Join Linda Rae Murray, MD, MPH, & Brenda Gazzar as they take a deep dive on the structural reasons for America’s fragmented healthcare system and what we can do to fix it.
‘Centuries of Inequities’ & the COVID Crisis
—– TRANSCRIPT —–
Welcome to Code WACK!, your podcast on America’s broken healthcare system and how Medicare for All could help. I’m your host, Brenda Gazzar.
How has the public sector in America been under attack? How can we better protect Black and other Americans who are disproportionately affected by COVID and chronic conditions? To find out, we spoke to Dr. Linda Rae Murray, a physician who spent 40 years in clinical practice helping the medically underserved. She retired in 2014 from her post as the chief medical officer for the Cook County Department of Public Health of the Cook County Health and Hospital System in Illinois.
Welcome to Code WACK!, Dr. Murray.
Murray: My pleasure.
Q: Looking at the pandemic specifically, how did social, structural, and personal racial inequities combine to affect Black Americans?
Murray: So let’s back up a little bit. Pandemics also are an interaction between the environment and human beings and so we have had pandemics, certainly a number of them through my career as a physician, HIV probably being the most impactful. It is a pandemic whether people think of it like that or not and it’s not a surprise that we have the kind of pandemic we have now with the respirable, transmittable organism. We have known that this was going to happen. That is also related frankly to climate change and our interaction with other species on the planet. So let me just say that in the beginning.
And whenever you have a challenge like this, and you have inequities, then the people who do not have the same level of resources are more vulnerable. That’s exactly what that means. So if I own three or four homes, and I leave New York City and go to the Hamptons or some other place where you know the population isn’t as dense and I can order in my food. Obviously you have less contact, you have less problems and my income is not impacted. But if I’m an ordinary American white or black working, say, for a public transportation system or in a factory, then I don’t have those options. If I don’t go to work, then I don’t get paid, I can’t pay my bills, etc. So certainly for Native Americans, African Americans, Latinx people in this country, those realities of our daily lives explain the huge differences that we’ve seen in mortality for COVID, but we should be clear that as a rich country we’ve done very badly in this global pandemic, and our lack of a public health infrastructure, the fact that we’ve historically underfunded public health, and don’t understand the role of public health has meant that many Americans of all races have died unnecessarily from preventable deaths that wouldn’t have occurred if we had a functional public health system and a functional health system in the United States.
Q: Hmmm. Yeah. Why do you think there’s been such an attack on public health over the years?
Murray: This is an attack on American people. It’s an attack on “the public sector.” If you think back to your sort of ninth-grade Civics course, government is what we do collectively. You can have good government and bad government but whatever you have, it’s what we collectively as a society use to structure what’s going on and so, this constant attack on government as though that were the problem or the public sector creates a problem… Look during the last election where people, Republicans were chanting they wanted to keep (the) government out of their Medicare. So there’s a real cognitive dissonance there.
Medicare is in fact the best medical system we have running in the country. It is a governmental system and it does provide sort of a single-payer-like system to help take care of people. Most Americans that are involved with Medicare think it’s great so when it’s framed as though it’s not government, that’s a problem. Most Europeans think rich people are rich because they got lucky. Most Americans think rich people are rich because they worked hard. Now most rich people, especially of our age now, are rich because their parents were rich. They didn’t do nothing.
So I think that it means we have to really as Americans be better educated. We have to have some sense of history and understand how the country works. We can have disagreements on what you should do about it but you cannot continue, for example, to allow people to make unlimited profit and expect not to have fires year around in Europe and the United States and Canada, not to have these floods. This is a direct result of us running amok and thinking that we can continually without any change, maximize profit and still in the world, starvation and malnutrition are still the leading causes of death in the world.
Q: Wow. Can you talk about some of these other things that you alluded to, like housing, exposure to environmental hazards, living next to freeways, how those during the pandemic affected African Americans?
Murray: You can almost pick anything. I think the biggest single issue if I had to pick one that affects Blacks during the pandemic is the necessity of trying to go to work. And then if you’re unable to work, either because your plant got closed down, or because you’re sick or whatever, the loss of any support. We did a little bit, which we think is amazing. We had some unemployment etc. but in other parts of the world, people were getting 80% or 90% of their regular income from the very beginning and in structures that already provide universal health care, etc.
So we’re a country that we don’t provide most of those social supports, and what we do provide is state by state. People forget we’re not approaching this pandemic as a nation. Let’s pretend for a minute that we were being invaded by another country. Okay? We would not allow every governor to decide how to fight that invasion. It’s another structural problem that goes to voting and everything else. The way our Constitution is set up, we have 50-plus public health departments in this country. Health care is a state power. It’s devolved to the states. They have the real legal authority to decide who can be a doctor, who can be a nurse, and what the response of governmental public health is.
So we’ve had 50 different responses, plus our territories, to this pandemic. We have not been able to have a coordinated response. Even though I personally, for example, thought that (Donald) Trump’s contribution to this pandemic was horrific, I don’t want to in any way excuse him, but even he had not been the president, our response would not have been adequate, because we have not invested in the public health infrastructure, we don’t have a coordinated approach, and we don’t think about these things in a rational way so at every point in our society, I don’t care whether it’s school systems, transportation, internet. You know there are major places in the country where people don’t have internet access, not just the rural areas. I live in the southside of Chicago and our internet service over here on the southside is notoriously bad and slow compared to whiter areas of the city. So when you create centuries of inequities on all levels, then when you have a crisis, those inequities just get more exposed and often widened.
Q: Yeah, right, thank you. What about the role of the health insurance system in healthcare inequities?
If I had my way, we’d get rid of health insurance. Think about what that means. I think little kids understand this, but what does health insurance mean? Does it mean we’re making a bet that we won’t get sick? I mean, all of us are going to die. All of us, and most of us will not die before having some other malfunctions that cause us pain or discomfort, etc. So, we should just prepare to take care of people and do it in the best way possible. So I don’t know what health insurance…you mean as a funding mechanism, so then we should ask ourselves, is this a basic human right or not? I think health is a basic human right, and so the cost of doing that should be shared. In this country we spend more on medical care than anywhere else in the world several times over. We have more than enough money to take care of every man, woman, child, every dog and cat in the United States, and provide the highest quality medical care, but we have to have a system.
We have to build a system that is designed to do that, not to make profits. We have to build a workforce that looks like the population. There are fewer black men entering medical school today than when I graduated medical school, fewer in number. So that means we have to not allow that to happen.
Q: Um-hmmm. Why else do you support Medicare for All?
Murray: Well, why not? Mostly it’s because I believe that health care, medical care especially but health care, which is broader than medical care, is a basic human right and I’ve seen around the world other countries that have this principle — that it’s a basic human right — and try to structure services to address that do much better, have much better outcomes. So the United States, we may have the most expensive medical care system in the world but we have the worst health of any rich country in the world. I mean that’s the reality. Our system is a failure. You can see it whether you look at life expectancy, maternal mortality, stroke. You can look at a whole range of things in comparison to other rich countries, other rich capitalist countries in the world and this has been true for a while — since the 50s — and it continues to be true, and the gaps continue to widen.
Thank you, Dr. Linda Rae Murray.
Find more Code WACK! episodes on ProgressiveVoices.com and on the PV App. You can also subscribe to Code WACK! wherever you find your podcasts. This podcast is powered by HEAL California, uplifting the voices of those fighting for health care reform around the country. I’m Brenda Gazzar.
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Please watch Michael Moore’s documentary “Sicko” to see how so many countries (Canada, England, France, Cuba and even the poorest countries) have universal healthcare that is completely free with extremely low cost prescription medications. If you have a visa and go to any of these countries, you qualify for the same free healthcare! America’s insurance and pharmaceutical industry corporate ownership allows healthcare providers to deny preventative, adequate, timely treatment and diagnostic testing to patients with so much red tape and paperwork that getting necessary help takes forever and is easily denied causing great suffering and even death. I’ve heard many tragic stories. Kaiser’s Senior Advantage is misleading as it is not actually Medicare although it is paid for through Medicare and discriminates against seniors because they aren’t paying enough according to membership services. There doesn’t appear to be any oversight! What is wrong with our government. Universal healthcare is long overdue here!
Thanks for your comments, Susan! “Sicko” is a brilliant expose of not only how universal healthcare systems deliver better care, but also disproves the false narratives spread by vested corporate interests! (One example – that doctors will be paid less.) I don’t know if it’s true that anyone with a visa will qualify for free healthcare in these countries – I personally wouldn’t take the chance without checking on that. But I have heard stories of people getting treated at an incredibly reasonable cost! Also, your comments on Senior Advantage are right on. In fact, Kaiser is being sued by the U.S. government for over-diagnosing patients to get higher reimbursements from Medicare.