Women Vs. The System: Why Healthcare Fails Us

Subscribe to the video podcast: https://www.youtube.com/@SomaMandalsays/videos   In this episode of Soma Says, Dr. Soma interviews Anjana Sreedhar, author of 'Healthcare of a Thousand Slights: Connecting Legacy to Access to Healthcare'. Anjana delves into the historical and ongoing healthcare disparities in the U.S., highlighting systemic issues affecting women and marginalized communities. They discuss the impact of societal views on women, healthcare access barriers, the Roe v. Wade overturn, and the multifaceted challenges faced by Native Americans. Anjana emphasizes the interconnected systems affecting health and shares stories from her book that illustrate these inequities. As an NYU Perlmutter Cancer Center strategist, Anjana also shares insights on operational strategies for equitable healthcare access.     00:00 Introduction and Disclaimer     00:48 Meet Anjana: Advocate for Social Justice in Healthcare     01:29 Exploring Healthcare Disparities     03:11 Personal Experiences with Healthcare Inequities     04:16 The Journey Behind 'Healthcare of a Thousand Slides'     08:21 Challenges in Women's Health     14:48 Impact of George Floyd and Systemic Inequities     28:22 Native American Healthcare Disparities     31:39 Future Directions in Women's Health     39:01 Healthcare Systems Around the World     43:21 Reflections on U.S. Healthcare Reform     46:21 Conclusion and Final Thoughts   To read more about Anjana Sreedhar, visit https://anjanasreedhar.mystrikingly.com/   To order Health Care of a Thousand Slights visit https://bookshop.org/p/books/health-care-of-a-thousand-slights-connecting-legacy-to-access-to-healthcare-anjana-sreedhar/15910867?ean=9781636765082&next=t&source=IndieBound&ref=https%3A%2F%2Fanjanasreedhar.mystrikingly.com%2F    

Episode Transcript

(00:01):
Hi, this is Dr.
Soma.
Just a disclaimer, this podcast is for informational purposes only and isn't intended as medical advice.
Always consult with your doctor before making any changes to your diet, exercise, or health regimen.
Let's go to the show.

(00:42):
Welcome back to Soma Says.
This is Dr.
Soma.
Sridhar.
Anjana is a passionate advocate for social justice and equity in healthcare.
.999She's the brilliant mind behind the enlightening book, Healthcare of a Thousand Slides, Connecting Legacy to Access to Healthcare.
This work dives deep into the history of healthcare disparities in the U.

(01:03):
S.
Transcripts, offering both a critical view of past injustices and innovative solutions for the future.
Anjana will share her journey of writing this transformative book and the crucial message she hopes readers will take away. 16 00:01:19,119.999 --> 00:01:26,840 Stay tuned as we delve into how interconnected systems shape our health and the vital importance of addressing these disparities head on.

(01:26):
.838Stay tuned. 18 00:01:29,746.278 --> 00:01:36,96.278 The medical system is almost obsessed with women as child bearers, as if they have no other identity. 19 00:01:36,96.278 --> 00:01:43,466.277 And we know not all women want to give birth, not all women do give birth, but that's the primary way in which our society thinks about women. 20 00:01:46,172.718 --> 00:01:57,872.717 it's really a case study for when you're in a position, when you're in a, an area where you can't access safe reproductive care, that ultimately has really negative downstream effects. 21 00:02:00,689.157 --> 00:02:02,989.157 in the United States we really pride ourselves on choice. 22 00:02:03,519.157 --> 00:02:08,939.157 Which is ironic because when we're talking about reproductive care, increasingly women in a lot of places do not have choice. 23 00:02:12,135.597 --> 00:02:14,385.597 if you're above 65, you get coverage. 24 00:02:14,385.597 --> 00:02:16,585.597 If you're below a certain income level, you get coverage. 25 00:02:16,585.597 --> 00:02:32,392.198 But if you're neither of those things and don't have an employer that sponsors your health insurance, what happens to you? I have definitely seen the disparities of health when it comes to different populations and. 26 00:02:33,407.198 --> 00:02:36,807.198 having struggled with those kind of issues as a physician. 27 00:02:37,607.198 --> 00:02:57,127.198 So now, the way It inspires me is that I focus a lot on women's health, but with that, and you talk about this in your book, there's a lot of stuff, That women are at a disadvantage about, especially minority women or, ethnic women. 28 00:02:57,647.198 --> 00:03:03,497.198 And so I was hoping that we could really focus our podcast on that. 29 00:03:03,737.198 --> 00:03:11,307.198 On women and women's health and the disparities of health care that we have to experience. 30 00:03:11,827.198 --> 00:03:31,557.196 I can only assume that you have, because when it comes to my patients, almost every single woman patient that I have that I've spoken with has experienced some kind of disadvantage, Up until my early thirties, I was blessed and I didn't have to necessarily experience that. 31 00:03:31,557.196 --> 00:03:38,797.196 I definitely experienced racism, systemic racism and racism in a variety of colors. 32 00:03:39,277.196 --> 00:03:39,687.196 Of course. 33 00:03:39,747.196 --> 00:03:45,177.196 But when it came to disparities of health I didn't necessarily experience it until. 34 00:03:45,812.196 --> 00:03:55,342.195 Certain health issues started coming up for me and then it hit me smack in the face and it left me feeling like, what was that? Yeah. 35 00:03:57,82.196 --> 00:04:23,597.196 I'm a doctor, having the background and the education to fend for myself definitely allows me to speak in a way where I can make myself heard, but I always wonder, What about that person who doesn't have that vocabulary and doesn't have that understanding? I wanted to understand what inspired you to go into this field and then understand why the book. 36 00:04:23,607.197 --> 00:04:30,237.196 Why did you write this book, Health Care in a Thousand Sights? And why did you title it that? Yeah. 37 00:04:30,327.297 --> 00:04:34,477.197 If I can work backwards, I think the title is really interesting. 38 00:04:34,827.197 --> 00:04:43,487.198 So I was I was working with a developmental editor at the time, just trying to work on high level ideas for what I wanted to cover in the book. 39 00:04:43,487.198 --> 00:04:54,677.198 And broadly speaking, I knew I wanted to tell the story of the people of the United States, very similar to Howard Zins of People's History, Of the United States, but really focus it on a health care angle. 40 00:04:54,947.198 --> 00:04:58,527.198 And this was around the time where Kobe was really picking up. 41 00:04:58,857.198 --> 00:05:08,397.199 This was around February, March 2020, which I don't need to tell you or any of your listeners was a really crazy time to be in health care, especially in the New York, New Jersey area. 42 00:05:08,847.198 --> 00:05:19,397.198 And so my developmental editor, who is also an emergency physician, was talking about his experience providing care to patients and how for a lot of patients, they experienced. 43 00:05:19,877.198 --> 00:05:34,677.198 the healthcare of a thousand slides where it may not be overt and direct racism like what you mentioned, but just the assumptions that are made about them based on how they're dressed or how they're speaking or what insurance or lack of insurance they might have. 44 00:05:35,2.198 --> 00:05:39,132.198 results in a different experience of care for those patients. 45 00:05:39,132.198 --> 00:05:45,32.198 And so in my mind, I was thinking about the fact that so much, so many of us experience marginalized identities. 46 00:05:45,42.198 --> 00:05:49,92.198 So many of us experience multiple marginalized identities at the same time. 47 00:05:49,92.198 --> 00:05:54,452.198 And so we've all had some experience with healthcare, experiencing healthcare of a thousand slides. 48 00:05:54,462.198 --> 00:05:56,562.198 So that's really where the title came from. 49 00:05:56,562.198 --> 00:05:57,872.198 It came from that conversation. 50 00:05:58,582.198 --> 00:06:06,172.198 With my developmental editor, especially as he was giving me his insights as far as providing care in the emergency room at such a critical time. 51 00:06:06,982.198 --> 00:06:10,482.198 And then in terms of my interest in the field and how I got interested in this. 52 00:06:10,512.197 --> 00:06:12,742.198 I've always been really passionate about history. 53 00:06:12,742.198 --> 00:06:19,487.198 I think We all know that history tragically is repeats itself as we've seen in the past couple of election cycles. 54 00:06:19,827.198 --> 00:06:29,817.197 But at the same time, it's really important to understand how we got here, right? I think a lot of people, especially when COVID started rearing its head had a lot of questions about the healthcare system. 55 00:06:29,827.196 --> 00:06:39,352.197 Why is it designed the way that it is? Why is it that certain people aren't? Getting proper access or access to high quality care or affordable care or whatever the case is. 56 00:06:39,732.197 --> 00:06:56,727.097 And so for me, I was really interested in that through line of like, how did this system get built? Who was it built for? Who was it built by? And how has that had everlasting impacts centuries or, generations later? And so what I realized was I was in grad school at the time that I started writing the book. 57 00:06:57,547.197 --> 00:07:10,377.195 And I realized that those of us in health care, we have a very high level understanding of how the system was designed, but we don't necessarily think about health care as a system that interacts with other systems, right? Nobody experiences health in a vacuum. 58 00:07:10,637.195 --> 00:07:19,233.78021053 We experience our health care in the context of our access to public transit, to green space, to quality education, to a safe place to live. 59 00:07:19,233.78021053 --> 00:07:22,130.26442105 We all live our lives in very intersectional spaces. 60 00:07:22,130.46442105 --> 00:07:34,150.36442105 And so I was really passionate about bringing those three pieces together, which was which were history policy and all of these different aspects of quality of life. 61 00:07:34,440.36442105 --> 00:07:45,970.36442105 So ultimately, when we talk about populations getting healthier, we're really not just talking about health, right? We're also talking about how do we improve their quality of life and health is just one factor through which a person's quality of life can be improved. 62 00:07:45,980.36442105 --> 00:07:49,570.36442105 So that's how I got really interested and passionate in the topic. 63 00:07:49,980.36442105 --> 00:07:53,490.36442105 And why the book? I just wanted to bring these different pieces together. 64 00:07:53,840.36442105 --> 00:08:03,850.36442105 And I actually started writing the book on the suggestion of a Georgetown professor who ran a book writing program who reached out to me on LinkedIn and said, Hey you post really interesting content. 65 00:08:04,130.36442105 --> 00:08:14,660.36442105 Would you be interested in joining this program? And I think that was a sign to me that my thoughts and ideas that were just vaguely being posted on LinkedIn could actually form a coherent narrative. 66 00:08:15,70.36442105 --> 00:08:20,60.36442105 that people would be interested in, especially given COVID and everything else that's been happening in the health care space. 67 00:08:21,120.36442105 --> 00:08:21,860.36442105 Oh definitely. 68 00:08:21,860.36442105 --> 00:08:34,825.36542105 As a doctor, as a internist, who, you know, who really zones in on women's health, there are all sorts of questions that I always form, why hasn't, research been done in this area. 69 00:08:35,325.36542105 --> 00:08:39,635.36542105 When I went to medical school and I graduated, gosh, I can't even keep count. 70 00:08:40,145.36542105 --> 00:08:44,595.36542105 But in many years ago we were 50 percent women and 50 percent men. 71 00:08:44,605.36542105 --> 00:08:50,725.42442105 So by now you would think that we would be well represented in certain fields. 72 00:08:50,725.42442105 --> 00:08:56,445.27775439 And from what I understand, we're still underrepresented in surgical fields. 73 00:08:56,495.37775439 --> 00:09:23,740.37875439 And you have to wonder, Why and what the discrepancy is and why? there are certain things that have affected us and I talk a lot about hormones and women's health and the women's health initiative and a lot of Doctors even back then, and those were my fellow residents, we would be referring to the women's health initiative. 74 00:09:24,120.37875439 --> 00:09:34,215.37875439 And we even at that time, and this was A couple of decades ago where we knew that there were some issues with that trial. 75 00:09:34,565.37875439 --> 00:09:38,525.37775439 However, when that trial came out, everything came to a stop. 76 00:09:38,725.37775439 --> 00:09:45,395.37875439 Women got taken off their hormones and for two or three decades after that, it remained the same. 77 00:09:45,635.37875438 --> 00:09:46,915.37875439 Nothing changed. 78 00:09:47,955.37875439 --> 00:09:50,955.37875439 And it was a big injustice that was done. 79 00:09:51,415.37875439 --> 00:09:54,565.37875439 There were no real major trials that happened after that. 80 00:09:55,335.37875439 --> 00:10:04,425.37675439 And no one really even up until now, no one really stepped up to the mic and said, Hey, there were some real issues with that trial. 81 00:10:04,435.37675439 --> 00:10:11,235.37775439 We need to really look at that and examine that and figure out whether we need to practice that way or not. 82 00:10:12,285.37775439 --> 00:10:16,695.37775439 But it just continued where women were not prescribed hormones. 83 00:10:17,75.37775439 --> 00:10:19,545.37775439 So these are always questions that I have. 84 00:10:19,575.37775439 --> 00:10:29,915.37875439 Why the discrepancy? what has happened to, the field of medicine when it comes to women? That's such an important question. 85 00:10:29,915.37875439 --> 00:10:38,135.37975439 And I think the way that you framed the question was from two different perspectives, right? One was lack of female representation in clinical leadership. 86 00:10:38,175.37975439 --> 00:10:40,725.37975439 I think to your point, I've definitely seen a lot of. 87 00:10:41,60.37975439 --> 00:10:45,690.37975439 female doctors, female interns residents, attendings who are just starting out. 88 00:10:45,700.37975439 --> 00:10:53,410.37975439 There's lots of those, but there aren't necessarily as many women represented in either clinical or administrative leadership positions. 89 00:10:53,670.37975439 --> 00:10:57,260.37975439 And that I think has been a global problem for a very long time. 90 00:10:57,550.37975439 --> 00:11:00,960.37975439 And that just has, I think there are lots of factors that play into that. 91 00:11:01,50.37975439 --> 00:11:11,920.37975439 But I think primarily one of the challenges is that I think people are still uncomfortable talking about women in the workplace in relation to women in their families as well. 92 00:11:11,920.37975439 --> 00:11:16,915.37975439 And it goes back to we're not just what we are in the hospital or what we are in the workplace. 93 00:11:16,935.37975439 --> 00:11:22,165.37975439 We're also people who belong to other communities, other groups, we have other responsibilities. 94 00:11:22,555.37875439 --> 00:11:33,565.37875439 What is ironic is that men also belong to these other groups and families and other responsibilities, but those, that's not necessarily considered as central to their identity as perhaps it is for women. 95 00:11:33,565.37875439 --> 00:11:37,305.37875439 And that might not be the case for everyone, but there are certain assumptions that are made. 96 00:11:37,785.37875439 --> 00:11:53,885.37775439 With women, there are concerns around, women, if you hire too many women of childbearing age, is that something you have to be concerned about from a staffing perspective? So I think a lot of those limitations continue to be in place and really are a barrier to promoting women to more senior positions in clinical institutions. 97 00:11:54,845.37875439 --> 00:12:17,340.37875439 But I think on the flip side just trying to understand why, for example, the Women's Health Initiative that you mentioned, I think that again, it goes back to the question of who is the system designed for and who is it designed by? And I think what we're increasingly realizing is that the medical system is almost obsessed with women as child bearers, as if they have no other identity. 98 00:12:17,340.37875439 --> 00:12:24,710.37775439 And we know not all women want to give birth, not all women do give birth, but that's the primary way in which our society thinks about women. 99 00:12:25,50.37875439 --> 00:12:29,90.37875439 And so that's why women weren't allowed to be part of clinical trials for a really long time. 100 00:12:29,350.37875439 --> 00:12:41,225.37875439 That's why women are often gaslit when they want to, when they want to do tubal ligation at a young age, and they know for a fact that they don't want to have Children, but they are people are often trying to convince them. 101 00:12:41,255.37875439 --> 00:13:01,225.37875439 Oh, you might change your mind when you're older etc But I think this real obsession with women primarily as child bearers before anything else Has really limited what the medical system is able to do for women as far as research, as far as clinical trials, as far as actual clinical care is concerned. 102 00:13:02,505.37875439 --> 00:13:09,845.37875439 Do you think that it is changing now? Do you see that change happening? Absolutely. 103 00:13:09,915.37875439 --> 00:13:14,225.37875439 I think the challenge is that this kind of change is gonna continue to be really gradual. 104 00:13:14,225.37875439 --> 00:13:16,55.37875439 It's been interesting too to watch. 105 00:13:16,450.37875439 --> 00:13:19,340.37875439 Other conversations about women happening at the same time. 106 00:13:19,340.37875439 --> 00:13:26,60.37875439 So obviously we're seeing increasing investments in women's research, particularly through the Biden administration. 107 00:13:26,70.37875439 --> 00:13:29,90.37875439 We've seen a lot more focus on women's health in the startup. 108 00:13:29,365.37875439 --> 00:13:37,725.37875439 Space with folks focusing not just on reproductive health or gynecologic health, but also on women's health as a separate field. 109 00:13:37,725.37875439 --> 00:13:41,275.37775439 For example, women have different microbiomes compared to men. 110 00:13:41,305.37775439 --> 00:13:45,685.37975439 So how do we actually make sure that they receive the correct care as a result of that? Or. 111 00:13:45,965.37975439 --> 00:14:01,805.37975439 For women who are experiencing chronic conditions and present differently from men or not even just chronic conditions, even things like heart attacks, right? As you well know, heart attacks may not always present in women the same way as they do in men, but that's not always widely taught in medical schools. 112 00:14:02,875.37975439 --> 00:14:10,475.37975439 So I think those conversations are very gradually shifting at the same time as conversations about women's roles in society. 113 00:14:10,475.37975439 --> 00:14:23,965.37975439 There's been so much more conversation about the mental load the work that women do to run households that is often invisibilized, not paid and often taken for granted, whether or not those women are in the workforce or not. 114 00:14:24,875.37975439 --> 00:14:29,175.37975439 And so I think a lot of these conversations about women are happening in parallel. 115 00:14:29,175.37975439 --> 00:14:46,740.27975439 So it's been exciting to see that transition, but unfortunately, I think, It's still going to take us a really long time to get to the point where we see more women in roles of clinical leadership as well as more investment and understanding of women's bodies and how women react to drugs and things like that. 116 00:14:48,970.27975439 --> 00:15:17,590.37775439 In your book, you mention what happened with George Floyd and how did it shape your ideas of the ine inequalities that come when it comes to Race and health and just everything in terms of equity, but how did it form your opinions and in terms of access to health? Yeah, absolutely. 117 00:15:17,590.37775439 --> 00:15:26,580.37775439 I think what happened with George Floyd is just a very sobering reminder of how inequity is experienced by people in different ways. 118 00:15:27,85.37775439 --> 00:15:37,385.37775439 So somebody like George Floyd had probably experienced health inequity, but unfortunately, the inequity that he faced in the context of police brutality is what ultimately ended his life. 119 00:15:37,415.37775439 --> 00:15:50,375.37775439 So I think it's a good reminder of how we, again, we all are interacting with different systems at the same time and how inequity that shows up in one Particular system can very easily show up in other systems as well. 120 00:15:50,585.37775439 --> 00:15:54,375.37775439 And one of those big challenges, like you mentioned in your question is access. 121 00:15:54,885.37675439 --> 00:16:14,125.37675439 So when we're talking about access to health, it's really important to also think about how, if you don't have access to other things, you also can't access health, right? If you are somebody who lives in a major urban center, like a New York city, if you don't have access to public transit, that's going to limit your ability to get to a doctor's appointment, let alone schedule. 122 00:16:14,540.37775439 --> 00:16:15,700.37775439 With a doctor's appointment. 123 00:16:15,910.37775439 --> 00:16:25,230.37775439 If you're in a place where you're on Medicaid and a lot of the doctors that you're interested in seeing don't take Medicaid, that's another form of a barrier to access. 124 00:16:25,310.37775439 --> 00:16:30,860.37775439 So it's interesting to think about, again, us as human beings interacting with all of these different systems. 125 00:16:31,0.37775439 --> 00:16:35,250.37775439 And if we have access to some systems, that might allow us access to others. 126 00:16:35,290.37775439 --> 00:17:16,510.3777544 But what's very clear is that when you don't have access to certain systems, it can really limit not just your access to health, but also your access to quality health, to affordable health, to all the things that, people need to do to maintain their health, right? I think we talk about access to health usually from the context of, can you get an appointment appointment? But before you even get to that appointment, can you get access to childcare so that someone can watch your kid while you go to that appointment? Can you even get something scheduled based on your insurance or lack of insurance? So there are all of these other factors that really play a role in your ability to access health, which is access to all of these other services and systems. 127 00:17:17,685.3777544 --> 00:17:27,345.3777544 And it's very good that you point these things out because those of us who are fortunate enough to have those things, we don't really think about it. 128 00:17:27,355.3767544 --> 00:17:28,615.3777544 We take it for granted. 129 00:17:28,980.3777544 --> 00:17:33,460.3777544 We have health insurance and we have someone else to take care of our child. 130 00:17:33,460.3777544 --> 00:17:39,560.3777544 And we don't have to worry about, how to take care of the co pay or how to even get to the appointment. 131 00:17:39,840.3767544 --> 00:17:50,130.3777544 But these are all things that I have witnessed as a young physician when I was working at Gouverneur Hospital where I had patients who struggled with those things. 132 00:17:50,530.3777544 --> 00:18:16,725.3772544 And thankfully gouverneur did have at that time, I can't speak for now, have systems in place to help those people so that they could access, but it doesn't really make up for, so when you don't have, as you were mentioning access to certain things, you likely don't have access to fresh fruits and vegetables, which happens to always be more expensive than anything that comes in a package or in a can. 133 00:18:17,495.3772544 --> 00:18:29,965.3772544 And, having lived in New York City for God knows how long, I used to ride the subways and I would see, kids drinking their Coca Colas in the morning with their Snickers bar for breakfast. 134 00:18:30,515.3762544 --> 00:18:37,305.3772544 And you have to wonder, what's happening with their blood sugars and what it puts them at risk for as they get older. 135 00:18:37,855.3772544 --> 00:18:46,385.3772544 These are things that we take for granted because as the whole socio economic status, it makes it Big difference. 136 00:18:46,435.3772544 --> 00:19:03,970.2772544 And I can tell you, I grew up in a middle class kind of family, but having entered the world of medicine, it completely opened my eyes to things that I didn't have access to in terms of information, in terms of. 137 00:19:05,840.3772544 --> 00:19:15,290.3762544 So many things that even to this day, I think about how many things I have access to that my parents didn't have because they came from a different country. 138 00:19:15,370.3762544 --> 00:19:22,720.3762544 They emigrated from India and yeah, they had their community, but it's different when, you're. 139 00:19:23,325.3762544 --> 00:19:27,35.3762544 At a different socioeconomic economic status. 140 00:19:27,705.3762544 --> 00:19:35,800.3762544 So I think that kind of Was one of the reasons why I chose to work in a in a community center. 141 00:19:36,220.3762544 --> 00:19:40,250.3762544 I always wondered why did I opt to do that where a lot of people didn't. 142 00:19:40,630.3752544 --> 00:19:43,110.3757544 And I think those were one, one of the reasons. 143 00:19:43,110.3757544 --> 00:19:51,510.3762544 And I think it inspires me to help women now because I, as a I'm a person, not as a doctor. 144 00:19:52,240.3762544 --> 00:19:57,390.3762544 And we were chatting about this offline where I've experienced inequalities. 145 00:19:57,430.3762544 --> 00:20:07,960.3772544 And when it first happened, it just threw me off because I, at that time, and this was several years ago, I didn't necessarily go in saying, Oh, I'm Dr. 146 00:20:07,960.3772544 --> 00:20:08,450.3772544 Mandel. 147 00:20:09,710.3772544 --> 00:20:15,410.3772544 I went in a humble okay, I'm just going to go in and, not necessarily use my title. 148 00:20:15,410.3772544 --> 00:20:26,450.3772544 And I have experienced things where I quickly learned that I had to announce that I'm a physician in order to level the care. 149 00:20:27,230.3772544 --> 00:20:27,610.3772544 Yeah. 150 00:20:28,110.3772544 --> 00:20:29,20.3777544 You shouldn't have to. 151 00:20:29,135.3777544 --> 00:20:32,925.2777544 But I've learned by my experience. 152 00:20:33,485.2777544 --> 00:20:57,785.1787544 You interweave in your book you talk about you, their stories, right? How did you choose those stories? What inspired you to talk about, different situations? Can you give us some examples so that my readers can understand? Because I, I was like, totally, your book flows so well, it really flows so well, it's so well written, and it's the stories that really capture that. 153 00:20:58,525.1787544 --> 00:20:59,5.1787544 Absolutely. 154 00:20:59,5.1787544 --> 00:21:08,615.1777544 I'm glad you mentioned that because I, for me, the objective of the book was yes, I want people who are already in the healthcare and medicine space to, to pick it up so that they hopefully learn something new. 155 00:21:08,895.1777544 --> 00:21:24,475.0777544 But my true goal was to make sure that those who aren't in healthcare can also understand, how we got to this point, especially because I think a lot of non healthcare people were opening their eyes to the injustices of our system, especially when COVID was around and rearing its ugly head. 156 00:21:25,660.0777544 --> 00:21:41,335.0777544 But to that end, I knew that stories would really help tell the story of this country and, the people who are In the people whose stories I've selected are all people who live here, whether they've lived here for a very long time or whether they've just gotten here. 157 00:21:42,95.0777544 --> 00:21:48,255.0767544 And so I knew that storytelling would be the most impactful way to really illustrate some of the challenges that people were facing. 158 00:21:48,525.0767544 --> 00:22:00,135.0777544 And in terms of how I encountered the these stories, I really am very thankful to those folks in my network because I tried to figure out based on the topic that I was writing about for that chapter. 159 00:22:00,135.0777544 --> 00:22:10,525.0777544 So just to back up for a second, each chapter is focused on a specific marginalized community, obviously with the understanding that a lot of us hold multiple marginalized identities at the same time. 160 00:22:11,375.0777544 --> 00:22:19,65.0777544 And so while going through the book, I was trying to make sure that there was at least one story that would really highlight the injustice of the healthcare system. 161 00:22:19,65.0777544 --> 00:22:30,695.0777544 And so I was really able to connect with people who were mostly friends of friends, acquaintances of acquaintances coworkers, ex coworker who had a story that they wanted to share and they were really passionate about it. 162 00:22:31,145.0777544 --> 00:22:39,365.0777544 And I think for me, I was also interested in recording the stories of people who have experienced these injustices and also are doing something about it. 163 00:22:39,375.0777544 --> 00:22:53,685.0777544 To that end, one story to highlight is the story of Bryce Soltan, who came to the United States as a refugee from Palestine and grew up knowing that, he wanted to be in the healthcare space and then came out as transgender at work. 164 00:22:54,35.0777544 --> 00:23:00,505.0777544 And was able to get the support from his workplace and from his health insurance to successfully transition. 165 00:23:01,45.0777544 --> 00:23:13,825.0767544 And at the time that I was interviewing him, he was head of business development for a startup that was providing hormone replacement therapy to young people in different states across the United States for those who were interested in transitioning as well. 166 00:23:14,145.0777544 --> 00:23:28,65.0767544 So for me, that was just a really beautiful story of someone who went through this experience, figured out what the challenges and difficulties were, and what was really motivated to make sure that other people had access to, to be able to transition in this case. 167 00:23:29,135.0777544 --> 00:23:38,325.0777544 And so I wanted to make sure that any of the stories that I was really focusing on told the story of that community with the supporting, data evidence, all of that. 168 00:23:38,650.0777544 --> 00:23:50,360.0777544 I think data is super important, right? It helps to tell a story, but then if you laser focus on a particular experience of one person, it really highlights what the qualitative challenges are for each of these communities. 169 00:23:52,240.0767544 --> 00:23:54,600.0777544 You also talk about Roe v. 170 00:23:54,600.0777544 --> 00:23:58,95.0777544 Wade and we all know what happened. 171 00:23:58,585.0777544 --> 00:24:04,825.0782544 But how did you feel when that whole thing happened? Yeah, I think it was devastating. 172 00:24:04,855.0782544 --> 00:24:11,365.0797544 I think the fact that there was a leaked memo or a leaked brief that came out a couple of days in advance before the official announcement. 173 00:24:11,820.0797544 --> 00:24:16,620.0797544 Was frightening because usually that sort of information that high up does not leak. 174 00:24:16,870.0797544 --> 00:24:18,980.0797544 So that was one, obviously the first point of concern. 175 00:24:18,980.0797544 --> 00:24:38,320.0807544 But then when the information actually came out that, the Supreme Court was going to strike it down, I think it immediately made me worried for, the sorts of people that you take care of, right? The people who don't have access to information, who aren't able to advocate for themselves, who are afraid potentially to advocate for themselves because of their socioeconomic status or their immigration status. 176 00:24:39,185.0807544 --> 00:24:40,425.0807544 or whatever the case is. 177 00:24:40,435.0807544 --> 00:24:51,915.0817544 And it's been really interesting to see what's been happening in Texas, for example, over the past couple of months, where they've seen an increase in the number of abandoned or dead babies in the state. 178 00:24:51,915.0817544 --> 00:25:03,915.0807544 And so it's really a case study for when you're in a position, when you're in a, an area where you can't access safe reproductive care, that ultimately has really negative downstream effects. 179 00:25:03,915.0807544 --> 00:25:08,35.0807544 And so it's really been interesting to make that direct link between Roe v. 180 00:25:08,35.0807544 --> 00:25:17,975.0797544 Wade, even though that overturn happened over two years ago, to what is directly happening now in places like Texas or in other states that have instituted total bans. 181 00:25:20,575.0807544 --> 00:25:20,935.0807544 Yeah. 182 00:25:21,155.0807544 --> 00:25:24,125.0807544 It's just, it's unbelievable. 183 00:25:24,285.0807544 --> 00:25:28,405.0797544 And I would never have imagined that this would have happened. 184 00:25:28,405.1797544 --> 00:25:50,645.0817544 And I feel fortunate that I live, in practice in, in New Jersey where, we have a voice still, but at the same time it just feels like we have stepped back in terms of, the progress that we made and we've, as women have lost a right. 185 00:25:51,545.0817544 --> 00:25:54,935.0817544 Based on what you were saying about where you live and you practice as a physician. 186 00:25:55,255.0817544 --> 00:26:00,625.0817544 It's been interesting to see how a lot of these states are now experiencing a situation where. 187 00:26:01,185.0817544 --> 00:26:28,420.0812544 Interns and residents don't want to go there for their residency or don't want to go there to practice Because they're worried about are they actually going to be able to provide safe care to pregnant women to postpartum women, etc So it's what I would describe a collapsing effect almost you have people who are no longer able to access care Legally, but then on the provider side, you also have a lack of people who are able to provide access to that care. 188 00:26:28,420.0812544 --> 00:26:35,960.0812544 So that gap between people who need the care and people who can provide the care is just widening because of these policy decisions. 189 00:26:36,580.0812544 --> 00:26:38,910.0812544 Totally, I could totally see that happening. 190 00:26:39,140.0812544 --> 00:26:46,800.0812544 It's something that I experienced myself when I was a medical student interviewing for internships and residencies. 191 00:26:47,130.0812544 --> 00:26:52,70.0812544 And I was making my circuit all along the Northeast and the Midwest as well. 192 00:26:52,510.0812544 --> 00:27:12,70.0802544 And I was, and I think I was up in Boston, and And this was, at the time when HIV AIDS was rampant and I was just talking, with my fellow interviewees and I said, Oh, are you interviewing at any of the New York city hospitals? And they were like, no. 193 00:27:12,840.0812544 --> 00:27:19,915.0812544 And I said, really? Why? And they were like, I'm not going to be training, with HIV, that much HIV. 194 00:27:19,965.0812544 --> 00:27:24,875.0812544 And then I realized okay, that's, I didn't even, that's not, that wasn't even a factor for me. 195 00:27:25,555.0812544 --> 00:27:25,895.0812544 Right. 196 00:27:26,355.0812544 --> 00:27:33,195.0812544 That wasn't something that I said, okay, I'm not, I'm going to leave New York or I'm not going to New York because of HIV. 197 00:27:33,695.0812544 --> 00:27:39,375.0812544 So these things definitely influence us in terms of where we choose to practice. 198 00:27:39,435.0812544 --> 00:27:47,615.0802544 And then you have to worry that the lack of care, less care, we're already experiencing primary care shortages. 199 00:27:48,915.0812544 --> 00:27:49,925.0812544 all over the country. 200 00:27:50,465.0812544 --> 00:28:02,625.0812544 So in those areas, right? How is it going to affect people? That's that is very worrisome in terms of access to care and everything else. 201 00:28:03,125.0812544 --> 00:28:15,145.0802544 Talk about you, you gave us a good example of a person who had a positive effect, but you also talk about native Americans and other groups of people. 202 00:28:15,325.0802544 --> 00:28:23,40.0812544 Can you give us an example where the discrepancies have not had a positive effect? Yeah, absolutely. 203 00:28:23,40.0812544 --> 00:28:33,30.0812544 I think at a very high level, because you mentioned Native Americans I think it's interesting because when you ask the average person on the street what they think of Native Americans have been relegated to history. 204 00:28:33,340.0812544 --> 00:28:47,860.0812544 People forget that there are people now who identify as Native American or who are upholding the practices of their tribes, right? And so I think a really stark example of a negative impact on that community was forced relocation. 205 00:28:48,220.0812544 --> 00:29:02,340.0812544 So originally the United States government had signed a very large treaty with a number of Native American tribes to basically say, we will respect your sovereignty of the land and we will, co exist and co exist together peacefully. 206 00:29:03,300.0812544 --> 00:29:09,470.0812544 And unfortunately, that covenant was very quickly broken with, the increasing number of settlers coming from Europe. 207 00:29:09,520.0812544 --> 00:29:16,830.0792544 The United States government was trying to make more space for them, and that resulted in a lot of Native Americans getting kicked off of their native lands where they had lived for, hundreds of years. 208 00:29:17,560.0802544 --> 00:29:27,810.0802544 And the sort of side effect of that is the land that they left was arable, fertile land that they had learned how to cultivate, they had learned how to make use of that land in all seasons. 209 00:29:28,90.0802544 --> 00:29:31,310.0797544 And there are a lot of cultural practices associated with the agriculture. 210 00:29:32,170.0807544 --> 00:29:33,80.0807544 of those communities. 211 00:29:33,410.0807544 --> 00:29:37,60.0807544 And they were shunted off to reservations where the land was not arable. 212 00:29:37,330.0807544 --> 00:29:41,760.0807544 There was no opportunity to really grow crops in the way that they were doing previously. 213 00:29:41,760.0807544 --> 00:29:45,570.0807544 And so they had to rely on the federal government for subsidies for basic foods. 214 00:29:46,80.0817544 --> 00:30:12,585.0817544 And what were the cheapest foods that the government could subsidize for Native American communities? They happened to be White flour, sugar, starch, just things that are not good for you, right? Things that you, basically what you, drawing the comparison to what you were talking about with seeing children on the subway with their Snickers bars and Coca Cola, right? And so as a result, you have this community that for generations has been deprived of their ability to access land for food. 215 00:30:12,985.0817544 --> 00:30:20,515.0817544 Which has resulted in really high rates of chronic conditions like obesity, high blood pressure, cardiovascular disease, et cetera. 216 00:30:20,715.0817544 --> 00:30:21,945.0807544 So that's one component. 217 00:30:22,275.0817544 --> 00:30:32,55.0817544 But putting that component aside, another challenge that the Native American community had faced was residential schooling, where children were pulled away from their parents and forced to attend school. 218 00:30:32,615.0817544 --> 00:30:56,245.0817544 Schools usually run by religious organizations, but often sponsored by the federal government in an attempt to wipe the Indian ness out of the child and make them, make them learn, forcefully learn English, make them cut their hair really short, which in a lot of communities, long hair was a sign of prosperity among boys and girls and that also robbed those children of the ability to preserve their culture and be proud of their culture. 219 00:30:56,505.0817544 --> 00:30:59,795.0817544 and to grow up with, grow up in a stable family environment. 220 00:30:59,825.0817544 --> 00:31:09,325.0807544 And that has also resulted in a really high rates of mental illness among this community because they have carried this intergenerational trauma throughout the decades. 221 00:31:09,335.0817544 --> 00:31:15,314.1417544 So it's very interesting to see how quote unquote non healthcare policies have had healthcare impacts. 222 00:31:15,314.1417544 --> 00:31:18,869.9817544 You wouldn't necessarily think of forced relocation and. 223 00:31:19,50.0817544 --> 00:31:25,860.0817544 The separation of children from their families as having an impact on health, but it has, and it's had an impact on physical health as well as mental health. 224 00:31:27,670.0817544 --> 00:31:33,470.0807544 Yeah I did read that and, that was fascinating, to read and obviously very sad. 225 00:31:33,470.0807544 --> 00:31:39,340.0807544 And, I think that happened, has happened to many different groups, not just Native Americans. 226 00:31:39,470.0807544 --> 00:31:49,125.0807544 So coming back to women's health as someone who Has, worked in health care administration. 227 00:31:49,515.0807544 --> 00:32:08,880.0807544 What do you think needs to happen? Into to level the care that women receive? What ideas do you have? So I think some of the ideas that I have had have already started happening, which has been really exciting just to see a general investment in in health care research associated with women's health. 228 00:32:08,880.0807544 --> 00:32:11,430.0807544 So that's been really promising and exciting to see. 229 00:32:11,710.0807544 --> 00:32:21,65.0807544 I think another challenge, which may not necessarily tackle specifically women's health But ensuring ensuring navigation services, not just for women, but for all people. 230 00:32:21,65.0807544 --> 00:32:30,55.0807544 I think we, even those of us who work in the health care system, we aren't always able to access it when we're patients because there's so many different complexities to navigate. 231 00:32:30,95.0797544 --> 00:32:42,760.0797544 And I think Making sure that women and in particular like we were talking about earlier, women of lower socioeconomic status who may have the most challenge navigating a complex medical system along with, everything else going on in their lives. 232 00:32:43,200.0787544 --> 00:32:50,760.0797544 It's been interesting to see that the government, federal government has made a pledge to ensure that community health workers will be funded through Medicaid. 233 00:32:51,95.0797544 --> 00:32:58,525.0797544 And I think that will have a lot of positive impact on the access piece of healthcare that we've been talking about so far. 234 00:32:59,515.0797544 --> 00:33:05,965.0797544 And I think another part of improving women's health is just making sure that people are aware of what's happening with women. 235 00:33:05,965.0797544 --> 00:33:18,910.0807544 I think, you can continue to invest in women's health as much as you want, but if you're not listening to the stories of medical gaslighting that happened to women and believing those stories,, we won't really meet our objective with improving women's health. 236 00:33:18,910.0807544 --> 00:33:44,520.0807544 And it's been interesting to see the role of social media on this because a lot of younger people have been using Tik TOK, for example, to document their experience of IUD insertion and how painful it is and how for a very long time, nobody believed women when they said that a pap smear or an IUD insertion was incredibly painful, but because of all of the stories that people have recorded on, Instagram or on TikTok, this topic has been getting a lot more focus and attention. 237 00:33:44,820.0807544 --> 00:33:53,890.0802544 So for me, it's been interesting to think about social media as a tool, both for spreading awareness, but also recognizing that it is also a tool for misinformation. 238 00:33:53,890.0802544 --> 00:33:59,64.9807544 But I think for women's health, it is going to be an incredibly important platform to continue to share. 239 00:33:59,405.0807544 --> 00:34:06,895.0807544 The stories of women, the work that's being done in the women's health research space and how we can advocate for ourselves when we get to the doctor's office. 240 00:34:06,935.0807544 --> 00:34:15,325.0807544 And the beauty of social media is that it's accessible to anyone who has a smartphone, which is a large percentage of this country regardless of their income level. 241 00:34:15,655.0817544 --> 00:34:24,435.0807544 So hopefully we can continue to educate patients using that platform and make sure that they have the tools that they need to advocate for themselves when they get to the doctor's office. 242 00:34:25,995.0807544 --> 00:34:26,985.0807544 I, I agree with you. 243 00:34:26,985.0807544 --> 00:34:27,745.0807544 Don't get me wrong. 244 00:34:27,755.0807544 --> 00:34:33,555.0797544 There are times when I get frustrated with some of the information that people pick up on social media. 245 00:34:33,605.0807544 --> 00:34:47,535.0807544 But at the same time, I am seeing are a large number of doctors who are coming out and using social media in various ways to educate the public, not just their patients, but the broader community. 246 00:34:47,620.0807544 --> 00:34:50,260.0807544 public about health issues. 247 00:34:50,610.0807544 --> 00:34:56,550.0807544 And I actually think that's really fascinating because we tend to be a conservative group. 248 00:34:56,940.0807544 --> 00:35:18,550.0807544 We tend to shy away from social media, but I think there are more doctors who are realizing that it's important to counteract some of the misinformation that can, widely spread as you are well aware in your everyday job, you work at the NYU Perlmutter Cancer Center. 249 00:35:18,600.0797544 --> 00:35:19,10.0797544 Yes. 250 00:35:19,440.0807544 --> 00:35:24,965.0807544 What do you do there specifically? So I work on the strategy and operations team. 251 00:35:24,965.0807544 --> 00:35:31,725.0807544 And so what that really means is really looking closely at what operational performance looks like across a number of disease groups. 252 00:35:31,725.0807544 --> 00:35:43,955.0807544 So how long is a patient waiting to schedule an appointment with a medical oncologist? How long is the patient waiting in the waiting room? Once they get to that appointment, are they being roomed as efficiently as they possibly can? And things of that nature. 253 00:35:43,955.0807544 --> 00:35:50,845.0807544 So a lot of the, a lot of that work is, keeping tabs on those metrics, identifying opportunities for improvement, if we see any fluctuations. 254 00:35:51,305.0807544 --> 00:35:52,245.0807544 things of that nature. 255 00:35:52,245.0807544 --> 00:36:00,735.0807544 And then the strategy component is really looking at making sure that our patients are receiving the same high level quality of care across all campuses. 256 00:36:00,765.0807544 --> 00:36:12,190.1802544 And the reason I mention that is because, as you well know, NYU has campuses in Brooklyn, Long Island, and Manhattan, with Manhattan sort of being the oldest campus with the most institutional history. 257 00:36:12,460.1802544 --> 00:36:25,310.1802544 So how do we make sure that our patients who are in Brooklyn and Long Island who have very different demographic profiles compared to our patients in Manhattan, how do we ensure that they are also able to access the same high quality care. 258 00:36:25,310.1802544 --> 00:36:34,880.1802544 And then especially when you're thinking about cancer care in particular, patients aren't just interfacing with their oncologist, they're also interfacing with a number of other physicians as a part of their cancer care. 259 00:36:34,880.1802544 --> 00:36:53,520.1802544 So how do we make sure that they have access to those doctor's appointments? How do we make sure that those appointments are affordable? What are we doing for our patients who are on emergency Medicaid because they're undocumented? So part of my role is also making sure that we're coming up with strategies to ensure that we have that equal access of care across campuses. 260 00:36:54,870.1802544 --> 00:36:55,330.1802544 That's great. 261 00:36:55,330.1802544 --> 00:37:09,130.1792544 And I think, there are more healthcare systems that are focusing on that, but it's really good to know that NYU has someone like you who is trying to equalize all that for patients all across the boroughs. 262 00:37:09,440.1792544 --> 00:37:23,770.1792544 What exciting projects are coming up in the, on the horizon for you? So I'm really glad you asked that question because I'm glad we're also doing this interview at the beginning of a new year because I've had the chance to do a lot of reflection on what I want to do. 263 00:37:24,85.1792544 --> 00:37:27,495.1792544 With my time, especially as it relates to health equity in the book. 264 00:37:27,765.1792544 --> 00:37:37,445.1792544 And I'm really trying to make this year about spreading the message about the history of health in inequity in this country, because again, I think a lot of people they see the system. 265 00:37:37,675.1782544 --> 00:37:48,785.1802544 They've been really frustrated by the system, they're not really aware of who all of the players are and why they exist and why the incentives for each of these players is so incredibly misaligned to the detriment of the patient. 266 00:37:49,265.1802544 --> 00:37:51,935.1802544 And so for me this year my goal is to really through. 267 00:37:52,320.1802544 --> 00:38:05,370.1802544 Speaking engagements through podcasts, through workshops, really spread this message of the history of health inequity and also provide some hope through solutions that I've seen work in the tech space and the policy space. 268 00:38:06,670.1802544 --> 00:38:14,730.1802544 So for me, the objective is really to continue to work with and do outreach for two, two people who are interested in learning more about the topic. 269 00:38:15,230.1802544 --> 00:38:21,70.1812544 I think it's comforting as a woman, as a doctor as well, but as a woman too. 270 00:38:21,550.1812544 --> 00:38:27,770.1812544 Have read parts of your book and to realize that, okay, I wasn't alone in all of that. 271 00:38:27,770.1812544 --> 00:38:53,641.924538 And my patients were not alone, but it also, it makes me feel sad and also a bit angry that we have had to endure and will likely, go through other things because of how the system is, but I'm glad that you are fighting the fight and I'm there as well to try to equalize and we're trying to make sure that we're doing the right things as much as possible. 272 00:38:53,641.924538 --> 00:38:58,726.4946872 So is there another book that's coming? That's such a funny question, because I've definitely gotten it many times. 273 00:38:58,726.4946872 --> 00:39:01,134.9752843 So no book, no second book on the horizon. 274 00:39:01,134.9752843 --> 00:39:11,207.2543887 But something that I've been thinking about a lot lately has been the comparison of health systems around the world and how increasingly we're realizing that nobody has it perfect. 275 00:39:11,207.3543887 --> 00:39:19,317.2543887 For a very long time we were pointing at the UK and Canada and countries in Europe and saying, look at how amazing their systems are. 276 00:39:19,317.2543887 --> 00:39:22,97.2543887 Everybody has access to care, blah, blah, blah. 277 00:39:22,97.2543887 --> 00:39:24,17.2543887 But now we, with the number of NHS. 278 00:39:24,467.2543887 --> 00:39:33,837.2543887 strikes and how long it takes for someone to call an ambulance in places like Canada and the UK, it's safe to say that no one has it perfect. 279 00:39:34,117.2543887 --> 00:39:45,697.2548887 And even though our system has been really detrimental to a lot of people the number of people who go into bankruptcy because of being unable to pay a medical bill is just astronomical in this country compared to others. 280 00:39:46,597.2548887 --> 00:40:28,67.2548887 And there are many things that other countries do well that we don't, such as, providing sufficient parent, paid parental leave that actually can not just improve, bonding with a new child or supporting a parent through an illness, but also improves the health of the caretaker, right? But at the same time, other systems have also had really big challenges both with demographic shifts and with identifying is the form of healthcare that exists in this country sustainable in the long run? The NHS is a really interesting example because I think in the UK it is such a part of the national identity the NHS is something that was created as a result of World War II and making sure that people didn't have to suffer in terms of paying for care. 281 00:40:28,462.2548887 --> 00:40:48,252.2538887 And I'm sure, when it first came out, it accomplished a lot of what it sought to do, but as times have changed, as the economy has changed over the past couple of decades, they're also experiencing a number of challenges that I think those of us in the US who were looking at them and thinking, wow, this is an amazing system, increasingly are realizing that their system may not be sustainable either. 282 00:40:48,502.2538887 --> 00:40:57,122.2538887 All of that's to say that if I was to write another book or long form post or whatever I'd be really interested in doing a bit of the history of these systems. 283 00:40:57,122.2538887 --> 00:41:13,657.2518887 How did, why did these countries choose to develop these systems? And what is, what are they struggling with now and how are they going to figure out what they're going to do in the future? I went to Oxford for a year having lived there and been a recipient of the NHS care it was good care. 284 00:41:13,657.2518887 --> 00:41:14,327.2528887 Don't get me wrong. 285 00:41:14,397.2518887 --> 00:41:24,157.2513887 It was very basic, but I had the opportunity to talk to different people and just do a comparison of what health care, what our health care versus their health care. 286 00:41:24,157.2513887 --> 00:41:37,787.2508887 And even then, and this is gosh, 20 something years ago where I realized that they didn't have the same access to surgeries that we had, that the wait times were much longer. 287 00:41:38,137.2508887 --> 00:41:49,137.2483887 You're talking about access, right? The people who had money were going to places like Germany to get their hips replaced even to, hospitals in India. 288 00:41:49,317.2493887 --> 00:41:52,537.2493887 for eye operations where they were paying in cash. 289 00:41:52,797.2493887 --> 00:41:57,837.2493887 But as you can imagine, not everybody has the opportunity or the means to do that. 290 00:41:58,737.2493887 --> 00:42:04,87.2493887 So it was easier and quicker for them to do it that way than to wait within the system. 291 00:42:04,787.2483887 --> 00:42:17,507.2483887 So yes, I don't know of any one ideal place where And then you have to wonder, right? The population, right? We don't have a homogeneous population. 292 00:42:17,507.2483887 --> 00:42:21,597.2483887 We have a very, mixed population all through the country. 293 00:42:22,77.2483887 --> 00:42:26,157.2483887 And what works for one country may not work for us. 294 00:42:26,167.2483887 --> 00:42:32,757.2483887 So these are all challenges that I often wonder about while I'm seeing my patients. 295 00:42:33,907.2483887 --> 00:42:34,247.2483887 Yeah. 296 00:42:34,537.2483887 --> 00:42:47,987.2493887 Because again, right now the type of practice that I have patients have access for the most part their socioeconomic status is different than, when I was a young resident in terms of the type of patients that I was seeing. 297 00:42:48,617.2493887 --> 00:42:53,757.2493887 And, they can go through the internet and figure out, what is valid for them or not. 298 00:42:53,767.2493887 --> 00:42:58,547.2493887 They're not necessarily looking at Tik TOK and saying, okay, this is totally valid. 299 00:42:58,977.2493887 --> 00:43:05,327.2493887 So I have a more educated population who, Typically more affluent. 300 00:43:05,817.2493887 --> 00:43:12,217.2493887 But it reminds me of the, those times when I was practicing at Bellevue, when I was practicing at Gouvernier. 301 00:43:12,637.2493887 --> 00:43:15,187.2493887 I feel like we've touched on a lot of big things. 302 00:43:15,247.2493887 --> 00:43:21,67.2493887 The one thing that I did want to share is just at a high level because we were talking about comparing healthcare. 303 00:43:21,452.2493887 --> 00:43:46,102.2493887 Across different countries is why health care reform in this country is so challenging and I think it's important to talk about that in the context of what everyone has been discussing, which is univer universal health care, like what does it mean for every single person in this country to have coverage or to have access, and what I find really fascinating is it has a lot to do with our identity as a country and I think in the United States we really pride ourselves on choice. 304 00:43:46,652.2493887 --> 00:43:53,212.2493887 and anything that, which is ironic because when we're talking about reproductive care, increasingly women in a lot of places do not have choice. 305 00:43:53,592.2493887 --> 00:44:01,812.2493887 But overall, we're talking about being able to select our providers, being able to move our providers based on where we're employed, things like that. 306 00:44:02,62.2483887 --> 00:44:11,902.2493887 I think that's something that's just so ingrained in the American psyche that if anyone tells us, where we must receive care, it's just incredibly offensive to our character. 307 00:44:12,272.2493887 --> 00:44:27,592.2503887 And so for that reason, anything that resembles government control of a very large group of people trying to access care, even though that's technically what Medicare is, that's technically what Medicaid is at the state level, is just too much for people to handle. 308 00:44:27,592.2503887 --> 00:44:36,502.2503887 And I think a good example of that is in the 1990s when Bill Clinton tried to push through Healthcare reform through the HMO process. 309 00:44:36,532.2503887 --> 00:44:51,722.2483887 And I can't remember the name of the ad, but there was a really popular ad that the Republicans had put out at that time that basically showed a couple having a hard time selecting the providers that they wanted and feeling really limited in terms of their ability to go certain places for care. 310 00:44:51,722.2483887 --> 00:44:55,992.2493887 And it played really well to the American public, which was very hesitant to that kind of reform. 311 00:44:56,502.2493887 --> 00:45:04,792.2493887 But it's been interesting to see how For so many countries, the kind of health care system that has been created as a result of how they think of themselves. 312 00:45:05,132.2493887 --> 00:45:07,432.2493887 And in the United States we're very individualistic. 313 00:45:07,432.2493887 --> 00:45:11,222.2493887 We really want the freedom to do what we want to move the way we want. 314 00:45:11,662.2483887 --> 00:45:16,172.2493887 And if anyone tells us otherwise, then it's, it becomes really challenging to put that into practice. 315 00:45:16,192.2493887 --> 00:45:18,902.2493887 So that was just one last piece that I wanted to share. 316 00:45:18,902.2493887 --> 00:45:25,482.2493887 And if people are still wondering why our system is the way that it is, it has a lot to do with our identity as a country. 317 00:45:26,312.2493887 --> 00:45:27,762.2493887 And that totally makes sense. 318 00:45:27,762.2493887 --> 00:45:33,572.2493887 And it also speaks to me, even when I think about someone telling me this is where you go for your care. 319 00:45:33,812.2493887 --> 00:45:37,502.2503887 I would say, what are you talking about? This is where, this is where I want to go. 320 00:45:37,502.2503887 --> 00:45:49,582.2493887 And even I pay extra for, whatever plan we have chosen so I can access care in parts of the country, all parts of the country, not just New Jersey. 321 00:45:49,992.2493887 --> 00:45:57,212.2488887 There are plans where you're just restricted to New Jersey, but that to me is like restricting my rights. 322 00:45:57,212.2488887 --> 00:46:06,202.2503887 I feel that, so every year I go through this and I tell my husband nope, we have to make sure that we can be seen in New York and in Philadelphia. 323 00:46:06,492.2503887 --> 00:46:11,142.2503887 So if someone told me, no, you would just be restricted to New Jersey, that would very much upset me. 324 00:46:11,152.2503887 --> 00:46:15,132.2493887 Not to say that there are bad, that there's bad care in New Jersey. 325 00:46:15,442.2503887 --> 00:46:17,472.2503887 It's just the access part. 326 00:46:18,42.2503887 --> 00:46:18,852.2503887 That's exactly right. 327 00:46:21,292.2503887 --> 00:46:34,482.2503887 I've been dealing with the health care system for a long time what made you decide to enter this field? What was it something that happened in your own life? That made you decide this is where i'm going to be heading. 328 00:46:35,602.2493887 --> 00:47:00,202.2493887 Yes and no So for me when we moved as a we moved as a family to the united states when I was five So I still remember, not living here and then getting here You and I think for us, we actually had a fairly positive experience with the healthcare system when we got here, and that was partially because we had a community, an Indian community, to rely on, ask, who are the best doctors or who are the most, rather, culturally competent. 329 00:47:00,602.2493887 --> 00:47:05,452.2493887 Doctors who won't laugh at us if we say that, we're going to give our kids turmeric milk if they're not feeling well. 330 00:47:05,922.2493887 --> 00:47:11,992.2493887 We were able to identify who those people were and have fairly positive, affordable experiences with the healthcare system. 331 00:47:11,992.2493887 --> 00:47:15,832.2498887 But as I got older, I realized that was not, that's not the case for a lot of other immigrants. 332 00:47:15,832.2498887 --> 00:47:17,852.2498887 That's not the case for a lot of other people. 333 00:47:18,232.2498887 --> 00:47:35,987.2498887 And from a policy perspective, And around the time I was in college was really when, Obamacare or the Affordable Care Act, I should say, was passed with the idea that we really need to be expanding coverage to all different types of people, not limiting coverage based on pre existing conditions, et cetera, et cetera. 334 00:47:36,327.2498887 --> 00:47:43,997.2498887 And it was around that time when the Republican Party was pushing back against the Affordable Care Act and trying to institute repeal and replace. 335 00:47:44,462.2498887 --> 00:48:03,522.2498887 And it was around that time where I was like what are they repealing? What are, what would they replace it with? What would that system look like if this actually succeeded? And that really forced me to look more closely into, how is our system actually Oh, it's set up in very interesting, patchwork ways where, if you're above 65, you get coverage. 336 00:48:03,522.2498887 --> 00:48:05,722.2498887 If you're below a certain income level, you get coverage. 337 00:48:05,722.2498887 --> 00:48:20,447.2498887 But if you're neither of those things and don't have an employer that sponsors your health insurance, what happens to you? So I started to really ask those questions of myself, if I was an American living here with this kind of job would I have health insurance? Or if I had pre existing conditions and. 338 00:48:20,867.2498887 --> 00:48:32,357.2488887 lived here would I have health insurance and that really motivated me to go into health care Administration to see if there was a way in which I could be part of the solution and part of the story of actually Improving access to care. 339 00:48:32,857.2488887 --> 00:48:44,787.2488887 You're definitely a voice that I want to continue hearing So you're welcome to come back on my podcast at any time and or collaborate on any future projects together Yeah, absolutely. 340 00:48:44,787.2488887 --> 00:48:46,727.2488887 That would be so much fun Sounds exciting. 341 00:48:46,727.3488887 --> 00:48:48,387.2155554 so much. 342 00:48:48,387.2155554 --> 00:48:52,487.2155554 And don't forget to like, share and review my podcast. 343 00:48:53,37.2155554 --> 00:48:56,827.2155554 Remember, it's always ladies first on Soma Says. 344 00:48:57,127.2155554 --> 00:49:00,787.2155554 Let's make a difference one conversation at a time.