By Lambert Strether of Corrente.
“A company for carrying on an undertaking of great advantage, but nobody to know what it is.” –Prospectus for a joint stock company in the South Sea Bubble (1720)
About 10 days ago, and shortly after Jeff Bezos, Warren Buffet, and Jamie Dimon launched their health care undertaking, a bipartisan group fronted by former CMS administrator and #SaveTheACA hashtag activist Andy Slavitt launched their own undertaking: the United States of Care, “a new non-partisan non-profit, we are building and mobilizing a movement to achieve long-lasting solutions that make health care better for everyone.” (I’m going to use their Twitter handle, @USofCare, for the remainder of this piece.) FAIR describes the launch. The headline:
Media Embrace New ‘Reform’ Group as Bulwark Against Guaranteed Healthcare
(At least on the Twitter, the instant reaction from many was more precise: A “bulwark” against #MedicareForAll, as opposed to the more generic “guaranteed healthcare.”) More:
Andy Slavitt, former head of the Centers for Medicare and Medicaid Services in the Obama administration, pro–Affordable Care Act activist, announced the creation of the USoC in an opinion piece for USA Today (2/6/18). Slavitt also has a long resume in the private sector: He was the founder of healthcare tech startup investor HealthAllies, a former UnitedHealth Group executive, a Goldman Sachs investment banker and a consultant for McKinsey & Co. The group also received a write-up in Axios (2/6/18) as well as a glowing profile from Bloomberg (2/6/18), which played up the group’s interest in promoting an “opening for bipartisan policy-making.”
(We will look in more detail at Slavitt’s “long resume in the private sector” tomorrow.) And more:
Neither the USA Today piece, the Forbes piece nor the United States of Care website mentions single-payer, Medicare for All or anything related to government-guaranteed universal healthcare. The Bloomberg write-up mentioned Sanders’ Medicare for All bill in the context of USoC’s hope of “heading off increasingly volatile swings in health policy when political fortunes shift in Washington.”
Well, that’s certainly a curious omission! In this piece, I will take a look at Slavitt’s undertaking, @USofCare. Should we be wary of it? Does it really oppose #MedicareForAll? And what can we expect from any solutions it provides? I’ll answer the first two questions today, and the seond question tomorrow.
Should We be Wary of @USofCare?
By “we,” I mean citizens generally, but particularly #MedicareForAll advocates, as I am. And the answer is “Yes,” for at least two reasons.
1. Undisclosed funding. Slavitt was beaten up pretty bad on the Twitter for not disclosing minor details like who was funding his undertaking, and so after a few days @USofCare emitted a FAQ. Here is their section on funding:
Who are your funders?
Our funders are individuals and non-profit health care organizations including not-for-profit charity hospitals and foundations.
We have not and will not accept funding from trade associations, PACs, insurance companies, or for-profit corporations.
So, funding has been or may be provided by high net-worth individuals — perhaps Bezos, Buffett, or Dimon? — or laundered through a foundation. Since @USofCare does not name its donors, I hardly find this reassuring.
In establishing this organization, Andy Slavitt says that we must put “health care over politics.” Yet the several politicians involved are either Republicans (majority) or conservative neo-liberal Democrats (minority). The 52 members of the Founder’s Council… include many strong supporters of the Affordable Care Act. There are many representatives of the health care industry. There are many outspoken opponents to single payer reform, aka Medicare for all. Yet there is not one individual who has taken a prominent stance in favor of single payer, even though a majority of Americans do support Medicare for All.
Does @USofCare Oppose Medicare for All?
Opinions differ, on the @USofCare site and among founders. The FAQ says No:
Does United States of Care oppose single payer or Medicare for All?
[B]United States of Care will identify, evaluate, and provide support for policies that meet our principles: affordable care for all Americans that protects against financial devastation. Our priority is to engage the public for a range of solutions.
(I have helpfully labled the “No” part [A], and the “But yes, really” part [B]. However, the Mission Statement — at least in my translation of the bafflegab — says Yes:
The mission of United States of Care is to ensure that every single American has access to quality, affordable health care regardless of health status, social need, or income.
The key word to watch for is “access.” Access implies a gatekeeper, and a gatekeeper implies eligibility determination, especially means-testing. Ask yourself: Do you want access to care, or do you want care? And the second word is like it: “Affordable.” That means you pay. Ergo, @USofCare is opposed to #MedicareForAll — at least NHS-style “free at the point of care” Medicare, a Medicare cleansed of its current neoliberal infestation — and the FAQ and the Mission Statement contradict each other.
I’m a #MedicareForAll advocate. I also want to make sure there’s a path to get there, which involves building a movement and persuading people who don’t currently agree.
— Jon Favreau (@jonfavs) February 6, 2018
(Consistent with the murky public commitments of the entire undertaking, I’ve been unable to find any public statement where Favreau acts as a #MedicareForAll advocate other than this one tweet, and I have looked True, Google search has been crapified, but you’d think an Op-Ed or an interview would crop up. Perhaps his advocacy was during a vow of silence? Or performed in mime? Taking Favreau at his word, it would be interesting to know when, exactly, his Damascene conversion took place. And why.)
And finally, we come not one but two interviews with @USofCare Board Chair Andy Slavitt. whose views on #MedicareForAll are so awe-inspiringly prolix that I cannot bring myself to edit them down — not because they’d lose any flavor, but because of the sheer volume and the sheer effrontery of their evasiveness convey the message — and so have adopted special formatting.
The first interview is by Gregory Krieg of CNN, who does a commendable job trying to nail Our Andy’s Jello to the wall:
KRIEG: Why not then put this energy and these resources behind some of the movements that are already out there? “Medicare for all” obviously now has traction with Senate Democrats, as do other less comprehensive plans. There are a lot of people already out there trying to create a new narrative, in favor of expanding care. Why not put your influence and, maybe, money behind them?
SLAVITT: One of the questions (being asked by critics) is about me personally and, you know, I personally am not changing. I don’t expect that my views or my activities personally around making sure that we’re fighting to get better health care for more people changes. And I don’t expect other people who are affiliated with the organization or part of sponsoring it to change their activities, whether they agree with me or disagree with me.
But we have to do something over the long term in addition to make sure that we’re not having this war forever. The question is how do we do that? And there’s no guarantees that it’ll ever happen. But what is clear to me, and I think a number of other people, is if we don’t take down the temperature of the debate, then, the next time we go at doing this, we’re still going to be more and more divisive.
So I think there is room for us in the debate to focus on both what needs to happen now and over the next couple years — which is, as you point out, there are a number of organizations that are well-suited for that and some of which I’m affiliated with and will continue to be affiliated with — but also for there to be a movement that’s a little bit longer term that changes the equation. Think about big changes that have happened in the country, (like) marriage equality. That didn’t start the year before laws were changed. That started decades before laws were changed. There needs to be a movement and effort to establish successful change that occurs beyond just the current year.
I think this is an organization that has an opportunity, if done right, to make a difference in the long-term debate even while people are working on these very challenging issues in the near term.
Kireg tries again:
KRIEG: To be clear, though, you were speaking to Modern Healthcare about this, and you’re quoted as saying, “We believe every single American should have access to basic, affordable care. But we avoid using language like universal coverage that is polarizing. We want to bring people together, and certain words are used by one party or another to create divides.” So, asking as directly possible: Do you support or oppose single-payer health care?
SLAVITT: Do I personally?
SLAVITT: I would personally love to be in a world where we have, once and for all, given every American health care, and that’s certainly one way to do it. So, to that extent, the answer is yes.
KRIEG: OK, but how do you feel, not personally now, but as an activist or political actor?
SLAVITT: What I believe is that there are a number of ideas, including new ideas, that are going to be necessary to get to where we want to get. I believe that it’s going to take a number of years from where we are today, so for someone who believes in single-payer, “Medicare for all,” I hope that you can also be for other things that are good for people in the meantime, and that those things might even build the ability to get there.
I also believe that there are lots of approaches, because there’s not even one ready bill; it’s not like there’s a bill that’s ready that can do everything because the Medicare program, of course, is designed for seniors. It’s not designed for younger people, low-income people, etc. So there’s a lot of un-sexy dirty work that has to happen, to make these policies work, to get public support for them. To vet them, to drive them.
So if you look at the three principles of (USoC), they include anything that can get people access to the coverage they need, the care they need, protect them from bankruptcy and do it in a way that can be lasting from an economic and political standpoint. That absolutely includes single-payer and it includes other ideas that are either currently formed or that need to be formed.
Forgive me, again, for quoting Slavitt at length, but you see what we’re dealing with here. And a second interview, even more revealing. This one is from the HealthChangers podcast by Cambia Health Solutions. I have used the same formatting convention is above. This is all Slavitt:
SLAVITT: I was on a right-wing radio program the other day, with a right-wing radio host. This is how he describes himself, so not being disparaging in any way. He says to me during a commercial break, “I’m for single payer.” He said. “I’m so sick of this.” He said, “Now that I know, all of the hands in the pot, all that stuff, screw it. I’m just for single payer,” he said. “And I’m about as right wing as you’re going to find.”
Let me break in for one moment here. Imagine how Sanders would have seized that moment (which, let me remind you, is about as bipartisan as you can get). Now let’s listen while “Jello Andy” emits a voluminous stream of baffegab:
SLAVITT: Something else always sounds better when we’re looking at the problem we’re looking at now.
Hoo boy. “Single payer,” “grass is greener,” ho hum, yadda yadda yadda.
Okay. So, so, let’s just be little bit sober by the fact, and I always think it’s good to remind people that we have to find a way to pay for the things we want, and that may change people’s minds. “Do you like single payer and this tax increase?” I think that’s a fair thing to ask people, but here’s the opportunity. Here’s what I like to see happen, I’d like over the next five to seven years, because I think it’s going to be that long before having that happen at the actual level, two things happen.
One is, at the state level we really try it out.We have a Medicaid buy-in opportunity in Nevada. The Governor almost signed, with some more real work with hospitals and others, possibly that could happen, it could happen somewhere else. So, we should try some experiments. See what happens. Stage level, I think we’re stage four.
The second thing is to get to a language that unites us around making how we think about health care in a universal way, rather than divides us. We ought to be smart about it, if we really want it. We ought to be having a dialogue about what it is we want. About what those trade-offs are, and what that language is, and what is it that we have a right to.
I would say we have a right to a regular source of care, and to not go bankrupt when we get sick. I don’t think we all have a right to every heart and lung surgeon, but I think there’s something we do have a right to. I think that’s the conversation that we let play out over the country. We should leave Washington the heck out of it, and then at some point in time, after we make some progress at the state level, the people who really care about this issue really want to see progress, we maybe will have built the foundation to do something more.
Quality work. And if this is “the language that unites us” (granted, for some definition of “us”) please kill me now. But to answer the question posed by this section, at the very best, and ladeling on great gobs of assumed good faith, Andy’s prayer is a lot like Saint Augustine’s: “Lord, give me #MedicareForAll — but not yet!”
What Can We Expect from @USofCare Solutions?
I’m putting this here as a placeholder for the post I’ll write tomorrow. I’ll argue that the three requirements I outlined for the Bezos, Buffett and Dimon undertaking also apply to any solution emanating from @USofCare. to review, those requirements are for:
- Accounting control fraud
- Financial predation
- Abuse workforce
to those three I will add a fourth:
- Conflict of interest
@USofCare’s big idea is right on the its splash page:
Let’s change the conversation and put health care over politics.
Holy moley. Splinter News has a fine response:
The multi-payer for-profit model of private insurance has had fifty years to address these questions, and the results speak for themselves
Let me reiterate the table stakes. Among so-called “developed” countries, America is the most dangerous place to be sick. America is the most dangerous place to be black. America is the most dangerous place to be pregnant—with the highest maternal mortality rate of any comparably wealthy nation, of which 60% are easily preventable. America is the most dangerous place to be a woman; to be trans; to be disabled; to be elderly; to be poor.
Last year, life expectancy at birth fell for the first time in almost 30 years by a tenth of a year. Across the four million people born last year, that constitutes a theft of 400,000 years. And I do mean theft—because the wealthy men in America get to live fifteen years longer than poor men; wealthy women, ten years longer than poor women.
Their solution, though—to try to place the heathcare battle above partisan politics—makes no sense. It makes no sense because the fight for universal care is a fight against a powerful cadre that opposes that goal.
USC envisions a world in which healthcare is fought for and won by technocrats, a small corpus of the benevolent and powerful. These are the same people who have, through pre-concession, lost any battle they’ve focus-grouped their way into meekly accepting over the past thirty years.
Anyhow, it’s ridiculous to think that Slavitt doesn’t practice health care politics. We’ve seen them, right in this post. They look like this. A voice as hushed as any undertakers…
 Stoller comments:
I was having trouble keeping track, so it was thoughtful of @ASlavitt to create a list of all the various stereotypes of cloying out of touch elites and put them in one organization. https://t.co/i5oQ6vm4ur
— Matt Stoller (@matthewstoller) February 7, 2018
 I’d been wondering why Slavitt, in all his Twitter work on #SaveTheACA, never endorsed Medicare for All — a search on “#MedicareForAll AND from:@ASlavitt” yields zero hits, so he’s really been quite disciplined — so perhaps I have my answer. Slavitt is an interesing figure, and I’ve only begun to disentangle his Flexian network. See this excellent long-form piece by Kam Sandhu of Real Media in the UK; it looks to me, for example, like Slavitt’s cohorts from his United Heatlhcare days are helping the neoliberal effort to gut the NHS on the other side of the pond. I also need to reviisit both the ObamaCare backend and medical coding, two areas with which Slavitt has been intimately involved for most of his career.
 Access is also a Jobs Guarantee for the credentialled professionals who determine who goes to HappyVille, and who goes to Pain City, what is “affordable,” and so and so forth.
 If this is what Slavitt believes, his hash-tag activism with #SaveTheACA did not reflect it; see note .
 It’s obviously very important to #MedicareForAll opponents that the currency issuer not implement the program. That way, when there’s a downtown, states will be forced to cut spending on it, and they can then argue the program is a failure.