CVIndependent

Sun05272018

Last updateWed, 27 Sep 2017 1pm

By many measures, the rambunctious campaign for a single-payer health-care system in California appears to be struggling.

A bill that would replace the existing health-care system with a new one run by a single payer—specifically, the state government—paid for with taxpayer money remains parked in the Assembly, with no sign of moving ahead. An effort by activists to recall Assembly Speaker Anthony Rendon for shelving the bill has gone dormant. And an initiative that would lay the financial groundwork for a future single-payer system has little funding, undercutting its chances to qualify for the ballot. 

But even if single-payer is a lost cause in the short term, advocates are playing a long game. For now, it may well be less a realistic policy blueprint than an organizing tool.

And by that metric, advocates are making gains.

Riding a wave of enthusiasm from progressive Democrats, supporters of single-payer have effectively made it a front-and-center issue in California’s 2018 elections. It’s been discussed in virtually every forum with the candidates running for governor, emerged as a point of contention in some legislative races, and will likely be a rallying cry at the upcoming California Democratic Party convention.

“This issue is not going away,” said Garry South, a Democratic political consultant who has worked with the California Nurses Association, which sponsored the stalled single-payer bill. “The progressive elements who are supportive of the single-payer concept know that it’s not going to happen now; it’s not going to happen tomorrow. It’s a long-term process, and Jerry Brown is gone as of January 2019.”

The governor has not needed to stake a position on the bill, because it skidded to a stop in the Assembly last summer without reaching his desk. But state Sen. Toni Atkins, a San Diego Democrat who co-authored Senate Bill 562, said Brown was not receptive. Analyses peg the cost of a statewide single-payer system at between $330 billion and $400 billion—far exceeding the state’s entire budget. That made it an anathema to Brown’s record of prioritizing fiscal stability for state government.

“When the governor saw that we introduced that bill… all he could look at me and do is shake his head and say, ‘$400 billion dollars.’ And I kept trying to say, ‘Can we back up and talk about what you've got to do to get (there)?’" Atkins said in an interview.

“He wasn’t letting it go.”

Atkins, who will take over as Senate leader next month, said she’s not giving up on the goal of single-payer, but does not expect it to happen this year. “People are polarized on this issue in a way that’s not good for coming together to get it done,” she said.

Led by the nurses association—a labor union that embraces firebrand activism—supporters of single-payer have targeted Rendon after he shelved the bill last summer, saying it lacked critical information on how to pay for a massive overhaul of the healthcare system. They peppered social media with images that not only portrayed the bill fight as a boxing match between Rendon and the nurses, but also depicted a knife labeled “Rendon” back-stabbing the bear symbol of California.

The nurses were not involved in the campaign to recall Rendon, said recall organizer Stephen Elzie, who has since dropped the effort and is now helping Democrat Maria Estrada challenge Rendon’s re-election bid. But the nurses union leapt into the governor’s race as one of the first labor unions to endorse Lt. Gov. Gavin Newsom. Single-payer has emerged as one of few issues on which the Democratic candidates disagree.

Newsom and Delaine Eastin, the former state superintendent of schools, have both said they support the nurses’ single-payer bill. Fellow Democrats Antonio Villaraigosa, former mayor of Los Angeles, and John Chiang, the state treasurer, say they want to expand health care so that everyone is covered, but not necessarily with the single-payer model that would abolish private health insurers and replace them with a government-run system.

A coalition of medical groups is lobbying against the single-payer bill, arguing that it makes more sense to protect and expand the federal Affordable Care Act, which has increased the number of Californians who have health insurance. Some members of the coalition have a history of spending big money to sway California elections. One of them, the doctors’ association, donated to Newsom before he voiced support for single-payer; it’s not yet clear if they will shift support to another candidate. 

Almost two-thirds of Californians like the idea of a statewide single-payer health-care system, although enthusiasm drops significantly if it would require raising taxes, according to polling last year by the Public Policy Institute of California. Still, Californians didn’t cite health care as a top priority when asked last month what the Legislature and governor should focus on in 2018.

The Assembly just wrapped up a series of hearings on what it would take to create a health-care system that covers all Californians. It exposed many obstacles—in both federal and state law—to swiftly enacting single-payer. For one, the state would need permission from the federal government—and perhaps an act of Congress—to shift billions of dollars from Medi-Cal and Medicare into a state-run single-payer plan. For another, if lawmakers raised taxes to fund single-payer, voters would likely need to approve changes to the California Constitution to allow the money to go to health care instead of schools. (That’s the only single-payer initiative that someone is trying to get qualified for the ballot; while a Silicon Valley tech consultant is gathering signatures for it, he doesn’t have support from the nurses’ union or any other well-financed group.)

Assemblyman Jim Wood, a Healdsburg Democrat who chaired the panel, called the single-payer bill “aspirational” and said he’s instead considering legislation that could help more Californians get health care without requiring permission from the federal government. One idea: extending subsidized health plans to adults who are undocumented immigrants.

“I believe we can actually get to single-payer, once we go through a lot of study and a lot of work,” Wood said. “But this feels, at times, more like a litmus test.”

CALmatters.org is a nonprofit, nonpartisan media venture explaining California policies and politics.

Published in Politics

California’s resistance began before there was a resistance.

When Gov. Jerry Brown unveiled his final budget on Jan. 10, it bookended eight years of a progressive march to reduce greenhouse gases, expand health care, grant more rights to undocumented immigrants and raise the minimum wage to $15 an hour. Along the way, voters have assented by passing temporary taxes on the rich—not once, but twice. The top marginal income tax rate is now 13.3 percent, the highest state income tax rate in the country.

In short, policies that are now labeled acts of resistance to President Donald Trump were alive and ascendant in California long before Trump won the White House. But the contrasts have become much more stark.

Instead of cutting taxes, the Democratic governor and his party’s legislative leaders have passed a gas tax to help pay for aging infrastructure. Instead of trying to shift government out of the healthcare marketplace, California is looking for a way to fund single-payer health care, including coverage for undocumented immigrants. Instead of criminalizing pot, the state is looking forward to collecting taxes on marijuana sales.

In the months between now and the June deadline for a final budget, the governor and the Legislature will hammer out details. The focus this year: what to do with an expected surplus of $6.1 billion—and there are definitely differing opinions all around. Republicans say return it to California’s 40 million residents as a nice tax refund. The governor's priority is to fill up the state’s rainy-day fund. Democratic legislators mostly want to spend it.

“We have a very different approach,” said Assemblyman Phil Ting, D-San Francisco, who chairs the Assembly Budget Committee. “Our focus, the people who we think need tax relief, are the working Californians who are making less than $25,000. That’s where we want to spend our money, making sure they have money to pay rent, to pay for food.”

Rather than giving out “huge corporate tax breaks and a huge tax break for the wealthiest in this country,” Ting has a long list of how he would like to spend that extra money, including:

• Increasing the state’s Earned Income Tax Credit, which puts money into the hands of the working poor.

• Expanding Medi-Cal health care for poorer Californians to cover all remaining uninsured residents, mostly undocumented immigrants.

• Expanding early education for 4-year-olds through preschool and transitional kindergarten programs.

• Increasing college aid.

• Expanding mental and social services to reduce the number of criminals who go on to re-offend.

As supportive as Brown might be of these Democratic aspirations, his administration is urging legislative leaders to proceed with caution. The state’s tax structure is more vulnerable than ever to the stock market gains and losses of its wealthiest citizens, and the governor said California must prepare for the next economic downturn, because a mild recession could wipe away at least $20 billion a year in revenues.

He also warns of uncertainty from Washington, D.C.

“There are certain policies that are radical departures from the norm, and California will fight those, whether it’s immigration or offshore drilling,” Brown said. “We don’t know what will happen. I wouldn’t want to portray a California-Washington battle, although there are some key differences, and we’ll espouse our values.”

Since Brown was elected to begin his second stint as governor in November 2010, the state has climbed out of the recession and enjoyed economic prosperity. The unemployment rate, which topped 12 percent, now stands at 4.6 percent. Since his return, California has added 2.4 million jobs, and hourly wages are up $4.76 an hour. The state, which carried a $25 billion deficit in his first year back, has enjoyed billion-dollar surpluses in recent years, and the state now has a rainy-day fund.

The governor’s proposed $190 billion budget is dominated by spending on education (29 percent) and health care (32 percent). Health care spending has been growing particularly fast since the state embraced the Affordable Care Act, also known as Obamacare. The act not only grew the marketplace for private health plans; it allowed states to expand their Medicaid health insurance programs for the poor.

Because California is among 30 states that expanded Medicaid, the federal government is paying at least 90 percent of the cost for newly eligible enrollees. That has allowed California to draw billions in extra funding from the federal government to bolster Medi-Cal, the state’s version of the national Medicaid program. As a result, the number of people without health coverage in the state has dropped to a historic low: from 17.6 percent in the 1980s to 7.6 percent in 2016. Today, one in three Californians is covered by Medi-Cal.

Public schools too have greatly benefited since the recession, with much of the extra spending on schools going to improve teachers’ salaries.

However, if the federal government doesn’t reauthorize the Children’s Health Insurance Program for 1.3 million children, that could add more than $850 million in costs to the state over two years.

Worse, if Republicans in Washington slash Medicaid funding in 2018, the state could lose between $25 billion and $50 billion, said Chris Hoene, executive director of the California Budget and Policy Center, a progressive think tank in Sacramento.

“The reality is California could not afford the scale of the cuts the GOP has been proposing,” Hoene said. “That’s going to put state leaders in a position of deciding who gets state services and how do they fund that.”

Other factors are straining the budget. For example, pension costs for public workers continue to be one of the fastest-growing liabilities—driven by lower investment-rate assumptions, higher health care costs and longer life spans.

Voters, too, could turn on Brown and lawmakers. Early polling suggests Republicans have a decent shot at repealing a gas tax hike that went into effect late last year. Brown said at a press conference Wednesday that he believes a repeal initiative could be defeated.

The Legislature’s nonpartisan budget analyst is also urging lawmakers not to commit to too many new spending programs.

“As it crafts the 2018-19 budget and future budgets, we encourage the Legislature to consider all of the uncertainty faced by the budget in future years and continue its recent practice of building its reserve levels,” the analyst wrote.

On the flipside, Republicans are calling for a tax refund, if not an outright repeal of state income taxes. They argue that California’s high taxes chase residents out of state.

“This surplus is a direct result of Capitol Democrats overtaxing hard-working Californians,” said Assemblyman Matthew Harper, R-Huntington Beach. “Rather than expanding an ever-growing list of government programs, our leaders should figure out a way to return that money to the people who earned it in the first place.”

Assemblyman Vince Fong, R-Bakersfield, said he plans to introduce tax cuts aimed at helping families and small businesses stay in California.

“As we see all too often now, we are losing families and small businesses to neighboring states that have tax burdens much lower than California’s high-priced tax code,” Fong said on Twitter. “We have an opportunity to change that.”

Brown dismissed the refund idea, saying it would only prompt service cuts to public schools and universities later. “If you want to budget responsibly, you need big surpluses in years that are good,” he said.

Still, there’s a growing sentiment that California may have to respond to recent changes in the federal tax plan, specifically a $10,000 cap on state and local deductions that will hit millions of households.

According to the state Finance Department, the average deduction for state and local income taxes alone is nearly $16,000 per return, while state and local property taxes average less than $6,000 per return. Because a portion of those taxes will no longer be deductible, it acts as double taxation for California taxpayers.

Senate President Pro Tem Kevin de León, who is running for U.S. Senate, introduced legislation Thursday to shield Californians from bearing the costs of the tax overhaul. The bill, dubbed Protect California Taxpayers Act, would allow taxpayers to make charitable deductions to the state and receive a dollar-for-dollar tax credit on the full amount of their contribution. By having residents donate to the state government as a charitable contribution, the contribution remains deductible on federal taxes.

“The Republican tax plan gives corporations and hedge-fund managers a trillion-dollar tax cut and expects California taxpayers to foot the bill,” de León said in announcing his legislation. “We won’t allow California residents to be the casualty of this disastrous tax scheme.”

Brown was particularly vocal against the GOP tax proposal, calling it a “tax monstrosity,” but the governor expressed reservations about whether the state could sidestep federal law.

“It looks interesting,” Brown said. “But two questions: Can it work? If it does work, can the Internal Revenue Service issue a regulation and completely subvert it?”

De León responded that he was confident it would work, because similar charitable deductions have already been given out for education-based contributions.

For now, state Democrats are in agreement about a common threat.

Whether it’s federal tax changes or entitlement cuts, the leader of the Assembly, Anthony Rendon, D-Paramount, said he’s most concerned Republicans in Congress and the Trump administration will take another swipe at liberal California in 2018. “We’re worried about the next shoe to drop.”

CALmatters is a nonpartisan, nonprofit media venture explaining California policies and politics.

Published in Politics

On this week's weekly Independent comics page, which could be fired by Donald Trump at any moment: The K Chronicles checks in with Republican Sen. Jerry Mandering; This Modern World examines a confederacy of sociopaths; Jen Sorenson hails the freedom to be screwed; Red Meat needs to use the bathroom; and Apoca Clips looks in on the shenanigans of Lil' Trumpy.

Published in Comics

With a small brown paper bag in her hand, Julie walked out of a Planned Parenthood clinic in Roseville with a new supply of birth control. It didn’t matter that she didn’t have health insurance.

“It’s awesome to have Planned Parenthood,” said Julie, who did not wish to give her last name. “To go to a regular health clinic like this would have cost $100, which would make you think twice about having to go.”

It’s the kind of clinic that President Donald Trump and conservative Republicans in Congress hope to cut off from receiving any federal funds. The federal government already prohibits any federal dollars from paying for abortions, except in cases of rape, incest or to save the mother’s life. But this effort seeks to block federal funds from paying for any other kind of health care by providers who also perform abortions.

If the effort succeeds, the impact would be particularly strong in California—a state where legislators over the years have interpreted federal laws and rules in ways that have allowed more federal dollars to flow to Planned Parenthood clinics. Roughly half of the federal funding that Planned Parenthood receives nationwide currently goes, mostly via Medicaid reimbursements, to cover health care and family planning services for Californians, mostly in the lower-income brackets.

Ironically, Planned Parenthood officials say if they were to lose all their federal funding, their California abortion clinics would remain open; those already are funded by private sources and by state reimbursements for poorer patients. Instead, what would be at risk are all the nonsurgical sites that provide other medical and contraception services.

The state’s progressive state policies, put in place 30 years ago under Republican Gov. Pete Wilson, created a friendly environment for Planned Parenthood to expand and offer family-planning services to low-income men and women above the federal poverty level. That’s in stark contrast to states such as Texas and Mississippi, which unsuccessfully sought to ban their state Medicaid healthcare programs for the poor from channeling any money to health care providers that perform abortions.

As a result, Planned Parenthood today is one of California’s major health care providers, operating 115 clinics that serve 850,000 mostly low-income patients a year who rely on Medicaid (in California, Medi-Cal) for health care. That’s nearly a third of the 2.5 million patients who visit Planned Parenthood clinics nationwide for basic health-care and family-planning services.

“Planned Parenthood is a major safety-net provider at a time of increased health care demand,” said Sara Rosenbaum, a professor of health law and policy at George Washington University. “In a state like California, with more Planned Parenthoods, the reliance would be that much greater.”

The Republican-controlled Congress, bolstered by President Trump’s election, is eyeing several strategies to stop the flow of federal funding to Planned Parenthood. That money—roughly $500 million a year nationwide, through Medicaid reimbursements, Title X family planning money and grants—pays for services such as cancer screenings, breast exams, birth control, prenatal care and the treatment of sexually transmitted diseases.

Although Trump has frequently acknowledged that Planned Parenthood helps millions of women, he also has said he would support congressional efforts to ban funding.

“I would defund it because of the abortion factor,” he said at a February 2016 GOP presidential debate. “I would defund it, because I’m pro-life.”

A draft House GOP bill obtained by Politico would eliminate all federal funding to Planned Parenthood as part of a repeal of the Affordable Care Act. While that provision is likely to clear the House, its fate is uncertain in the Senate, where several moderate Republicans could side with pro-choice Democrats.

If the effort were to prevail, California Planned Parenthood would lose $260 million a year in federal funds—approximately 80 percent of its operating budget. Unless it found a way to replenish that money, the organization warns that it could have to close its 82 California sites that furnish basic health care and family-planning services to mostly low-income patients.

Meanwhile, its remaining 33 surgical abortion sites—which don’t get federal funding—would remain open, said Kathy Kneer, president and CEO of California Planned Parenthood.

“The irony here is that they are going to put in place more barriers for women to gain contraception, and that will lead to more abortions—and by the way, all the abortion sites will stay open,” Kneer said.

The House recently voted to reverse an Obama administration regulation that requires states and local governments to distribute family-planning funds to health centers, even if they perform abortions. President Barack Obama issued the rule in his final days in office after more than a dozen conservative states directed those funds only to community health-care centers.

Such an 11th-hour move by an outgoing president, Republicans argued during the floor debate, was an affront to states’ rights.

“I know that vulnerable women seeking true comprehensive care deserve better than abortion-centric facilities like Planned Parenthood,” said Rep. Diane Black, R-Tenn.

The resolution is now awaiting a vote in the Senate, where California Democratic Sen. Dianne Feinstein is working to defeat it. It would have no effect on California, given that it is not among the states that have tried to limit those Title X dollars. Nonetheless, she noted that Planned Parenthood provides the only Title X family planning services in 13 California counties, and that any effort to strip federal funding would take a toll in other states and leave “huge numbers of women across the country (with) no place to go for essential health services.”

Trump on the campaign trail vowed to defund Planned Parenthood, and then he appointed Health and Human Services Secretary Tom Price, a former Republican congressman from Georgia who has supported cutting off taxpayer money to Planned Parenthood. Both men have suggested the federal government could reallocate taxpayer dollars to community health centers. But many experts and health care advocates say those health centers cannot absorb the significant number of patients who now rely on Planned Parenthood.

That concern was echoed in January when the Democratic-controlled California Legislature approved resolutions opposing any congressional efforts to defund Planned Parenthood. They did so after Planned Parenthood President Cecile Richards met with Democratic senators at their annual policy retreat in Sacramento.

Assembly Speaker Anthony Rendon, D-Lakewood, proclaimed: “California stands with Planned Parenthood, because Planned Parenthood stands with California.”

But his sentiment was not unanimous. Several Republicans spoke out against the resolutions, with state Sen. Mike Morrell, R-Rancho Cucamonga, saying he could not support an organization that provides abortions. 

“I have no war against women,” he said. “But I also do not have a war against babies created in the image of God.”

With a Democrat-controlled state Legislature, California Planned Parenthood is hopeful it could ask lawmakers to backfill any federal shortfall. However, Medicaid funding is already strapped in the state, where a record one in three Californians are receiving Medi-Cal benefits. Given the potential for other federal cuts in health funding, it’s unclear whether the state would be able to make up the difference.

Meanwhile, Planned Parenthood is drafting contingency plans.

“We are looking at scenario planning. These are all very difficult decisions,” Kneer said. “Closing any location is the last thing we want to do.”

One option is to more aggressively raise funds, but Kneer said private donations can’t possibly make up what they would lose. She also raised the question of whether private funds should be required to pay for a government reimbursement that other organizations receive.

Even if President Trump receives and signs legislation to strip Planned Parenthood of all its federal funding, Planned Parenthood could still challenge in court whether such a restriction is constitutional.

In the last few years, federal courts across the country have denied other states’ efforts to block Planned Parenthood as an eligible provider of taxpayer-funded health, ruling that such moves violated the First Amendment right of free speech and free association to choose a medical provider, and the right of a clinic to provide abortion services under the equal protection clause of the Fourteenth Amendment, said Julie Cantor, an adjunct professor at UCLA who teaches a law class on reproductive medical ethics.

“The government’s behavior has to comport with the Constitution,” Cantor said.

Samantha Young is a contributor to CALmatters.org, a nonprofit, nonpartisan media venture explaining California policies and politics.

Published in National/International

If you live in the Coachella Valley, you may receive a phone call sometime early next year from a nonprofit called HARC—Health Assessment and Research for Communities.

HARC’s new board president, Bruce Purdy, says it’s vital for you to take that call, and answer all of the survey questions that follow—even if the questioning is lengthy and a bit tedious.

“The data we’ll collect will ultimately support and improve the health and well-being of the residents of the Coachella Valley,” he said. “It will provide an objective picture of the health of citizens in this community, and help create programs and policies that will help improve health of a whole lot of residents.”

It’s HARC’s job to conduct this survey of residents every three years, and then compile and release the results.

So, why’s it so important to have this data?

“We believe that in the last five years, grants have provided roughly $12.8 million in support to local nonprofits that used HARC data to justify their requests,” Purdy said.

It’s Purdy’s experience with one of those nonprofits, the Desert AIDS Project, that led Purdy—a semi-retired development economist—to get involved with HARC. Purdy sits on the Desert AIDS Project’s board, and saw how helpful HARC’s data was to DAP.

“We’ve gotten so many grants because (we) have really good, analytical data (from HARC),” he said.

David Brinkman, the CEO of DAP, encouraged Purdy to join the HARC board, Purdy said. Dr. Glen Grayman, the chief population health officer and regional medical director of Borrego Health, had been the president of HARC’s board since it was founded in 2006, and oversaw the first three HARC surveys. When Grayman decided it was time to hand over the reins to someone else, Purdy was tasked with becoming that someone else. Purdy became the HARC board president in October.

The last HARC survey, conducted in 2013, showed the Coachella Valley’s collective health badly needed improvement. It showed a third of local adults between the ages of 18 and 64 didn’t have insurance. The data also showed high rates of hypertension, high cholesterol and binge-drinking, and that cancer rates and the number of children living in poverty were on the rise.

Of course, a lot has changed in the last three years. The economy has improved, and the Affordable Care Act has given more adults access to reasonably priced insurance plans. Purdy said he’s curious what the 2016 numbers will show.

“I’m really interested to see if the increase in people covered by Obamacare has helped, hurt or not changed at all the health and wellness of people in the valley,” he said.

Purdy said HARC is “inundated” with requests from nonprofits for various questions to be included in the survey. He said the 2016 survey will include deeper questions regarding two matters on different ends of the age spectrum: childhood obesity/early-onset diabetes; and the various health issues the valley’s older snowbird population is facing.

Purdy said the survey includes about 160 questions, and that he hopes to get more responses than the 2,000-plus received during the 2013 survey. Kent State University will again conduct the survey.

“We are very proud of and excited about the work we do,” Purdy said.

For more information, visit www.harcdata.org.

Published in Local Issues

It began when Joshua Ellis could no longer spit.

The blockage in his saliva gland resulted in swelling, and the pain forced him—a freelance web designer and writer—to visit a place that 50 million Americans who lack insurance coverage know too well: the emergency room. Finally, after hours of waiting, waves of guilt washing over him as a rising tide of heart-attacked, bullet-riddled and generally worse-off souls gurneyed inside to meet their fates, he received an X-ray.

What it revealed would lead Ellis 700 miles away into the Mexican city of Juarez and into the inscrutable mystery of the preserved heart of a baby vampire. To put it to a point, his teeth were killing him—specifically, his severely impacted wisdoms, which his skull had grown around. The teeth threatened to pierce his sinus cavity. Left unaddressed, they would likely break his jaw and possibly stab his brain.

In other words, Ellis’ new ebook, An American Vampire in Juarez: Getting My Teeth Pulled in Mexico’s Most Notorious Border Town (nsfwcorp.com, $2.99), is hardly your average trip-to-see-the-dentist tale. It’s a sordid, noir-esque memoir of how the richest country in the world fails to take care of its own and offers a vivid, no-holds-barred snapshot of the border relationship between the U.S. and Mexico. (Disclosure: Ellis and I worked together at Las Vegas CityLife almost 10 years ago, along with Independent head honcho Jimmy Boegle.)

In a civilized country like, say, oh, Canada, a death panel would convene to decide the best moment for Ellis’ grey matter to be lacerated by his own tusks and for his organs to be harvested to benefit Islamist militants needing donations. Kidding. In any other First World nation, Ellis would simply have made an appointment. In the U.S., he lacked coverage, and couldn’t afford treatment, so he did nothing. Luckily he landed a gig with a military contractor and months later met with an HMO dentist in a Vegas clinic sandwiched between a Food 4 Less and a smoke shop.

That’s when this Hellraiser-grade tell-all really gets under way: The Vegas dentist can only remove Ellis’ lower wisdoms and suggest an oral surgeon for the uppers. What the American clinic inflicts on the writer is absurd. The doctor calls him fat and leaves his lower mandible riddled with fragments and a serious abscess. Months later the healed socket still issues chunks of bone.

This is all before Ellis, 34 and married, decides to become a medical tourist in a city recognized as the world’s murder capital. Where rival drug cartels rack up massive body counts over turf and the only good journalist, foreign or not, is a dead one. Using El Paso as base and clandestinely armed with several unusual “pigstickers,” he moves across the border and back—carefully. Like a hyper-vigilant Hunter S. Thompson with chops rot, Ellis delivers darkly hilarious descriptions, as when a Juarez hooker solicits him.

A tiny woman steps away from a baby stroller and approaches me. She looks exactly like what would happen if Rosie Perez played the part of Gozer the Gozerian in a downmarket version of Ghostbusters. She’s got a bulldog jaw, a bizarre pompadour/mullet, and a white outfit that looks like something Juice Newton left in a Dumpster after a show in 1982. The general effect is disturbing.

 

It’s not entirely a freak show. Ultimately, his treatment at the hands of an Anglo doctor and his staff provides an interesting contrast to what Ellis endured in Vegas. I don’t want to give away what happens—hint: it’s terrifying and not for the faint-hearted. Suffice to say the author ends up spooking coyotes with a mouthful of blood while crossing the border and then contemplating a mummified pawnshop curiosity in El Paso. (The symbolism is rife with political meanings.) Along the way Ellis instructs the reader, breaking everything down, from maquiladoras to right-wing hysteria over Obamacare to pricing on (and clientele) for oral surgery in Mexico.

Vampire is the closest thing to a how-to guide for those of us who are uninsured and considering a trip for affordable care. At 20,000 words, the book is a brisk read and Ellis a riveting guide into a realm few have documented so compellingly. Perhaps more significantly, if you’re someone who makes resolutions to floss regularly and fails, this first-person account of medical travails will scare you straight and clean.

An American Vampire in Juarez by Joshua Ellis is available in Kindle, Nook and ePub formats.

Published in Literature