Not that anybody was asking for it, but I organized my healthcare writing in the last few years by topic for those new to healthcare activism looking for some background reading (obviously there’s much more out there from many others — maybe at some point I’ll put together an annotated bibliography of work I’ve found useful.

1. Single-Payer: What it is, why we need it, and why other reforms fall short

Academic work

Gaffney A. Health Insurance Reform in the United States – What, How, and Why? Journal of Policy Analysis and Management 2018;37:188-95.

Gaffney A, Berger ZD.  The collapse of Trumpcare and the rise of single payer.  British Medical Journal Opinion, October 17, 2017.

Gaffney AW, Verhoef PA, Hall JB. POINT: Should Pulmonary/ICU Physicians Support Single-payer Health-care Reform? Yes. Chest. 2016;150(1):9-11.

Gaffney A, Woolhandler S, Angell M, Himmelstein DU. Moving Forward From the
Affordable Care Act to a Single-Payer System. Am J Public Health. 2016
Jun;106(6):987-8.

Popular Writing

 “Single-Payer or Bust,” Dissent, Spring 2018

“The Failure of Obamacare and a Revision of the Single-Payer Proposal after a Quarter-Century of Struggle,” with David Himmelstein and Steffie Woolhander, Healthcare Under the Knife: Moving Beyond Capitalism for Our Health, edited by Howard Waitzkin (Monthly Review Press, 2018).

“The West Virginia teachers’ strike is over. But the fight for healthcare isn’t,” Guardian, March 7, 2018.

“Why are Democratic party thinktanks still not backing universal healthcare?,” Guardian, February 25, 2018.

“Single-payer won’t pass now. But its popularity proves our morals are changing,” Washington Post, September 13, 2017

“Medicare-for-All Should be a Litmus Test,” Jacobin, August 10, 2017.

“The Case Against the Public Option,” Jacobin, July 19, 2017.

“The Washington Post is Selling Snake Oil,” Jacobin, June 19, 2017.

“How Liberals Tried to Kill the Dream of Single-Payer,” New Republic, March 8, 2016.

“Lessons from Vermont,” Jacobin, January 8, 2015.

2. The Affordable Care Act: Achievements, shortcomings, and repeal efforts

Academic Work

Gaffney A, McCormick D. The Affordable Care Act: implications for health-care equity. The Lancet; 389:1442-52.

Gaffney A, Berger ZD, Jha S. Should US doctors mourn for Obamacare? British Medical Journal 2017;356.

Popular writing

“Obamacare Lives,” Jacobin, October 16, 2017.

“After Trumpcare,” Jacobin, July 30, 2017.

“Trumpcare is like a vampire, set on sinking its teeth into the poor,” Guardian June 23, 2017.

“The US Healthcare System is at a dramatic fork in the road,” Guardian May 25, 2017.

“Trumpcare is dead. May it forever stay in its shallow grave,” Guardian March 27, 2017.

“Five Lessons From Trumpcare’s Collapse,” Jacobin, March 27, 2017.

“Republicans call kicking millions off their healthcare ‘freedom’? That’s perverse,” Guardian, March 14, 2017.

“Why Trumpcare Will Only Make the Rich Richer,” Fortune, March 9, 2017.

“Obamacare’s Original Sin,” Jacobin, February 15, 2017.

“Healthcare in the Age of Trump,” Jacobin, November 11, 2016.

“Obama on Obamacare,” Jacobin, July 26, 2016.

“What Obamacare Can’t Do,” Jacobin, February 11, 2016.

“From Exchange to Egalité,” Jacobin,  June 18, 2015.

3. Health and Inequality

 A two-part essay for LARB provides something of a survey of ideas about the relationships between health and inequality; the first focuses on class, the second on race:

a. “Is the Path to Racial Health Equity Paved with “Reparations”? The Politics of Health, Part II,” Los Angeles Review of Books, March 7, 2016 (review of Dayna Bowen Matthew’s Just Medicine and Damon Tweedy’s Black Man in a White Coat).

b. “The Politics of Health,” Los Angeles Review of Books, October 26, 2015 (review of Beyond Obamacare by James House).

Also:

“The Devastating Effects of Dental Inequality in America,” New Republic, May 25, 2017 (review of Mary Otto’s Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America).

 “How Class Kills,” Jacobin, November 8, 2015.

4. Pharmaceutical Policy:  The BMJ paper provides an overview of the failings of the status quo together with a comprehensive proposal of how to fix it; the WaPo article gives the tl;dr on the proposal.

Academic work

Gaffney A, Lexchin J., and the US/Canadian Pharmaceutical Working Group. Healing an ailing pharmaceutical system: prescription for reform for United States and Canada. The British Medical Journal. 2018;361.

Popular Writing

“Trump’s plan won’t lower prescription drug prices. Ours would.” Washington Post, May 23, 2018 (PostEverything)

“Do We Need Pfizer,” Jacobin, February 26, 2018.

 “How ADHD Was Sold,” New Republic, September 23, 2016 (review of ADHD Nation: Children, Doctors, Big Pharma, and the Making of an American Epidemic, by Alan Schwarz).

“The Dawn of Antidepressants,” New Republic, June 16, 2016 (review of Ordinarily Well: The Case for Antidepresssants by Peter Kramer).

“Socialize the EpiPen,” Jacobin, September 2, 2016.

“Your Wallet or Your Life,” Jacobin, September 22, 2015.

5. Healthcare in history

Academic work

To Heal Humankind: The Right to Health in History (New York, NY: Routledge, 2017).

Popular writing

“Just Another Business,” Jacobin, October 21, 2015 (review of Cinemax’s The Knick).

“Baltimore’s secret history of death,” Salon, May 6, 2015.

6. Healthcare Abroad: I mostly write about healthcare in the US, but occasionally in the international context, with a special interest in the attack on universal healthcare in Europe.  The chapter below written with Carles Muntaner provides an overview of the effects on austerity for Spain, the UK, and Greece.

“Health and Austerity,” with Carles Muntaner, Healthcare Under the Knife: Moving Beyond Capitalism for Our Health, edited by Howard Waitzkin (Monthly Review Press, 2018).

“Need Surgery, Will Travel,” New Republic, January 13, 2016 (review of Outpatients by Sasha Issenberg).

“Saving the NHS,” April 26, 2016.

Single-payer cost estimates are in the news this week.  A key issue in estimating the cost of single-payer is how it will increase healthcare utilization.  Increased utilization, it’s worth pointing out, is basically the only way that single-payer adds to overall healthcare spending.  Now some increase is clearly expected and desirable – after all, we’re providing insurance to the uninsured and eliminating copays and deductibles for the rest.  However, as David Himmelstein and Steffie Woolhandler and others have argued, there are supply limits – the system can only provide so much care.

In any event, utilization increases are typically presented as abstract figures.  For instance, the recently released Mercatus Center study estimates an 11.3% increase in utilization (for 2019), whereas the Urban Institute estimates a 16.9% increase (averaged over 2017-2026).

It’s helpful to put those percentages in the context of actual services provided, as Himmelstein and Woolhandler sometimes do, because they translate into a concrete increase in the number of doctors’ visits, nights in the hospital, ER visits, etc.  I offer some rough estimates of these changes below, with the assumption that the average increase in utilization affects all services equally.  So, for instance, using Urban Institute estimates, 16.6% more utilization translates into 185 million more visits to the doctor and nearly 4 million more therapeutic surgeries a year.

Are those numbers realistic?  For the moment I won’t editorialize on this, but it’s worth keeping these figures in mind as cost estimates of single-payer are released and debated in coming days.

* There were 990,808 doctor office visits in 2015 per NAMCS.  However, data on visits to hospital outpatient departments (OPD) has not been released by NAMCS since 2011.  In that year, OPD visits were 12.7% office visits.  I inflated the office visits figure by this percentage, assuming that the proportion had not changed.