For all

A project manager is excited to finally have a job offer after months of looking; but when she reviews the benefits package she discovers there’s no employer coverage for dependents’ premiums. After talking to a benefits manager, she finds herself steered towards a high-deductible, health-savings style plan.

The people officer at a two hundred-person tech company shares the news that their health provider is raising the rates by twenty percent. Unwilling to bear the costs, they are switching back to their previous provider, one employees reported was near impossible to use because the network was too small and every claim was preemptively denied.

A coffee shop has made a point of providing health benefits to their staff, retaining many of the same people for years. But rates are now so high they must either cut benefits or lay some people off. Collectively, the staff decides to preserve everyone’s job and accept a stipend they can either use towards buying a plan on the state marketplace, or else pocket and do with as they please. Several members of the staff, looking at the cost of premiums, decide to go without.

A seasoned engineer teams up with a few long-time colleagues to start a cooperative consultancy. They have the network and the skills and as soon as they start quietly telling people they’ll be available, they have a short list of prospective clients. But when they sit down to do the math on how they will structure the business, one cost looms large and menacing: health insurance.

None of this is new, but the trends have been accelerating and the train, running downhill for years now, is picking up speed and rattling in its tracks. What before was a rumble or quiet worry is now a panic-inducing up-all-night nightmare. And it’s the whole system, not merely some small neglected corner: egregious cuts to Medicaid, slashed subsidies for ACA plans, hospitals gobbled up by private equity when they aren’t being summarily closed, huge cost increases for the elderly on Medicare, increasingly automated and capricious claims denials, public plans for teachers on the brink of collapse, pharmacies closing right and left, a horrific deportation campaign contributing to a nursing shortage, and on it goes, all the while health insurers rake in record profits. And there’s no refuge for people with purportedly good jobs, the kind that once seemed like a solid bet for decent healthcare, with the biggest rate increase in decades hitting employers, who are either passing those costs on or simply giving up.

Perhaps a few people will slip through the barricade and end up at the vanishing number of very large companies that still provide halfway decent healthcare—for a while, at least. But no healthcare system can survive as the covered population gets smaller and older. And even if you manage to be one of the lucky few, how many of your friends and kin will not be? Their health matters to you, too.

This is not a problem with an individual solution. You cannot manifest your way to good health insurance or keep hospitals open with pluck. There is no strategy that you can execute that will guarantee that you get health insurance even as the rest of the system crumbles. No amount of the right training or hard work or connections are going to get you to a place where you don’t have to worry about health insurance any more. You need to gather up everyone else in the same camp—which is just about all of us at this point—and fight.

The only way through this mess is politics. The only way through is Medicare for All.

We’re approaching the eve of that most frightening of American holidays, open enrollment. This whole experience is designed to make you think that the only choice you have is between the very expensive plan and the even more expensive one, both of which will be miserly with care should you need it. It’s designed to make you feel stuck in your job, unable to leave even though you desperately want to, because the work you really want to do doesn’t cover benefits. This, of course, was the whole point of employer-sponsored health insurance in the first place: to make you dependent on your employer, when they should be dependent on you. That was never a good bargain for workers, and it’s an untenable one now.

So: use the horror of open enrollment to talk about rising healthcare costs at your workplace and recruit your coworkers to the cause. Don’t let your employer dump higher costs on you without a fight. Find the people in your neighborhood who are already organizing for M4A and pitch in. Canvas this weekend for the candidate most amenable to supporting universal healthcare, and whoever wins next week, don’t let them off the hook. This will not be easy—getting what you deserve in a system that prefers your desperation never is. But we’re out of other options.

And if we get this right? Imagine what else we can do.