New Health Rock

Nate Chinen (NYT) brings some much-needed mainstream attention to the plights of Andrew D'Angelo and Dennis Irwin, both of whom are fighting virulent cancers, neither of whom has medical insurance. It's a good piece, but it raises some issues that could benefit from a wider view -- especially in an election year where both Democratic candidates are promising major health care reform. [John McCain, for his part, promises more of the same. As a US Senator, his health care coverage is just fine, so what's the problem?]

The article is pinned on the idea of community support -- when jazz musicians get sick, the jazz scene steps up with benefit shows and the like:

When the focus turns toward the health of jazz musicians, the discussion assumes a different, less abstract character: solicitous and supportive. Most people who play jazz for a living are accustomed to self-reliance. When that system fails, they lean on one another.

“Since I’ve been on the scene, there have been benefits for musicians that were in need, unfortunately, because so many of us are,” the guitarist John Scofield said in the rear stairwell of the Village Vanguard on Monday night. Along with the tenor saxophonist Joe Lovano and the Vanguard Jazz Orchestra, he was playing a benefit for the bassist Dennis Irwin, who has recently been struggling with a spinal tumor.

Benefit shows are great, of course, and I know both Andrew and Dennis have been floored by the tremendous outpouring of love and support in their time of need. [A reminder that the first benefit show for Andrew is tomorrow (Friday) night at the Union St. Tea Lounge -- I will be there, and I hope you will be too.] But let's get real -- treatment for brain tumors and spinal tumors is crushingly expensive. The costs run in the hundreds of thousands of dollars and could easily push past the half-million mark. The people showing up for the benefit shows at Small's and the Tea Lounge and kicking in whatever they can are primarily other jazz musicians. You know, the people who can't afford health insurance in the first place. This is not a viable solution.

We also see, lurking in the wings, the old right-wing trope that people who "choose" to live without health insurance are "irresponsible," and therefore if they are faced with crippling medical bills, they deserve what they get. Chinen acknowledges the sentiment and tries to defuse it:

It may seem negligent that so many jazz musicians lack basic health-care coverage, but monthly fees through an organization like the Freelancers Union easily run to several hundred dollars, and these days many gigs in New York literally involve a tip jar.

Jazz musicians living in New York -- even relatively well-known jazz musicians like Andrew D'Angelo and Dennis Irwin -- have trouble enough paying the damn rent every month. If you have a full-time day job and are lucky enough to get decent coverage through work, your employer shoulders much of the cost of health insurance -- but as a freelancing musician, it's all on you.

Chinen mentions the Freelancer's Union, which is an organization that sells health insurance to the self-employed -- but in order to even be eligible, you need to show them proof of either 20 paid hours each week over the previous eight weeks, or $10,000 worth of income over the past six months. If you're working mostly cash gigs, this documentation can be difficult or impossible to come by. Even if you are eligible to join, the least expensive plan with the highest deductible still costs $239.64 every month. And if you have a couple of lean months and can't afford the premium, you lose your coverage.

Still, Chris Speed blames himself:

“A lot of my friends, myself included, don’t have insurance, which seems really idiotic, especially now,” he said.

But this is absurd. Chris Speed doesn't have heath insurance because he can't afford to have health insurance. Not having a reliable extra $240 of disposable income kicking around every month is not a moral failing or a stupid mistake, it's simple a fact of life for the overwhelming majority of NYC jazz musicians.

What is idiotic is the American system of for-profit private health insurance, which costs far more and covers far fewer people than any other system in the developed world. It forces poor working musicians into an impossible situation, and then lays a guilt trip on us for "choosing" to be the victims of a broken and exploitative system. As jazz musicians in America, we gamble with our lives, placing a sucker's bet every month: health insurance or rent, health insurance or food, health insurance or buying an instrument, heath insurance or renting a rehearsal space, health insurance or making a record, health insurance or hiring a publicist to promote your record, health insurance or going on tour, etc. Not to mention that even those who do mange to obtain heath insurance often still end up bankrupted by medial bills. (And of course, then there's the Bankruptcy Bill.)

And then if the unthinkable happens -- if you are diagnosed with a brain tumor, or a spinal tumor -- the system says, "Too bad for you, but it's your fault for not having gotten a real job. If you cared about your health, you wouldn't have become a musician in the first place. But, hey, don't despair, I'm sure your fellow musicians can raise a few hundred bucks for you at benefit show. That'll really put a dent in those six-figure medical bills."

Ezra Klein, the blogosphere's best health care wonk, has a piece in the American Prospect: Why 2009 Is the Year for Universal Health Care. Let's fucking hope so.

Comments

[Mike Baggetta]

1.

Right on, DJA. This is a very important issue for all of us since we are living in this country with an incredibly F'd-up healthcare system. I've dealt with this on an all-too-personal level in the recent past and can tell you that had I not been finishing a degree at the time (within 2 months!) and on the schools "affordable" "health insurance" "policy" I, and my family, would have been bankrupt...although we still payed out a small fortune. This matter needs to be addressed ASAP. Cheers to you and Chinen (and of course best to Dennis an Andrew...and all the lesser-knowns who don't get the attention!). And, of course, you know that I don't have health insurance not because I'm "irresponsible!"

[Peter Matthews]

2.

It's nothing short of Economic Darwinism: you don't have insurance, you die. Meanwhile, there will be assholes all over this city plunking down $500 a pop for bottle service...Someone should send this directly to the Clinton and Obama campaigns and make them promise to take action within 60 days of entering the White House.

[David Adler]

3.

I was having beers with some Canadian colleagues during IAJE and they stated matter-of-factly that the Canadian health care system is terrible. They were quite amused by my disbelief. You're Canadian, Darcy. Your take?

[DJA]

4.

Hi David,

My response is, as always to these kinds of stories, is that the plural of "anecdote" is not "data." There is simply no contesting the fact that the US system is the most costly, inefficient, and inequitable in the developed world.

46.6 million are uninsured, medical bills are the leading cause of personal bankruptcies, and three-quarters of those bankruptcies happened to people who had insurance. US health care spending per capita is more than 140% above the median for industrialized nations -- but it does not result in better health outcomes, even for those who can afford care.

As for Canada, health outcomes are generally as good or better than the in the US. The Canadian system does have its problems, but it's not because there is anything fundamentally wrong with the system itself. It's because the system is underfunded. If Canadians spent as much on health care as Americans do -- $7,100 per capita versus $2,900 per capita in Canada -- they would have the best health care in the world, with full coverage for all.

But if people really want to use anecdotal evidence to make up their minds, they should take a look at this story.

[David Adler]

5.

Thanks Darcy - and to clarify, my friends' critique of the Canadian system was not a defense of the American one.

[DJA]

6.

Hey David,

Well, if people are complaining that the Canadian heath care system isn't quite as good as what they have over in France, fine. But the most frequently invoked comparisons are to the American system, and despite the constant sowing of fear, uncertainty and doubt by the right wing noise machine, there's really no basis for any of it. By any objective measure, the Canadian system delivers comparable care to the US at roughly 40-50% of the cost, and everyone is covered. France and Germany do better still, but that's pretty damn good.

Again, the best person to read on this is Ezra Klein -- here is his piece in The American Prospect comparing American private care to the systems in Canada, France, the UK and Germany.

[andrea]

7.

there was an article in saturday's nytimes that featured both obama and clinton talking about health insurance in these very same, f'ed up terms, basically saying we need some sort of carrot-and-stick scheme to get these 'free riders' in line and paying for health insurance. what i don't understand is, we don't talk about road repair or highway building as something we have to persuade people to pay taxes for, but we somehow have to persuade people to do this for health insurance?
http://www.nytimes.com/2008/02/23/us/politics/23health.html?scp=5&sq=two+plans&st=nyt

[DJA]

8.

Hey Andrea,

I agree, and I wish both candidates had bolder health-care plans. Clinton's is actually a bit better than Obama's on paper, but I do not trust her to stand up to the established pharmaceutical and insurance interests in any way -- after all, they are some of her biggest campaign donors.

That said, either plan would be a massive improvement over what we have now. What's most important, though, in terms of actually getting this done, is to secure 60 Democratic seats in the Senate, and elect a few more progressive types to Congress. If that happens, the Republicans become irrelevant and there's some chance the conversation can be shifted to "ObamaCare or Single Payer," with the progressive Dems in Congress pushing for Single Payer. That way, there's some chance that the inevitable compromise solution will actually be better than what's on the table now. But that can only happen if we elect more and better Democrats to Congress. Because we need a victory by a large enough margin to enable ignoring anything the Republicans have to say on the topic, and to embolden the cowards, weaklings, and sellouts in our own party to do the right thing, for once.