The Fiction Issue

stay at home orders. We watched millions of Americans already teetering on the edge o financial insolvency lose their livelihoods. With their jobs, up to 27 million Americans also lost employer-sponsored health insurance during the pandemic.

Meanwhile, local and state health departments, as well as the CDC, anemic after decades of disinvestment through the austerity of the G reat Recession, struggled under the load of the pandemic. Burnt out from the experience, a third of public health workers in a national survey say they are considering leaving the public health workforce in the next year.

Despite the stress the pandemic put on hospitals around the country — and the desperate need that communities had for hospital beds — 21 hospitals shut down or ended service in the course of 2020 alone. These hospitals are shutting down in disproportionally rural communities and in states that did not expand Medicaid. Millions of Americans are being forced to drive further and further for medical care, those distances posing serious obstacles in emergencies.

H ospitals, despite being gorged with patients, were being starved for cash ow. he pandemic orced them to cancel their most lucrative elective procedures to make way for COV ID-19 patients. But it wasn’t only shutdowns that robbed people of healthcare options; 2020 also featured 73 hospital mergers or acquisitions that leave patients around the country with fewer choices for care. More than one in three (37 percent) of these deals involved a or profit healthcare system, up rom less than one in four (23 percent) in 2019.

Along with or profit hospitals, guess what other industry had a banner year in 2020? The health insurance industry. uddenly, they were ush with all the money they should have had to spend on elective procedures. U nitedH ealth roup made . illion in profits in the second quarter of 2020 — nearly double the $3.4 billion it made in the same quarter in 2019.

Where did they put that money? Well, 2020 was an election year — so they invested in making sure that nothing fundamentally changed about the nature of our healthcare system. They plowed that money back into our political process through everything from lobbying to electioneering. In the 2020 cycle, Blue Cross/Blue Shield—the biggest political spender among health insurers — spent $6,406,253 in political contributions. It also spent a whopping $49,879,310 lobbying. It was a key sponsor of the “Partnership for America’s H ealthcare Future,” a lobbying group that ran millions of dollars in ads throughout the cycle to specifically target Medicare for All.

The pandemic has claimed nearly a million American lives. It’s claimed millions more livelihoods. U S life expectancy fell by several years — even more so among people of color — erasing a quarter century of growth.

This singular health catastrophe demonstrates so many of the other healthcare challenges in America in addition to coverage and cost.

American healthcare is precarious. Employer sponsored insurance means that while you may have health insurance today, you could lose it for several reasons: losing a job, getting a new job, turning 26, getting married, getting divorced, or striking at work. Beyond that, in an America where we believe in the can-do entrepreneurial spirit, consider how many businesses are left unbuilt, career opportunities left unpursued for fear of losing health insurance.

American consumers are losing healthcare choices. The choice that Americans want in healthcare isn’t which health insurer, but which doctor to see or what hospital to go to. But mergers and acquisitions, let alone hospital closures, are robbing Americans of the healthcare choices that matter most to them.

H ealthcare workers are being exploited. The power of consolidating healthcare companies leaves healthcare workers — nurses, doctors, and other healthcare workers — at a disadvantage. When large hospital chains consolidate, workers are left with limited alternatives, reducing their ability to hold their employers accountable for unsa e sta ng, orced overtime, and unsafe working conditions. They also fall prey to the well- documented reduction of pay due to what economists call “monopsony” — the ability of oligopolies to collude to suppress wages.

We are failing to invest in prevention and public health. Our public health institutions were responding to the worst pandemic in modern history on shoestring budgets. But the continued defunding of public health does not align with Americans’ preferences. If given the choice, most Americans would choose to stay healthy rather than pay for healthcare after they’ve already gotten sick. But our healthcare system rakes in trillions of dollars, nearly a fi th o our entire gross domestic product, to pay for healthcare while our national investment in public health — the means of keeping Americans healthy — remains minimal. We live far shorter lives than our counterparts in other high-income countries. G ermany’s life expectancy, for example, is more than four years longer than ours.

Medicare for All: a single solution for all our healthcare problems

Well-meaning people often attempt to explain why alternative proposals to Medicare for All could also provide universal coverage and reduce our healthcare costs. But as discussed, assuming that those are the only two problems we must solve hinges on a limited understanding of the full scope of America’s healthcare challenges. When I introduce those challenges — the closing of rural hospitals, the expansion of forprofit healthcare through mergers and acquisitions that eliminate choice, the defunding of American public health, the exploitation of America’s healthcare workforce, the tiered nature of our health insurance system that turns lowincome Americans into second-class healthcare citizens — they propose Rube G oldberg add-on policies that render their proposals so complex as to be unworkable.

Medicare for All — a universal national health insurance program for everyone — is the most elegant, a ordable, understandable, e uitable solution to our myriad healthcare challenges. H aving enumerated a fuller scope of America’s healthcare challenges, I want to map how Medicare for All would solve each of these.

Medicare for All would provide universal health insurance coverage. edicare or All would o er the clearest pathway universal healthcare insurance coverage. Every single resident would have cradle-to-grave coverage. That coverage would insulate Americans from the escalating premiums, copays, and deductibles that leave even privately-insured Americans rationing, delaying, or forgoing healthcare right now.

Medicare for All would do away with second class healthcare citizenship. It would finally o er the e uitable health insurance every single American deserves. Regardless of what you earn, the color of your skin, or wear you work, you would be entitled to the same coverage — that reimburses at the same rate — as everyone else. This would save lives. A Yale study found that Medicare for All would save up to 68,000 lives every year.

Medicare for All is durable. Turn 26, get a job, lose a job, get married, get divorced: none of these would cost you your health insurance under Medicare for All. Regardless of the nature of their employment, Americans would be secure in the knowledge that they would not lose their health insurance. Beyond the peace of mind, this would support America’s economy as well: it could unleash the entrepreneurial spirit of Americans to start new businesses or explore new career opportunities without worrying about what it might mean should they or their families fall ill.

Medicare for All would slow the hospital mergers, acquisitions, and shutdowns that rob American consumers of their healthcare choices. Mergers and acquisitions, let alone hospital closures, are robbing millions of Americans of the choice of what doctor to see or what hospital to go to. These deals are driven by non-transparent negotiations over reimbursement rates between hospitals and health insurers. Larger hospitals can leverage their size to negotiate better reimbursement rates than their competitors—allowing them to press their advantage and ultimately purchase their competitors. Meanwhile, hospitals in low-income or rural communities shut down because their communities lack density or people with private insurance, leaving residents with no healthcare options at all.

U nder Medicare for All, there would be just a single insurer. H ospitals in similar catchment areas would be reimbursed at the same rate for the care they provide, barring larger hospitals from commanding better reimbursement rates simply for being larger. This allows smaller hospitals, as well as independent practices, to remain competitive, and o ers consumers more choice.

Similarly, Medicare for All would keep rural hospitals open through “global payments” — rather than reimbursing for each unit of healthcare

Our disinvestment in prevention and public health is a function of the fact that prevention rarely makes financial sense in a system predicated on profits that accrue only after people fall ill.

they provide, these hospitals would be paid in lump sum for the critical services they provide rural communities.

Medicare for All empowers healthcare workers. Today, nurses are being exploited by consolidated healthcare systems, just as those systems are squeezing physicians out of their practices because they cannot command the same reimbursement rates. These systems dehumanize their employees and cheapen the provider-patient relationship. In curbing the power of these mammoth healthcare systems, Medicare for All empowers the people who actually provide America’s healthcare, not the C-suite executives who manage their workplaces.

Medicare for All aligns incentives to invest in prevention and public health. Our disinvestment in prevention and public health is a function of the fact that prevention rarely ma es financial sense in a system predicated on profits that accrue only after people fall ill. Indeed, many of the most important investments in prevention take decades to manifest. But because people transition between insurance providers so often during their lives—ultimately transitioning to Medicare after they turn 65 — an investment in prevention today is unlikely to save an insurer money in the long-term. Insurers have little incentive to invest in prevention that won’t save them money.

Furthermore, the most important long-term investments in prevention and public health are structural interventions upon the “social determinants” of health, which are beyond the power of a single insurance company — these include rebuilding our decimated public health infrastructure, building walkable communities, addressing inaccess to healthy foods, improving air and water quality, or investing in early childhood education.

Medicare for All aligns these incentives. In this system, there is no churn in insurance providers because every American is insured by the same entity throughout their entire lives. Every investment in prevention yields savings for the very same entity. And because the insurer is the federal government, rather than a corporation motivated by its profit margin, it has the power to act on those incentives to address the broader social determinants of health.

Medicare for All would reduce the costs of healthcare for individuals, families, and the country — and expand the economy. An authoritative report by the Congressional Budget O ce, which you will hear about in the second witness panel today, has demonstrated that Medicare for All would reduce household out-of-pocket costs, increase wages, improve the e ciency of the healthcare system and “economywide productivity,” and increase labor productivity.

Conclusions

Medicare for All saves lives. It saves money for families and the country. And it o ers a sense o security that millions of Americans go without in our inhumane healthcare system. But opponents for Medicare for All continue to make the same fearmongering arguments opponents of national health insurance have been making for nearly a century.

They will tell you that Medicare for All would eliminate “healthcare choices,” although Medicare for All is critical to addressing the consolidation that is, in fact, robbing Americans of the choices they actually care about: which doctor, clinic, or hospital at which to seek care.

They will say that Medicare for All is too e pensive, that we cannot a ord it. In fact, Medicare for All is the best way to protect Americans from the exorbitant — and rising — healthcare costs that force the median American family to pay 12.5 percent of their before-tax income for basic healthcare needs.

“But the free-market drives innovation!” they claim, even though healthcare providers would remain private under Medicare for All, and smaller, more innovative, providers would finally be able to leverage their innovation to compete with larger providers rather than get crushed by unfair reimbursement rates. Never mind the fact that the U .S. federal government is one of the most important funders of biomedical innovation in the world.

“What about rationing?” they’ll ask, when in fact rising out-of-pocket costs are forcing Americans to ration, delay, or forgo their care every day in America under our current system.

They will tell you that more government is the problem, when in fact our private, or profit health insurance system delivers mediocre healthcare outcomes despite being the world’s most expensive healthcare system.

They will say Medicare for All is somehow “un-American,” when what is truly un-American is staring at our broken healthcare system and the people it breaks along with it and choosing to look away.

But today, you are choosing to stare our broken healthcare system in its cruel, indi erent ace. I commend you. And I hope that I have o ered some insight into how and why it is so broken, and how Medicare for All is the solution to fi it.

Originally published May 12 in T he Incision. You can get more at abdulelsayed. substack.com.

FEATURE

In the Distance

By Andrea Kowch

A globally collected, acclaimed, and institutionally recognized artist with new museum exhibitions set to open across the U.S. in 2023 and 2024, Andrea Kowch is a Detroit native and former adjunct and alumna of the College for Creative Studies, residing and working in Michigan, where she paints full time and is represented exclusively by RJD Gallery.

The 2022 Fiction Issue

Guest edited by Nandi Comer and deputy editor Zig Zag Claybourne The Ghanaian symbol, the Sankofa,

is represented by a bird with one foot stepping forward with its neck bent backward arching its head toward its back feathers. It represents the belief that in order to step into the future, we must look back and learn from our past. I have been thinking a lot about the future, but lately, every time I try to step forward through the doorway of a café or bar I pause, mask in hand, a little paralyzed by our new normal. Inside venues across metro Detroit, throngs of people elbow to elbow lean into one another unmasked, as if trying to dismiss the last two years of social distancing and washing our hands to “happy birthday.”

One thing these past two years have taught me is that the future is not certain, that no matter how advanced we humans think we have developed, no matter how sophisticated our technology, no matter what modes of transportation we build to arrive at destinations much farther and in the fastest means imaginable, we are still at the whim of our own nature. We are vulnerable creatures that have been grounded by terrible illnesses and natural disasters. And these illnesses and disasters happen every generation. But we have also forged resilient communities. We are made up of gardeners, healers, scientists, and caregivers. When faced with uncertainty we turn to one another.

In this Fiction Issue, by taking on the theme “Conjuring Future Visions,” writers and artists meditate on what lies ahead. Some pieces create speculative imagery of a future Detroit where citizens have access to devices that read our emotions; others ask us to question our relationship to the multiverse, the imaginative selves that may be more accessible to us than we thought.

But not all the work ventures into a distant future that is tech-driven. Some of the work asks that we only think about actions that will affect our future selves, others to consider the next seconds. There is even a piece where a future sage sends a message to the past (our present) warning us and guiding us as we move towards a radical future. To be, in the most personal sense, wizards and magicians.

And then there is ritual. Some of our artists acknowledge that in our desire to move forward and transition into a new day there is a need to uplift traditional practices that we have preserved for generations. They embody the spirit of the Sankofa by remembering our past in order to move forward into the future. Together these 21 artists present work of documentation mixed with that of conjecture and speculation. There is magic in the scenery. Their work highlights the alchemy of our survival, the importance of looking at our land, and ancestral practices.

The 2022 Fiction issue invites us to conjure and meditate on our tomorrow. They help me to understand that while the next step into the future may not be assured, it will be guided by our past and filled with curiosity and imagination. I hope you find delight in their work, like I did.

-Nandi Comer

Artist fees provided by Kresge Arts in Detroit (a program generously funded by The Kresge Foundation and administered by the College for Creative Studies). Nandi Comer is this year’s editor and Zig Zag Claybourne the deputy editor. Leila Abdelrazaq is the cover artist.

future sermon # 1 | WHAT IF I TOLD YOU (abridged)

By Cherrise Morriss

What if I told you that we are revolution unfolding,

that cain’t shit scare you when you realize who you really are

that your healing was your inheritance

that you and I, we, are bigger than our problems, more brilliant and beautiful and wise than our undoing fiercer than our mistakes and more formidable than any force working against us.

What if I told you that all the tools we need, we already have within

that it was, in this time, when we waited, wanted, wished for change, for growth, for love and transformation, healing and hope and safety

that it was,

all along

we were transformation in the esh and bone

we were the happily ever after

we were the substantiation of our wildest dreams

As if we were everything we’ve ever awaited

As if we were lightform coming home

As if we were all we needed to get free.

What if I told you that you were magic unfolding and you and me, we got the power to shift the reality of everything we’ve ever known to be true

that the world we been dreaming up, is not only possible but promised

and no — it won’t be perfect but it can be just and accepting and embracing and understanding,

it can be honest and loving and kind,

it can be wiser and more beautiful and divine,

it can support us all in living better lives.

And what if I told you how we’ll get there — with our loving and our healing and our fearlessness

with our intention and our consistent actions and efforts our unbrea able will and our diligence to show up and show out as the best version of self we can possibly be at every moment, even and especially amid crisis.

We will do it by listening to the wisdoms whispered by the wind, by looking in the mirror and noticing the ancestor holding your hand, by sitting with yourself and remembering how divine you really are,

the vestige of heavenly bodies that had to be broken to become whole, you were made in the image of God,

And cain’t shit scare you when you realize who you really are.

What if I told you, it was this, this whole time, it was us We are the change that’s gone come. We are possibility untamed. We are magic in motion. We are revolution, alive.

CAN I GET AN ASÉ, CAN I GET AN AMEN, CAN I GET A GITCHI GITCHI YAYA AND A UH NANA NANA

Cherise Morrisis a writer and spirit worker dreaming towards a future, free.

Aubade for the changing season

By Brittany Rogers

The sun will not rise early yet today may be the day to unplug the sunlamps, glaring at each other from their corners of the room. Testify: it is true what they say of winter’s rotten mouth, of this sky, bark-dry and starless. Before today, I obeyed its dog whistle. Sit. Stay. Roll over. It could be worse. In some states, sunlight is a myth whispered by folks who are from not there. But what of it? What, when there are places where the soil is soft year round, the sun chirping and kind each morning. This morning I woke up singing. What if? Heard my own self sing back. Wade into what could be. Light the candles on the dresser; the vanity; the nightstand. Fling open the curtains. Wide. Wider.

Brittany Rogers is a poet, educator, native Detroiter, and Editor in Chief of Muzzle

Leaving Home

By Dalia Reyes

Acrylic paint, gold leaf, gold pigment, chrome pen on paper, 11” x 15” in

Dalia Reyes is an artist, curator, and music lover from SW Detroit.

Magazine; learn more about her at www. brittanyrogers.org .

The Land Knows Us By Name

By Christiana Castillo

Knows me The seeds in my throat

How my bis bis bis abuela planted maíz in Jalisco How my abuela planted maíz

Created space for pollinated golden tassels To reach towards the sky Next to clouds of smoke in Detroit

The land remembers their names Knows every shape of their body All their curves, the scars, self-proclaimed beauty marks Even in decomposition The land remembers

Knows the seeds I keep in my throat The maíz I plant on Anishinaabe land And the seeds I always save

Knows how I dream of seeds Covered in dirt So I know my lineage is Seeds covered in dirt

Christiana Castillo (she/ella) is a MexicanBrasilian-American poet, educator, and gardener.

The Girl with a Bird’s Wings

By Matthew Fogarty

She was a girl with a bird’s wings they locked in the attic. Her sister was a lion they kept chained in the basement.

This was in the old house, in the old neighborhood of auto workers and artists and immigrants, corner stores. The old blue house with three stories and shutters and a wood porch and a front wal lined with red and white owers. The house with the chainlink fence and the tall gutter spouts where she’d watch a nest gather in the curve under the overhang of the roof. The house in which they were left behind, the sisters, after the family business collapsed, literally, the restaurant, it burned, the joists fell, and the family moved on. The house where the worst of things happened.

The two girls so young they formed few memories before what they became. For the eldest it was all at once: a collapse of the legs, the nose, the mouth, the ears, the golden eyes, the back arch, the pads and claws, the mane. The youngest, they grew over months, the wings, small bits of bone calcified into the changing shape of her back, under her skin, which stretched, minerals gathering into new joints of bone and sinew as though currented toward a delta. First she remembers noticing was sitting back in a chair, the discomfort. Then the welts appeared. The surface broke.

They are real wings, gray and feathered and grown now, and she hides them always under a coat, under clothing, even in summer. They can ap. he s ne er wished to y. In a wind she holds firm. In uiet moments alone, before locking the attic door at night, her mother would say you’re our baby blessing and she d run her fingers around each knot in the girl’s back and the fingers made a feeling close to lo e.

Though the parents, they were religious, there was so much they hid in shame, why they hid the girls at opposite ends of the home, why they scuttled the middle children away from the city into the Thumb like the animal parts of their daughters were some strain of contagion.

Left, the girls grew together. Out from the cold of the basement and the empty of the attic they imagined a future they could live out together, a life among farmland like where they pictured their siblings. Cows and a tractor. A barn the shape of an ark. A family the shape of a bruise. heltering woods.

After months, the sisters left the house, too, to explore the city for companions. In fact it was the other left children who lived under the bridge amidst the shifting owing forms of the strangenesses of weather and the swift currents of the river, it was they who gave birth to the idea that the girls— that they all—had some graver purpose in life in service of nature. nd this is when she saw it that first night, alone among the others, under the bridge: The violent hailstorm, that it could come on like nothing and a wicked wind that whipped waves into the shores of the peninsula, a wind so hard it could blow over signs and blow out storefronts and blow down barns, tear ea es from attics. In the worst of the storm strong enough to blow down even her make believe farm’s shipshaped barn. A storm in the shape of a freight train locomoting through everything in its path. Her face, it’s sweet and tired and worn for her age, but warm, her face with the easy wonder of a youngest. That they might come looking for her—for a blessing, for safety, forgi eness. he d be outside then in a future woods, hidden away by nature and watching as they searched. This: all of what she wished would appear within the haildrops.

In wa ing in the morning in the soft humid light of spring and the warmth of the fur of her sister next to her and the shadow of the bridge above, she remembered as a child, her sister stalking abo e her bed her tail ung wild and wailing, the broad smile of teeth, and the way she would sing out a sweet roar as a welcome, to welcome them both back to the wide awake world and all the wild wide joys of being two whole real things alive, sweet and soft, spreadwinged and taildriven and alone in the city, together.

I make things that I am passionate about.

When Grace Is A orded

By Rashaun Rucker

-Rashaun Rucker

Matthew Fogarty is the author of a collection of stories titled Maybe Mermaids and Robots are Lonely (Stillhouse Press, 2016) and is currently at work on a novel.

Quetzalcoatl’s Shadow On Vernor

By Reyes

He walks down streets unknown

His cans spray truth, colors combine for beautiful images of re ection Visions of past blood memories echo through his hands

He conjures spirits of ancestral songs, sung seeing the feathered serpents in a solilo uy ubtle as it is it is his truth

is brush fills the can as His words conjure the future visions prayed with aerosol cans Of the world that could be

Ancient cave paintings guide his way Mammoth, mastodons, bears, bison, lions Once walked with him pears car ed from stone Walking through turtle island

He is the poet moving about A world that wants him silenced

He is the conjury of spells Words forbidden, As he speaks truth to power Yet power does not yield to mere words

With “wat up doe” met with sign language onfidently showcasing colors po en in codes and codices oded in crucial con ict on icted future constricted crucified by the choices that await him

Candles light corners where souls once stood with smiles Now the candles illuminate the empty li uor bottles Blunt guts, ash, and haze, a gaze can be caught Once a year as they attempt to return home again

Just a shadow on Vernor

As a poet, artist and curator, Reyes performs internationally and facilitates performances and workshops by merging creative expression and critical thought whose work has been featured on HBO, CNN, PBS, The Chicago Tribunes Hoy Noticias, and Latin Nation.

Bad Day

By Keith Gaston

BB, the voice stuck in Jasmine’s head, whispered, “You’re tired, honey. Call in sick.”

“That sounds good,” Jasmine purred, pressing her head to the pillow, then o I can t do it she said shooing away s sweet urgings. I e missed too many days already.”

“You’ll regret it,” BB replied. asmine had ta en fi e sic days only one of those days because she was actually ill. lipping her legs off the bed she s uinted at the daylight coming from the window. “Curse you, sun.” tanding she stared at the bed.

“Missing it, already?” BB taunted. I don t.

“Liar.”

Inside the bathroom the sin and toilet were so close that her head and butt could touch them simultaneously if she bent slightly. Budgeting herself