Ep. 20 Birth and Death in America (w/ Sanjeev Sriram)

Briahna Joy Gray: American exceptionalism. The belief that the US stands unique among all world’s nations, a shining city on the hill, as Ronald Reagan put it. And while some on the left might be tempted to poo-poo that notion, in some ways, it is indisputably true. Take maternal mortality for instance. Between 1991 and 2014, bucking just about every international trend, the maternal mortality rate in the United States more than doubled. The US has the highest maternal mortality rate in the developed world. In fact, we rank lower than countries like Bulgaria, Kazakhstan and Saudi Arabia. And if you break that down by ethnicity, the numbers are even starker. According to a report from the Centers for Disease Control and Prevention, African American, Native American and Alaskan Native women are about three times more likely to die from pregnancy-related complications than white women. In Louisiana, 72 black women will die for every 100,000 live births. According to World Bank rankings, that puts us right between Syria, a country in the midst of a devastating civil war, and Kyrgyzstan, which has a GDP per capita of about $1,200.00. 

 America, sweetie, we can do better. 

This is Hear the Bern. A podcast about the people, ideas and politics that are driving the Bernie Sanders 2020 campaign and the movement to secure a dignified life for everyone living in this country. My name is Briahna Joy Gray and I’m coming to you from campaign headquarters in Washington, DC. 

 You might think that wealth provides a shield against this racial disparity. But that shield is only partial. Although college educated black women fare better than non-college educated black women, they are still more likely to die in childbirth than white women who never graduated from high school, according to a study of New York City mothers. This was highlighted recently when both Serena Williams and Beyoncé endured life-threatening complications in their pregnancies. 

Serena Williams:  “And then they had to check for, you know, blood clots and everything, so they were doing all these different tests, everything was negative. I’m like, ‘Listen. I need you to run a CAT scan. With dye. Because I have a pulmonary embolism in my lungs. I know it. I know. I’ve had this before. I know my body.'”

Briahna Joy Gray:  Now, the reasons for that disparity are complex, and they are deep. 

 Sanjeev Sriram:  To me, structural racism is the number one-

Briahna Joy Gray:  Mm-hmm (affirmative).

 Sanjeev Sriram:  … right? Like, that’s our oldest culprit. It’s the most ingrained culprit. We have a healthcare system that fundamentally does not want or look forward to everybody being healthy and thriving. 

Briahna Joy Gray:  Mm-hmm (affirmative). 

 Sanjeev Sriram:  We have a healthcare system that is fundamentally built upon who is deserving and who is undeserving. 

Briahna Joy Gray:  Mm-hmm (affirmative). 

 Sanjeev Sriram:  And race has a huge amount to do with that because of the way that undeserving and deserving plays into racial hierarchies even outside of healthcare. 

Briahna Joy Gray:  That was Dr. Sanjeev Sriram, a pediatrician who practices in Southeast DC, a predominantly black part of the capital which just so happens to be the most dangerous place in the country to give birth. 

 Sanjeev Sriram:  I remember a public health expert, you know, guiding us through the numbers here in DC and she was saying the, you know, when she had been to sub-Saharan Africa, that the numbers were comparable to what-

Briahna Joy Gray:  Mmm. 

 Sanjeev Sriram:  … we were seeing in southeast DC and yet, just across a river, in a small town like DC, you’ve got some of the highest rates of maternal success. And so how is it that you have failure and success so close together and separated only a river?

Briahna Joy Gray:  Dr. Sriram is also an activist. I first met him earlier this summer, when he took part in a protest against the closure of Philadelphia’s Hahnemann Hospital. And it is as an activist that he has crafted an alter ego, one designed to put people at ease when talking to an authority figure. 

 Sanjeev Sriram:  When I would go out to rallies and, and protests and I would wear the white coat over just like my regular work clothes, I got the feeling that people felt kind of intimidated-

Briahna Joy Gray:  Mmm.

 Sanjeev Sriram:  … like, “Oh I don’t know if I can really approach this guy,” like, “Let me have like, everything put together first.” And then I’m a very casual person and so I thought, “You know what, let’s just like, cut all of that and let’s at the same time appropriate, you know, or reappropriate some symbology here,” and I just threw on, I’m a comic book nerd and I thought, “You know, I’m gonna be Dr. America.” And I just, you know, threw on this shirt and put the white coat on top.

Briahna Joy Gray:  And so, Dr. America was born. The doctor dropped by the campaign headquarters last week to explain by Bernie’s Medicare For All plan would do much, although not everything, to close that gap. Dr. Sriram explained that like most disparities, racial health disparities, including the high maternal mortality rate experienced by women of color are rooted in a large number of factors. The problem is structural and intersectional. The problem is about race, it’s about class, it’s about housing, it’s about healthcare. It’s about substantive justice. 

 Sanjeev Sriram:  All of those hierarchical systems that are built upon race end up having an impact of health just because of the way that now that we’re learning more about toxic stress-

Briahna Joy Gray:  Mm-hmm (affirmative).

 Sanjeev Sriram:  … the way that things happen along the epigenetic, uh, line, people are born vulnerable. 

Briahna Joy Gray:  Mm-hmm (affirmative). 

 Sanjeev Sriram:  And then, you know, vulnerable people struggle through their life not even knowing that they were put in this position for no fault of their own and these vulnerabilities become part of the almost like, family heirlooms that are passed down the line and either get exacerbated or every now and then maybe a little bit better-

Briahna Joy Gray:  Yeah. 

 Sanjeev Sriram:  … but it’s still like, not necessarily wiped out at the root. 

Briahna Joy Gray:  So, I, I want to pause ’cause you, you said epigenetics and I and-

 Sanjeev Sriram:  Yeah. 

Briahna Joy Gray:  … I know we’re getting a little bit in the weeds here. 

 Sanjeev Sriram:  Yeah. 

Briahna Joy Gray:  But what’s funny is, I was actually explaining epigenetics to my boyfriend the other night-

 Sanjeev Sriram:  Yeah, yeah. 

Briahna Joy Gray:  … because I think, I think it’s fascinating. I was a history of science major.

 Sanjeev Sriram:  Mm-hmm (affirmative).

Briahna Joy Gray:  And in school, right, we grow up and we learn okay, you know, Darwinian evolution works a certain way, your genes don’t really change, like, it’s natural selection over time-

 Sanjeev Sriram:  Yeah. 

Briahna Joy Gray:  … versus a guy name Linnaeus and he thought that like, genes changed and that’s why you have the different kind of-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … you know, like, you can like, you change in your life and then you pass that on-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … and that was supposed to be hogwash. Now we’re learning that what happens to you during your life-

 Sanjeev Sriram:  Yeah. 

Briahna Joy Gray:  … can actually have an effect on your offspring. 

 Sanjeev Sriram:  Offspring. And especially during childhood because everything is so plastic and so vulnerable at that time. So, when you look at this country’s history, we’ve been terrible to children of color-

Briahna Joy Gray:  Mm-hmm (affirmative).

 Sanjeev Sriram:  … since the very beginning. 

Briahna Joy Gray:  Mmm.

 Sanjeev Sriram:  I know that, I mean, this is not to, you know, disrespect anything happening at the border, but we’ve been separating children from-

Briahna Joy Gray:  Right. 

 Sanjeev Sriram:  … their parents since the country’s foundation.

Briahna Joy Gray:  Right. 

 Sanjeev Sriram:  It’s, I mean it’s a huge part of who this country has been and that trauma that’s-

Briahna Joy Gray:  Yeah. 

 Sanjeev Sriram:  … starts at such a, you know, vulnerable young age, it is how the seeds of mistrust and stress and, I, I think that the, the stress of who can I, like, who can I rely upon, is anything going to be stable around me and to live your entire childhood like that, I mean you, you, we can only imagine what kind of adults we create at the end of all of that. 

Briahna Joy Gray:  Right. 

 Sanjeev Sriram:  And the same thing is happening at the border and the same thing happens even in mundane exercises where kids fall in and out of insurance-

Briahna Joy Gray:  Mmm. 

 Sanjeev Sriram:  … where their parents get, you know, insured, uninsured, all of those, like, those might not be like, on the same level of stress as being separated from your family, but there’s still most definitely some kind of an impact because your stability has been upended. 

Briahna Joy Gray:  Right. So, what is sounds like, that there is like, there’s this kind of complex and inextricable relationship between racism-

 Sanjeev Sriram:  Mm-hmm (affirmative).

Briahna Joy Gray:  … and some of the consequences of racism that are uh, a jumble of race and economic factors, right? So, uh, you know, in a racist society where it’s more difficult to, um, secure housing-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … or where there’s an income gap, that means that black and brown people are disproportionately living in low-income housing. That means you have the stress of not having secure housing. That means pregnant mothers are enduring the stress of not knowing where they’re gonna live or where they’re gonna be-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … able to give birth to their child. The stress of not having insurance, of not being able to get prenatal care-

 Sanjeev Sriram:  Yeah.

Briahna Joy Gray:  … of not being able to get postnatal care because of a lack of insurance, of living in housing that might give them exposure to lead and other kinds of elements. How do we start to go about ameliorating all of that like, complex, like cluster of-

 Sanjeev Sriram:  Yeah. 

Briahna Joy Gray:  … factors that is going into these disparities?

 Sanjeev Sriram:  There’s something about America that hates confronting its vulnerability-

Briahna Joy Gray:  Mmm.

 Sanjeev Sriram:  … and just owning that all of us are vulnerable. 

Briahna Joy Gray:  Mmm.

 Sanjeev Sriram:  Whether by biology, history, finances, whatever, all of us have vulnerability of some kind or the other. And if you don’t feel you have vulnerability yet, just give biology or time, you know, its due course, and-

Briahna Joy Gray:  Yeah. 

 Sanjeev Sriram:  … before you know it, you’re gonna be vulnerable in some kind of way. 

Briahna Joy Gray:  Mm-hmm (affirmative).

 Sanjeev Sriram:  And I think that instead, what we do is we attach vulnerability to virtue-

Briahna Joy Gray:  Hm. 

 Sanjeev Sriram:  … in that if you are vulnerable, then that clearly is a lack of virtue-

Briahna Joy Gray:  Mmm.

 Sanjeev Sriram:  … and if you are invulnerable, that’s because you are virtuous. 

Briahna Joy Gray:  Mmm. 

 Sanjeev Sriram:  And it’s, in, in fact, the truth of it is, is that a lot of the things that we consider virtuous behaviors are things that happen in safe, stable environments. 

Briahna Joy Gray:  Mm-hmm (affirmative).

 Sanjeev Sriram:  It’s easy to do delayed gratification and study for an exam and not go hang out with your friends when you kind of feel like, “Oh, but if I do this now, it’s gonna pay off.” Like- 

Briahna Joy Gray:  Yeah, or-

 Sanjeev Sriram:  … if you- 

Briahna Joy Gray:  … the financial advice that says, “Well, why aren’t poor people saving?”

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  (laughs) 

 Right. Right. 

 We don’t have any money to-

 Sanjeev Sriram:  Yeah. 

Briahna Joy Gray:  … put aside. Yeah. 

 Sanjeev Sriram:  Yeah, I mean that, and I see this even in healthcare where, you know, I’ve got colleagues who criticize moms for having like, you know, their nails done and the hair done and you know, their health is not doing all that great and that criticism of like, “Well, if she has the money to do all that for her hair and her nails, like, why doesn’t she take better care of her health?” And I have to always hit that pause button at work to say that, “You know how good she feels after she gets that nails and hair done? That might be the only time she gets to-

Briahna Joy Gray:  Yeah. 

 Sanjeev Sriram:  … feel good about herself for the next quarter.”

Briahna Joy Gray:  Yeah. 

 Sanjeev Sriram:  And whereas, like, yeah, doing the work that it takes to be healthy, sure there’s a long term payoff for that, but no time during the, all the, the grind of being healthy do you get to ever look at yourself in the mirror or like, just take a step back and feel, “I feel good.” 

Briahna Joy Gray:  Yeah. 

 Sanjeev Sriram:  “Like, this is, this is nice.” You know, in a, in a very concrete-

Briahna Joy Gray:  Yeah. 

 Sanjeev Sriram:  … satisfying way that getting your hair and nails done kind of does it. 

Briahna Joy Gray:  Yeah, I was literally just having um, this conversation with uh, a woman who sits next to me at work whose nails look very nice, where mine do not. 

 (laughs) 

 (laughs) 

 I want to talk about the particular issue which is that, one thing that’s really interesting about the racial disparities in this area is that it affects even higher income black women-

 Sanjeev Sriram:  Yeah. 

Briahna Joy Gray:  … right? So, some high-profile cases happen in the last few years where Serena Williams had a very difficult pregnancy and so did Beyoncé-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … Knowles. What’s going on there? Is it that those kind of stressors are still, race related stressors, are still affecting them, you know, why is it that even highly educated, affluent women-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … are still affected?

 Sanjeev Sriram:  Well, I think that that’s almost kind of like where you see racism do this turn of the, “Oh, well we already know that black people are invulnerable to pain.”

Briahna Joy Gray:  Mm-hmm (affirmative). 

 Sanjeev Sriram:  And if you’re a wealthy black person, then you must have like, the double invulnerability-

Briahna Joy Gray:  Mmm.

 Sanjeev Sriram:  … of wealth and being black so what’s your problem? Like, you should be doing great. And it’s not recognizing that no, pregnancy is a risky endeavor. 

Briahna Joy Gray:  Mm-hmm (affirmative). 

 Sanjeev Sriram:  There are tons of vulnerabilities that come up with going through a pregnancy just as a human. Where you know, regardless of, like, even before you get into like, what, what are your financial resources like, what is your housing situation like, your education like, even before you get into all of that, just having a human body, go through the process of making another human body-

Briahna Joy Gray:  Mm-hmm (affirmative).

 Sanjeev Sriram:  … is a stressful thing. 

Briahna Joy Gray:  (laughs). 

 And- 

 I can imagine. (laughs) 

 Sanjeev Sriram:  (laughs) and I, and I think that, you know, what, at least for me, what I took away from, you know, from Serena Williams and Beyoncé’s experiences were that, you know, welcome to how like, that human vulnerability-

 Mm-hmm (affirmative). 

 … does not care-

Briahna Joy Gray:  Mmm.

 Sanjeev Sriram:  … you know, how much money you made or what contracts you signed or how famous you are or how many followers you have-

Briahna Joy Gray:  Mmm.

 Sanjeev Sriram:  … biology like, you know, will get you. 

Briahna Joy Gray:  Yeah. 

 Sanjeev Sriram:  One way or the other. 

Briahna Joy Gray:  A, a fatalist might say, “Okay. Serena Williams and Beyoncé, this can happen to them”-

 Sanjeev Sriram:  Mm-hmm (affirmative). 

Briahna Joy Gray:  … is this even an issue about, you know, you know, is there, all the kind of like housing stress, you know, if it’s happening to wealthy women who don’t have those concerns, should we even care about everything else? Like, should we be focusing our efforts somewhere other than, you know, providing insurance an all of these other things which are also predictors of high mortality rates?

 Sanjeev Sriram:  Okay, I, I think that that, to me, look I’ve, I’ve heard that fatalist-

Briahna Joy Gray:  Mm-hmm (affirmative).

 Sanjeev Sriram:  … attitude too and I’ve always felt that it’s a bit of a cop out. 

Briahna Joy Gray:  Mm-hmm (affirmative).

 Sanjeev Sriram:  It, it’s, because I kind of feel that that is never something that we would accept for our own families. 

Briahna Joy Gray:  Mm-hmm (affirmative). 

 Sanjeev Sriram:  When my wife was pregnant-

Briahna Joy Gray:  Mmm.

 Sanjeev Sriram:  … and I mean, a, again, I got in touch with like, how risky everything is and how powerless you can feel as a partner-

Briahna Joy Gray:  Mmm.

 Sanjeev Sriram:  … when you’re at the hospital and the only thing that you think that is going to help you out is knowing some of the jargon that you overhear and-

Briahna Joy Gray:  Mm-hmm (affirmative). 

 Sanjeev Sriram:  … even that it’s, it’s still, you know, like, not enough power to create outcomes. 

Briahna Joy Gray:  Yeah. 

 Sanjeev Sriram:  You’re still kind of at like, these places where biology is gonna do what it’s gotta do. 

Briahna Joy Gray:  And you feel that way even as a physician.

 Sanjeev Sriram:  Even as a physician, you feel that way. And so, when I look at the things in our world that we do have some kind of impact upon, I feel that you have a moral imperative to build upon those things. I, I mean, my brown butt is not here-

Briahna Joy Gray:  Mm-hmm (affirmative). 

 Sanjeev Sriram:  … talking to you as a doctor because anybody played it safe-

Briahna Joy Gray:  Mm-hmm (affirmative). 

 Sanjeev Sriram:  … because anybody gave in to fatalism-

Briahna Joy Gray:  Mmm.

 Sanjeev Sriram:  … back in the day and felt that, “Well, you know, those Brits had a really good empire and-

 (laughs) 

 … hey, you know, they’re on every continent-

 (laughs). 

 … all right, you know? You win some, you lose some.” And they won that. They, nobody did that. Like, instead, it, like, you know, people organize. People, you know, I mean like, fought for their freedom and even in this country, to go from being a second-class citizen to being equal when it’s still an incomplete process-

 … there are still tons of work to be done, but if it wasn’t for the risks that were taken for, and the, there was no predictable outcome for anything that happened so far in the civil rights movement, right?

Briahna Joy Gray:  Mm-hmm (affirmative).

 Sanjeev Sriram:  Like, my being here is not, was not guaranteed.

Briahna Joy Gray:  Right. 

 Sanjeev Sriram:  And so, because people were willing to sacrifice, who didn’t even know me and didn’t even know this life trajectory that I’m on, I feel compelled to pay that forward. I feel the, well, this is proof that effort does work-

Briahna Joy Gray:  Yeah. 

 Sanjeev Sriram:  … ’cause and even if that, that payoff is not something that you’d necessarily are gonna see with your own eyes in your own family line. 

Briahna Joy Gray:  What strikes me about the Serena Williams example is that the narrative that, you know, as she tells it, is that she felt like something was wrong-

 Sanjeev Sriram:  Mm-hmm (affirmative).

Briahna Joy Gray:  … she raised her voice and she was ignored. And, and that’s the piece where we see some racial bias, you know-

 Sanjeev Sriram:  Yeah.

Briahna Joy Gray:  … there are studies that show, as you mentioned earlier, that doctors will perceive black patients to be in less pain-

 Sanjeev Sriram:  Mm-hmm (affirmative). 

Briahna Joy Gray:  … than white patients. I read that that’s even at the root of why there’s these disparities between where the opiate crisis has hit. 

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  You know, more opioids were just given-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … to white patients and has had this negative consequence that they are facing more of an addiction problem although it’s spreading more into the black community as well. But the part of, there’s another part of that story, which is that perhaps because she’s empowered as Serena Williams, ultimately, she keeps making noise-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … and ultimately, you know, she survived-

 Sanjeev Sriram:  Yeah. 

Briahna Joy Gray:  … where so many women didn’t. 

 Sanjeev Sriram:  Yeah. 

Briahna Joy Gray:  So, when she’s brought up as an example of why power and class is irrelevant, I would, you know, I would caution people to say it is not a panacea. 

 Sanjeev Sriram:  Right. Right. 

Briahna Joy Gray:  You know, being wealthy certainly does not save you. Black women even as you know, wealthy, educated black women, have outsized disproportionate, the disparity exists-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … absolutely. And so, without addressing racism, there is still an unconscionable gap even among those-

 Sanjeev Sriram:  Yeah. 

Briahna Joy Gray:  … who are very affluent. However, there are a set of factors that we can address-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … without doing this laudable but very difficult task of alleviating racism. 

 Sanjeev Sriram:  Mm-hmm (affirmative).

Briahna Joy Gray:

I want to talk to you a little bit about like, what are some of the controllable, you know, like, in terms of a policy-

 Sanjeev Sriram:  Yeah. 

Briahna Joy Gray:  … from a policy perspective, you know, what can we do as administrations, as policy makers, as politicians, as, as advocates to shrink the gap-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … what tools are at our disposal?

 Sanjeev Sriram:  One of the first tools that I’ve, that I think of is Medicare For All-

Briahna Joy Gray:  Mmm. 

 Sanjeev Sriram:  … simply because it gets people through the door- 

Briahna Joy Gray:  Mm-hmm (affirmative).

 Sanjeev Sriram:  … of clinic. And I, I mean again, like, I don’t believe Medicare For All is going to fix all of racism-

Briahna Joy Gray:  Mm-hmm (affirmative).

 Sanjeev Sriram:  … in medicine or anything-

Briahna Joy Gray:  (laughs) 

 … like that. I know like-

 I don’t think there are very many people who do. 

 Sanjeev Sriram:  … and I mean and, and I think the, you know, there will be, still be tons left to do-

Briahna Joy Gray:  Right. 

 Sanjeev Sriram:  … in terms of racial justice, particularly in healthcare even after the passage of Medicare For All. But as far as getting patients to the door, that is a powerful tool that we have at our disposal because when you look at the uninsured currently, 59% of America’s uninsured are people of color. 

Briahna Joy Gray:  Mmm.

 Sanjeev Sriram:  Now, we were told by all the demographic experts that America was not gonna be a majority/minority country until about 2040. 

Briahna Joy Gray:  Mm-hmm (affirmative).

 Sanjeev Sriram:  And yet, our uninsured population is already there. 

Briahna Joy Gray:  Yeah. 

 Sanjeev Sriram:  And that’s not an accident. That is a result of policy being, you know, either used or unused or abused or attacked in ways that leave people in certain, specific people of color to be very vulnerable-

Briahna Joy Gray:  Mmm.

 Sanjeev Sriram:  … to, eh you know, to, in the terms of their health. Which should be a basic human right. 

Briahna Joy Gray:  I mean a lot of the states that rejected Medicaid expansion for instance, under Obamacare are these redder states, but that are also blacker states. 

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  I mean, disproportionately black people are living in these southern states like Mississippi, South Carolina, etc., which have some of the worst health-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … outcomes in the country. So, can you help to unpack a little bit, you know, what effect does not having insurance or being on Medicaid, which I have read is another predictor of having poor birth outcomes, what affect does that have, why does that have an effect, rather, on, on maternal mortality rates?

 Sanjeev Sriram:  Right. So, when it comes to being uninsured or, you know, being on Medicaid, but not having confidence that you’re gonna get to hold on to the coverage-

Briahna Joy Gray:  Mm-hmm (affirmative).

 Sanjeev Sriram:  … because if you happen to do a little bit better at work and you start to, you know, earn past the eligibility point-

Briahna Joy Gray:  Right. 

 Sanjeev Sriram:  … then you’re gonna lose your Medicaid and for a lot of working-class people, this, these are the realities that happen again and again. That, you know, you go in between these periods of being briefly uninsured, then covered by Medicaid, then, “Oh, if I just stick out this job long enough, the benefits will kick in and I’ll be covered again.” 

Briahna Joy Gray:  Yeah. 

 Sanjeev Sriram:  And that fluctuation of being uninsured, partially covered, hoping that coverage will kick in, it changes your decision making about going to the doctor. 

Briahna Joy Gray:  Mmm.

 Sanjeev Sriram:  I mean, if you rewind back to a woman’s life trajectory and look at preconception-

Briahna Joy Gray:  Mm-hmm (affirmative).

 Sanjeev Sriram:  … where before she even decides that she wants to have children, she should be getting an annual physical to, you know, learn more about her own health, you know, stop problems before they become bigger problems, and to just get questions answered.

Briahna Joy Gray:  Mm-hmm (affirmative).

 Sanjeev Sriram:  I mean, have some peace of mind about, “Well, this is the way that I’ve always had my cycles. Is that normal?”

Briahna Joy Gray:  Mm-hmm (affirmative).

 Sanjeev Sriram:  And it’s like, that’s a great conversation to have with your doctor-

Briahna Joy Gray:  Yeah. 

 Sanjeev Sriram:  … and if necessary, to work it up. 

Briahna Joy Gray:  Yeah. 

 Sanjeev Sriram:  But if you don’t have access to that, or if that starts to look more and more like a luxury or privilege, then you’re going to postpone going to the doctor until you really need it-

Briahna Joy Gray:  Mmm.

 Sanjeev Sriram:  … or until the system even says, “Oh now you are worthy-

Briahna Joy Gray:  Right. 

 Sanjeev Sriram:  … of coming to the doctor.”

Briahna Joy Gray:  Right. 

 Sanjeev Sriram:  And I think the, with Medicare For All, we have the opportunity to just start to unravel some of that culture of are you worthy or unworthy-

Briahna Joy Gray:  Mmm.

 Sanjeev Sriram:  … of being at the doctor’s office. 

Briahna Joy Gray:  Mmm. There are these women, who even before they get pregnant, are going into the pregnancy potentially with, with health, a health situation that is not ideal-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … to give birth. So, you know, I’ve read for instance, this statistic was crazy to me, that 20% of African Americans over the age of 20 have diabetes either diagnosed or undiagnosed. 

 Sanjeev Sriram:  Mm-hmm (affirmative).

Briahna Joy Gray:  And diabetes has an effect-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … on pregnancy outcomes. 

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  So mid- there’s myriad, um, illnesses, heart disease, hypertension, etc., that similarly have an effect on these pregnancy outcomes-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … um, that people aren’t getting treated for because they don’t have healthcare-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … or because they have, well, here’s another issue with the Medicaid issue. You know, we met in Philadelphia-

 Sanjeev Sriram:  Mm-hmm (affirmative).

Briahna Joy Gray:  … where we were there to protest the closure of Hahnemann Hospital which was, is, a hospital that has existed for almost 200 years?

 Sanjeev Sriram:  Something about that. 

Briahna Joy Gray:  In Philadelphia that served disproportionately black and brown people, I think, 2/3 of the people served there and also disproportionately serves people on Medicaid. 

 Sanjeev Sriram:  Mm-hmm (affirmative).

Briahna Joy Gray:  And something that ends up happening, again, because of this bias that’s not just racial bias, there’s some class bias, that patients who are on Medicaid wlll be attended to less sensitively or less, there’s less investment on behalf of medical professionals-

 Sanjeev Sriram:  Mm-hmm (affirmative).

Briahna Joy Gray:  … and so people are giving birth in hospital hallways and there’s incredible wait times and things like that just because people are low-income.

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  And so you, you know, part of the lack of care or, or the, the outcomes again are tied to these, you know, economic factors which of course in a country that’s pluralistic and has had racial hierarchy since its inception, are going to also be racialized. 

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  Right? Like the idea-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … that we can and like, extricate these things is-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … kind of like-

 Sanjeev Sriram:  Yeah. 

Briahna Joy Gray:  … ridiculous. 

 Sanjeev Sriram:  Right (laughs).

Briahna Joy Gray:  Okay. So, we have getting Medicare For All-

 Sanjeev Sriram:  Mm-hmm (affirmative). 

Briahna Joy Gray:  … is, is something that was can do. We talked a little bit earlier about some of the, the stress-related factors.

 Sanjeev Sriram:  Yeah. 

Briahna Joy Gray:  So, are, are there, are there things that we can do? Like, for example, would a, a housing plan that takes that stress off the plate…?

 Sanjeev Sriram:  Well, yeah, I mean the, like, you know, when it comes to housing, I, the number of times that patients, like, a large part of, what my patients have to do when they come to clinic is update our front desk about their change of address. 

Briahna Joy Gray:  Mmm. 

 Sanjeev Sriram:  And they would’ve just moved a couple of blocks. 

Briahna Joy Gray:  Mmm.

 Sanjeev Sriram:  The family, in a strange way, they adapt and I think that they do so in the sense of like, well we need to get a roof over our head and get through this, but in those series of adaptations, I kind of wonder like, whether the whole system is start, is never going to hit that pause button and say, “Hold up a second.”

Briahna Joy Gray:  Yeah. 

 Sanjeev Sriram:  “This is a mom with three kids, like, should they be moving this often? Like, what is making them move this often?”

Briahna Joy Gray:  Yeah. 

 Sanjeev Sriram:  And to have stable housing is, I think, such a fundamental part of our human experience. It’s where, I mean, almost everyone looks at their home at some point as some kind of haven, whether that be like, you know, personal or with your family, but the idea that home is your safe place, that you know where it is, you can always come back to it, that you’re going to be warm and fed and that is not an easy assumption the make-

Briahna Joy Gray:  Yeah. 

 Sanjeev Sriram:  … especially for people of color in this country.

Briahna Joy Gray:  Mmm. 

 Sanjeev Sriram:  And those were the kinds of health outcomes that I can’t write a prescription all time for that. I mean, there’s tons of advocacy that pediatricians do around housing. My colleagues are very involved with a lot of that, and we push for stronger housing programs all the time, but I think it’s one of those issues that if we actually did it as a country as opposed to just leaving it up to a few do-gooder regions here and there, I think that that actually sends, again, a cultural message- 

Briahna Joy Gray:  Mmm.

 Sanjeev Sriram:  … that all of us are worthy of a home. 

Briahna Joy Gray:  Yeah. This point about the importance of housing really resonated with me. I’d recently come across an article by Elizabeth Dawes Gay, co-director of the Black Mamas Matter Alliance, in which she made the same point. The article argues that housing instability is an important, yet overlooked factor in the maternal health crisis. Not only does housing instability create stress for mothers, Gay wrote that homelessness makes it difficult for expecting families and parents to obtain quality, affordable care if they’re forced to relocate to a community without such access. 

 A five-city survey found that homelessness during pregnancy was associated with an increased likelihood of preterm birth and low birth weight. Lower birth weight is associated with poor health outcomes in infancy and across the life course. 

So much of, in the popular imagination or cultural imagination, we watch these movies like Father of the Bride, you know, when they have the baby, it’s all about nesting and-

 Sanjeev Sriram:  Yeah. 

Briahna Joy Gray:  … painting the room-

 Sanjeev Sriram:  Yeah. 

Briahna Joy Gray:  … with all these montage scenes and we do, you know, all these like, gendered color-

 Sanjeev Sriram:  Yeah. 

Briahna Joy Gray:  … (crosstalk)

 Yeah. 

 Sanjeev Sriram:  … of the bedroom and then the reality for probably a majority of Americans is not just not nesting with the full, like, $1,000.00 worth of Pottery Barn materials-

 Right. 

Briahna Joy Gray:  … to literally not know where you’re going to be living-

 Sanjeev Sriram:  Yeah. 

Briahna Joy Gray:  … next month. It’s an extraordinary thing to wrap your head around. And what I’m hearing from you is that, you know, there are people who have presented solutions to the maternal mortality rate that don’t start with Medicare For All-

 Sanjeev Sriram:  Mm-hmm (affirmative).

Briahna Joy Gray:  … which don’t start with insuring every American, right, ’cause we know, and again, in this country, in this country that has had these racial hierarchies, if we have a healthcare system that doesn’t guarantee insurance to all, we can all predict who disproportionately is not going to-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … be insured. 

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  Right? So, there are these people who have presented solutions that don’t include Medicare For All, which provide incentives which would punish hospitals like Hahnemann Hospital-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … um, for having bad maternal outcomes when really, they have bad maternal outcomes because it’s a hospital that’s actually willing to see Medicaid patients-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … you know, lower income patients, right?

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  So, providing kind of a perverse incentive there, it seems like it requires a systemic approach.

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  A policy platform that says, “We’re gonna provide housing as a human right, we’re gonna provide healthcare as a human right, we’re going to provide education and resources-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … as a human right.” There’s no one thing that you can point to-

 Sanjeev Sriram:  Oh yeah. There are no magic bullets in any of this. 

Briahna Joy Gray:  Mm-hmm (affirmative).

 Sanjeev Sriram:  I mean, the number of times that I’ve gone to the grocery store and I see a mom, uh, pregnant mom on her feet working at a-

Briahna Joy Gray:  Yeah. 

 Sanjeev Sriram:  … job that I know that that job does not have a predictable schedule. I know that her workload does not necessarily have any kind of predictability to it. The day that one nice manager is on vacation is going to be a really rough week for her. 

Briahna Joy Gray:  Yeah. 

 Sanjeev Sriram:  I’m not saying that pregnant women shouldn’t work. It’s that they should work with jobs that have dignity-

Briahna Joy Gray:  Yeah. 

 Sanjeev Sriram:  … that respect what the processes are, that they respect that yeah, this person is going through a vulnerable period of their life. We, we as a workplace can adapt. 

Briahna Joy Gray:  Yeah. 

 Sanjeev Sriram:  And the, I mean, and these are all of the little, little things, it’s always a, to me, uh, it’s, it’s all these little pushes and nudges that everybody contributes to that build our collective public health as a public good-

Briahna Joy Gray:  Yeah. 

 Sanjeev Sriram:  … that become something that all of us are invested in and all of us actually benefit from. 

Briahna Joy Gray:  And you raise an interesting point. You say, you know, it’s not that she shouldn’t be able to work, but we are also a country that is well behind most of the other, the industrialized-

 Sanjeev Sriram:  Mm-hmm (affirmative).

Briahna Joy Gray:  … world in respect to the, the leave time-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … that women get-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … either before or after their pregnancies. 

 Sanjeev Sriram:  Yeah. 

Briahna Joy Gray:  So, there are women who are not recovering, you know, pardon me if I’m wrong, they’re not recovering from the trauma of, of childbirth-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … I mean, forced right back into the job market-

 Sanjeev Sriram:  Yeah. 

Briahna Joy Gray:  … without being able to rest the way they need to or if they’ve been, indicate, it’s been indicated by their doctors they need to rest prior to giving birth-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … in order to secure a, a healthy pregnancy. 

 Sanjeev Sriram:  Yeah. And I mean and we know from science, from medical science, they’ve looked at, at medical leave and especially at maternity leave, and they feel that the minimum time that’s good is 12 weeks. 

Briahna Joy Gray:  Yeah. 

 Sanjeev Sriram:  Uh, and I was expecting this, like, when I was, you know, talking to my employer, I thought, “Oh, you know, we, we follow science here, right? Like, you know, 12 weeks.” And the message I got back from HR is that yeah, but we’re talking about your paternity leave. You get two weeks. And I was like, “Hold up, hold up. Like, you’re telling me that my partner has this other person, and I’m a pretty involved dad, and I have to be back at this job-“

Briahna Joy Gray:  Yeah, bye honey, you’re split from tip to toe, but I’ll- 

 Sanjeev Sriram:  … eh, it, it’s-

Briahna Joy Gray:  I’ll see you in eight hours.

 Sanjeev Sriram:  Yeah, I mean like, she’s not even fully recovered from the childbirth process yet. This is a newborn that we’re talking about-

Briahna Joy Gray:  Yeah. 

 Sanjeev Sriram:  … and, and yet, we have even in medical workplaces, you know, we don’t always adhere to the science that we know is right-

Briahna Joy Gray:  Right. 

 Sanjeev Sriram:  … to keep people healthy. And so, to me, like, I, I look at Medicare For All, I appreciate all the provisions that are there, I’ve gone through the policy and I’m really familiar with it, but I know that it is not this, like, panacea that oh, like, you know, we’ve prescribed this and everything just radiates from there. It’s like, no, this is the contribution that we make to this part of the system. Workplace justice is still a huge undertaking and it has a lot to do with health. It’s just that we don’t necessarily always as doctors, what they think about these policies-

Briahna Joy Gray:  Yeah. 

 Sanjeev Sriram:  … or when we do, you know, there’s always somebody coming back saying that, “Yeah, the shareholders aren’t gonna like that-

Briahna Joy Gray:  Mmmm.

 Sanjeev Sriram:  … so we’re not going to go with that policy.”

Briahna Joy Gray:  I think this is, is a really important point because there is this way in American politics that we are used to understanding policies that are designed to address particular ills as, you know, Briahna Gray policy to fix poverty.

 Sanjeev Sriram:  Mm-hmm (affirmative).

Briahna Joy Gray:  Briahna Gray’s policy to fix the maternal health gap. 

 Sanjeev Sriram:  Yeah. 

Briahna Joy Gray:  You know, the Briahna Gray policy to resolve housing. And the reality is that if you take an issue, you know, we talk about intersectionality a lot-

 Sanjeev Sriram:  Mm-hmm (affirmative).

Briahna Joy Gray:  … but there is this intersectionality was respect to how to design policy-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … that we have to keep in mind too.

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  And so, there, the idea that some people might put forward, like, a fix that’s labeled so that it seems like we’re gonna throw, you know, this amount of money at this problem, you know, what it really takes to create, um, substantive equality is to say we have to have a right spaced-

 Sanjeev Sriram:  Yeah. 

Briahna Joy Gray:  … humanistic approach to resolving these, these harms. 

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  And that doesn’t mean, by the way, that the goal of addressing racism comes off the table. 

 Sanjeev Sriram:  Right. Right. 

Briahna Joy Gray:  You know, part of the Medicare For All policy a lot of people don’t know is that it creates an office of primary health-

 Sanjeev Sriram:  Yeah. 

Briahna Joy Gray:  … which figures out a, how to increase access to care-

 Sanjeev Sriram:  Yeah. 

Briahna Joy Gray:  … and includes how to train the workforce to address these disparities. Something that Bernie Sanders talks a lot about is funding HBCU’s-

 Sanjeev Sriram:  Yeah. 

Briahna Joy Gray:  … fully funding HBCU’s so that we have more black doctors, canceling student debt-

 Sanjeev Sriram:  Right. Yep. 

Briahna Joy Gray:  … means that those black doctors don’t feel compelled to take the highest earning job-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … that they can and they can go and work in some of these communities that are being underserved and have lower-

 Sanjeev Sriram:  Yeah. 

Briahna Joy Gray:  … worse, worse, uh, health outcomes. Are there any other kinds of things that I might be missing that are a part of this agenda?

 Sanjeev Sriram:  Yeah, I mean, you know, I mean I think you’re really nailing it because when I look at even my own colleagues-

Briahna Joy Gray:  Mm-hmm (affirmative).

 Sanjeev Sriram:  … right, and the choices that they’ve had to make for career-

Briahna Joy Gray:  Mm-hmm (affirmative)

 Sanjeev Sriram:  … and for family and realizing that how much like, you know, even among physicians like, people quietly sacrifice pieces of their health here and there. People quietly sacrifice like, a dream here or an ambition there just because they’ve got student debt that they need to cover, because their housing is ridiculously expensive, because they want to afford better childcare, and then you start to find out well what like, “Let’s go back to some of these pieces you’ve put down, let’s talk for a second here.” And it’s like, “Oh, this is why you’re burning out.”

Briahna Joy Gray:  Yeah. 

 Sanjeev Sriram:  Because you know, you gave up on this thing that used to bring joy to your life, like, you know, once a week and you decided to put that aside. 

Briahna Joy Gray:  Yeah. 

 Sanjeev Sriram:  Oh, you originally came from a rural area and you, like, that was where you always uh, envisioned yourself going back home to, but you canno- like, that’s not a place where you feel you can afford to make a living and pay back your loans? Like, I mean, you start to see that like, there are all these fragments that we all leave behind and I think that in some ways a lot of the capitalist run amok looks at those sacrifices and says that, “Oh, well that’s responsible decision-making-

Briahna Joy Gray:  Right. 

 Sanjeev Sriram:  … you can’t have it all.” And it’s like, this isn’t really so much about having it all as much as it is that a lot of us when we wrote our personal statements to get into medical school- 

Briahna Joy Gray:  Mm-hmm (affirmative).

 Sanjeev Sriram:  … like, none of us wrote that, “Oh, I want to be a corporate shill that like – 

 (laughs). 

 … fills out paperwork for Aetna and does it again and then uses a fax machine because they say-

 (laughs). 

 … that they lost it and they can’t do electronic copies. I want to be on the phone haggling with the pharmacy about last year’s formulary versus this year’s formulary and I promise you-

 (laughs). 

 … if you let me in, I’ll be the best-

 (laughs). 

 … at all of it. And it’s like, that, nobody wrote that. I didn’t write that-

 Yeah. 

 … I’m, a, nobody writes that on their-

Briahna Joy Gray:  Yeah. 

 Sanjeev Sriram:  … on, on, on their med school application essay, but yet the, these are, this is kind of what the system forces you to become-

Briahna Joy Gray:  Yeah. 

 Sanjeev Sriram:  … and I do envision that, you know, with a lot of the policies that we’ve been talking about, that people might be able to get back in touch with like, what has been driving them all this time and actually put that sweat and grind and hustle into something that is productive for themselves and for their communities. 

Briahna Joy Gray:  For their communities. That, that’s a really important point because uh, there’s been some pushback about the idea that Bernie Sanders is gonna cancel all student debt, right, as opposed to capping it at a certain salary level-

 Sanjeev Sriram:  Mm-hmm (affirmative).

Briahna Joy Gray:  … as, as other candidates have said, and some people have said that’s, that’s smart because why do we need people who are making, you know, over- 

 Sanjeev Sriram:  Yeah. 

Briahna Joy Gray:  … $150.000 a year-

 Sanjeev Sriram:  Yeah. 

Briahna Joy Gray:  … to have their debt canceled. Well, that’s what we’re talking about in many instances is a doctor who might have $300,000.00-

 Sanjeev Sriram:  Yeah. 

Briahna Joy Gray:  … maybe $400,000.00 worth of debt-

 Sanjeev Sriram:  Dollars worth of debt. Right. 

Briahna Joy Gray:  … who might be earning over $150,000.00-

 Sanjeev Sriram:  Mmm.

Briahna Joy Gray:  … a year, but is paying astronomical, an astronomical amount in student loans every month-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … who absolutely is not going to be able to go to a rural hospital-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … is not going to be going to one of these community health, health centers that, again, Senator Sanders has paid so much attention to and found $12,000,000,000.00 worth of-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … funding for it and support in these communities that are under serviced. Hospitals are not going to populate those areas. 

 Sanjeev Sriram:  Yeah. And ah- and honestly, like, I mean, I’m, I’m a pediatrician, I’m all for the expansion of primary care to, especially to places that need it, but you know, the number of times that I’ve heard families say, or, you know, tell me about their loved ones who live in a rural area that need surgeons-

Briahna Joy Gray:  Mmm.

 Sanjeev Sriram:  … that need specialists, that need mental health-

Briahna Joy Gray:  Mmmmm.

 Sanjeev Sriram:  And, I mean, you know, you, it’s really tough to get those specialties out there when they are burdened with this kind of debt. And I think that with, especially when it comes to student debt. What I feel is unique about that burden is, is that this was work that people took on and it’s not just healthcare, but it’s, it’s that people took on this work because they wanted to be bigger than what they were-

Briahna Joy Gray:  Mm-hmm (affirmative). 

 Sanjeev Sriram:  … when they started the process. And they envisioned something for themselves and their community, no matter how big or small that was, but it was larger than themselves, it’s not the same thing as forgiving a car loan or a home loan-

Briahna Joy Gray:  Mm-hmm (affirmative).

 Sanjeev Sriram:  … like, those are things that yes, those are really strictly for your personal enjoyment and, and satisfaction, but education was, has, uh, no matter what major you are, like, I mean, you know, I, I know that a lot of people like, you know, to, to talk about STEAM and STEM and uh, but it’s like, even for the people who are creative writing majors, like, they were really thinking about writing the next great novel that-

Briahna Joy Gray:  Yeah. 

Sanjeev Sriram:  … almost any of us would’ve loved to have picked up.  

Briahna Joy Gray: Or just getting a liberal arts education that doesn’t put you in a place where, as someone who went to law school- 

 Sanjeev Sriram:  Mm-hmm (affirmative). 

Briahna Joy Gray:  … I ended up sitting next to a lot of people who had no relationship to how the world works-

 Sanjeev Sriram:  Mm-hmm (affirmative).

Briahna Joy Gray:  … no understanding of history, no understanding of basic human impulses, I mean you get these people making decisions about our economy, our legal system-

 Sanjeev Sriram:  Yeah. 

Briahna Joy Gray:  … which says things like, willingness to pay equals ability to pay. You know I could go on for ages about all the dumb things that were said by these ostensibly brilliant people at the law school that I attended. But the reality is that understating how humanity works, being in professional career environments with people of different class backgrounds-

 Sanjeev Sriram:  Yeah. 

Briahna Joy Gray:  … if, the only way you can access someone of a different class background is by reading The Jungle-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … then your English class did something better for you than (laughs) –

 Sanjeev Sriram:  Yeah. 

Briahna Joy Gray:  … a lot of these other STEM classes. 

 Sanjeev Sriram:  Absolutely. 

Briahna Joy Gray:  You know, before we wrap up, I just really want to be clear-

 Sanjeev Sriram:  Mm-hmm (affirmative). Mm-hmm (affirmative). 

Briahna Joy Gray:  … um, because there is this kind of either/or dynamic that has emerged by some people discussing the issue particularly at the black maternal health disparity.

 Sanjeev Sriram:  Mm-hmm (affirmative).

Briahna Joy Gray:  That posits that because race and racism is such an essential component of this that exists even among the very privileged-

 Sanjeev Sriram:  Mm-hmm (affirmative).

Briahna Joy Gray:  … that it is a misnomer to suggest that any of the other factors which predict bad maternal health outcomes are inadequate. 

 Sanjeev Sriram:  Yeah. 

Briahna Joy Gray:  And is it, would it be accurate to say these other factors that we can control are insufficient, but necessary?

 Sanjeev Sriram:  Oh absolutely. Absolute- I mean insufficient, but necessary is kind of like a large part of what almost all of do in healthcare, right? I mean that like, when, I’ve got obese kids who come back and tell me at their weight check that like, I gave up chocolate milk and then I’m kind of like looking at the Doritos bag that they’re like, eating solo. It’s like, “Okay, insufficient, but necessary.”

Briahna Joy Gray: (laughs). 

 You know? Like, your teeth are gonna probably appreciate you giving up all that sugary stuff, so let’s chalk that up for a win and now let’s start talking about these Doritos. 

 Yeah. 

 Sanjeev Sriram:  It’s like, I mean, we have to be willing to like, look at all the different fragments that got us to where we are and to do all the different augmentations that, that we can, never knowing really actually which augmentation’s gonna have bigger ripple effects than we could’ve anticipated. 

Briahna Joy Gray:  Yeah.

 Sanjeev Sriram:  When it comes to yes, fight racism like, you know, with all your heart, I mean, you know, and prioritize it. 

Briahna Joy Gray:  Absolutely. 

 Sanjeev Sriram:  You know- 

Briahna Joy Gray:  And to be clear, it is prioritized-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … as part of Medicare For All. There is this provision that says we have to have a racial bias training-

 Sanjeev Sriram:  Right. 

Briahna Joy Gray:  … as a part of Medicare For All and I think that that gets lost in the story-

 Sanjeev Sriram:  Yeah. 

Briahna Joy Gray:  … unfortunately and I really want to highlight that here, but…

 Sanjeev Sriram:  Oh, absolutely. And I mean I think that that is also another part of like, even when it comes to like, the kinds of people that I want to see join healthcare from here on out-

Briahna Joy Gray:  Mmm.

 Sanjeev Sriram:  … is the, I don’t really want the country club alumni kids to show up at med school because they were the ones who could, you know, put down the tuition bills-

Briahna Joy Gray:  Right. 

 Sanjeev Sriram:  … for four years of undergrad and give up, you know, summers where they chase whoever in whatever part of the world or wherever-

Briahna Joy Gray:  Right. 

 Sanjeev Sriram:  … instead of you know, going home and taking care of an elderly, you know, loved one or-

Briahna Joy Gray:  Right. 

 Sanjeev Sriram:  … or getting a job that is just kind of, you know, retail or something. I want people who have lived life-

Briahna Joy Gray:  Yeah. 

 Sanjeev Sriram:  … who know what it is to walk in those shoes, who know what it is to go to a pharmacy and like open your pocketbook and realize like, I don’t know if I can do groceries and the copays for uh-

Briahna Joy Gray:  Yeah. 

 Sanjeev Sriram:  … you know, these prescriptions. And you know, people who have been through that, the, you know, that journey themselves are going to have a lot more to bring to like, the art and science of medicine than I think our current crop does even. 

Briahna Joy Gray:  Well I, I just really want to thank you so much for having this conversation with me. Your advice has been invaluable. 

 Sanjeev Sriram:  Oh, thank you. Thank you. 

Briahna Joy Gray:  And I’m glad that there’s a Dr. America out there on the streets. 

 Sanjeev Sriram:  Yeah. Absolutely. 

Briahna Joy Gray:  Before we leave this week, I wanted to read a letter we got from a listener. Now, this is hardly the first time I’ve been moved by those of you who have written in. I really want to take this moment to honor the time and the vulnerability involved in you all sharing your stories with me via email. I read them all and I appreciate them deeply. Even if I don’t always have the time or space to share them here. But this week, we got a letter from someone with a particularly moving story, who was generous enough to tell us we could share it with you here. The letter is from Cody Franks from Santa Cruz, California. 

 Cody says he first became a Sanders supporter in 2015 after a Reddit AMA Bernie did during the last election cycle. He says, in his own words, “It was my first-time hearing about Senator Sanders and I read his responses during my lunch break at my underpaid food service job. Right away, I was filled with hope from his words and ideals. And if anything, my opinion of Bernie has only grown since then. The part of Bernie’s campaign that excites me the most is his belief in healthcare as a human right. 

 See, I have cystic fibrosis and at 33 years old, I have three times lived past the life expectancy that my doctors have given me. When I was 15, I was told I would be dead by the age of 30. When I was 24, I was lucky enough to benefit from the then passed ACA and not lose coverage under my parents’ plan. Also, at age 24, I lost my older sister to the same disease. She was only 27 when she died. Also around this time, just before the ACA went into effect, I was trying to purchase my own personal plan and actually had an insurance representative say to me about why they would not insure me, ‘This is a business and if you were a business, would you really want to waste your money on a lost cause?’

 They really said that to me. Told me to my face that I was not only a waste, but a lost cause. Thanks to the ACA, I was eventually able to buy my own personal insurance plan. But then two years ago, due to financial struggles, I missed a payment and had my coverage canceled. I was very lucky that my wonderful wife and partner has a good teaching job and I was able to find coverage through her insurance. 

 To me, a Bernie presidency really is a matter of life and death. Americans need and deserve healthcare as a human right. That is why I will do anything in my power to spread the word and do my part to get Senator Sanders elected as our next president.”

 Thank you, Cody, for reminding us all why we’re in this fight together. 

 Now, Cody is a musician and he shared a song which he says he wrote for the campaign immediately after he watched Bernie’s 2020 campaign launch video. I thought it was too cute not to share, and I hope you enjoy it as much as I did. 

That’s it for this week. Let us know what you think at [email protected] or send us a tweet using the hashtag #hearthebern. If you haven’t already, please take a moment to rate, review or like us on Apple Podcasts, Sound Cloud or wherever you’re listening. As always, transcripts will be up soon. Till next time.