Scenes from the Class Struggle at CVS (09/28/23)
Death Panel podcast co-hosts, Beatrice Adler-Bolton, Artie Vierkant, Phil Rocco and Abby Cartus discuss how the widely reported expense and unavailability of the new covid boosters is the disastrous (and predictable) consequence of the Biden administration’s move to kick covid vaccines and therapeutics to the private market.
Transcript by Kendra Kline. (Kendra is currently accepting freelance transcript work — email her if you need transcripts!)
[ Intro music ]
Beatrice Adler-Bolton 0:32
Welcome to the Death Panel. To support the show, become a patron at patreon.com/deathpanelpod, to get access to our second weekly bonus episode and entire back catalogue of bonus episodes. And if you'd like to help us out a little bit more, share the show with your friends, post about your favorite episodes, pick up a copy of Health Communism at your local bookstore, preorder a copy of Jules' new book coming in January called A Short History of Trans Misogyny, or request them both at your local library, and follow us @deathpanel_. So today we have a panel episode for you. I am joined by my co-hosts, Artie Vierkant.
Artie Vierkant 1:10
Hello.
Beatrice Adler-Bolton 1:10
Phil Rocco.
Phil Rocco 1:11
Hey.
Beatrice Adler-Bolton 1:12
And Abby Cartus.
Abby Cartus 1:13
Hello.
Beatrice Adler-Bolton 1:14
So it's mid September, fall is definitely here. And we've got quite the COVID episode for you today. But first, I just wanted to shout out a very important milestone. Last week was the one year anniversary of Abby and Jules joining the Panel.
Artie Vierkant 1:30
Hell yeah.
Abby Cartus 1:31
Yay.
Phil Rocco 1:31
Wooo.
Abby Cartus 1:31
[laughing]
Beatrice Adler-Bolton 1:33
And I just want to say that I know we're still trying desperately, one year into this, to schedule --
Artie Vierkant 1:40
To get all five of us on one recording. Yeah, for real.
Beatrice Adler-Bolton 1:42
Yeah, to schedule the episode with all five of us on mic together. I know we get requests about this constantly. I promise you, we are trying, we're trying really hard. And I wish Jules was here today. But I just wanted to just stop and say thank you, Abby, Artie, Jules and Phil, thank you for everything that you bring to our conversations. It's a fucking honor to collaborate with you on this project and be in struggle together. I'm not a very like sentimental person -- Artie can attest. But at this one year mark of Abby and Jules joining the Panel, as we head into this like pretty bleak fall and winter, I'm just feeling grateful to be doing so surrounded by all of this rage and solidarity. So thank you, not just to you guys, but of course to all of the folks who have generously given their time, come on the show, joined the Panel as guests to think with us and all of the thousands of comrades who listen to the show. It means a lot to be able to think with you all and survive together, even if it's only one week at a time.
Abby Cartus 2:42
Fuck yeah. Right on.
Beatrice Adler-Bolton 2:44
Anyways, sentimentality aside, we have a lot to get into today. But I just wanted to mark that, you know, for the record, so to speak, but I think or hope maybe it sets the tone for what we're going to get into. So in early September, the US Food and Drug Administration, the FDA, approved a new updated COVID booster vaccine. The next day, the US Centers for Disease Control and Prevention, the CDC, signed off on that and then released recommendations that all people six months and older should get the updated COVID booster. So that was September 11th and 12th. So this booster situation, now that this booster is coming out, is actually kind of uncharted territory. We have been talking about this literally for years now. And specifically warning about this since the beginning of the year. But this is the first round of COVID vaccination in the United States, where COVID vaccines have been kicked to the private market. So what this means is that for the first round of COVID vaccines where the federal government is not the purchaser or distributor, this is the one that we're working with right now. This is the updated booster. In this round, pharmacies, hospitals, doctors offices, urgent care, community health organizations, other providers, etc., they're all buying the vaccine directly through distributors like third party companies that handle that, kind of PBM, or directly from the manufacturers themselves, which is Pfizer and Moderna. So disaster and chaos has ensued as vaccines and private insurance companies and pharmacies have sort of all come together. Fall is here, we've got this new booster, the recommendation is out. But now we're also getting to see the dramatic results of this push to the private market. And, you know, it's not really a surprise that things are bad. We'll get into what has happened in more detail in a second. But I just wanted to give like a quick overview and set the stakes here. Because basically, in the first week of these boosters being available, people been running into ridiculously predictable problems: insurance companies denying coverage of the booster, being quoted $190, $200 to pay for it out of pocket, appointments --
Phil Rocco 4:48
Can attest.
Artie Vierkant 4:49
Yeah, as happened directly to Phil, who's still -- also just to say -- actually, Abby was able to get the booster somehow this morning.
Phil Rocco 4:58
Congratulations.
Artie Vierkant 4:59
Congratulations. I guess miracles do exist.
Abby Cartus 5:04
It's just my natural charm.
Phil Rocco 5:05
[laughing] Yes, Virginia.
Artie Vierkant 5:06
But the rest of the Panel has not been able to do it. And, you know, we're people who, I would say that navigating the health insurance system in the United States is kind of one of the main things that we do here. So not only here, but like off -- I mean, you have no idea how much time Bea spends being on the phone with insurance companies or care providers of one kind or another, when she's not speaking to you on the show, so --
Beatrice Adler-Bolton 5:33
Hours and hours and hours.
Artie Vierkant 5:35
In any case, I digress.
Beatrice Adler-Bolton 5:37
But yeah. So, you know, we've run into these, again, predictable problems. The litany of things that we have been dreading to sort of run into, right? Appointments being canceled, inventory messed up, vaccines destroyed by easily avoidable temperature errors in shipping and storage, the supply is constrained because nobody knows how much to order or how much they can afford to order. It is a total fucking mess. And, you know, this is an avoidable total fucking mess, just to say, that should surprise no one, also, who is even at all remotely familiar with American health care. And what has the response been from people whose deliberate policy decisions set this whole thing into motion, right? Call your insurance provider.
Phil Rocco 6:22
I did that, I did that. Can I just -- so like, the issue for me, right, is that like Walgreens here, they've got it, right. But Walgreens is out of network for me, which is hilarious that the largest pharmacy in the country is out of network for me. But you know, they're like, well go to your provider. My provider doesn't have the shots. And so I'm just trying to see if I can get the shots covered, even though Walgreens is out of network. So I go to the online -- you know, the chat with the insurance company, which is like a -- you know, it's a company that basically --
Artie Vierkant 6:57
Probably the way that they prefer for you to contact them, I'm sure.
Phil Rocco 6:59
Right, right.
Beatrice Adler-Bolton 7:00
Well, it's really hard to actually get through the phone system now.
Phil Rocco 7:03
Yes. So the first question that the person asked me is like, for what reason do you seek the vaccine? [laughter]
Artie Vierkant 7:12
Oh my god.
Abby Cartus 7:12
I believe the way you phrased it in your text was, “may I ask why you want the vaccine?” [laughing]
Phil Rocco 7:18
Yes. was like, I don't know what to say to that. But it does sort of give a -- it gives like an impression of the American approach to any sort of infectious disease. And the idea, like the way that initially -- this has initially been covered is like, this is an oopsie. This is like a hiccup. You know, it's like, whoops, like things --
Abby Cartus 7:40
“A bumpy rollout.” Obstacles are just arising somehow!
Phil Rocco 7:43
“A bumpy rollout.” Now the funny thing --
Abby Cartus 7:45
Being encountered.
Phil Rocco 7:46
The funny thing about that is like, since roughly 2000, the National Academies of Medicine have had a report out there, that just describes in gory detail, and there have been some amendments since, the absolute just disaster that our system of vaccine purchasing is in the United States, and how it works, and the fact that it's just this patchwork of state and federal purchasing programs that go to different populations. And you even have, for years before Maine developed its universal vaccine purchase program, you would have to have different stores -- different supplies of vaccine for commercially insured children, and non commercially insured children.
Artie Vierkant 8:35
Oh my god.
Phil Rocco 8:36
Which just gives you a sense of like, you know, the fact that --
Artie Vierkant 8:39
That does demonstrate our priorities right there, yeah.
Phil Rocco 8:41
Well, right. And the thing is like this, the whole rigmarole of just in time purchasing, which just doesn't make sense at all when you're trying to get vaccines out during, I don't know, a pandemic, has been well-known for years, and we can get into more of how it works, if the spirit moves us. But during the first few years of the pandemic, there was like at least some recognition that that was not going to work. And there were two big changes. One was that you actually had a kind of comprehensive federal purchasing of these vaccines. And then there was a second component of that, which is that while the public health emergency was in effect, you had a requirement that insurers, private insurers cover vaccine, even if, for example, it was like out of network. So you basically just had this -- all of the things that make it make no sense for me to go get a vaccine at Walgreens, which is like, you know, a few blocks from where I work or a few blocks from where I live or any number of places versus like scheduling an appointment, like going in and like having my physician assistant tell me that they don't have any vaccines. That was -- essentially that structure was in advance and now we are back to your regularly scheduled programming. So this isn't like "a bumpy rollout." This isn't a hiccup. This is going back to exactly the way that we did vaccine purchasing prior to, you know, 2020.
Abby Cartus 10:13
Yeah, well, this is how the system is designed to work. Like to grind to a halt because there aren't billing codes, you know, that can be input.
Artie Vierkant 10:22
Right, exactly. And I mean, just to say too, and because this is how the regular system works, first of all, this is why we've been warning about COVID commercialization from the jump, from the moment they started talking about it, we've been talking about this whenever we have the opportunity to, right, particularly because the only intervention that the federal government seems to be, or seems to have been interested in at all, particularly since Joe Biden took office, like the only pandemic intervention the federal government would undertake is vaccines and like Paxlovid or something, and because, even though like the -- even though we have seen, like the booster that came out in 2022, fall 2022, right, only reached like, what, 17%, 18% of the entire population in total. And they've just like progressed apace, or whatever, we marched directly into this situation anyway, which again, was predictable. For all the things that the federal government could say about -- I can't, I literally can't count the amount of times they said, don't worry, it's going to be a smooth transition. We're working with all of our partners to ensure a smooth transition to the private market, etc. This is obviously --
Abby Cartus 11:35
It will be free for most Americans.
Artie Vierkant 11:36
Right. This was obviously what was going to happen all along. Like anyone who pays any attention to the actual -- to the political economy of health in this country at all could -- and more generally, could have told you that this is how it's going to work. And so this is kind of the problem. There's I mean, a couple of things. One is that, first of all, if you're -- if this is the only intervention you're willing to do as a federal government, it's pretty fucking disastrous for this to be what is happening, because if -- I mean, if the last one where it went relatively smoothly, because it was still free for everybody, last fall, only reached 17% of people, I fucking shudder to think how few people this is going to reach, right. And we're left with stuff with like literally the official statement of HHS, which I was going to read from New York Times, but since then, I've seen that they've given this exact statement to multiple outlets since this was first published. But literally quoting from the New York Times, "Department of Health and Human Services, HHS, says, 'Our message is simple. If you are being turned away for no coverage [no health insurance coverage], please call your insurance provider for details about in network coverage to receive an updated COVID-19 vaccine.'" Like the federal government is saying, go call your insurance company. So Phil is doing -- as we're talking about, like Phil is doing the thing that the state is telling him to do [laughing] even. And obviously, that's not going to resolve it. But that is literally the -- that's like all they have. If you look at the -- like Mandy Cohen put out like a short Twitter video last week, where she said, if you're having a problem finding the vaccine, stick with it. I mean, their solution is like --
Phil Rocco 13:21
If you're in line, stay in line [laughing].
Artie Vierkant 13:22
Is like if you're in line, stay in line.
Abby Cartus 13:24
If you're in line, stay in line. Yeah. [laughing]
Artie Vierkant 13:26
Which is like, I mean, that is the Democrat's solution to everything. But you know, again, yeah. Little to say other than this is how -- this is always how it was going to be.
Abby Cartus 13:35
Oh, totally. I mean, I just want to underscore this point that this is going to fuck up, like, quote --- I mean, I hate the way that they use the term "access." But like just to underscore your point, Artie, that like there's no way that this doesn't like once again, harm and limit vaccine uptake. And at the same time, Javier Becerra is like in the news, saying that if you die of COVID, it's because you didn't take precautions and that like, we're working with everyone to get this figured out as soon as possible. And it's just like, the narrative that's placing all this blame on Republicans and vaccine hesitancy and vaccine refusal. I mean, it has always been stretched a little bit too thin by this administration, I think, but I don't know. It's gonna be -- it's gonna be hellish. So I don't know what's gonna happen with this, but there's no way that it doesn't play out as like piss poor uptake. Anyway, I'm sorry, Phil.
Phil Rocco 14:26
Well, I mean, I think Pfizer, Pfizer projected uptake at maybe 24%. I think that's a little -- that seems a little optimistic actually, but it's -- again, one of the other changes is that like the data infrastructure for monitoring uptake has also gone away [laughing]. And so, but I think part of the issue, right, is that there's all of these opportunities for like misdirecting the conversation. So like one thing that I hear is that, well, why -- you know, you're complaining and yet the policy that the ACA put in place is that your insurer has to cover -- it has to cover the vaccine. And it's like, sure, it has to cover the in network provision of the vaccine. But part of the -- this is why the problem is the result of an interaction. It's not just the vaccine coverage policies, right. It's the fact that the federal government is no longer the senior fiscal agent in the purchase, the mass purchase of vaccines. So now, essentially, you have the federal government, HHS, like writing letters to manufacturers, to providers, to insurers, saying, like, please coordinate, you know, make sure that like this is all going to work. Rather than, you know, using the federal government's purchasing power --
Abby Cartus 15:51
[Laughing] Damn, if only someone had the power to make them --
Phil Rocco 15:53
Right. And this is the thing, is that when people talk about what's wrong with commercialization, and Bea and Artie, you guys were on this, you know, way back when --
Abby Cartus 16:05
Way before anyone else.
Phil Rocco 16:06
Before anybody else, but the -- you know, the issue is not just that this is a way for Pfizer to jack up the cost of vaccine, that's not just it. The point is that like -- and again, this isn't me talking, this is like the National Academy of Medicine writing in like 2000, right, is that, like, the problem with vaccines is that it is because of the nature of what vaccines are, how they have to be stored, and the importance of getting them out to as many people as possible, that vaccine provision just simply does not align with the insurance financing infrastructure that we have in the United States. And that as long as you have this patchwork of purchasers and providers trying to get the vaccine, and there's no coordination on that, and there's no coordination between that and financing, that you're going to have a really, really tough time getting shots in arms, as they used to say, in the early first two years of the pandemic. And I think that that is sort of what's being missed, is that like there is a sense in which it's not just important that vaccines be a public good, that is important, and that they sort of be removed from, among other things that should be a public good, like the rest of health care provision. But it's that like you actually need a certain level of central planning to get them out effectively. And central planning is like -- that's where the role of the state as a coordinative force in society, because of its purchasing power, can work best. And reading these letters from HHS, which basically amount to like, pretty please coordinate, it's like that is not how coordination happens. So I'm sure that -- I'm sure that the way that, you know, even senior executive officials see this is like, yes, we're busting our ass to try to make this not a failure. But the point is, you've set yourself up for failure, or you've been set up for failure, when that central role as purchaser has been taken away from you. And I think, to me, what's sort of interesting is like, where has the Biden administration been on attempting to restore that? I think that most of its -- the focus, policy wise, has been trying to continue these sort of gap filling programs, so like vaccine for children and vaccine for adults, are these programs that are essentially like, you know, if you don't have access to some other form of financing for the vaccine, these are purchasing programs that are supposed to purchase it for you. But that -- maintaining that structure is exactly the problem. And we've seen this, you know, again, this is why 14 states have already moved to like a universal purchase program, because this like patchwork of purchasing programs simply does not work at doing the job that public health agencies think is important here.
Abby Cartus 19:17
Yeah, well, and I really like the way that you're putting this and just to put it in like public health perspective, because like, I don't know, I appreciate how you're describing how this is playing out institutionally. And just to bring back the programmatic public health aspect of it, I guess, this like fragmentation of the so-called "access" landscape is very, very dissipative. And I just want to like underscore that, like people who want to get the vaccine, with every step, you know what I mean, like with every additional step or difficulty, some people who were going to get the vaccine are not going to get it. And that is just like a totally predictable consequence of this fragmentation, even though the outcomes of the fragmentation of this access landscape, I think, are a little bit different, like in different places. You know, there are some like different reasons underpinning why people are running into issues getting this, but like, I just -- I feel like it can't be driven home enough that like every -- every thing that makes it harder or more difficult, or every time you're telling people who are showing up that they have to come back, there's going to be like attrition. You're going to lose people. And that's like -- that's a fucking disaster for a public health program. Anyway, that's all I have to say.
Beatrice Adler-Bolton 20:31
Well, we don't [sighs] -- this is, this is the problem with spending all of our energy and analysis on teasing out and chasing the question of how to deal with the fact that people may quote unquote, like, purchase inappropriate amounts of health care, right? Like, I'm thinking back, you know, when we were talking about the --
Artie Vierkant 20:58
For what reason are you getting the COVID vaccine, etc.
Abby Cartus 21:01
Thinking about Vinay Prasad a lot. Yeah.
Beatrice Adler-Bolton 21:03
Right. You know, to what you said, Phil, the sort of initiation of that encounter that you had, with the sort of, why are you getting the vaccine, right? I mean, just thinking too, you know, the kind of conversations we were having earlier, in January, even last year, in 2021, I went back into my notes, and it's really kind of staggering how often we're revisiting this topic, right. And a lot of the times that we've talked about it, we've talked about it in terms of cost sharing, and we've often referenced like this very important study, that's considered a kind of gold standard study on cost sharing, which is like the RAND health insurance experiment. And what that experiment sort of tells us is, is very complicated, right, but we've been returning to it because of the idea of cost sharing, and how cost sharing was going to factor into commercialization, right, because part of what's going on is cost sharing literally, in terms of like what the person is paying, their literal skin in the game, which is thought to like make people more invested in healthcare and make them more cognizant of using too much healthcare, avoiding the kind of, you know, balance of moral hazard, right, like the whole idea of well, you can't really fix a body once you ruin it, so don't make healthcare too easy to get, because people will think they can just ruin their bodies and get fixed for free. Like, that kind of mindset has been a singular policy obsession for so long. And I think it's detrimental to spend so much fucking time thinking about this shit, right? Like the the kind of only way that people know how to understand health finance and health reform, right, has sort of been like, well, how do we make markets around this? How do we find the right market? How do we tweak things and make things an equitable access landscape? It's never about actually like, how do we make sure that people are vaccinated with the vaccine we just approved? It's about asking the wrong question. It's about looking at things for decades and prioritizing things for decades in the American political economy of health that are so beside the fucking point of the reproduction of life, of like survival, of what care actually means, and have everything to do with like, how do we sort of turn this into something that's profitable, right? And it's not that like the profit is the point. It's the fact that these perspectives that we're talking about and we're talking about like these consequences of like, okay, you impose cost sharing, you impose administrative burdens, you impose any sort of burden on accessing the vaccine, whether that's $1 of cost sharing, or that's like an extra two steps in a phone system or on a website or having to call back or come at a later date or reschedule. This reduces uptake. This reduces actual follow through on vaccination, study after study after study fucking reproduces it, right? Like, which just gets to the point that it's not about -- like the studies aren't about proving that we need to do one thing or another. It's this thing that Phil, you wrote about years ago in your policy craft essay of like, analysis that's frequently a cause of inertia, right? Like, these are the kinds of forces that we're up against, and to people in the Biden administration who are saying, oh, well just call your insurer, their position in the administration as a policymaker is so bought up into this, that the things that are really obvious to us are absolutely not obvious to them, because they have not conceptualized healthcare in terms of provisioning, planning or access once probably in their entire fucking careers. You know, think about Rochelle Walensky, a fucking policy framework that she proposed and thought about for years and years and years was like how to reduce costs with AIDS drugs that the US was shipping out. This is a kind of like mindset that whether it's Mandy Cohen thinking about work requirements, whether it's sort of just the politics of healthcare that people like Becerra came up in, it doesn't matter who the figures are, it doesn't matter if we replace the people in these positions. The fact of the matter is, this system is literally just designed to produce thought and analysis towards reducing access to care and calling it like access equity. And when that hits a pandemic, like COVID, which they haven't risen to the occasion and been able to conceptualize properly for years at this point, like what we're seeing is absolutely predictable. But to them, their perspective is so skewed away from like delivering care and what people having care means, right? Because this access mirage has just stood in for that for so fucking long that like, how could they even fucking think about what it means to actually get people vaccinated, right?
Beatrice Adler-Bolton 21:04
Well, all these officials were crowing this weekend after they had gotten their -- you know, like, I think Javier Becerra, I think Joe Biden got like their COVID shots at a Walgreens. And were like, no, no, no, no, no, this should not be happening. You know, like, we're hitting bumps in the road and like you need to advocate for yourself and call your insurer. And it's just such a great illustration of what you're saying, it's like, you are not living in the world that you're making at all, like you have no idea [laughing].
Beatrice Adler-Bolton 26:21
Right. And Phil, you made that point, you know, in the original context, you made that point. You were talking about how like there are study after study after study that say like releasing price transparency around healthcare does nothing to increase utilization, or give people actual care. And yet, we see this continually targeted as a kind of space for health reform, as a way to achieve "equity," you know, and what we can see is that exact same dynamic playing out in the commercialization, we see this reverberating all across the political economy of health. And that's partially because it's entirely structured away from people getting the care that they actually need.
Artie Vierkant 26:58
Right. And so I mean, I think, importantly, that's why I think that for all of this, because even -- you know, obviously, we can be very upset about this very obvious kind of big event where we're seeing, really for the first time, what the commercialization of COVID vaccines and therapeutics looks like at a mass scale, right? We're like really seeing the impact of that. And on one hand, it's difficult because, as always, it's only one part of the picture, because the vaccines were never the silver bullet that was going to like end the thing, or whatever.
Beatrice Adler-Bolton 27:31
Exactly, yeah.
Artie Vierkant 27:32
But on the other hand, I think it's really important still to look at the specifics of what's going on, as we're kind of trying to do, in part because I think this is the apex of the Biden administration's successful push to kind of fragment where the blame is going and absolve themselves of being to blame for any of this. I mean, I see -- like, I see this HHS statement, like, you know, contact your insurer, because you should have -- they should cover the vaccine for you, so just call your insurance company and memorize the phone tree, I guess, or whatever. Hope that you can get access to something that as Phil was saying, just might not exist in the area right now, in part because private entities are ordering probably as few -- like ordering the vaccine in as small amounts as possible, because now they're more on the hook for actually paying for the stock that they're holding, or that might get destroyed, etc. I digress. My point is, if you look at this as sort of the latest and possibly apex of this blame avoidance scheme, or this fragmentation -- this sort of fragmentation of like the ability for people to even see a definitive site of struggle, with regards to COVID, which used to be, and in many ways remains, the federal government. But the federal government has done such a good job at sort of dispersing the blame. If you think about the kind of trajectory of this, in like 2021, it was very established that it was a sort of like hearts and minds thing. I don't see anything that the "pandemic of the unvaccinated" line was, other than sort of an attempt to say, like, look, you know, pandemic's over for you, if you're vaccinated. If you're not, then you probably fell prey to some misinformation or something. They were talking about the "disinformation dozen" at the time, etc., etc. It was this very, like, as we've talked about before, COVID is a problem of other people, but also, you know, COVID is a problem of the people sort of framework. Then by 2022, when it was clear that the pandemic was still ongoing, who gets the blame then but all of a sudden, there's this huge shift to well, Congress won't fund it. And you know, we're trying so hard, but it's Congress or whatever. And so I think ultimately, it just -- it makes sense to look at this full trajectory, which I'm not necessarily summarizing every element of here, but I mean, there is I think a very clear trajectory from it's a problem of the people, or only a problem for a specific subset of individuals to, you know, okay, you say it's still a problem, well, then it's not us, the Biden administration, who's at fault, it's Congress because they won't continue to fund it. And trust us, we're doing everything in our power, even as we, at the same time, out of one side of our face, we're saying that we're doing so much to convince Congress to find the continued coverage response and out of the other side of our face, we're like doing everything that we can to undo COVID guidance, and we're dismantling testing and all this and that, and we're kind of -- we're doing things up to and including saying off the cuff, the pandemic is over, by the fall 2022, right? And now, by 2023, it's like, oh, you got a problem with this, call your insurance company, I don't know.
Phil Rocco 30:45
Well, I think the -- when we're thinking about the, why doesn't the solution appear clearly. I mean, you're right, in the sense that part of the issue is that thinking about this in terms of just like costs is -- you're going to be unable to see the just value of having a very easy ability to get a high level of vaccination very quickly, because you're only conceptualizing costs in this very narrow way, on the front end. I always think about this study this consulting firm did for the state of Maine after it put its universal purchase program for vaccines into place. And like they go and talk to all of these providers, and they're like, you know, what is the -- can you put like a dollar value on what this universal purchase program has meant for you. It's like, nobody can, but it's like, but also the response from all the providers is like, well, this is self evident why this is better. Like, we don't actually need to cost it all out for you. It's self evident that it's better. And it's also, you know, you don't have to be like a high paid management consultant to see this. If you go to -- and I'm not, you know, it's like by no means a perfect healthcare system, but simply go to the Government of Canada's website today, and look at how, do I get a vaccine in Canada. And it's like, here are the provinces and territories. Here are each of their websites where you can sign up for an appointment. Like this is -- I mean, it is basically that sort of coordinated, and that's not -- you know, it's obviously not singular. What the singular thing is the United States' approach, which is, you know, call your insurer and like pray, I guess. Or, to be generous to their argument, which is that, oh, you know, the ACA requires your insurer to cover these basic preventative health things. It's like, okay, well, then I guess I'm just gonna wait --
Artie Vierkant 32:44
Asterisk, unless it's out of network.
Phil Rocco 32:45
Unless it's out of network, right? And it's like, well, okay, I guess I'm just going to wait to get my vaccine, or if I don't have the time, or it's too complicated, like, I'm not going to get it. So you have just deliberately, you have deliberately raised the bar. And you've done it, why, right? Well, obviously, like Pfizer, you might think like, why does Pfizer want this to happen? You know, why, why -- like, isn't having a giant federal purchase program a cash cow for them? Actually, I think the money for them is better, even if you're buying, even if the purchasing is like at a fraction of what the federal government was purchasing, because they've been able to switch over to the commercial price -
Artie Vierkant 32:46
Yeah, more per unit.
Phil Rocco 33:32
Per unit, they're actually making more from having fewer doses. Like I mean, it's -- there's a cruel kind of economic logic, I think, for Pfizer here. But I think the bigger issue is that you have a bunch of people thinking about this, and giving advice on this, who are not, in a way, part of any kind of bigger political program on it, right? They're just like, how do I give the advice that is going to allow me to advance in my professional career as a policy advisor. Well, I guess the thing that would allow me to do that is giving advice that is most likely to be able to be implemented, that you're going -- that it's going to be implemented quickly, and that the Biden administration will look good and be able to deflect blame. I mean, that's how you advance. You don't advance by, I don't know, announcing anything like, oh, what we actually need is a universal purchase program for this that exists in perpetuity, because that's going to look just absurd to people who have the sort of political responsibility for this. So like that --
Artie Vierkant 34:45
Because that's not the type of stuff that Biden world does. That's the stuff that gets you kicked out of Biden world.
Phil Rocco 34:49
Well, right, because it's like, well, we've got a Republican Congress and you know. But like to not even say that that should be the administration's starting position or their argument, like at this point -- so I was looking at their policy statements, the Office of Management and Budget's statements of administration policy, which they have to release every time a major bill goes through Congress and is probably going to come up for a vote. And like in the last year, you can't find those statements of administration policy talking explicitly about like, we think a vaccine provision should be added here. And to the extent that they have been in their budget, which is the other document that I looked at, talked about a vaccine program, it continues to be these more or less means tested purchasing programs, you know, Vaccine for Adults, VFA, which is supposed to model the VFC, Vaccines for Children program, which has been around for a long time, and enhancing purchasing under those things. It's like, that is part of the problem, right? If you want to know why people are not getting shots as quickly as they can, it's because you fucked up not only at the insurance side, but the purchasing side, too.
Abby Cartus 36:03
Such a good point.
Artie Vierkant 36:04
And if I may introduce a sort of extra perverse part of this, because as you're saying, Phil, I think if I understand you correctly, it's like, at the very least, you could have, as we've said for a long time, you could have been just like very openly advocating for like, no, this needs to be, like this needs -- this part of it, If we are going to -- if the bargain is vaccine, ergo back to normal, right, then this part of it needs to be funded in perpetuity, right? You could have been arguing that all along as the Biden administration, right? Like not even doing any of the bigger things, like obviously, there are big systemic changes, including like we talk about the -- you know, if we're gonna talk about where Pfizer and Moderna is in all of this, for example, like I don't think it's a shocker to anyone that our answer as the Death Panel or whatever, or at least mine personally, is fucking seize pharma, right? This is like a public good, these should be put to use for public purposes, all these things, all this intellectual property that they have dominion over internationally, etc. But if you're just -- if you're the Biden administration, right, there's such a clear cut reason to actually really pursue this goal of continuing to have the vaccines and therapeutics being free. And the reason that I say this is in part because I found this thing that I just want to bring us back to, we can kind of like imagine turning back time right now to April 2022. In March, like March 2nd, 2022, is just for context, so you get the sort of lay of the land. March 2nd, 2022, it's like Jeff Zients is about to leave the White House, they do the pandemic -- they haven't yet introduced community levels. They've got the pandemic preparedness plan update to that document, the 2022, March 2022 update to the pandemic preparedness plan. That is still the current plan, by the way, it hasn't been updated since then. But so that plan document is released. And that contains some of the first public hint that the administration was going to "explore public and private insurer coverage of COVID-19 treatments this year." Shortly after, we started talking about this on the show. So that's March, right? April 1st, 2022, and this was not -- I guarantee you, this was not an April Fool's joke. April 1st, 2022, who else but the Brookings Institution, even, posts a paper titled, The Economic Case for Federal Investment in COVID-19 Vaccines and Therapeutics Remains Strong. I'm just gonna quote from this because I think it is highly, I'm gonna say ironic, I don't think it's ironic. It is maybe distressing. I'm not sure. I don't have a word for it exactly. Interesting, at the least, to see the Biden administration being to the right of even Brookings on this. So this Brookings Institution paper says, "While the health and economic costs of the pandemic appear to be receding, sustaining this progress will depend on the continued broad availability of safe and effective vaccines and therapeutics." I'm gonna note again, you know, this is -- the vaccine only strategy was always wrong. But I just want to note that what we're talking about here is like in classic Brookings fashion, this was the original bargain, right, the federal government throws funds at the tools, "the tools," toward the goal of economic recovery specifically. They continue, "We argue that there is a strong economic case for continued federal investment in COVID-19 vaccines and therapeutics. In brief, the private sector on its own will invest too little because COVID-19 vaccines and therapeutics generate enormous benefits for public health and the macro economy, that private firms can only very partially capture. Pre-existing uninsurance and under insurance, especially among vulnerable populations, will also hinder access to preventive measures and treatment. Direct federal investment in development, manufacturing, and procurement of vaccines and therapeutics and in ensuring affordable access to these products has been key to overcoming these challenges to date, and will remain important in the future. Over the long term, policymakers could consider assigning the health insurance system a larger role in paying for these activities, but doing so in a sensible way will take time and require legislative changes." So very straightforwardly, you know, this is a pretty conservative think tank saying explicitly, in order for this bargain to work, right, in order for this idea to continue to work, that like vaccine ergo economic recovery ergo everything is open and we can pretend it's all fine, in order for this to continue to work, it needs to remain widely free and accessible. That the government has to have -- that the government has to retain its purchasing role, right. And I just think it's -- I just think it's fascinating to look at that, because this is the kind of thing where I think it can be easy to say -- you know, we joked, for instance, that like, you know, us talking about this so forever ago was like us doing our Cassandra thing or whatever, right, and like calling the shot early that this was going to be a disaster, right. But it wasn't just us, like the people at Brookings, right, even them were like, this is a disaster. You shouldn't do -- like you shouldn't do it this way. Or you should -- you need to at least -- you can maybe eventually figure out how to do it, but it will take time and a lot of effort. And clearly that time and effort -- well, and I mean, I should say also, again, obviously, that's their imperative, because their whole focus is on the economic recovery part. Ours is on more like the lives and health of everybody.
Beatrice Adler-Bolton 41:54
You know, it's interesting, in Mourning Group this weekend, folks asked me, like, how does it feel to be right all the time about all this terrible stuff?
Abby Cartus 42:03
[sighs] Oh boy.
Artie Vierkant 42:04
Yeah.
Beatrice Adler-Bolton 42:05
And I was like, good question. Feels really bad, but in a way I wouldn't have been able to expect before experiencing it. But it's like, I just kind of find myself in this position now where I'm looking at the work we've done over the past couple of years, and I am like very, very sort of impressed with what you can have in terms of a discussion when you move away from questions like the pay for, when you move away from questions like, do people deserve care or not, right? There are a whole series of problems that we refuse to acknowledge or look at or tackle, when we talk about healthcare as a country, right, or as a society. And part of what I think we're doing is not calling the shots or being right, but just stating the fucking obvious, right? At the moment that we're at, knowing what we all know at the time, there is a way walking into this pandemic, there has been knowledge reproduced since the '70s, that once this pandemic response became tied to a vaccine only response and once that vaccine hit the US private insurance landscape, which our good friend Bill Bronston calls a "medical wealth transfer system," that it's going to be a fucking disaster. And lo and behold, we are seeing that even people who are health policy researchers, who are pharmacists themselves --
Artie Vierkant 43:37
People that I got in arguments with over this being an issue or not, people who assured me that it was going to be fine for people who are insured, who themselves having their insurance deny their booster shot.
Beatrice Adler-Bolton 43:52
Mhm. And the thing that I think's like always interesting about kind of the way that that's tied up often in terms of like predicting the future or the mythology of Cassandra, right, who's like the Trojan Princess, cursed by Apollo to predict the future and never be believed, is that Cassandra's actually the other side of probably what is like the most popular meme of contemporary reference to Greek culture or whatever, which is like the Trojan horse, right? Cassandra is the one saying don't let the Trojan horse into the city. Like don't let those Greeks in, and so the fucking thing that's frustrating is like when you see people be like, oh, you know, like, how does it feel to feel like Cassandra, I'm like, well, I kind of don't because it's -- [sighs] it's not that we're predicting the future, right? Like it's not that we know --
Abby Cartus 44:43
Yeah. It's not divination. It's theorizing.
Beatrice Adler-Bolton 44:45
Right. We're not aware that there is someone inside the Trojan horse, right? Like we are simply just saying, every other time we let a horse in the gate, it was a problem. Can we not do it again this time, right? Like it's a different kind of -- it's not predicting the future, it's not being an oracle, it's not seeing far in advance. It is fucking responding to and living through our political economy of health and trying to see it for what it is, which is very difficult, right? And requires an ongoing practice to actually train your eye and mind and thoughts and desires for healthcare and what a political horizon could be away from all of these constraints that occupy so much of this space so often.
Abby Cartus 45:31
This is why to me, I mean, I keep harping on this, but I think it's really fucking important. Like, it's important to theorize about what the fuck is going on here. Because otherwise, you know what I mean, you just get the received -- the received wisdom of the public health and like health policy communities, which is a dead end. I don't know, I'm responding to you saying this, because I've had a very similar experience, like over the past couple of years. And there's not really anything super special about -- you know, like I don't like it when people treat me as if I'm clairvoyant or something, because I'm not. Like I'm just a Marxist, you know what I mean, who's been like trying to build my own little Marxist analysis, you know, like that's how I understand the world and that's how I think about how things are gonna play out. And it tends to be pretty right, but like -- you know, what I mean, that's because there's like -- there's theoretical work going on to try to understand what some of these things actually are. And I think this show really excels at that.
Artie Vierkant 46:37
And in reality, a lot of it is responsive. I mean, like plans come out, we talk about the plans that are being put in place, or we talk about what is happening. And we basically just try to point out what are going to be some pretty obvious problems with whatever that plan is, right? And I think though, aside from this though, to the actual -- I actually think the actual question is interesting.
Beatrice Adler-Bolton 47:02
It is, yeah.
Artie Vierkant 47:03
And the answer is like, it feels fucking bad.
Beatrice Adler-Bolton 47:04
Really fucking bad.
Artie Vierkant 47:06
It feels really bad and like --
Beatrice Adler-Bolton 47:09
But it doesn't feel like predicting the future.
Phil Rocco 47:11
It also feels confusing to me. I mean, like --
Abby Cartus 47:13
Yeah, it's disorienting.
Phil Rocco 47:15
To prepare for this episode, let me give you the behind the scenes. Okay. I read, you know, I read the Biden administration, sort of went back and looked at the sort of plans for commercialization. I looked at what they were asking Congress to do, what they weren't asking Congress to do. I looked at some reporting on what has happened with commercialization thus far. I looked at a couple examples of what states are trying to do to respond to this. And I also looked at some studies by the main kind of chartered organizations that the federal government relies on for high level advice about things like the vaccination system. And again, published in 2000, I read, you know, here are some findings from the National Academy of Medicine panel on vaccines. "Finding 3.1. While most private health plans provide some form of immunization coverage, this coverage varies by type of plan, as well as by vaccine. Enrollment in a private plan does not guarantee that immunizations will be provided as a plan benefit." Not really any sort of amazing finding there. Here's another one. "Finding 3.5. Complex eligibility criteria and coverage conditions for the multiple federal and state programs supporting vaccine purchase and delivery have left gaps and omissions in the financial coverage of immunizations for children and adults." I mean, and this is, again, written in 2000. A lot has changed policy wise, but the basic architecture of those statements remains at least at some level, true. I mean, and so there's no prediction involved there. It is merely observation about the static state. And to say like, yes, it was temporarily on pause, and now we have returned to, you know, V 1.0 or whatever, you know. So, yeah.
Artie Vierkant 49:14
Yeah. It's like, if anything, we don't understand how the state operates when it's actually taking this stuff seriously, because we've seen so vanishingly little of that, right? And now we are -- I mean, I think it's interesting to consider -- I again do think it's interesting to consider kinda what flavor of bad it feels. Because to me, I'm like, I think what conversations like this always kind of remind me of, or when people like ask something like was asked of you in Mourning Group, Bea, it always makes me think of like, it's the same bad feeling that I remember really distinctly from 2021, which is -- I'm gonna try and tell a little story here, I guess. So in 2021, I feel like especially the first half of that year, but really, that year as a whole was, I think to me, at least politically, the most kind of disheartening point, not only because of seeing, I think how many people sort of disengaged entirely about COVID when the Biden administration came in, but also because I think of some of the conversations that we would have with people who were like fellow travelers or people we respect a lot, who -- many of which I would say have since come around completely. But who legitimately, I think, were like eyeing our work, for example, as the Death Panel, over the course of that year, with this kind of suspicion of like, these fucking people think that the pandemic is going to continue to drag on, into a second year or even longer, like are you out of your fucking mind. And I'm just paraphrasing, basically, that was the sentiment, right? Or being like, or assuming that we're just like bleeding hearts or something, like trying to win the oppression Olympics, right, by being like still caring about COVID, or something. That was the sentiment that -- that was like a vibe that we absorbed a lot of in 2021, that was like directed at us, and that's fine, whatever. Like, I'm sure that a lot of listeners are very familiar with that feeling being directed at them, because that shit still happens, right? But anyway, but my point is, like, in 2021, the feeling it always reminds me of is in 2021, we're like sitting here being like, the pandemic is clearly not over. The vaccine only strategy doesn't appear to be something that is going to work. We are concerned because even though the sort of social reproduction that's happening, broadly speaking right now is like, you know, everything I'm hearing is 95% efficacy this, miracle of science that, etc. And, you know, obviously, I think part of our reservation with whether it was in fact true that the vaccines were gonna have what's called, for instance, like sterilizing immunity or -- which is like this broad, kind of over vague idea actually for basically halting transmission of the thing that's being vaccinated for in question, right. Part of our skepticism was like, you know, I think a lot of people, culturally speaking, just the vast majority of people, including people in power, were not really prepared to think about what it would mean for a thing that you can get vaccinated for to remain a health threat, right? I mean, just culturally, like before the pandemic, it was like, especially within -- specifically, I'm talking about like a United States context, but I imagine the same holds true in some other contexts as well. You know, I think before COVID, a lot of people in the US live their lives thinking that fundamentally anything they were vaccinated for was something they didn't really have to worry about, right? And now I think we can understand a little better that it's -- sort of like a better analogy, specifically for COVID, which I know that a lot of people have beaten this analogy into the ground, but like, we've made similar jokes a long time ago, like the reality of COVID is a little bit more like, you know, just because antibiotics exist doesn't mean that we don't need sewage or plumbing, right? Anyway, my point is, all of this is to say that I think from the moment that Biden came into office, that feeling of like the very persuasive pull of the overriding sentiment being like, it's going to be fine. This is almost over, or whatever, which obviously is kind of the -- like being aware of that pull existing is, in some ways, the thing that feels the worst, I actually think. But like the kind of -- if I encapsulate like the feeling, that feeling of 2021 and the weirdness of when a lot of people came back around and were like, oh fuck, it's true that it isn't over. You're right, shit, I'm so angry. And the weirdness and the uncomfortability of like the shame that people felt even of being like I can't believe I didn't take this seriously, and all this stuff, and having to deal with it. I just like -- maybe the story has gone over long now. But I feel like, to me, that's the feeling. It's like that same feeling that I feel like I've had since 2021, over and over and over again, of just like you're sitting there wanting to be wrong or something.
Abby Cartus 54:34
Yeah.
Beatrice Adler-Bolton 54:34
So bad. So fucking bad.
Artie Vierkant 54:34
You want so desperately for it to just be fucking over. You know, even now, we see like the stuff that's currently being built out or whatever, or the promises that are being made, or not being made, or the lack of discussion in general, or the fact that Biden's entire plan by some reports for like the 2024 election cycle, by note to no one's surprise, is to like be talking about his post-pandemic America or whatever, right? I mean, yeah, I don't know. It's like, it's just a -- it's a perpetual feels bad.
Beatrice Adler-Bolton 55:10
Right, right. No. And I think the thing that I just want to make clear too is that I -- it's not that I didn't appreciate the question in reading group. I actually really did. I don't appreciate when people online say like, how come Death Panel is always predicting the future, because that also frames it as if it's coming from us and not fucking thousands of us, right? Like, we couldn't do any of this fucking work if we weren't connected --
Artie Vierkant 55:32
Everyone makes this together, yeah.
Beatrice Adler-Bolton 55:33
To the thousands of you who are participants in this fucking project, right? Like, this isn't a kind of thing that's coming from any one place. But the thing that's really difficult, right, is that I think this is where this question actually led us in Mourning Group was into a discussion of the experience of being shunned and living through that.
Abby Cartus 55:55
Yeah.
Beatrice Adler-Bolton 55:55
And making decisions about sort of how you're going to deal with that, and what responsibility you're going to feel for that, and what you're going to sort of decide to do with living through that, right, which is really kind of difficult, and one of the things that I think a lot of us are dealing with now. And I really appreciate, Artie, you laying out the story from 2021, because that was a moment where, yeah, we had been shunned pretty hard, you know? And when sort of folks were like, oh, we're so sorry for thinking you were crazy for the last year and like avoiding you online even, and just being really quiet. Like, I just kept wishing you'd be wrong. And I was like, yeah, man me fucking too.
Abby Cartus 56:40
I get it. I fucking get it.
Beatrice Adler-Bolton 56:41
But I felt relief actually. I didn't feel resentment. I felt relief that people had taken a second to reconsider -- not like to come back to me, because it's not -- that's not what's going on here, right? Like, I'm not here to convince the world that COVID is a problem. I'm trying to be convincing when I talk about COVID being a problem, right? Like, I was glad to see that they had stopped and reconsidered some of the things that they were holding as assumptions, right, which is that the vaccine only strategy was gonna work, and that everybody's immune system is exactly the fucking same, right? And these were just things that we were saying were really open fucking questions, right? And I know that right now, there's like a lot of fucking grief and despair and frustration and failure that people feel. Like one thing I get asked all the time from folks is like, well, how did you convince the people in your life to take it seriously? How did you get it to work, right? And I always try and emphasize that like I really didn't. Long story short is that I have not succeeded in these things that we're all still fucking dealing with. Like, we're not in any position where -- unfortunately, where we are Cassandra, where we can see the fucking future, but what we can do right now actually is rather than like worrying about if we're gonna give those people grace who are coming back into the fold, who might be looking at COVID continuing for several years now and go, okay, well, maybe somebody had a point. Like, we don't need to worry about giving those people grace, we have to give ourselves grace for not having convinced everyone yet of the way we see things, which the pressure on that is really heavy, because we want to save each other, and we know that no one is coming to save us, right? And that's something that thousands of us share.
Artie Vierkant 58:32
Yeah. Which can be like shame all around, easily, if it's not -- yeah.
Beatrice Adler-Bolton 58:34
Yeah, yeah. So we have to forgive ourselves first, for not having accomplished the impossible, because like what we've talked about today is everything we're up against, right, which is decades of the way that health works. And this is a tremendous challenge that thousands of us have been engaged in struggle with, or in struggle against together. And that's really hard. But we have like a long way to go. So we have to worry less about what we're gonna think about people coming back into the fold. Worry more about how do we sustain what we're doing long-term, because we all know that COVID is unfortunately being perpetuated by these decisions, these policy choices that we talk about, you know, week in, week out now for years. Like we have always wanted the pandemic to end. It's not like that fucking guy Benjamin Ryan's been complaining about, that like people are goading and bragging that like COVID is a problem again. Like every single person who cares about COVID is fucking devastated and furious that like 1,200 kids were in the hospital last week.
Artie Vierkant 59:47
Which is the space that when people do say, look, I told you, it's still a fucking problem, that is where they're coming from, that they don't want it to be a fucking problem.
Beatrice Adler-Bolton 59:56
And it feels bad to be right. Yeah.
Phil Rocco 59:59
But I think the bigger conclusion that at least I come to from that experience is it doesn't matter. Being right, really, in a profound way doesn't matter.
Abby Cartus 1:00:12
Doesn't make any fucking difference.
Phil Rocco 1:00:13
No. And it's obviously, you know, there are plenty of people I would -- that I have encountered who've worked kind of in this area, in government, outside of government, it's like, yeah, there are plenty of people who they understand what's going on, they were right about things, they were right about the idea that commercializing -- like the idea that you can have a public health response to not just COVID, but any number of things, when you have our health financing setup is, you know, an exploration of absurdity. Like plenty of people know that. The question is, why is there this disconnect between the reality that, you know, hundreds of thousands of people probably know to be true and what gets done? And what is that, what explains that bad feeling about being right, which is the feeling of being right and powerless to do anything about it. And I think one very important explanation for that is that the political, sort of mezzo level political institutions in this country leave the working class disconnected from people who have power.
Abby Cartus 1:01:29
Yep.
Phil Rocco 1:01:29
And that's -- I mean, to me, that's not the only thing that's wrong. But I think it is fundamentally a problem, that the kind of party structures which connect all of the institutions of government together have no mass base. Of course these people don't understand what it's like for regular people. The way that you get selected into that cadre of leadership is that you probably haven't had those experiences. And if you -- you know, if you're among the share of people who have had the experiences of like being a regular person in the United States, like the chances that you're going to be at that level of leadership cadre is very small. And I think that -- which is why I say, I think one of the issues here is that there is this perforation of the people -- the way that you advance is by giving suggestions that recapitulate the structure, and not kind of giving voice to what hundreds of thousands of people know is true, because, you know, this is -- there's no connection between those two sides of policymaking, between the mass base and the kind of high level decisions. That's why -- that's one reason why they don't make sense. And I think a big part of that, too, is that those decisions really, in the absence of that mass base for parties, essentially, there's no way of holding those people to any kind of account.
Abby Cartus 1:03:07
I don't know. I think what everyone is saying is totally right, and it feels bad. It feels really bad to be powerless. It feels really bad to [getting emotional] -- oh man, sorry.
Beatrice Adler-Bolton 1:03:22
It's okay, dude. It's totally fine. It sucks. It fucking sucks.
Abby Cartus 1:03:28
It fucking sucks to watch. It sucks to watch this like system killing people and to know exactly why that's happenin, and to be totally powerless to do anything about it. And I'm sorry that I'm getting like emotional. The thing --
Artie Vierkant 1:03:45
No, it's okay.
Abby Cartus 1:03:48
You know, the thing Bea said about, like, kind of like forgiving ourselves really stuck with me. I don't know, I have a lot of really like complex guilt about the years of the pandemic. And I feel like I'm just kind of carrying it by myself, because it's less the case now, but it really felt like everybody in my field kind of turned on me. You know, like I felt like I was getting like ostracized in that way for using the tools that I was taught, like the way that I was taught to use them.
Beatrice Adler-Bolton 1:04:27
How dare you question Vinay Prasad.
Abby Cartus 1:04:31
Yeah [laughing].
Artie Vierkant 1:04:32
How dare you correctly analyze the political economy, which we've given you tools to look at.
Abby Cartus 1:04:39
I'm not even going anywhere with this and I'm fully like crying. I'm sorry. Like we can cut this all out, because I'm just like not able to compose myself but like, I don't know, the occasion of the vaccines have always been -- like every time I've gotten a vaccine shot, I felt really emotional. I felt really emotional the first time I did it, and something about like getting these -- like being able to successfully get these vaccine shots makes me feel guilty and like weird in weird ways, which I don't know, I imagine everyone has some kind of version of this, some kind of version of this story. So I'm not alone.
Artie Vierkant 1:05:17
I mean, I feel like every time I've marched up to CVS or wherever to get a booster, and I think about the difference between that experience and getting it in a state mass vaccination center the first time, even the problems being with that, that it was extremely -- like the set up with the large state vaccination centers, the one that I experienced at the Javits Center was way too militarized in the way that Manhattan, America's largest open air shopping mall, always is. But every time I do have that experience of getting another shot, I do feel like this sad sense of loss for how different the at least portrayal of trying to do something about this was or how different it has become, I suppose.
Beatrice Adler-Bolton 1:06:22
I mean, honestly, what this makes me think of is actually the interview I did with Ruth Wilson Gilmore last fall. I mean, I'm in a similar headspace as I was then. But I think it's just, you know, every fall with COVID starts to feel the same a little bit, in the most terrible way. Getting used to this feeling is also something that's really frustrating and difficult.
Artie Vierkant 1:06:46
And a feeling you don't want to be used to, yeah.
Beatrice Adler-Bolton 1:06:48
Absolutely, yeah. Even just getting used to the feeling of alienation being the only masked person in public, like it's -- there's a real feeling of loss there even. But when I was talking to Ruthie, one of the first things I asked Ruthie about was one of my favorite essays that Ruthie wrote, with her partner, Craig Gilmore. And it's called Restating the Obvious. And there's one section that's called "Stateless World, Hahaha." And it's not only a great subtitle, I think it's a great subtitle.
Artie Vierkant 1:07:23
Mhm, I agree.
Beatrice Adler-Bolton 1:07:23
It's a really important provocation that Ruthie and Craig are making with that subtitle, right? And I think it's -- it was beautiful, the conversation I had with her, we spent a lot of time talking about why being able to sort of look at things and separate it out saying, what is state, what is government, what is governance, what is ideology, what is science, what is policy, right? That all of these different ways that we can sort of fragment and look at different things, it's not like we're just like circling around it to navel gaze and analyze for the sake of analysis, right? It offers us ways to think about what we're fighting when we're fighting it. So she said, you know, "The state is also the institutions that provide healthcare when the state provides healthcare. That's not not the state. That's not the government, that's the state. The state is also the institutions that provide education and provide the education of educators. That's also the state. And it's not just the government. So you see that when I talk about these different institutions, what matters here is not that the state is one thing and the government is the other, but that the state gives us certain analytical insights into what we should think about when we are fighting. And government gives us other analytical insights into what we should think about when we're fighting. So if we replace a government with a new government, we haven't changed the state until we change the state. And if we change the state, but we, you know, have governments that are ideologically predisposed to expanding vulnerability to premature death, then we haven't really changed the state except for on paper."
Artie Vierkant 1:09:06
Yeah.
Abby Cartus 1:09:06
I love that.
Beatrice Adler-Bolton 1:09:08
So, I kind of felt like that was like the right sentiment to end on because ultimately, this is -- this is all what we're working towards, right, is being able to find ways together, all of us, the thousands of us together in struggle to articulate this. And it's not just for the point of analysis that reproduces inertia, you know? It's about setting and seeking a horizon together.
Artie Vierkant 1:09:33
And -- and, I mean, don't let the fucking Biden trick work.
Beatrice Adler-Bolton 1:09:37
Don't let it work. Yeah.
Artie Vierkant 1:09:38
The site of struggle remains the state
Abby Cartus 1:09:41
The state, yes!
Artie Vierkant 1:09:43
I mean, it is not the insurance company. It is not -- I mean, like, obviously, these are all individual things that you can struggle against. And that is why, in part, our political economy of health is oriented towards having such a fragmented variety of different entities on which to distribute the struggle that would otherwise fall on the state, right?
Phil Rocco 1:10:06
Yes. Not just your insurer, but your PBM too, you know, like --
Artie Vierkant 1:10:10
Exactly. But the site of struggle remains the state. It's not the pharmaceutical company. It's not your health insurance company, unless your health insurance company is the state [laughter]. It's not, it's not simply like each other or some like mass psychological equation that needs to be solved.
Abby Cartus 1:10:31
Yep.
Artie Vierkant 1:10:33
It's the state.
Abby Cartus 1:10:34
It's the state as the instantiation of an organizer of the social form of capitalism. Like, let's fucking go [laughing].
Artie Vierkant 1:10:45
Yep.
Beatrice Adler-Bolton 1:10:46
Well, I think that's the perfect place to leave it for today. Patrons, as always, thank you so much for your support. We couldn't do any of this without you. To support the show, become a patron at patreon.com/deathpanelpod, to get access to our second weekly bonus episode, and entire back catalogue of bonus episodes. And if you'd like to help us out a little bit more, share the show with your friends, post about your favorite episodes, pick up a copy of Health Communism at your local bookstore, pre-order a copy of Jules' new book coming January, called A Short History of Trans Misogyny, or request them both at your local library, and follow us @deathpanel_. Patrons, we'll catch you Monday in the patron feed. For everyone else, we will catch you later in the week. As always, Medicare for All now, solidarity forever. Stay alive another week.
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Transcript by Kendra Kline. (Kendra is currently accepting freelance transcript work — email her if you need transcripts!)