Welcome to Sick Note.

A newsletter about America's broken healthcare system.

Hello, friend, and thanks for clicking. I’m Libby Watson, and this is the introductory edition of Sick Note, a new newsletter about American healthcare, which will begin publishing regularly in January.

About Sick Note:

We are in the middle of an awful, acute health crisis, which was dumped on top of an awful but more routine health crisis. (Imagine the frog in the boiling water, but then someone dumped a bunch of acid in the water as well.) 268,000 people have died from coronavirus. Millions of people will struggle with the consequences of this pandemic for years to come—the lingering health effects, sure, but also lost income, jobs, homes, all of which will affect their health. Congress hasn’t passed anything to help anyone in months and state governments are facing horrifying budget cuts, cuts that will hurt Medicaid, mental health services, and much more.

But even if our friend SARS-CoV-2 had never mutated into existence, America would have been a sick country, with a healthcare system on life support. We spend more on healthcare for worse health outcomes. In 2019, there were 29 million uninsured people in America; there are undoubtedly many more now, with the massive job losses caused by the pandemic. Millions further are underinsured, meaning their out-of-pocket costs are unaffordable, so they’re paying for insurance they can’t use. Even people with Good insurance risk an absurdly large bill if they go to hospital. Non-profit hospitals boast about their charity care while placing liens on patients’ houses to ‘recover’ the ‘costs’ of the care they provided. Nothing about the system we have is designed to be easy to use, or to provide the best care for everyone. Much of it was barely designed at all. (After all, who would design this?)

Sick Note aims to be a chronicle of everything shitty about American healthcare. We’ll talk about insurance and hospitals and doctors, sure, but we’re also going to talk about shitty jobs that make you sick, shitty housing, shitty air. To me, all of these things are just as much about healthcare as a surprise medical bill. (But if you have one of those, get in touch!) We can talk about whatever you want—I want to hear from you, about your health and your healthcare. Maybe you’ve delayed necessary dental work because of the cost, or skipped a month’s meds. Maybe you’ve experienced racism in the medical system, as a patient or a provider. Maybe you’ve had to leave a job, or been rescheduled or mistreated, because you were sick, or pregnant, or mentally ill. Maybe you were evicted from your apartment in the middle of a health crisis. Maybe you’ve got a story about trying to find a therapist that will take insurance. Maybe you have a story I can’t even imagine. 

Each Tuesday, you’ll receive a Sick Note featuring an interview about healthcare, starting in January. You will not find any kind of healthcare industry sponsorship; there will be no laundered takes by lobbyists and CEOs, or anonymous quotes from Senior Officials in Congress about how giving everyone healthcare would be too expensive. It will simply be the voices of real people about what healthcare looks like in America today, especially for the poor. You can send me your stories by emailing sicknotenewsletter@gmail.com, or just reply to any Sick Note email. You can even reach me on Twitter, if you prefer. (I’m also going to do my own work to reach out to people who are far from my usual online audience.) These interview posts will never go behind a paywall.

Aside from the interviews, I’ll send out a roundup of healthcare news each Friday, with some commentary. I will also throw in a recipe (I love to bake!) and a picture of my cat, Digby. Eventually, these posts will go behind the paywall, because Digby and I gotta eat. For the first couple months, though, everything will be free and public—but you can subscribe right now if you want to support the project. And I’ll throw in some other content, too; you can usually expect about three emails a week from me.

About me:

I’m Libby Watson, a journalist based in Washington, D.C.. Until last month, I wrote about politics and healthcare for The New Republic. Before that, I wrote for Splinter, also about politics and healthcare. I’ve covered tech for Gizmodo and campaign finance at the Sunlight Foundation, and written freelance for a number of other websites. I’ve lived in Washington for the last 8 years, but I grew up in Britain, a country with a really very good (but not perfect!) healthcare system, which informs a lot of my thinking about America’s not-good healthcare not-system. I get frequent-to-chronic migraines, so I’ll probably write about those, too. Here’s some of my best writing about healthcare:

The Fetishization of Employer-Provided Health Care (The New Republic)

Government Healthcare Is Saving My Mum's Life (Splinter)

Look at These Absolutely Ordinary Americans Who Hate Medicare for All (Splinter)

Wellness Brands Skirt FDA Rules to Push Shady UTI ‘Cures’ on Instagram (Vice)

I left a full-time job at The New Republic to start Sick Note. I had a lot of reasons for doing this, but the one that sealed it, even in those terrified “WHAT AM I DOING???” moments, was that the work I’m proudest of is when I actually talked to people about their experiences with our bad healthcare system. Like the piece I did for TNR where I talked to people waiting for free healthcare at the Remote Area Medical clinic just outside DC, or the pieces I wrote for Splinter about women who suffer from migraines but have no paid sick leave, or couldn’t access groundbreaking new drugs. That’s why I’m here; if it doesn’t work, at least I tried.

The past few years have been rough, and the next few are going to be no picnic either. We’re looking down the barrel of four years (at least) of little progress on healthcare, depending on Joe Biden’s willingness to use the powers of his office and the Democrats’ success in the two Senate runoffs in Georgia. Whatever happens there, no one expects Congress to come to its senses and pass single-payer; if we’re lucky, we could get some tweaks to the Affordable Care Act, and the reversal of some of Trump’s worst executive actions. But I would bet my life that we will end this presidential term with still millions of people uninsured, and millions further with insurance too expensive to use; with hospitals suing patients for fraudulent bills; with undocumented immigrants going without care for fear of deportation. Poor people will still get sicker than rich people. People will still die for lack of healthcare. All of the basic and fundamental injustices of our healthcare system are likely to remain. The least we can do is talk about them.

Thanks for reading, and I’ll send you another e-mail next week with details of my first story. See you soon.