Featuring Dr. Stephanie Kang, PhD, who is Congresswoman Pramila Jayapal’s health policy director and a graduate of the Harvard T.H. Chan School of Public Health. She is speaking on behalf of herself and not necessarily on behalf of the office of Rep. Jayapal.

 

This is part one of a two-part series. 

 

Setting the stage for health equity in America

 

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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.

Why does Rep. Pramila Jayapal continue to fight for Medicare for All when President Joe Biden has opposed it? How would the congresswoman’s bill promote racial equity in America? To find out, we spoke to Dr. Stephanie Kang, who serves as Jayapal’s health policy director and has assisted in crafting Medicare for All legislation in the U.S. House of Representatives. She completed her doctorate of public health at the Harvard T.H. Chan School of Public Health.

 

(5-second stinger)

 

Welcome to Code WACK,  Dr. Kang!

 

Q: You serve as health policy director for Rep. Pramila Jayapal, who has consistently championed equity – including healthcare equity – as part of her platform. In both 2019 and 2021, she introduced Medicare-for-All bills in the House. In light of President Joe Biden’s stated opposition to Medicare for All, why does Rep. Jayapal continue to fight for it?

 

Kang: As you mentioned the congresswoman, she has been a fighter in the frontlines for health equity for a long time, and over the last couple years we have built up a momentum inside Congress that has just been completely unprecedented both in terms of policy consideration and politically and we saw that throughout the presidential debate. Every single Democratic presidential debate Medicare for All was at the top of the conversation. Despite the fact that we have a president currently who has stated his explicit opposition against Medicare for All, momentum for Medicare for All has continued, and I think there’s a lot of reasons for this.

One is definitely COVID, so we’ve all been through this pandemic for the last year that just clearly made the case as to why we can no longer tie health care to employment. It’s just never been clearer than ever before when millions of people were losing their jobs, they were losing their health insurance, and this just wasn’t happening in any other developed country and so while we’re already having to worry about a public health response, we’re having to worry about an unemployment crisis, we’re having to worry about health security crises, all happening at the same time. 

And so, I haven’t heard the other side saying again that there’s a lack of choice in Medicare for All because you know we saw the current system really doesn’t give you any choice. And also I mean what we saw when we introduced the bill this Congress, we had the most number of cosponsors on a bill on introduction day than we’ve ever had. We had Congress members who’ve been in Congress for long periods of time and have never been on a Medicare for All bill until this Congress. And so, you know, while there aren’t all of the political pieces in line yet, they’re falling into line, and that’s what I truly believe. It’s what I’ve been seeing inside the House. We are seeing that there is movement, that we are building that power both inside and outside and so, you know, you can’t stop just because one of the political pieces isn’t there yet. You have to get everything else fortified so that when we do have a president that’s supportive, we’re there for them.

 

Q: Great. Thank you. Even before COVID-19, racial inequities in healthcare were very apparent. One example is African American maternal mortality rates. Now, after COVID, racial and wealth inequities in healthcare appear even starker. How would Jayapal’s Medicare for All legislation help promote equity in health care? 

Kang: Absolutely. So I strongly believe that we will never achieve health justice, racial justice, economic justice until we have a single-payer universal health care system, right, so just to be really clear what we mean. We have to have an equitable leveling of the playing field. Everyone has the starting basis of coverage that they need to live a dignified life. But to be really clear that alone does not dismantle all of the different barriers and structures that are in play that have made people who are … communities of color, BIPOC communities sicker, and more prone to either dying — you said maternal mortality but we also saw that very clearly with COVID. And so we also have to be thinking deeper than just universal health care. We have to also be thinking through what is happening at the clinical level, what is happening when health care is being delivered. Who are the people that are delivering care? We have to look at who they look like. 

We have to also be thinking through a much more public health perspective and be thinking deeper into all the social determinants of health. And so that’s what Medicare for All is really transformed into and because this is definitely an already very ambitious bill, it establishes a national health insurance program, but this Congress we also included a provision that would establish an Office of Health Equity. 

And this was really critical because you know we were getting feedback from our partners, and that, you know, yes, we’re talking about universal health care but let’s just be really clear once again that that alone does not address health inequities, and so we established this provision. It would be in the Office of the Secretary of Health and you know we’re not only will it be able to collect the data that you need, make sure that we’re also monitoring all the different disproportionate burden diseases and death that happens among people of color, as well as you know other inequities we see by sex, for our LGBTQ community, disability status, immigration status. We’re also wanting to make sure that they’re able to develop policies based on that data, and then actually enact them. Right? Because we’ve been collecting data for a long time. We know. We know things are worse for our brothers and sisters of color and so we want to make sure we’re getting that data, that we put teeth behind it and the money behind it and we make sure that they get enacted.

 

Q: An article came out recently in a publication called Corporate Crime Reporter. The title was Sanders, Jayapal Put Single Payer Medicare for All on the Back Burner.

It noted that Sanders has yet to reintroduce his single payer bill in the Senate. Instead, the article said, he is pushing for a step-by-step approach – dropping the Medicare age to 60 and expanding it to cover dental, hearing and vision. It also said that Jayapal introduced her Medicare for All legislation as we know in March, but she has made it clear that she was more interested in the Sanders step-by-step approach. Do you agree with that assessment?

Kang:  I mean I cannot speak for Senator Sanders’ office but you know I think that both have made it clear that they’ve been fighting for single payer for a really long time and I think that we’re able to … what is the expression? Walk and chew gum, right, like at the same time. It’s not like it’s one or the other. There is a broader movement that has to be built for single payer. They’re extremely powerful forces at play, and the movement that will have to be established in order for us to ever achieve this, we’re not there yet. And we have to do the work. And that can happen simultaneously while we are then putting down the legislative groundwork toward single payer. 

People have to recognize that laws are going to be passed every Congress no matter what and so if those laws are promoting more privatization, more fragmentation of our health insurance system, that only makes it harder then to get to a single-payer system. So we have to be doing both. We have to be on the offense and the defense. And so to me, pushing for these quote on quote step-by-step proposals is being on the defense, right? We’re making sure…Or maybe on the offense. We’re being on the offense by making sure that we’re preemptively ensuring that our health insurance system does not become less able to then transition to a single-payer system. Those steps that you just mentioned — so lowering the Medicare age, improving Medicare, I  mean these are extremely popular policies across party lines. Why wouldn’t we make those changes when, as you said, we have a president who is opposed to Medicare for All?

People have to recognize the history of health reform. We’ve had a president who supported a single-payer system. He had the Congress and he still couldn’t do it. This is how hard health reform is in this country. This is how powerful interests.are.

 

Q. That’s right. In 1947 President Harry Truman said healthy citizens constitute our greatest natural resource and we should strive to make good health equally available to all citizens.

Kang: And so this is why I’m saying we have to build up the movement inside Congress and outside so strong so that when we do finally again have a president who is ready for a national health insurance plan, we’re able to beat the interests and we’re able to make it happen. But there’s a lot of work in between and people have to be willing to recognize that and people have to be willing to put in that work. 

 

Thank you, Dr. Stephanie Kang.

 

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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