Why I'm turning on the paywall

The next phase of Sick Note

I’m writing to you today to let you know that starting this weekend, some Sick Note posts will be behind the paywall. 

If you subscribe to other Substacks, you might not have seen as much fanfare from them when they did this; they might have just done it. But I wanted to take a bit of your time to explain why this is happening now, and not earlier or later, and why it’s worth your money to subscribe. 

First, I’ll remind you that subscriptions are 30% off for the next few weeks, so now is the best time to subscribe!

If you can’t afford to subscribe but wish you could, please send me an email and let me know. I’m more than happy to give you a free one. If your circumstances change and you’re suddenly rich, you can always pay in the future, if you want! But in the meantime, it’s very important to me that people with lower incomes are able to read Sick Note. This is not a newsletter for rich healthcare lobbyists or insurance executives; it’s for the people they hurt. I don’t need details on why you need a free one, either—I’m just going to trust that no one with lots of money is going to try and scam a free subscription, which would be the most low-stakes grift in the world. It’s just a newsletter, after all. 

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I think it is fair to say that last year did not go the way I expected. A few weeks after I quit my last job to start this newsletter, I got the news that my mum’s cancer had probably returned; less than three months into the existence of Sick Note, she fell ill, and she died a few weeks later. This was right before I planned to turn on the paywall the first time—that is, the thing that makes running a Substack financially feasible in the long run. This is what the business school graduate types call “a very bad thing for running a business.” 

As I’ve written about here before, Mum was my best friend, and I still don’t really know how to navigate life without her. After what is, in hindsight, not a very long amount of time, I decided I was doing ok enough to get back to writing. It took me a few months of frustration and self-flagellation to realize that I was not actually doing ok. I felt awful. I took a few weeks off, started taking more Wellbutrin, and set my mind to getting back in gear.

I’m painfully aware that all of this might have looked to readers like I was unreliable, flaky, or inconsiderate of my subscribers. I get it, and I worry about it all the time. That makes it even more personally uncomfortable for me to ask you to subscribe; my mental image of the average Sick Note reader looking at this email and going, “this loser? No way!” is very vivid.

But I can promise you that I am no longer doing badly, and am in fact doing well, all things considered. Things are simply different this year. First of all, I’m pretty sure my mum isn’t going to die again; that’s a one-time thing, as far as I know. The more time passes, the easier it is to work. And I simply can’t sing the praises of Taking More Wellbutrin enough.

This is a long way of saying that if you subscribe, you will get the extra posts you’re promised. 

What can I expect if I subscribe?

It’s important to me to keep as many interviews as I can out from behind the paywall. I’ve always conceived of Sick Note as primarily a place to publicly document the atrocities of the American healthcare system; I call it a chronicle of everything shitty about American healthcare, and that’s hard to do when the entries are behind the paywall. 

But! I have to pay rent and buy medicine, and I want to keep doing this newsletter for as long possible, so I have to charge for something. If you subscribe, you will get extra content on top of the weekly interview posts. That includes weekly news roundups, like this and this, which come with a short bit of commentary from me on a healthcare issue (and sometimes pictures of Digby, my cat).

It will also include an idea I’m very excited about: A recurring feature called Sickos, a guide to the mires of healthcare lobbying in Washington. 

Once a month, I’ll publish a mini-profile of a healthcare lobbying group, nonprofit, or other influence organization in DC. Think PhrMA, the American Hospital Association, and so forth—but also smaller, less well-known groups that you might never have heard of. I used to write about money in politics for the Sunlight Foundation (RIP), and some of my favorite stories at Splinter were about shady influence activities in Washington, like the suspicious op-eds from Real Americans cited by the industry’s anti-single-payer groups, the Partnership for America’s Health Care Future—many of which turned out to be written by people either in politics or employed in the healthcare industry. I’ll tell you who these groups are, how much money they have, what they spend it on, and what particular sorts of lies they tend to spread. 

You’ll also get a copy of any freelance articles I write for other outlets about healthcare (when they allow it). And you’ll get other exclusive stories I write, too—next week, for example, I’ll publish a conversation with my good friend Ashley Feinberg about grief. I have planned posts on topics that range from Instagram to The Simpsons, which you’ll get to read in the coming weeks and months. You’ll be able to comment on posts, and participate in exclusive subscriber-only conversations. And More!

Before I let you go, I want to remind you what your subscription would be supporting. In the last year, I’ve interviewed:

• A public housing resident in DC, on how the terrible conditions in her building made her sick

• A woman in Florida working one by one to convince people in her small town in Florida to get vaccinated for Covid-19

• Bernie Sanders’ older brother Larry, on his decades of work in health and disability justice in the UK

• A trans woman in the South, on the costs and pain of trans healthcare 

• A pair of new dads, on how you can get screwed if your baby arrives in December or January

• A multiple sclerosis patient on the Trump era policy, kept by Biden, that makes his drugs thousands of dollars more expensive

• An organizer with Mutual Aid Diabetes, on their online network of diabetics sharing supplies and insulin they need to survive

And many others, of course—you can always check out the archives.

Despite how thoroughly awful last year was, I’m proud of what we’ve achieved in the last year. Sick Note was the only outlet (other than legal news blogs) I could find that covered the expiration of COBRA subsidies in September. Best of all, I’ve been able to publish some guest essays from great writers:

• Beatrice Adler-Bolton on the miserable process of applying for Social Security Disability Insurance

• Ryan Cooper on how the structure of American government empowered lobbyists to water down drug reform proposals

• Holly Cortland, the pseudonymous journalist who received a heart transplant in her teens, and will be paying for her condition the rest of her life

• Victoria Dominguez, who learned just as she was graduating college how much one errant hospital bill can screw with your finances

• Philip Rocco on how conservative Democrats use the Congressional Budget Office as an excuse to maintain the status quo

With the exception of Ryan, who wouldn’t take my money, I was able to pay all these writers thanks to subscriptions. (Freelancers who are interested in writing for Sick Note: I pay $500 for an essay, promptly and without fuss. I can’t afford to do this that often, but I’ll do it as much as I can.) Every subscription makes it a little easier for me to publish writers that might not appear elsewhere, on topics that are rarely addressed. 

When I started out doing this, I didn’t have huge ambitions. I didn’t expect that Sick Note would be the thing that convinced Joe Biden to stump for Medicare for All, or get me on TV (which is thoroughly the last thing I would ever want to do, to be clear). I just want to make a living writing about the abuses and cruelties of America’s broken healthcare system. But I can tell you that right now, the number of subscribers I have would not be sustainable long term. If I can make enough to pay the bills (and occasionally freelancers) reporting on the outrages that people experience in our healthcare system every day, I’ll be thrilled. If I ever make much more than enough to pay the bills, you and I can think of ways to pay it forward.

Thanks so much for reading this, and Sick Note in general. If you have any questions, just let me know. I hope you’ll consider subscribing, or just sharing Sick Note with a friend.