The Atypical Messenger We Need: On Timothy Faust's "Health Justice Now"

Timothy Faust | Health Justice Now: Single Payer and What Comes Next | Melville House | August, 2019 | 128 Pages

Health Justice Now: Single Payer and What Comes Next concludes with “solidarity now, solidarity forever.” While not a typical way to end a detailed book about health policy in my experience, this rhetoric is for the better. Melville House’s new book is not written by the usual suspects from the health policy world but from a Wisconsonite heavy metal and wrestling fan with a Texas flag tattoo. Activist and single payer campaigner Timothy Faust brings an unruly outsider perspective to health care and the medical industrial complex; he brings the fire of passion to the single payer, Medicare for All cause and the message of health justice.

What’s the message? It’s a message not repeated enough by those who know better: the American private health insurance system kills, maims, and bankrupts. And for those with mental health or substance abuse problems, it locks you up in jail. It is designed to fail with or without the Affordable Care Act (ACA). Faust should know, as he worked in the health insurance industry enrolling people into ACA programs in the South. Tinkering with the current system (he considers the ACA to be a tweak) will not address the systemic mistake of building a national health care system on private, for-profit health insurance sponsored by employers.

Faust views Medicare for All as a federal, universal single payer program for all residents of the United States as the solution. He accepts no inferior substitutes proffered by the Center for American Progress and other Beltway organizations. No other program would help all Americans from coast to coast the way that Congresswoman Pramila Jaypal’s (D-WA) House bill and Senator Bernie Sanders’s (I-VT) Senate bill would. A single program with a single insurance risk pool with a single budget represents a huge stride towards efficiency and equity that the current fragmented, public-private multipayer can never have.       

The second message is the second half of the title (What Comes Next). Tim Faust, a member of the Democratic Socialists of America, does not see Medicare for All as the end goal. Rather, Medicare for All (M4A) would be a tool for bringing health justice to the masses. M4A becomes a strong lever to address social injustices such as pollution, joblessness, mental health, and substance abuse. Specifically, it would address the social determinants of health, the inequities and inequalities that affect the vast majority of one’s health even before entering the health care system. 

What are the social determinants? The World Health Organization defines them as the “conditions in which people are born, grow, live, work, and age…. [which] are shaped by the distribution of money, power, and resources at global, national, and local levels.” The term began when Dr. Michael Marmot began to uncover health inequalities among government workers in the United Kingdom in the Whitehall Study despite the National Health Service being free at the point of usage. Your health is shaped by more than just health care.

Faust focuses on a few of these determinants, such as housing and food. A common issue I personally see is housing. Homelessness and housing insecurity increase health care costs as people pursue hospitalization for a problem that is more social than medical. Lack of affordable, secure, and consistent housing also leads, in part, to an inability to make appointments or take medications or refrigerate insulin. Food insecurity, linked to perennially low incomes, or living in a food desert (areas without grocery stores) affects the health of millions of Americans. To adapt, they buy canned or processed foods because they cannot afford or access fresh fruits and vegetables locally. This does not make their diabetes or high blood pressure any better, as dietary compliance is just as important as taking medicine. 

Spreading the Message

In 2017, as a 30-year old, Faust embarked on a multi-state tour of the USA. He learned about health issues around the nation from Houston to Idaho to Pittsburgh (Full disclosure: I shared a stage with him in Kansas City and Cleveland). The book allows regular people to tell their personal stories of how the American health system has harmed their health, finances, and sanity. Many have buried friends and family members before their time.  Sharing stories in public (a strategy currently being implemented at Sanders’ presidential campaign townhalls) gives regular people a first step into activism, advocacy and community. As Faust writes, “Our goal is not just insurance, but emancipation.”

His best example of regular people gaining their voice starts in northern Idaho. A community upset about school funding began a citizens’ campaign for public education. After this victory, it became “Reclaim Idaho,” and began a statewide conversation from city to suburb to trailer park about health care. Since the state refused to expand Medicaid, Reclaim Idaho put a Medicaid expansion referendum on the ballot. Proposition 2 passed by 61% of the vote in the vast majority of counties on November 6, 2018. This is what emancipation looks like: building communities, building power, building victories. Victories like Medicaid expansion increase political participation and voting. Winning single payer at a national level will require dozens of such groups. 

However, one small knock can be made on the book. Faust could have stepped back from the abundant details of the human cost of the current system to look at the cost of not changing the system. How much would health care cost in 20 years without single payer?  How many people would be uninsured?  How many would have died or gone bankrupt?  How far would life expectancy fall (as it has for 3 years in a row) without de-commodifying health?  How low would we rank internationally in health outcomes? 

Worrying trends in the future include private equity’s move into buying hospital chains and now physician practices. Large physician group practices have been gobbled up by Wall Street. When hunting for a job in 2018 after a move, I found out that a rival to my employer had been bought out by Summit Partners, a Boston private equity firm. The Journal of the American Medical Association noted risks to physician autonomy and the primacy of the patient-physician relationship when investment funds call the shots. Wall Street has found a recession-proof industry. Fighting for Medicare for All becomes a fight against the financial industry’s $42.6 billion in health care “deals” of nursing homes, hospitals, practices, staffing companies, and so on. 

Knowledge as Power 

Those who disseminate information for a living can play one of two roles. They can provide knowledge to empower the listener or to show off their knowledge to obscure and obfuscate essential realities. Tim Faust’s book intends to empower the reader with all the right facts and tools. He admits that health care provision is difficult and complicated and requires both expertise and local knowledge. Financing health care, however, is perfectly within the domain of knowledge of the general public and needs to be simpler, more efficient, and more just. Health care provision is hard but health care finance need not be. Single payer is simplified health finance for the masses.        

In the current Internet era, “experts” we see on TV can be exposed for their conflicts of interest and even past contradictions in a moment.  The bipartisan foreign policy establishment exposes its hawkish conflicts of interests, the economic prognosticators continue to mumble and fumble about the future, and polling “wizards” like Nate Silver and Harry Enten withhold the details of the data. Their time has been coming.   

Similarly, the favored health policy experts of the political-media-medical industrial complex such as Dr. Atul Gawande (New Yorker magazine, Harvard) and Dr. Ezekial Emanuel (Obama advisor, UPenn) and the Dartmouth Atlas gang (inventors of the accountable care organization) are all due for a reckoning. Their soft bigotry of low expectations for the world’s most expensive health care system reveals them for the part-time tinkerers and prestigious profiteers they always were. Tim Faust’s long hair, bandana, and tattoos stand out in the crowd of accredited health policy wonks, but he can cite the literature up with the rest of them. He is not the typical messenger, and that is exactly what we need right now. 

This piece is part of our Healthcare and Society Series, in which we look critically at the way we provide healthcare in the US.