of insulin,” Newsom said in his announcement, adding that some patients have to spend $300 to $500 per vial, which typically only last a patient about 30 days.
The state will allocate $100 million to produce the drug “at a cheaper price, close to at cost, and to make it available to all,” he said. Half of the money will go toward opening and staffing a manufacturing facility in the state and the other will cover costs of developing the product. Newsom has also been working on plans to potentially lower prices of other prescription drugs in the state.
“In California, we know people should not go into debt to receive life-saving medication,” Newsom said. The governor’s office says that the plan will cut the cost of insulin in half, if not more.
People in the U.S. pay more for insulin than people in any other wealthy country — often paying between 5 to 10 times more than what people in other countries do, research has found. With such high costs for common types of insulin, some people with diabetes have been organizing caravans to travel to Canada in order to obtain the medication for a fraction of the cost.
A recent survey by CharityRx found that a whopping four out of five patients have taken on credit card debt in order to afford insulin, taking on an average of $9,000 per patient. Additionally, 83 percent of respondents said they’ve feared not being able to pay for basic necessities like clothes, food and rent due to the cost of their insulin.
The high costs of insulin have had dangerous consequences. Yale University researchers found that one in four diabetes patients who visited the Yale Diabetes Center in 2017 said that they were skipping or skimping on doses of insulin because of the cost of the drug — which led to poorer health outcomes for those patients. Further, about a third of these patients didn’t discuss their underuse of the drug, which could have caused additional health problems.
CharityRx’s findings were even more drastic. The survey found that 38 percent of respondents said that they have had to stay at the hospital for more than a day due to problems caused by insulin rationing, while 33 percent said that rationing has caused them to get sick with other health issues.
Likely partially a result of high insulin prices, diabetes is a leading cause of death in the U.S. In both 2020 and 2021, over 100,000 Americans died due to diabetes, and the illness was the seventh highest cause of death in 2019. Meanwhile, the average price of insulin increased 11 percent every year between 2001 and 2011, research has found, making the condition the most costly chronic condition in the U.S., according to American Action Forum; in the U.S., one in four dollars spent on health care is spent on people with diabetes.
Democrats in Congress have been pushing to lower the cost of insulin. In March, the House passed a bill that would place a cap on prices of insulin to $35 a month or 25 percent of insurance plans’ prices, whichever is lower.
Over the past year, Democrats have also been working on plans to lower drug prices in general. Senate Majority Leader Chuck Schumer (D-New York) released a plan this week that would allow Medicare to negotiate drug prices for the most expensive drugs, though the plan excludes the insulin price cap, unlike the drug price negotiation plan introduced by House Democrats last year.
Quickly delivering donated organs to patients waiting for a transplant is a matter of life and death. Yet transportation errors are leading to delays in surgeries, putting patients in danger and making some organs unusable. This week, we look at weaknesses in the nation’s system for transporting organs and solutions for making it work better.
More than any other organ, donated kidneys are put on commercial flights so they can get to waiting patients. In collaboration with Kaiser Health News, we look at the system for transporting kidneys and how a lack of tracking and accountability can result in waylaid or misplaced kidneys.
We then look at the broader issues affecting organ procurement in the U.S. with Jennifer Erickson, who worked at the White House Office of Science and Technology Policy under the Obama administration. She says one of the system’s weaknesses is that not enough organs are recovered from deceased people – not nearly as many as there could be.
We end with an audio postcard about honor walks, a new ritual that hospitals are adopting to honor the gift of life that dying people are giving to patients who will receive their organs. We follow the story of one young man who was killed in a car accident.
This episode originally was broadcast Feb. 8, 2020.
Since the end of Roe v. Wade, numerous European political leaders have lamented the decision. British Prime Minister Boris Johnson labeled the Dobbs decision a “big step backwards,” and French President Emmanuel Macron said abortion “must be protected,” as his country prepared to place a nationwide right to abortion in its constitution.
In response, conservatives have cried hypocrisy, both to deflect criticism and to cast doubt on European institutions in general. “Many of the leaders who criticized the United States for the decision have laws that are either comparable to the Mississippi law at the center of Dobbs v. Jackson Women’s Health, which outlawed abortion past the 15th week of pregnancy,” Charles Hilu writes at National Review. “Americans should be very skeptical of the opinions of leaders across the pond.”
But this is not true on multiple levels. Though there are some moderate restrictions on abortion access in most European countries (and strict ones in a few), in practice almost all of Europe had far greater access to all aspects of reproductive freedom than Americans did even before Roe was overturned, and vastly greater freedom now.
Following last week’s Supreme Court ruling that struck down federal protections for abortion rights, major companies, including a number of Silicon Valley giants, publicly broadcast their intention to assist their workers in traveling out of state to obtain an abortion. Meta, Apple, Disney, Dick’s Sporting Goods and Condé Nast were among them, the New York Times noted, joining companies that had made similar pledges in May, when a leaked memo revealed that the Court would overturn Roe v. Wade. These companies include Reddit, Tesla, Microsoft, Starbucks, Yelp, Airbnb, Netflix, Patagonia, DoorDash, JPMorgan Chase, Levi Strauss & Co. and PayPal, the Times reports.
Prime Minister Jacinda Ardern called the US Supreme Court’s decision to overturn Roe v Wade “incredibly upsetting” as New Zealand politicians reacted to the controversial ruling.
Millions of American women have lost the constitutional right to abortion, after the 50-year-old Roe v Wade decision protecting the right to an abortion was overturned yesterday.
Ardern said in a statement that the decision was a loss for women everywhere.
“Watching the removal of a woman’s fundamental right to make decisions over their own body is incredibly upsetting,” she said.
“Here in New Zealand we recently legislated to decriminalise abortion and treat it as a health rather than criminal issue.
“That change was grounded in the fundamental belief that it’s a woman’s right to choose. People are absolutely entitled to have deeply held convictions on this issue. But those personal beliefs should never rob another from making their own decisions.
“To see that principle now lost in the United States feels like a loss for women everywhere.
‘We need progress … not move backwards’
“When there are so many issues to tackle, so many challenges that face woman and girls, we need progress, not to fight the same fights and move backwards.”
In a statement last night, he reaffirmed that, saying that abortion laws “laws will not be relitigated or revisited under a future National government”.
Roe v Wade is an issue for the American people who have a different set of constitutional arrangements than us. NZ’s abortion laws were voted on and ultimately settled in the last parliament. These laws will not be relitigated or revisited under a future National government.
Green Party MP Chlöe Swarbrick blasted the decision, expressing “solidarity with Americans fighting for restoration of their rights to healthcare.”
Prohibiting abortions doesn’t stop abortions. It prevents safe, regulated abortions. It prevents access for those without the resources to travel to areas where abortion is legal.
Solidarity with Americans fighting for restoration of their rights to healthcare.
ACT leader David Seymour said that “It may be that this is just returning the question to a state one, but half the states are going back a century in just a few days.”
What’s happening, Twitter? Great question. It may be that this is just returning the question to a State one, but half the States are going back a century in just a few days. pic.twitter.com/BFM0U0wFNB
Seymour, who supported New Zealand’s Abortion Legislation Bill to decriminalise abortion, said he was deeply concerned for the rights of American women and the future of US politics.
“I think that this will bring about a political earthquake in America. And this is a time when New Zealand really needs America to be focused on trade and security, rather than re-litigating battles of the 1950s.”
‘We cannot be complacent’
Green Party MP Jan Logie did not expect the decision would encourage people to push for changes to the abortion laws in New Zealand.
“We’ve seen a result of that an increasing number of New Zealanders who recognise the importance of reproductive justice. But this tells us also that we cannot be complacent.”
Logie said she feared the decision would increase the rate of unsafe abortions in the US.
Family Life International’s Michelle Kaufman said she wanted New Zealand’s abortion laws to change.
“I hope one day that we will see an end to abortion, that people will see that it’s the unthinkable choice, that there are better ways.”
Kaufman said abortion was violence and that it did not solve problems.
This article is republished under a community partnership agreement with RNZ.
As early as 1976, three years after Roe, Congress passed the Hyde Amendment prohibiting the use of federal funds like Medicaid for abortions, except to save “the life of the mother.” States have since enacted many other restrictive laws, such as mandating onerous insurance for clinics, requiring parental consent for an abortion, mandatory “counseling,” forced ultrasounds and waiting periods. Tax-exempt religious institutions like Catholic hospitals have prohibited their medical providers from performing abortions.
Right-wing extremists and religious fundamentalists have waged a violent war against abortion providers and abortion seekers, including the bombing of clinics and the murder of doctors, clinic staff and patient escorts.
Large crowds of people took to the streets of cities and towns across the United States Friday evening to protest the Supreme Court’s reversal of Roe v. Wade and to vow to fight for reproductive rights.
In San Francisco, hundreds of youth-led protesters shouting slogans including “We won’t go back!” and “Keep your rosaries off my ovaries” rallied in Civic Center Plaza, while hundreds marched and staged a sit-in on Market Street.
Medics for the People (Médecine Pour Le Peuple, MPLP) marked 50 years of providing health care to people in Belgium in 2021. The network of health houses currently employs more than 200 health workers in 11 health centers across Belgium, providing care to approximately 25,000 patients. This May, they launched a new mission statement in which they outlined their vision of how the healthcare system in Belgium can be changed in order to better serve the needs of the people. People’s Health Dispatch spoke to Janneke Ronse, President of MPLP, to learn more about the role the mission statement will play in the organization’s work and what effects it will have on the people who access healthcare services through MPLP’s health houses.
Having tanked his party’s effort to expand Medicare and close the Medicaid coverage gap, Sen. Joe Manchin is now dangling his support for an extension of Affordable Care Act subsidies as massive premium hikes loom for millions of people who buy insurance on the exchanges.
Insider reported Wednesday that Manchin has “signaled he’s open to extending enhanced subsidies under the Affordable Care Act, a move that would help Democrats avert a huge political threat in the November midterms.”
The American Rescue Plan — a Covid-19 relief package that President Joe Biden signed into law last year — included provisions that boosted ACA subsidies for low-income people and ended the income cap on subsidies. The changes were aimed at ensuring no one is forced to pay more than 8.5% of their total income to purchase health coverage in the ACA marketplace, which can be prohibitively expensive without federal subsidies.
But the provisions are set to expire at the end of the year in the absence of congressional action, sticking the roughly 14 million people who buy insurance on the ACA exchanges with dramatically higher premiums. Notifications of premium increases would begin going out in October, just ahead of the crucial midterm elections.
Even though eligibility for ACA subsidies — which progressives often characterize as gifts to the insurance industry — is already restricted on the basis of income, Manchin told Insider that he wants even more means testing, which he called “the main thing.”
“We should be helping the people who really need it the most and are really having the hardest time,” said Manchin, who supported the ACA subsidy boost in the American Rescue Plan. “With healthcare, people need help. They really do.”
That’s certainly true of people in his home state of West Virginia. After visiting a free medical clinic located just miles from Manchin’s riverfront home in Charleston, The Lever’s Andrew Perez reported earlier this week that one resident, Charles Combs, “has resorted to extracting his own teeth because dental care is too expensive.”
Traditional Medicare currently doesn’t cover dental services. Late last year, Manchin blocked an effort — spearheaded by Sen. Bernie Sanders (I-Vt.) — to expand the program to cover dental, vision, and hearing.
“The Charleston clinic made clear just how badly people need such care — and not just seniors, and not just West Virginians. Combs, for instance, is still in his 50s, while the clinic saw patients of all ages driving hours from Ohio, Kentucky, and Virginia,” Perez noted. “The [Remote Area Medical] clinic hinted at the kind of universal healthcare system America could have, if not for senators like Manchin and their healthcare industry donors.”
“The organization doesn’t ask patients about what its team calls the ‘three I’s’: identification, income, or insurance,” Perez continued. “Patients are treated with kindness, compassion, and professionalism — and fairly quickly. All services are free.”
In an interview with Punchbowl News this week, Manchin voiced concerns about the price tag of extending the ACA subsidies — scrutiny he has not applied to the trillions of dollars in Pentagon spending he’s voted for over the past decade.
“The bottom line is there’s only so many dollars to go around,” Manchin said.
According to a recent analysis by Families USA, the roughly 23,000 West Virginians who buy health insurance coverage on the ACA exchanges will see their annual premiums rise by an average of $1,536 — 63% — if Congress lets the subsidy provisions expire.
“With little debate or media focus, Democrats are on the verge of dooming millions of Americans to huge new healthcare bills, which will in turn serve to ruin any hope Democrats have of winning the midterms,” journalist Jon Walker warned in The American Prospect earlier this year. “Beyond broadly hurting 14 million people, the end of these subsidies will create thousands of uniquely horrific stories of financial devastation.”
The COVID-19 pandemic and the corresponding failure at every level of government to prevent its spread dealt a devastating blow to healthcare workers. Nurses, doctors, and other medical workers faced increasingly dangerous conditions, along with employers more concerned with increasing profits than saving the lives of their patients or employees. At St. Vincent Hospital in Worcester, Massachusetts, nurses fought back against their corporate employer by organizing a strike of over 700 workers that lasted for 10 months. Filmed by TRNN contributor Gino Canella, these interviews with St. Vincent nurses comprise an oral history of a ferocious labor battle that became the longest nurses’ strike in Massachusetts state history.
As reproductive rights groups brace for an anticipated US supreme court decision to overturn Roe v Wade and strike down federal abortion rights in America, workers at these groups are organizing to unionize ahead of the expected legal changes.
About 400 workers at 28 clinics in five states in the midwest – Minnesota, Iowa, Nebraska, North Dakota and South Dakota, announced in late May 2022 their intent to unionize with SEIU Healthcare Minnesota and Iowa. They have filed for a union election with the National Labor Relations Board after a majority of workers signed authorization cards and their request for voluntary recognition was turned down by management.
In the early days of 2021, when it became clear no member of Congress would champion the cause of Medicare for All, a group of long-time health care activists, unionists, grassroots organizers, and progressives met to discuss the need for a national organization to unite activists across the country and rally the movement for national single payer health care free from corporate profits. The activists were frustrated. After all, the Democrats held power in the House, in the Senate, and in the Executive Branch, and yet, there was no enthusiasm for improved and expanded Medicare for All.
We speak with Bishop William Barber and Reverend Liz Theoharis, co-chairs of the Poor People’s Campaign, about plans for Saturday’s Moral March on Washington and to the Polls to demand the government address key issues facing poor and low-income communities. The march will bring together thousands of people from diverse backgrounds to speak out against the country’s rising poverty rates, voter suppression in low-income communities and more. “To have this level of poverty that’s untalked about too often … is actually morally indefensible, constitutionally inconsistent, politically insensitive and economically insane,” says Barber. Theoharis says the lack of universal healthcare in the U.S. is a major source of economic insecurity and has contributed to the COVID-19 death toll. She asks how a rich country “that spends more money on healthcare than any other nation with a comparable economy still has [these] kind of poor health outcomes.”
TRANSCRIPT
This is a rush transcript. Copy may not be in its final form.
AMYGOODMAN:Democracy Now!, democracynow.org, The War and Peace Report. I’m Amy Goodman.
As the United States experiences its worst inflation in decades with skyrocketing food, gas and energy prices, we end today’s show in Washington, D.C., where the Poor People’s Campaign has organized a massive Moral March on Washington Saturday. The demonstration is being led by low-income people and workers demanding access to stable housing, healthcare, living wages, gun control, and reproductive and voting rights.
For more, we’re joined in Washington, D.C., by Bishop Dr. William Barber II, co-chair of the Poor People’s Campaign, president of Repairers of the Breach. We also hope to speak with Dr. Liz Theoharis, co-chair of the Poor People’s Campaign.
Bishop Barber, welcome back to Democracy Now! If you can talk about what you’re doing in Washington? As inside the Capitol there is this epic historic hearing around the previous president’s attempted coup, the man who would not let go of power but was forced to in the end, I’m wondering if you could contrast what we’re seeing exposed there with what you’re doing this weekend.
BISHOPWILLIAMBARBER II: Well, thank you, Amy.
We are not the insurrection. We are the resurrection, and a resurrection of thousands, of every race and creed and color and kind and geography, who are coming nonviolently to Washington, D.C., from all across this great land, to say that the 140 million poor and low-wealth people in this country, 43% of this nation, 52% of the children, 68% — 60% of Black people, 33% of — 30% of white people, 68% of Latinos, and so forth and so on, 87 million people who are uninsured or underinsured, 32 million people that get up every morning and work jobs that do not pay a living wage, less than $15 an hour — we won’t be silent or unseen anymore.
The time has come for us to have a Third Reconstruction. We had one in the 1800s, one in the 1960s. We need one now, that’s about policy, reconstructing a moral framework, political framework in this country, because to have this level of poverty, that’s un-talked-about too often and unseen and unheard, is actually morally indefensible, constitutionally inconsistent, politically insensitive and economically insane. So people are coming. But poor people are coming to say not only do we need a moral reset — and low-wage workers are saying it — we represent 32% of the electorate now, poor people do, and 45% of the electorate in battleground states. And it’s time for that power to be organized, mobilized and felt in every election throughout this country.
Now, when we look at what you see in these hearings, we have to ask the question, I think: Why were Trumpism or Trump and his team fighting to hold onto power? Why wouldn’t McConnell and them impeach him when they had a chance? I believe, Amy, and we believe, this isn’t just about personality, but policy. We’re witnessing a crisis of democracy, because some of the people who didn’t go along with Trump in this and didn’t go along with Eastman’s scheme still took the time to see if it was right, if there was a way they could do it. They still voted 99% of the time for Trump’s policies of extremism. And they still believe in a political policy coup d’état to suppress the vote, to rob the government of its resources by giving tax cuts to the wealthiest and to the greediest and the corporate interests, that disempowers the government from doing the things it needs to do for the least and the left-out and the workers and women. They are still the group that wants to take — to have a political coup d’état and take women’s rights to their own body. They’re still the group that wants to block living wages, block healthcare, block addressing climate change, block police violence. And all of these policies produce a policy murder. And we found out just this week that the denial of universal healthcare during COVID, for instance, has cost 330,000 lives. We found out, because of Trump and his allies’ policies in the beginning of COVID, poor people died at a rate of two to five times higher than anyone else in this country.
So, we are the contrast. What you saw January 6th was the insurrection. What you see on Saturday is a resurrection. It’s a resurrection of people coming together, the Mass Poor People’s, Low-Wage Workers’ Assembly and Moral March to the Polls. And we are calling on people to still join us at Third and Pennsylvania at 9:30 a.m. on Saturday morning.
AMYGOODMAN: Liz Theoharis is also with us, the Reverend Dr. Liz Theoharis, who is co-chair of the Poor People’s Campaign and president — also executive director of the Kairos Center at Union Theological Seminary.
Liz, welcome back to Democracy Now! If you could talk about the significance of this march, and this coming at a time where a Yale study just came out saying that something like 338,000 people who died of COVID-19 during the pandemic in the United States — a third of the people — died unnecessarily, could have been saved if the U.S. had Medicare for All? Can you talk about how healthcare is a basic right, as one of the tenets of what people are calling for in Washington?
REV. LIZTHEOHARIS: Well, thanks so much, Amy, and it is great to be back.
And as Bishop Barber said, and as you just referenced, this study came out this week that says that, yeah, a third of the people who did not have healthcare would not have died from this pandemic. What we in the Poor People’s Campaign have been putting out, and we did a study with Jeffrey Sachs and with folks over at Columbia University that showed that between two and five times the number of poor people from poor communities died from the pandemic than richer communities and richer people. And again, this is because of these underlying issues of health inequality, of poverty, of low wages.
And so, indeed, when we gather on Pennsylvania Avenue on Saturday and we hear the voices, the stories, but also the solutions coming out of poor and low-income people’s experience and lives, we will surely hear about the need for healthcare. As Bishop Barber has said, we need healthcare to be connected to people’s bodies, not to their jobs. And how is it, in this rich nation, that spends more money on healthcare than any other nation with a comparable economy, still has the kind of poor health outcomes, still has 87 million people who before the pandemic were uninsured or underinsured, and even some more who have — you know, tens of thousands who have lost their healthcare coverage in the worst public health crisis in generations?
And again, this just does not have to be. It actually — you know, we could spend less on healthcare and lead healthier lives, and everyone could have universal coverage. We need to expand Medicaid, but we also need to implement a single-payer universal healthcare system. And again, this will lift society from the bottom.
And so, this and then the cry and demand for living-wage jobs, for adequate housing, for immigration reform, for protecting this democracy, they’re all connected. And we see the interconnections, the intersections of the denial of healthcare, the destruction of our environment, the militarization of our communities, and the problems of poverty and low wages that are infecting almost half of the population, and, therefore, bringing this impoverished democracy to a real crisis.
AMYGOODMAN: Liz Theoharis, you’ve also said that declaring war is a declaration of war on the poor. Explain.
REV. LIZTHEOHARIS: So, you know, that actually comes from Dr. King and from many that have come before. But Dr. King, you know, when he comes out against the Vietnam War all those years ago, says that war, in all its form, is a war on the poor, and it’s cruel manipulation of the poor.
And we’re seeing this today. I mean, we don’t have a draft in this country, but we have a poverty draft. And 22 veterans commit suicide every day in this country because of the moral costs of war. And if we look at our military budget, 53 cents of every discretionary dollar goes to the military. We can’t even spend 15 cents on healthcare and living-wage jobs and investments in our children and in anti-poverty programs combined. You know, this disproportionately impacts poor people. And that’s poor people in the United States, and that’s poor people across the world. As Dr. King said, you know, you have poor people come together from this rich nation to go and kill poor people across the world. And we’re seeing this, you know, across the world in this moment, as well.
AMYGOODMAN: Bishop Barber, this is Pride Month, and there have been serious attacks or attempted attacks, from Coeur d’Alene to the Bay Area. You had Patriot Front in Coeur d’Alene, a small army stopped by police before they attacked a Pride march. Can you talk about the far right and the white supremacists using Christianity to justify what they’re doing?
BISHOPWILLIAMBARBER II: Well, I don’t call them “right.” I never use the term “far right” and “far left.” I think those terms are problematic. And one of the things the Poor People’s Campaign is saying is we need to have a moral conversation about right versus wrong, constitutional versus unconstitutional. And that’s part of our problem.
The reality is that that’s heresy. Any time you use religion to justify violence against gay people, against women, against the poor, against any segment of a community, when you use it to suppress the vote, when you use religion to try to block living wages and healthcare, it is exactly wrong. One of the reasons it’s wrong from a moral and a religious standpoint is because those become the policies of death. You know, every piece of regressive policy costs lives. When you deny healthcare, it costs lives. When you attack LGBT communities, you cost lives. When you allow guns to flourish in the society, people to walk around with AK-47s, you cost lives. When you block living wages and people moving up out of poverty — we knew that, even before COVID hit, poor people were dying at a rate of 700 people a day, nearly 30 people an hour per day, 250,000 a year, from the effects of poverty. That is contrary to the biblical call to life. It is contrary to the call of the ancient prophets that says, “Woe unto those who legislate evil and rob the poor of their rights and make women and children their prey” — P-R-E-Y. It’s contrary to the call of Jesus, that we’re supposed to be about life and good news to the poor. And it’s contrary to the Declaration of Independence, that we are supposed to be about life, liberty and the pursuit of happiness, and contrary to the Constitution promise to establish justice and equal protection under the law.
We are a movement of life, though. What we are saying is — and on Saturday, we are having Black people, white people, Brown people, Asian people, Native people, gay people, straight people, Republicans, Democrats, veterans, nonveterans. These are the voices you will hear, poor and impacted people, on the stage. It’s not a march and a rally and an assembly, really, for [inaudible] —
AMYGOODMAN: We have 10 seconds.
BISHOPWILLIAMBARBER II: — for people to come and talk for people. People will talk for themselves. We are the resurrection and not the insurrection.
AMYGOODMAN: Well, we want to thank you both so much for being with us, Bishop Dr. William Barber and Dr. Liz Theoharis, co-chairs of the Poor People’s Campaign, holding the Mass Poor People’s Assembly and Moral March on Washington on Saturday.
Oh, and, Liz, I also want to congratulate your sister Jeanne Theoharis. The film The Rebellious Life of Mrs. Rosa Parks, based on Jeanne’s best-selling book by the same title, just premiered last night at the Tribeca Film Festival, directed by our former Democracy Now! producer Yoruba Richen, as well as Johanna Hamilton. It is fantastic, not to be missed by anyone. It was at the Tribeca Film Festival.
And that does it for our show. Democracy Now! is produced with Renée Feltz, Mike Burke, Deena Guzder, Messiah Rhodes, Nermeen Shaikh, María Taracena, Tami Woronoff, Camille Baker, Charina Nadura, Sam Alcoff, Tey-Marie Astudillo, John Hamilton, Robby Karran, Hany Massoud, Mary Conlon.
On Monday, a Juneteenth special — don’t miss it — on Democracy Now! I’m Amy Goodman. Stay safe.
A universal health care system could have saved more than 338,000 lives in the United States by preventing roughly one in three deaths resulting from the COVID-19 infections through March 2022, according to a new study. A single-payer health care system would also have saved the nation an estimated $105.6 billion in health care costs associated with COVID treatments and hospitalizations, leading the study’s authors to conclude that universal health care, often called “Medicare for All,” is both a moral and financial imperative for policymakers.
Published this week in the Proceedings of the National Academy of Sciences USA, the study and a companion analysis are a stunning indictment of what their authors describe as a “fragmented and inefficient” health care system that leaves millions of people uninsured and underinsured every year. Americans spend more money on health care than people living in any other nation, but the U.S. has sustained 16 percent of COVID’s global “mortality burden” while only representing 4 percent of the world’s population.
James Kahn, a professor of health policy at the University of California, San Francisco, and a co-author of the study, said the modeling and analysis present a precise estimate of the massive human and financial costs “imposed on the U.S. population by the lack of universal insurance” during the pandemic. Even in non-pandemic years, a single-payer health system would save tens of thousands of people from preventable death annually.
“Placing the profits of private insurers over the lives of hundreds of thousands of Americans is obscene,” Kahn said in a statement this week.
By comparing the risk of death from COVID and other conditions for the insured and uninsured populations, the researchers concluded that Medicare for All could have saved 131,438 people from dying of COVID over the course of 2020 alone, when the virus swept across the country and overwhelmed local hospitals and public health systems.
Before COVID, about 28 million people in the U.S. did not have health insurance, and another 9 million lost insurance coverage after losing their jobs during the pandemic. Millions more are underinsured and face high out-of-pocket costs for prescriptions and medical care. A recent investigation by media outlets found that 100 million people in the U.S. — about 41 percent of adults — are in debt due to unpaid medical bills.
People who are uninsured are more likely to develop preventable conditions such as type 2 diabetes because they typically do not have a primary doctor who can catch potential health problems early on. Such comorbidities can complicate a COVID infection and increase the risk of death, as does any delay in seeking medical care.
Uninsured (and underinsured) people are more likely to wait longer to seek treatment or attempt to avoid racking up medical bills altogether, and during a viral pandemic, that means they are also more likely to become seriously ill and transmit COVID-19 to others, according to the study. Lower-income and frontline workers may also show up to work sick if they worry about losing income or their employer’s health coverage, one reason why advocates say the government must guarantee paid sick leave for all workers along with health care.
Opponents of Medicare for All argue a single-payer system would be expensive, but once again researchers have concluded that privatized insurance and health care services are less efficient and require far more spending. After factoring in the cost of insuring everyone in the U.S., the study concludes that universal health care would produce a net savings of $438 billion in a typical, non-pandemic year. In 2020, the first year of the pandemic, $459 billion in costs would have been saved along with so many lives.
In a comment published at Health Justice Monitor, Kahn said the study’s modeling determined that the current health care system wasted half a trillion dollars in 2020 thanks to “ongoing inefficiency.”
“Health care access leads to earlier diagnosis, with better treatment and reduced transmission, as well as stronger prevention such as higher vaccination rates,” Kahn wrote. “Promises of special insurance coverage for COVID fall short when individuals don’t know about it, and when implementation is seriously flawed. Fewer cases also mean lower hospital burdens that may compromise quality of care.”
Medicare for All would also reduce administrative costs by eliminating the maze of bureaucracy created by private insurance companies, which also deflect health care spending toward advertising and legal expenses. As the primary and universal provider of health coverage, the government would also have great negotiating power over the price of pharmaceuticals, medical equipment and related fees, which would promote market efficiency and bring costs down across the board.
Ann Keller, an associate professor of health policy and management at the University of California, Berkeley, notes that disturbing levels of preventable death during the pandemic may actually underestimate the costs of the current system’s failures. While the study looks at preventable comorbidities and other risks, it does not consider lower rates of chronic illness associated with single-payer systems in other countries.
“Having consistent access to care can prevent chronic disease from occurring and can ensure that patients who develop chronic disease have it better managed,” said Keller, who was not involved in the research, in an interview with Scientific American. “I would think that, if one took that into account, the estimates of avoided deaths would be greater than the numbers reported here.”
Elizabeth Woodruff drained her retirement account and took on three jobs after she and her husband were sued for nearly $10,000 by the New York hospital where his infected leg was amputated.
Ariane Buck, a young father in Arizona who sells health insurance, couldn’t make an appointment with his doctor for a dangerous intestinal infection because the office said he had outstanding bills.
Allyson Ward and her husband loaded up credit cards, borrowed from relatives, and delayed repaying student loans after the premature birth of their twins left them with $80,000 in debt. Ward, a nurse practitioner, took on extra nursing shifts, working days and nights.
“I wanted to be a mom,” she said. “But we had to have the money.”
The three are among more than 100 million people in America ― including 41% of adults ― beset by a health care system that is systematically pushing patients into debt on a mass scale, an investigation by KHN and NPR shows.
The investigation reveals a problem that, despite new attention from the White House and Congress, is far more pervasive than previously reported. That is because much of the debt that patients accrue is hidden as credit card balances, loans from family, or payment plans to hospitals and other medical providers.
To calculate the true extent and burden of this debt, the KHN-NPR investigation draws on a nationwide poll conducted by KFF (Kaiser Family Foundation) for this project. The poll was designed to capture not just bills patients couldn’t afford, but other borrowing used to pay for health care as well. New analyses of credit bureau, hospital billing, and credit card data by the Urban Institute and other research partners also inform the project. And KHN and NPR reporters conducted hundreds of interviews with patients, physicians, health industry leaders, consumer advocates, and researchers.
The picture is bleak.
In the past five years, more than half of U.S. adults report they’ve gone into debt because of medical or dental bills, the KFF poll found.
A quarter of adults with health care debt owe more than $5,000. And about 1 in 5 with any amount of debt said they don’t expect to ever pay it off.
“Debt is no longer just a bug in our system. It is one of the main products,” said Dr. Rishi Manchanda, who has worked with low-income patients in California for more than a decade and served on the board of the nonprofit RIP Medical Debt. “We have a health care system almost perfectly designed to create debt.”
The burden is forcing families to cut spending on food and other essentials. Millions are being driven from their homes or into bankruptcy, the poll found.
KFF Health Care Debt Survey of 2,375 U.S. adults, including 1,674 with current or past debt from medical or dental bills, conducted Feb. 25 through March 20. The margin of sampling error for the overall sample is 3 percentage points.Daniel Wood / NPR and Noam N. Levey / KHN
Medical debt is piling additional hardships on people with cancer and other chronic illnesses. Debt levels in U.S. counties with the highest rates of disease can be three or four times what they are in the healthiest counties, according to an Urban Institute analysis.
The debt is also deepening racial disparities.
And it is preventing Americans from saving for retirement, investing in their children’s educations, or laying the traditional building blocks for a secure future, such as borrowing for college or buying a home. Debt from health care is nearly twice as common for adults under 30 as for those 65 and older, the KFF poll found.
Perhaps most perversely, medical debt is blocking patients from care.
About 1 in 7 people with debt said they’ve been denied access to a hospital, doctor, or other provider because of unpaid bills, according to the poll. An even greater share ― about two-thirds ― have put off care they or a family member need because of cost.
“It’s barbaric,” said Dr. Miriam Atkins, a Georgia oncologist who, like many physicians, said she’s had patients give up treatment for fear of debt.
Patient debt is piling up despite the landmark 2010 Affordable Care Act.
The law expanded insurance coverage to tens of millions of Americans. Yet it also ushered in years of robust profits for the medical industry, which has steadily raised prices over the past decade.
Hospitals recorded their most profitable year on record in 2019, notching an aggregate profit margin of 7.6%, according to the federal Medicare Payment Advisory Committee. Many hospitals thrived even through the pandemic.
But for many Americans, the law failed to live up to its promise of more affordable care. Instead, they’ve faced thousands of dollars in bills as health insurers shifted costs onto patients through higher deductibles.
Now, a highly lucrative industry is capitalizing on patients’ inability to pay. Hospitals and other medical providers are pushing millions into credit cards and other loans. These stick patients with high interest rates while generating profits for the lenders that top 29%, according to research firm IBISWorld.
Patient debt is also sustaining a shadowy collections business fed by hospitals ― including public university systems and nonprofits granted tax breaks to serve their communities ― that sell debt in private deals to collections companies that, in turn, pursue patients.
“People are getting harassed at all hours of the day. Many come to us with no idea where the debt came from,” said Eric Zell, a supervising attorney at the Legal Aid Society of Cleveland. “It seems to be an epidemic.”
In Debt to Hospitals, Credit Cards, and Relatives
America’s debt crisis is driven by a simple reality: Half of U.S. adults don’t have the cash to cover an unexpected $500 health care bill, according to the KFF poll.
As a result, many simply don’t pay. The flood of unpaid bills has made medical debt the most common form of debt on consumer credit records.
As of last year, 58% of debts recorded in collections were for a medical bill, according to the Consumer Financial Protection Bureau. That’s nearly four times as many debts attributable to telecom bills, the next most common form of debt on credit records.
But the medical debt on credit reports represents only a fraction of the money that Americans owe for health care, the KHN-NPR investigation shows.
About 50 million adults ― roughly 1 in 5 ― are paying off bills for their own care or a family member’s through an installment plan with a hospital or other provider, the KFF poll found. Such debt arrangements don’t appear on credit reports unless a patient stops paying.
One in 10 owe money to a friend or family member who covered their medical or dental bills, another form of borrowing not customarily measured.
Still more debt ends up on credit cards, as patients charge their bills and run up balances, piling high interest rates on top of what they owe for care. About 1 in 6 adults are paying off a medical or dental bill they put on a card.
How much medical debt Americans have in total is hard to know because so much isn’t recorded. But an earlier KFF analysis of federal data estimated that collective medical debt totaled at least $195 billion in 2019, larger than the economy of Greece.
Tabulations of the August 2021 Urban Institute credit bureau data.Juweek Adolphe for KHN and Alyson Hurt / NPR
The credit card balances, which also aren’t recorded as medical debt, can be substantial, according to an analysis of credit card records by the JPMorgan Chase Institute. The financial research group found that the typical cardholder’s monthly balance jumped 34% after a major medical expense.
Monthly balances then declined as people paid down their bills. But for a year, they remained about 10% above where they had been before the medical expense. Balances for a comparable group of cardholders without a major medical expense stayed relatively flat.
It’s unclear how much of the higher balances ended up as debt, as the institute’s data doesn’t distinguish between cardholders who pay off their balance every month from those who don’t. But about half of cardholders nationwide carry a balance on their cards, which usually adds interest and fees.
Tabulations of the August 2021 Urban Institute credit bureau data.Juweek Adolphe / Alyson Hurt for KHN and NPR
Debts Large and Small
For many Americans, debt from medical or dental care may be relatively low. About a third owe less than $1,000, the KFF poll found.
Even small debts can take a toll.
Edy Adams, a 31-year-old medical student in Texas, was pursued by debt collectors for years for a medical exam she received after she was sexually assaulted.
Adams had recently graduated from college and was living in Chicago.
Police never found the perpetrator. But two years after the attack, Adams started getting calls from collectors saying she owed $130.68.
Illinois law prohibits billing victims for such tests. But no matter how many times Adams explained the error, the calls kept coming, each forcing her, she said, to relive the worst day of her life.
Sometimes when the collectors called, Adams would break down in tears on the phone. “I was frantic,” she recalled. “I was being haunted by this zombie bill. I couldn’t make it stop.”
Health care debt can also be catastrophic.
Sherrie Foy, 63, and her husband, Michael, saw their carefully planned retirement upended when Foy’s colon had to be removed.
After Michael retired from Consolidated Edison in New York, the couple moved to rural southwestern Virginia. Sherrie had the space to care for rescued horses.
The couple had diligently saved. And they had retiree health insurance through Con Edison. But Sherrie’s surgery led to numerous complications, months in the hospital, and medical bills that passed the $1 million cap on the couple’s health plan.
When Foy couldn’t pay more than $775,000 she owed the University of Virginia Health System, the medical center sued, a once common practice that the university said it has reined in. The couple declared bankruptcy.
The Foys cashed in a life insurance policy to pay a bankruptcy lawyer and liquidated savings accounts the couple had set up for their grandchildren.
“They took everything we had,” Foy said. “Now we have nothing.”
About 1 in 8 medically indebted Americans owe $10,000 or more, according to the KFF poll.
Although most expect to repay their debt, 23% said it will take at least three years; 18% said they don’t expect to ever pay it off.
Medical Debt’s Wide Reach
Debt has long lurked in the shadows of American health care.
In the 19th century, male patients at New York’s Bellevue Hospital had to ferry passengers on the East River and new mothers had to scrub floors to pay their debts, according to a history of American hospitals by Charles Rosenberg.
The arrangements were mostly informal, however. More often, physicians simply wrote off bills patients couldn’t afford, historian Jonathan Engel said. “There was no notion of being in medical arrears.”
Today, debt from medical and dental bills touches nearly every corner of American society, burdening even those with insurance coverage through work or government programs such as Medicare.
KFF Health Care Debt Survey of 2,375 U.S. adults, including 1,674 with current or past debt from medical or dental bills, conducted Feb. 25 through March 20. The margin of sampling error for the overall sample is 3 percentage points.Daniel Wood / NPR and Noam N. Levey / KHN
Nearly half of Americans in households making more than $90,000 a year have incurred health care debt in the past five years, the KFF poll found.
Women are more likely than men to be in debt. And parents more commonly have health care debt than people without children.
But the crisis has landed hardest on the poorest and uninsured.
Debt is most widespread in the South, an analysis of credit records by the Urban Institute shows. Insurance protections there are weaker, many of the states haven’t expanded Medicaid, and chronic illness is more widespread.
Tabulations of the August 2021 Urban Institute credit bureau data.Juweek Adolphe / Alyson Hurt for KHN and NPR
Nationwide, according to the poll, Black adults are 50% more likely and Hispanic adults 35% more likely than whites to owe money for care. (Hispanics can be of any race or combination of races.)
In some places, such as the nation’s capital, disparities are even larger, Urban Institute data shows: Medical debt in Washington, D.C.’s predominantly minority neighborhoods is nearly four times as common as in white neighborhoods.
In minority communities already struggling with fewer educational and economic opportunities, the debt can be crippling, said Joseph Leitmann-Santa Cruz, chief executive of Capital Area Asset Builders, a nonprofit that provides financial counseling to low-income Washington residents. “It’s like having another arm tied behind their backs,” he said.
Medical debt can also keep young people from building savings, finishing their education, or getting a job. One analysis of credit data found that debt from health care peaks for typical Americans in their late 20s and early 30s, then declines as they get older.
Cheyenne Dantona’s medical debt derailed her career before it began.
Dantona, 31, was diagnosed with blood cancer while in college. The cancer went into remission, but when Dantona changed health plans, she was hit with thousands of dollars of medical bills because one of her primary providers was out of network.
She enrolled in a medical credit card, only to get stuck paying even more in interest. Other bills went to collections, dragging down her credit score. Dantona still dreams of working with injured and orphaned wild animals, but she’s been forced to move back in with her mother outside Minneapolis.
“She’s been trapped,” said Dantona’s sister, Desiree. “Her life is on pause.”
KFF Health Care Debt Survey of 2,375 U.S. adults, including 1,674 with current or past debt from medical or dental bills, conducted Feb. 25 through March 20. The margin of sampling error for the overall sample is 3 percentage points.Daniel Wood / NPR and Noam N. Levey / KHN
Barriers to Care
Desiree Dantona said the debt has also made her sister hesitant to seek care to ensure her cancer remains in remission.
Medical providers say this is one of the most pernicious effects of America’s debt crisis, keeping the sick away from care and piling toxic stress on patients when they are most vulnerable.
The financial strain can slow patients’ recovery and even increase their chances of death, cancer researchers have found.
Yet the link between sickness and debt is a defining feature of American health care, according to the Urban Institute, which analyzed credit records and other demographic data on poverty, race, and health status.
U.S. counties with the highest share of residents with multiple chronic conditions, such as diabetes and heart disease, also tend to have the most medical debt. That makes illness a stronger predictor of medical debt than either poverty or insurance.
In the 100 U.S. counties with the highest levels of chronic disease, nearly a quarter of adults have medical debt on their credit records, compared with fewer than 1 in 10 in the healthiest counties.
Tabulations of the August 2021 Urban Institute credit bureau data and the 2018 Centers for Medicare & Medicaid Services data.Juweek Adolphe / Alyson Hurt for KHN and NPR
The problem is so pervasive that even many physicians and business leaders concede debt has become a black mark on American health care.
“There is no reason in this country that people should have medical debt that destroys them,” said George Halvorson, former chief executive of Kaiser Permanente, the nation’s largest integrated medical system and health plan. KP has a relatively generous financial assistance policy but does sometimes sue patients. (The health system is not affiliated with KHN.)
Halvorson cited the growth of high-deductible health insurance as a key driver of the debt crisis. “People are getting bankrupted when they get care,” he said, “even if they have insurance.”
Washington’s Role
The Affordable Care Act bolstered financial protections for millions of Americans, not only increasing health coverage but also setting insurance standards that were supposed to limit how much patients must pay out of their own pockets.
By some measures, the law worked, research shows. In California, there was an 11% decline in the monthly use of payday loans after the state expanded coverage through the law.
But the law’s caps on out-of-pocket costs have proven too high for most Americans. Federal regulations allow out-of-pocket maximums on individual plans up to $8,700.
KFF Health Care Debt Survey of 2,375 U.S. adults, including 1,674 with current or past debt from medical or dental bills, conducted Feb. 25 through March 20. The margin of sampling error for the overall sample is 3 percentage points.Daniel Wood / NPR and Noam N. Levey / KHN
Additionally, the law did not stop the growth of high-deductible plans, which have become standard over the past decade. That has forced many Americans to pay thousands of dollars out of their own pockets before their coverage kicks in.
Last year the average annual deductible for a single worker with job-based coverage topped $1,400, almost four times what it was in 2006, according to an annual employer survey by KFF. Family deductibles can top $10,000.
While health plans are requiring patients to pay more, hospitals, drugmakers, and other medical providers are raising prices.
From 2012 to 2016, prices for medical care surged 16%, almost four times the rate of overall inflation, a report by the nonprofit Health Care Cost Institute found.
For many Americans, the combination of high prices and high out-of-pocket costs almost inevitably means debt. The KFF poll found that 6 in 10 working-age adults with coverage have gone into debt getting care in the past five years, a rate only slightly lower than the uninsured.
Even Medicare coverage can leave patients on the hook for thousands of dollars in charges for drugs and treatment, studies show.
About a third of seniors have owed money for care, the poll found. And 37% of these said they or someone in their household have been forced to cut spending on food, clothing, or other essentials because of what they owe; 12% said they’ve taken on extra work.
The widespread burden of medical debt has sparked new interest from elected officials, regulators, and industry leaders.
In March, following warnings from the Consumer Financial Protection Bureau, the major credit reporting companies said they would remove medical debts under $500 and those that had been repaid from consumer credit reports.
In April, the Biden administration announced a new CFPB crackdown on debt collectors and an initiative by the Department of Health and Human Services to gather more information on how hospitals provide financial aid.
The actions were applauded by patient advocates. However, the changes likely won’t address the root causes of this national crisis.
“The No. 1 reason, and the No. 2, 3, and 4 reasons, that people go into medical debt is they don’t have the money,” said Alan Cohen, a co-founder of insurer Centivo who has worked in health benefits for more than 30 years. “It’s not complicated.”
Buck, the father in Arizona who was denied care, has seen this firsthand while selling Medicare plans to seniors. “I’ve had old people crying on the phone with me,” he said. “It’s horrifying.”
Now 30, Buck faces his own struggles. He recovered from the intestinal infection, but after being forced to go to a hospital emergency room, he was hit with thousands of dollars in medical bills.
More piled on when Buck’s wife landed in an emergency room for ovarian cysts.
Today the Bucks, who have three children, estimate they owe more than $50,000, including medical bills they put on credit cards that they can’t pay off.
“We’ve all had to cut back on everything,” Buck said. The kids wear hand-me-downs. They scrimp on school supplies and rely on family for Christmas gifts. A dinner out for chili is an extravagance.
“It pains me when my kids ask to go somewhere, and I can’t,” Buck said. “I feel as if I’ve failed as a parent.”
The couple is preparing to file for bankruptcy.
About This Project
“Diagnosis: Debt” is a reporting partnership between KHN and NPR exploring the scale, impact, and causes of medical debt in America.
The series draws on the “KFF Health Care Debt Survey,” a poll designed and analyzed by public opinion researchers at KFF in collaboration with KHN journalists and editors. The survey was conducted Feb. 25 through March 20, 2022, online and via telephone, in English and Spanish, among a nationally representative sample of 2,375 U.S. adults, including 1,292 adults with current health care debt and 382 adults who had health care debt in the past five years. The margin of sampling error is plus or minus 3 percentage points for the full sample and 3 percentage points for those with current debt. For results based on subgroups, the margin of sampling error may be higher.
Additional research was conducted by the Urban Institute, which analyzed credit bureau and other demographic data on poverty, race, and health status to explore where medical debt is concentrated in the U.S. and what factors are associated with high debt levels.
The JPMorgan Chase Institute analyzed records from a sampling of Chase credit card holders to look at how customers’ balances may be affected by major medical expenses.
Reporters from KHN and NPR also conducted hundreds of interviews with patients across the country; spoke with physicians, health industry leaders, consumer advocates, debt lawyers, and researchers; and reviewed scores of studies and surveys about medical debt.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
An investigation by KHN and NPR shows more than 100 million people in America, including 41% of adults, are beset by a health care system that is systematically pushing patients into debt on a mass scale. The investigation reveals a problem that, despite new attention from the White House and Congress, is far more pervasive than previously reported. That is because much of the debt that patients accrue is hidden as credit card balances, loans from family, or payment plans to hospitals and other medical providers.
To calculate the true extent and burden of this debt, the KHN-NPR investigation draws on a nationwide poll conducted by KFF for this project. The poll was designed to capture not just bills patients couldn’t afford, but other borrowing used to pay for health care as well. New analyses of credit bureau, hospital billing, and credit card data by the Urban Institute and other research partners also inform the project. And KHN and NPR reporters conducted hundreds of interviews with patients, physicians, health industry leaders, consumer advocates, and researchers.
