Interviews for Resistance: The Opioid Crisis Is a Public Health Crisis Rooted in Poverty

Welcome to Interviews for Resistance. Since election night 2016, the streets of the United States have rung with resistance. People all over the country have woken up with the conviction that they must do something to fight inequality in all its forms. But many are wondering what it is they can do. In this series, we’ll be talking with experienced organizers, troublemakers and thinkers who have been doing the hard work of fighting for a long time. They’ll be sharing their insights on what works, what doesn’t, what’s changed and what is still the same. 

Cait Vaughan: I am Cait Vaughan. I live in Portland, Maine and I have been organizing for the past four years with the Healthcare is a Human Right campaign as a member of the Southern Maine Workers’ Center, which is a human rights organization that organizes and does movement building to improve the working conditions of poor and working class folks in Maine.

Sarah Jaffe: Maine’s governor was kind of the original proto-Trump. I thought it would be interesting to start out talking a little bit about what it has been like in Maine living and organizing under [Gov. Paul] LePage.

Cait: During the presidential campaign, that is some of what folks at the Workers Center were feeling — all of the things that Trump was saying were really familiar to us. We have been here with Governor LePage for a while. The big difference between Trump and LePage is really money. LePage is a tough figure because he is not a wealthy person. He never has been. He actually comes from poverty. He spent time as a young person being homeless on the streets and came from a home where there was a lot of domestic violence, which he is really public about.

But, similar to Trump, he hates on poor folks all the time. He is constantly telling people to go back to work. He has really focused a lot on villainizing Maine’s growing African immigrant population and blaming the opioid crisis here in Maine — which is a Mainer is dying at a rate of at least one person a day from a heroin overdose — on out of state folks, who are black, coming from New York City to peddle drugs here. So, while he uses a lot of the same rhetoric as Trump, our challenge has been that he has some credibility with some people in Maine because he does come from poverty and they see him as someone who has really worked his way up and who tells it like it is.

Maine is the oldest state in the nation, we are one of the more rural states in the nation, and we are also one of those places where a lot of mill jobs used to exist, and factory jobs, jobs that are never coming back. A lot of white people are really looking for somebody to tell them why they are all so poor or why they are working so hard but can’t get anywhere. We have been up against that narrative for quite a while here. It has looked like all the things you could imagine. We have kicked so many people off of food stamps over the past six years. That is touted as, ​“Look at all the people who are off of food stamps who got jobs.” We know that is not true. Kicking people off of food stamps, creating barriers for general assistance, which is housing, food, and medicine vouchers, especially, trying to kick immigrants off of those programs. It has looked like a tax on our public school teachers. It has looked like trying to sell the idea that more law enforcement is going to solve our drug problems. It is pretty bleak.

Right now, we are in a budget process at the state level where he is trying to eliminate $55 million from the budget, almost entirely out of the Health and Human Services side of the budget. So, trying to kick more people off of Medicaid. We were one of those states where we have never had Medicaid expansion and each budget he has been trying to kick more and more people off. Right now they are trying to kick 19-20-year-olds of Medicaid in Maine. It is pretty bad.

Sarah: Trump and all the Republicans ran on repealing the Affordable Care Act [ACA]. In states like Maine where they didn’t see a lot of the benefits of the Affordable Care Act, do you think that argument got more purchase with people because they hadn’t felt the benefits of it in the first place?

Cait: Yes. The Workers Center and the Healthcare is a Human Right campaign, for the past four years, one of the things we have been doing is going out and gathering people’s healthcare stories, using a survey for canvassing and meeting people at food pantries and public libraries and festivals and fairs to say, ​“How are you experiencing the healthcare system we have now?”

When we started four years ago, a lot of people were in the midst of trying to figure out the ACA and trying to figure out how to sign up for it and if it would work for them. There were a lot of people who were really disgruntled. I do think because Medicaid wasn’t expanded, that is part of it. Really, people’s biggest issue that I heard over and over again is, ​“First of all, it is confusing.” The rollout of the ACA, people were very confused. There were navigators and stuff available, but people were really confused about how to even figure out if they could get a good plan through the ACA. People were pissed that they were being fined for not being able to afford the ACA. Of course, had we expanded Medicaid, this wouldn’t have been such a pervasive problem. But when, as an organizer, people were telling me, ​“I can’t believe I have to pay a fine for not having coverage because I am too poor,” I said, ​“Yes, that sucks.” My response was to validate that. I was also one of those people who had to pay a fine.

Sarah: If you don’t have the expansion, then those two things interact in a really unpleasant way.

Cait: I do think not having the Medicaid expansion created a climate paired with LePage’s narrative about everything about Obama being terrible, those two things paired together gave people a story about why healthcare wasn’t working. In my experience, talking to people and really engaging them and listening to them, they might start a conversation saying one thing like, ​“The ACA is the problem.” Then, by the end of the conversation, we usually ended up in a place where they were like, ​“Having any insurance companies involved making money off of healthcare is wrong.”

What we were trying to do was engage people wherever they were at, whether they had lost their Medicaid, whether they were still on Medicaid, whether they got insurance with the ACA, whether they had no insurance at all, or even employer based insurance. We were trying to engage all of those folks to figure out, ​“What are the real roots of the problem?”

We know that everything right now is about protecting the ACA, but we know that the ACA has not served the folks that we are out here trying to organize. Not in the way that it could. We are, obviously, against taking away healthcare. We have absolutely met people who were saying, ​“The ACA is not perfect and it is frustrating, but it means I have healthcare that I desperately need.” We have just been listening and really leading from people’s own knowledge about their experience, what does it tell them and how do we help them unpack? ​“So, given all these experiences and what you are telling me, who do you think the real enemy is here?” The enemy is a profit driven system. That is everybody’s enemy. It doesn’t work for anybody.

Even in the midst right now of ​“Don’t repeal without replacing” or ​“Don’t defund Planned Parenthood” and all of the crisis and all of the calls that are going on to save healthcare, I was at a rally recently in Maine where someone was saying, ​“Save Our Care! Save Our Care!” after a person had just spoken who was an immigrant seeking asylum here who works fulltime who cannot afford anything through the ACA or through his employer right now. He had just talked about how he had no care expect free care through a hospital for emergencies. Then, there is a white woman from Maine screaming, ​“Save Our Care!” I am thinking, ​“Yes, but who is the ​‘our’ and who has actually been receiving care and who has been living in this gap all of this time?” Those are the folks that we are trying to engage.

Sarah: I want to go back and touch on the question of the opioid crisis. Talking about how this has affected Maine, again, it is the oldest state and one of, if not the, whitest state and a very rural state where this has hit really hard and where healthcare has been not only a political football, but has legitimately not been expanded to people.

Cait: Absolutely, it is really messed up that it has taken this crisis reaching middle and upper class white people for people to pay attention. To me it is a crisis of empathy and humanity and it is about racism. We are in this state that is 95 percent white. So, of course, the majority of people who are dying in this epidemic are white people.

It is hard, because all of us have lost people, I will say that. I have lost people that I love to this and I don’t know anyone who hasn’t. When we are talking about it, it is deeply personal for people because we are literally watching our communities die and that is really rough. To be in a moment where people are dying from using drugs and we are also shrinking whatever public safety net has been left, to me it is so ridiculous to live in a place where people don’t see that this is a public health crisis that has its roots in poverty. Also, I would say, in the white denial. People not wanting to believe that this could be such a big problem with white people.

I would say that it is not just the Republican folks who have been pushing law enforcement over increasing access to care. Here in Portland, we have an all-Democratic City Council that chose to shut down one of the premier, in the country, clinics that had a needle exchange, that had an HIV positive program and did STD testing and counselling, that was serving folks on the street, really low income people, had incredible relationships to their providers. This clinic, India Street Clinic, was reaching people that no one else could reach and doing a really good job at harm reduction and using this very progressive model that other folks nationally have looked at and been like, ​“Wow, that is a great model.” And our all-Democrat City Council decided that we don’t want to be in ​“the business of healthcare” and they were going to defund it and try to shift it over to a federally qualified health center in town that did not have those relationships, that did not have the skill, and they just wiped it out. There was a big public fight to save it and we lost. So, in the midst of a crisis where everybody’s friends and brothers are dying, we are eliminating things that work.

There are some amazing people in Maine who are starting to get it and people who are pushing harm reduction models and pushing for expanding services under Medicaid to cover addiction and also fighting for services that will actually connect people to life saving resources. There are a lot of people doing really good work in the midst of this really crappy narrative that law enforcement is the answer and if we just put more people in jail and we just to more raids and confiscate more drugs that we are going to get better. We know it is not going to work. We cannot solve this without taking seriously how we fight poverty. We take poverty as a given and we accept these folks as casualties. That is pretty repulsive.

Sarah: After the election, people were overlaying the Trump vote onto various different other maps of things. The one that really stuck me was the Trump vote overlaid with the opioid crisis, that you have people who are literally dying who are looking for something, anything that is going to make their lives better. When you are living and seeing that around you, it is really hard to write people off as just terrible people because of who they voted for.

Cait: I don’t believe that the Democratic Party cares more about poor people than the Republican Party as a whole. I think if we did, we would have had really different things happen. But I also think that we have to strike this balance about saying, ​“Okay, there is a narrative out there that” — like from Trump and from LePage — ​“We are going to bring these jobs back. We are going to build jobs by doing X, Y, and Z.” That does resonate for people who are on that line or in poverty. But there is also a way to come out strong against white supremacy and xenophobia and also have a message that resonates with working class people who are white and poor people who are white. The Democratic Party is not coming out strong enough against the really easy scapegoating narratives.

It matters in Maine that our governor is saying, ​“The drugs are coming in with black men from New York” and saying wild things like, ​“They are coming here, bringing drugs, and impregnating some white girl and then going back home.” He says these things that are really provocative and people will, at that point, come out against him and say, ​“You have got to apologize for this statement.” But he also says things that aren’t quite that outlandish but are just as dangerous and people are okay with that.

There needs to be a stronger and more nuanced story. We can’t just look at the white working class in this country and say, ​“Well, we have empathy for your suffering that is caused by economic injustice.” Absolutely. And there are white working class folks in this country that would rather go hungry themselves than push for policies that give immigrants GA, too. In our state, the majority of people who use General Assistance are white because the majority of our population is white. But our governor has framed General Assistance as a program that asylum seekers from central African countries are using, and therefore people are okay with, for example, the elimination of the entire program when it is going to mostly hurt white people. It is going to really, really hurt this population of immigrants who do not have another legal means of income to support themselves before they have work permits, it is going to, absolutely, disproportionately hurt them. But, also, you would rather chop of your own arm than see bread in your brother’s mouth. That is true and that is white supremacy.

For me, as a white person in Maine to be facing that head on with other white people and say, ​“How is it you would rather see your kid go hungry than see some immigrant who lives next to you eat? You are like, ​‘Well, I will take it from him even though it is taking from me, too.’” That is illogical. The only answer is white supremacy is that strong. We need to really dig deep in there and say, ​“Whoa! How wild is that that these policies have always been hurting white working class people and poor people, yet we have charged ahead? We have said, ​‘Okay. As long as it is hurting them, we are cool.’” I think the Democratic Party wants to talk just about economics. You can’t. There is something that white supremacy does for white people. There is stuff that we get from it that is not always tangible and sometimes even antithetical to our own material well-being and we still choose it again and again.

For me, working on the Healthcare is a Human Right campaign, I am trying to get healthcare for every single person who lives here, no matter what, that is comprehensive and dignified. Working on an issue that is a universal human need allows me to dig into some of those conversations with people in a nuanced way. I have seen some success with that.

Sarah: Tell us more about the ways that the healthcare campaign has allowed you to talk about that stuff.

Cait: The single payer movement has been around for a long, long time. There have always been people calling for a universal health program in this country. What the Healthcare is a Human Right campaign does differently, by using a human rights framework and by using not just a legislative strategy or even a ballot initiative strategy, we are trying to do true base-building that actually engages people around ​“What are your rights? Do you know them? Do you claim them?” Then, ​“Do you demand a different life based on knowing that you have human rights?”

Some single payer folks are really scared of that model. We have gotten pushback saying, ​“That is too bold a model. That is going to alienate the average person.” What they mean by the ​“average person” is probably a conservative white person who maybe doesn’t have a lot of money and maybe doesn’t have a lot of education. They are afraid that it alienates those people by saying ​“human rights.” What I have found is it is the opposite. For me, if I go up to someone and I just shove a policy solution at them and say, ​“Sign onto this” they are a lot more likely to be like, ​“No. Why are you talking to me like that?” You are just talking at somebody.

What we have done is engage people on values and talk to them about what they think human rights are and what it means to their lives. The response that I have gotten is that whether people have a good or negative reaction to it, they have a reaction that causes them to engage. And making such a bold claim — which is sad that it is such a bold claim, but whatever — actually gives us room to nudge people’s analysis forward.

One example is that I was at a library in Biddeford, just kind of hanging around with snacks and inviting people to come chat with me. Biddeford is a low income town. It is one of those places that is on a river. Saco was where the managers lived in the mills and Biddeford is where the workers lived. It is a place that has a lot of low income folks and the drug problems there are really serious. I am just hanging out at the library being like, ​“Do you want some food? Do you want to talk to me?” and a woman comes in with her 8 or 9-year-old son. She is like, ​“I heard you are back here talking to people about healthcare and I am just so mad and I really want to talk to you.” I am like, ​“Great. This is an organizer’s dream.” But, I am worried that she is going to yell at me. She is really worked up. She launches in saying that she voted for LePage, twice, she really likes a lot of the things he is doing, and also, she is really pissed because she just lost her healthcare. She just lost her Mainecare. Now her son will still get healthcare, but she won’t and she is feeling furious. She is a single mom who works fulltime who barely makes ends meet and she says, ​“How is it possible that my son can get healthcare and I can’t? What if something happens to me? Who takes care of him? If I can’t take care of him, how is that good for him?”

Then, we get to this part of our conversation where I say, ​“Do you believe healthcare is a human right?” She immediately says, ​“Well, yes, but not for immigrants. They are not from here and I don’t think we should give them anything.” So, this question about human rights is bold enough to make people come out with what they really believe. Then, she starts telling me how they act and how they soak up all of these resources and they don’t work hard. I am just able to ask her, ​“Do you really know people that you are describing?” She pauses and says, ​“No, not really. I have read about them in the news.” I was like, ​“Oh, okay. Yes, I hear a lot of people tell those stories, too. Let me tell you about the immigrant people I have met who have told me their stories. What I have heard from them is that they are often mothers who are worried about their children just like you are. You just told me that being a mother and protecting your son is one of the most important things to you. I am telling you that these immigrant women feel the same way about their children. They feel the same responsibility. I just don’t believe that someone should have to suffer because they weren’t born here. I don’t think their children should have to suffer.” We engaged in this conversation for 45 minutes and this woman who was a LePage voter, who has all of these racist and xenophobic ideas about immigrants, by the end of this conversation was moved to a place of saying, ​“I think healthcare should be a right for everyone and I guess I don’t believe anyone should have to suffer. Period.”

That is just an example of one conversation where you are able to move the needle. I don’t think this women’s entire worldview has changed, but I think that being able to sit with someone and have a values-based conversation instead of a policy-based conversation right out the gate actually made some space for her to be able to separate what she had heard versus what she actually knew and believed. I don’t think all people can necessarily get to that place in a 45-minute conversation, but I have experienced lots of conversations like that where people say ​“Well, what about this group…? Yes, healthcare for everybody except them.” Then, we engage them on it. We actually go there with them and we find out that most people’s values are that nobody should be suffering.

For me, as a white person, going out and talking to primarily other white people in Maine about this, I need to be willing to hold the line on white supremacy while also inviting people to really tell me ​“What are your real values?” We need to offer a much more compelling and bold narrative from the left. Not just about ​“How did we get here?” but ​“What are the real solutions forward?” The Democratic Party, they are not presenting a bold set of solutions. They are not saying, ​“Here is a path forward to prosperity.” They are not doing that and, frankly, Republicans are. Whether they are wrong or not, they are coming out and saying, ​“We are going to build this great thing. We are going to create all these jobs.” They just tell lies. I think there is an opportunity to say something that isn’t a lie, but that is very inspiring and compelling and speaks to the best in people while also holding them accountable for what they say and how they behave towards black folks, immigrants, etc.

Sarah: One of the other things you had mentioned was the idea of all of these people who are excited and getting politically engaged for the first time now because of Trump’s election and how to bring those people into this work while maintaining the vision that you were just talking about.

Cait: It is a challenge. A happy problem to have that you have so many people who are saying, ​“Oh my god, I want to do something.” But a lot of our organizations have actually been pretty small. Really, truly progressive grassroots organizations and movements in Maine have been really small and suddenly we have this surge of people. We have to figure out how to absorb them. I do think that it is really important that those of us who are radical folks on the left who are doing grassroots and big community based work right now, I think we should be engaging these newly activated people, many of whom are really much more aligned with the Democratic Party.

Also, in Maine I have been talking to a lot of people who are more affluent who are showing up all of a sudden, who are at least middle class who have pretty normative views about the world. They hate Donald Trump, but they wanted to see Hillary Clinton be president. They had very few qualms with who she was and her record. I think if those of us who are doing the kind of work that the Workers Center is doing, if we are not doing more to engage those folks who potentially could be brought into this much more transformative project, I think we are missing an opportunity. I think it means we have to teach people what real organizing is. A lot of what we are seeing right now is civic participation. We are seeing people call their representatives and feel like they have done what they can do or they are going to rallies and are not doing things that are necessarily unimportant or wrong, but a lot of folks don’t know what organizing is. I feel a responsibility as an organizer with a really transformative concept of what is needed — we need radical projects. We need to build a real movement. I really have to engage these folks that in the past, honestly, haven’t really been my priority to engage. We need to build something that has a very different scale right now than we are used to.

I am trying to balance both true loyalty to poor and working people in Maine, which that is where my heart is and where I think real liberation is going to come from, with also being like, ​“How can I work with the folks and hopefully have transformative learning experiences with the folks who are new and do not yet have a radical vision of a very different world, they just don’t want Donald Trump in office?”

I work for a reproductive healthcare and abortion provider. I am a paid organizer through that role. A lot of people are contacting us to talk about Roe v. Wade and saving abortion, the legality of abortion, and protecting that. I use those opportunities to validate that that is something that is really important and also be like, ​“Oh, and you know, we are facing cuts at the state level to TANF, to General Assistance. These are things that make it really difficult for women to start or grow families at a pace that they choose. And taking food out of people’s mouths is antithetical to reproductive justice. Let’s talk about that.” I feel like there are little ways to push people’s understanding of the problem. But, it is true that we have a huge influx of people who are not trained up. Those of us who are trained up, we need to be giving away everything we know at every opportunity. We need to be willing to go to these groups who are willing to have us and try to train them and try to push them analytically.

Also, we need to be trying to get those folks to give their money to truly radical projects. That is not going to save the world, but one of the things a lot of these newly active folks have is money and a lot of the folks we work with on a daily basis don’t have that kind of money. We need to figure out how to engage them, though, because there is danger in some of the narratives that they are presenting. Like, ​“We are a country of immigrants.” That totally erases settler colonialism and ongoing violence against indigenous people right here in Maine. That narrative is out there and it is very popular. We need to pull that back. We need to help people figure out the roots of the problem.

Sarah: How can people keep up with you and the organizations you work with?

Cait: Mainework​ers​.org is where the Workers Center is. Also, we are a part of a four-state collaborative of Healthcare is a Human Right campaign. If you go Health​careisahu​man​right​.org, you will also find out about our coordinated strategy with folks in Vermont, Maryland and Pennsylvania. In Maine, we have to make a lot of things from scratch because we are very different than our neighbors here in the north. We have a lot more in common, I think, with some of our southern states, except we are not as religious. Whenever I am on national calls trying to learn things from other organizers around the country, I learn a lot, but I also often feel like in Maine we are making things from scratch. I am hopeful that if people follow Maine, they might learn some things that they could reshape to fit their circumstances, other folks who are working in rural contexts and in very white and conservative and working class contexts. If people want to reach out to Maine, we want to hear from them.

Interviews for Resistance is a project of Sarah Jaffe, with assistance from Laura Feuillebois and support from the Nation Institute. It is also available as a podcast. Not to be reprinted without permission.