The Miseries of Strangers

Timothy Faust’s Health Justice Now

“This is not an intentionally designed system,” writes Timothy Faust about healthcare in the United States in Health Justice Now: Single Payer and What Comes Next. “It is one that emerged, like a prehistoric corpse from an ancient and foul bog, and is now stinking up the place.”

Faust, a healthcare correspondent known for his theatrical barnstorming tours across America; affinity for heavy-metal music and professional wrestling; and long hair, trucker jacket and bandana aesthetic, declares simply and plainly: “Healthcare is personal.” 

And because it’s personal, organizing takes its toll. “It is always the same, every morning on the road,” he writes.. “I wake up and drive six hours, get to a new town, give my speech, and answer as many questions as I can. Then somebody walks up to me and shares with me the worst thing that has ever happened to them. I have become a library of the miseries of strangers.”

The stories Faust shares could lead anyone to despair. Chronic illnesses, disability, racism, lack of abortion access, immigration status—the endless cruel ways that our system fails us make it difficult to see the even larger, more horrifying picture. Through his careful explanations, Faust demonstrates how the healthcare system, rather than being a failure of a well-intended structure, does not work for our well-being at all.

Too often in leftist discourse, demands for Medicare for All begin with tautologies. The system is in crisis, so Medicare for All is necessary. Medicare for All is cheaper than other options, so therefore we must have a universal single payer program. Infant mortality rates are high, disease rates are high, life expectancies are low, therefore Medicare for All must be the solution. 

Faust, however, warns against that kind of rhetoric. Yes, Medicare for All is a solution to many, many issues. But crisis is the point of the system. The system wasn’t intentionally, or even intelligently. designed, but it works. For whom does it work? Those who seek to benefit from the exploitation of others, Faust answers, noting, “Some of these grifts are massive and structural; some are tiny, personal, small enough to fit in your palm or under your tongue. The scams of American healthcare are all very tightly interwoven; they are like a hundred thousand bloated rats…an impenetrable, writhing, nauseating mass.”

Okay, some of the prose might be purple, but it breaks down the myriad ways health insurance providers and their collaborators screw us. Faust explains, like a careful and patient teacher to a new student, how a formulary—a list of medicines available to patients based on their insurance—can become a battleground for profit at the expense of patients and providers. He names each of the villains and their motives, like pharmacy benefit managers, “one of the meanest, cruelest actors in American health finance” who do things like demand high rebates from manufacturers while raising list prices, driving prices up rather than down. They’re just middlemen, charging insurance companies more than they reimburse pharmacies or manufacturers and pocketing the change. When he needs to land a punch, he does so without showboating. Few can explain how a set of arcane, obscure policies and corporate procedures wound people—people we love—with more righteous anger than Tim Faust.

Faust’s dramatic style is most effective in the final act, as the reader realizes that the profiteering bad guys won’t be defeated by a babyface hero who enters the ring, but by the screaming fans themselves. We are the ones with the power to dismantle the entire arena. This isn’t Wrestlemania; it is life and death. We needn’t be passive observers.

This is among the most important books DSA members will read this year. Health Justice Now is more than a book about Medicare for All. It’s a framework for thinking about how health policy connects to real people whose agency can lead the way to active participation in our collective response. It weaves together stories at many of the intersections of healthcare injustice in the United States from housing to economic, racial, and rural-urban divides. It is a book that situates us among other movements and tilts our line of sight upward toward liberation. But most important, mass movements have to start somewhere; this is a book of inspiration for how we can campaign for health justice now.