Rep. Donna Shalala: U.S. Representative (Raise the Line)

Hi, I'm today on raise the line. I'm honored to be joined by us.

Representative Donna Shale, whose district includes part of Miami and the surrounding area. Congresswoman Shala brings a unique perspective to the COVID-19 crisis.

Given her tenure as the longest serving Secretary of Health and Human Services in US history. Not to mention other roles in government and serving as president of the U of the University of Miami and president of the Clinton Foundation among other leadership BS in Congress.

She's known as a leading advocate for civil rights, increasing access to health care and trying to get better education in a clean and sustainable environment.

Thanks so much Donna for being with us here today. And Donna, your background obviously is remarkably relevant here.

You know, we're talking about uh civil unrest, health care issues, unemployment. So I'm really excited to kind of get right into this.

I'll start out by asking you, you know, we've seen widespread protests in the response to the murder of George Floyd and the systemic racial injustice that led to it.

Many people right now don't trust the federal government to look out for their interests. You've worked across different branches of the federal government.

So you have kind of the perspective of a citizen as well as a lawmaker. I'm really curious to get your take on the current situation.

Well, I'm, you know, in some ways it's very exciting. Um I was out with protesters.

They were for the most part young. Um And um it was, um it was uh very much represented by em.

Um It was Hispanics, it was white kids, it was college students, it was high school students, it was their parents um standing with uh members of the African American community.

And the message was very clear, this um uh our police um are not taking care of us that uh uh they're in fact uh breaking the law and there's no accountability in the system.

Um And there are too many examples of police killings around this country, particularly of young black men and Children.

There was a case of a 12 year old in Cleveland who was shot by a police officer that had been fired from another uh from another department.

So it's very clear that we need fundamental reform of the justice system. But more importantly, um we need to understand racism and work on it at every in every part of our society, including ourselves that this has gone on for too long since the end of the Civil War.

And um uh it's unacceptable for a country that prides itself on its diversity to ignore the needs and the challenges that one part of our society uh experiences.

You know, I'm really curious, there have been a number of young black men and as you said, kids as well. And when you said that I got chills that have died in recent years and for some reason right now feels different to me and, and maybe it's just the magnitude of the protest and the fact that there's an international peace.

Now, I'm curious, do you feel that as well? And if you do, why do you think that is because we saw it, the whole world sought, saw that police officer with his foot on that man's um uh on his neck, we actually saw it and um saw the death of George Floyd and that had an impact on every single one of us.

But it also reminded us what had been going on in this country, what we had been protesting about and that the police departments across this country had to look at themselves and all of us had to look at them and say we want fundamental change.

We do not want bullies in our police department. We want people that understand what their roles are and their public service roles as well and that their rules and, and they cannot get away with anything.

And I think that we have said that very clearly with these protests. You know, there's so much focus right now on law enforcement as a public institution, a societal institution, you just kind of correctly brought up that we need to root out racism and its causes from all institutions in terms of health care.

We know that obviously there's a lot of bias in health care as well. Uh, race affects health outcomes.

It's very well documented. Now, maternal health, how much pain medication you get?

I'm just curious, can you talk about any work that you're aware of that's helping to reduce systemic racial bias in health care specifically?

Well, we've been working on um on disparities in health care for a very long time and we know that disparities are different for different ethnic groups.

Uh For example, so um the healthcare system, particularly at the federal role has been working on these disparity issues.

They have made some impact but not significant impact. And when Coronavirus hit, when COVID-19 hit, we saw the flaws in our system and it wasn't just coverage.

Um it was access to coverage obviously. But um it was more fundamental to that because it wasn't just related to poverty, middle-class.

Minorities were not getting the level of care uh that they needed to get. This was hitting uh older people in nursing homes, but it will also was disproportionately hitting minorities.

Now, we've known for a long time that things like maternal mortality gets black women in higher percentages um than it does uh white women.

So we've had these disparities and what COVID-19 did was remind us the disparities in the healthcare system. But it also reminded us about the disparities in the education system.

At the same time, we had to pass out, we did pass out 100 more than 100,000 laptops to kids in our community. In my district here in Miami, the school board, 75% of, of the kids that go to the public schools in my district are um are at the poverty level or below the poverty level.

So we're distributing meals to those kids meals that they're missing because they're not in school. Their parents don't have the um the systems, the it systems that middle-class families had.

So we've had to upgrade, make sure that they had access to the internet. If they were going to do their classes, we lost a lot of kids.

We don't know where they are in the process and these were low-income minority kids that um the teachers are missing from their classes and we're trying to track them down.

We don't know whether they moved to another place or where they did just didn't have access um in their homes. Um And so we've gone knocking on doors to try to track down four or 5% of the kids that aren't showing up for these uh tele classes.

Um So in education, in health care, in job opportunities, everybody's talking about the fact that we're gonna shift back to uh shift over because we've learned a lot about our ability to work, uh, with zoom and with other things and to do our business.

That's not true for poor people. They work in the restaurants in Miami, they clean the buildings.

They're not going to be able to, uh, do teleworking. They're more at risk than anyone else for COVID-19 because they have to be out, they work in the grocery stores, they work in the drug stores.

Um, And when people talk to me about, well, work is going to change, not for them. And, and that's why our investments in unemployment and in small business uh has been so important, but we have to remember that and, and we haven't focused testing on, on the population that has to go to work.

There are huge gaps and they're not just health care. Um and they're not just education, they're for working folks in this country uh because they're gonna have to do as work is changing.

Their work is not changing and their incomes are going down. Yeah, I mean, you're describing a perfect storm where incomes are going down.

If their parents, their kids aren't going to school, they're hard to track down and there's limited relief it feels like for, for folks in that income bracket.

I just got off the line on a huge discussion with a number of leaders of Congress on hunger in America and the feeding programs and the fact that we're plowing under certain kinds of foods because we don't have the distribution system.

People in long lines in every community uh to get free food, undocumented people that aren't eligible for staff benefits.

I mean, there we, we have big problemss in this country and they are made worse by COVID-19 and by racism and we need to get our arms around them.

This is not, uh this is not Donald Trump's strength. Well, you brought up the next point I wanted to ask you about is the hyperpartisanship, right?

So it, it feels like in the last four years or even in the last 20 years in, in my adult lifetime, uh There hasn't been really a time quite like this one and you always feel like this moment is the busiest maybe, but this feels extremely busy.

And uh what's frustrating about it is the, is the feeling of hyper citizenship in, in the federal level. What is your sense on any sort of glimmer of optimism?

So I know, I know the the list of things to be down on is quite long. Point me to something that gives you hope when you wake up in the morning, given all the things that you've seen and done.

It's called the first two bills, three bills that we passed the caries bills. The initial bills were bipartisan overwhelming votes and now suddenly, but we need to get another tranche of money out.

The president and the uh Republicans in the Senate have said, wait a minute, maybe we spent enough money. Look, employment's coming back.

Those numbers are fuzzy. Employment is coming back because we invested in small businesses, but we didn't invest enough in those businesses.

We're gonna have to do a lot more because there are a lot of people that aren't gonna be able to get back to work. We need to extend that unemployment.

We need to give money to state and local governments. So they're gonna start laying people off.

Can we afford to have teachers laid off or police officers or, or fire officials or other municipal officials, the sanitation workers?

No, of course, we can't. So we need to give money to state and local governments fairly quickly.

That was in our heroes Bill. Uh And um there's no movement over at the Senate but the first bills were bipartisan, but we still believe that there is a crisis here and that we need to invest more resources in this crisis and a payroll tax doesn't do it.

The people that I represent um are not helped particularly by a payroll tax, Donna. What are some, some things you've seen then at the state level or the local level?

Uh solutions at that level that you think are, are, are creative and are effective that you just wish more communities knew about.

Uh so they could implement as well. I think we did a heck of a job trying to get food to kids and to seniors.

Uh, we put a simple telephone number in place for seniors. 311, call, 311 in Miami.

They'll hook you up with meals on wheels and anything else you need. For example, if you're homebound, you need to get tested for COVID-19, we'll send a fire official, a fireman over to or a fireman over to, uh, uh, to test you if you need meals.

We'll deliver meals. If you're over 60 we'll deliver meals.

We're not asking your income. We're just asking um, where you live, uh to deliver meals.

Um We also have been very responsive on testing for people that don't have cars that can't do a drive-through and in which we don't have a lot of public transportation in Miami.

And what we have has been cut way back uh because of COVID-19. So we have walkin clinics in the community and the federally qualified community centers for people to walk in.

But we haven't sent a conti message that says if you're going to work, you better get tested and if you're staying at work, you better get tested.

We um our testing sites all had different messages. Uh You have to be over 18, you have to have symptoms and now we're at the point where we can actually test people that are going to work and we need to do that.

We haven't focused our resources on the nursing homes where that's where the deaths are in our communities and they've always had problems with infections.

Yeah, I was wondering about that and that's kind of one of these, um, blind spots for the average person that may not know that.

But now of course it's in the news and people become more aware of it. I'm, I'm curious given that you've been so involved in the US healthcare system.

You know, you've taught classes on the US healthcare system. What are some common misconceptions people have about the way things work.

I'm just uh would love to get your thoughts on, on gaps in knowledge. Well, you know, it's a highly fragmented system.

Uh It's very fragmented and different parts of the population are covered in different ways. It's so fragmented that you have big gaps in the system.

So if you live in Florida and you're a low-income, a low-income worker, you can't get government health insurance because Florida has an expanded Medicaid.

Now, why did Obamacare put in Medicaid as opposed to the exchanges? Because it was cheaper, they were trying to keep within a budget.

Um And that was fair. Um The cost of prescription drugs.

It's not only that you could buy them cheaper in Canada, it's really that we've refused to step forward and negotiate as a nation with the drug companies to drive down the cost.

And, and we actually introduced a bill in January which I was one of the lead sponsors on to say the Secretary of HHS ought to negotiate directly with the companies.

The third thing I think we're confused about is that we've sent our supply chains for drugs abroad. And with a single exception of uh the flu shots where in the 19 nineties, we were talking about flu pandemics and I was so nervous about it that we moved the entire production of flu vaccine to the United States.

It's the only one we really produce here in this country. We're totally dependent on China, on India, on other places to produce the next vaccine.

But more importantly to produce the drugs that we need to save people's lives. And we're gonna have to think that through, I believe we've gotta have a 3 to 6 month supply, which means we've gotta have companies here that actually produce some of that supply without depending on the supply chain.

Um But our, we've known for a long time that our health care system is highly fragmented. Now, I am not a Medicare for all person.

I keep saying to people, imagine Medicare for all a single payer system with Donald Trump as president, oh my God, who wants to deal with that?

And by the way, England, and I'm a good friend of Simon Stevens who runs the British healthcare system is struggling with the same issues we're struggling with in terms of the quality of care, depending on where you live.

And um you know, they certainly have brought up the bottom, but they've got a problem with their senior population dying in their own facilities.

They've got a problem with disparities uh, for minorities in terms of access to the health care system. Yeah.

No, I, II think, uh, uh, parts of what you're saying resonate highly. II was born in the UK.

So I know the NHS from that world and, um, I think that I, if anything, one thing that has become very clear is that some solutions that were posed, let's say, even uh five years ago or 10 years ago are being discussed more vigorously because of what you just said, that fragmentation and, and the other issue, the earlier point around, you know, universal basic income framed differently as you know, uh a bailout for small business owners.

I think these things are discussed so much more today because we see these issues or, or global issues or, or certainly affect all, all swaths of America.

And I've become a critic of uh what we did for income support that is we did the unemployment situation. It's uneven across the country in terms of states being able to deliver that our assumption always has been use existing platforms to get the money out fast.

It turned out that the existing platforms, the small Business Administration, unemployment, they couldn't get the money out fast.

Would it have been easier to do what the Europeans did that is, go to the IRS tell them to take the first quarter of payroll and send a check to all those businesses.

The answer is probably yes. Um, but no one really was thinking that through, they've never dealt at the scale when you're trying to scale up.

You better make sure your infrastructure is ready for this. It's a really good point.

I think that's, that's a key thing and I think people think of infrastructure frankly as a boring topic. Um, but it's not boring the moment it breaks down and we see the effects of broken uh healthcare system in the sense of like, you can't get testing done all of a sudden that's not boring anymore.

Or the moment freeway breaks down and you can't actually get from point A to point B that's everyone's focus. So II think that's a really valid point.

II, like that you brought that up health system, look at the public health system in this country. We've defunded it over the years.

I remember going before Congress and testifying on our public health infrastructure, their eyes glazed over. Exactly.

It's not, I kept arguing, you know, to handle all these infectious disease and these outbreaks, we have to make investments in state, local systems, in laboratories across the country.

Um, and everybody's eyes glazed over it. The only time I ever got money for it is when I went to the defense department and argued bioterrorism and then people got sensitive and were willing to put some money.

Yeah, into the system. Yeah.

I mean, it, it captures the imagination. I think if you can't capture someone's imagination, you're not gonna get them to care about what you're interested in.

And, but now we're in a different situation now. We've got to be ready.

Now. We have to build a system, a readiness system all across the country.

We have to use academic labs. We had labs across the country that all we needed to do is certify them.

Yeah. Clear certification.

Yeah, absolutely. I, so Donna, this is, this is a great segue for my final question, which is we have a whole cohort of students that are rising up that are entering the, the medical profession and public health profession.

This is what they're seeing for the first time you've seen, I won't say you have, you've seen it all, but you've seen a lot and I'd love for you to give some advice to folks that are coming up right now in terms of what, how to put the current situation into perspective and what they can do right now to be more and more prepared for kind of the new tomorrow.

Yeah. You know, you have to read a lot.

Um I always recommend that people get on uh the Henry uh Henry Kaiser Foundation Family Foundation website, so they can get those newsletters that kind of summarize all the articles around the country or the Commonwealth Fund that also has a set of things.

You just have to sort of keep up. But the best way to understand health care and the best way to be, um, a world-class physician is to understand people's lives.

Look, I'm not a doctor but everyone that provides me with a service, I can tell you exactly what their healthcare situation is.

What kind of insurance they have. I used to walk into these, um, big hotels in which I was giving a speech before 1000 people that are experts in health care at a dinner meeting.

And I uh the first thing I'd say when I got up is, do you know what kind of insurance your waiter has? Because I had asked, wow, you don't understand people's lives.

You can't do healthcare. You can't, certainly can't do healthcare policy, but you've got to understand their lives, not simply their ethnicity, their cultural background, you have to actually understand their history with the healthcare system and that involves asking people questions.

It's not so private to ask someone what kind of insurance they have. I've had waiters that kept me standing for 10 minutes while they described how their union had changed their healthcare system over time and what the difference was in their copays.

But it gives you a feel for the, for the system that you wouldn't have otherwise because you've gotta put a face on it. So as much of a policy wonk as I am and a data nerd, the difference between me and others is I actually know a lot about people.

Look, I've been on the board of Major healthcare system. I was on the board of United Healthcare.

I see it from the corporate and I've run hospitals. I've delivered healthcare systems.

I've been at the federal level. Um, and um, so I've been at every level, I've had thousands of doctors that have and nurses that have worked for me and other healthcare professionals.

I've run big schools of nursing and medicine. But what I've learned most and what I've told my students is you've got to understand people's lives and if you don't do that, um you can't, you can't understand what's going on in our country.

You just have to ask, ask your uncles and aunts for heaven's sakes. That's fantastic.

Have different kinds of my cousins. They all are in different kinds of systems.

That's really good advice. And I would imagine that people just don't get that question and probably when they do get it, it feels good to get that question that someone cares.

I remember my manicurist explaining to me before we did Obamacare that she could get her kids into kid care. And um so they were covered uh but she made too much money to be in Medicare herself.

So she took care of her kids and she took a risk. But once Obamacare came by, she got deep discounts and so she was paying about $50 a month and she was so proud.

I remember uh my mother's home care uh people because I never have anyone work for me that doesn't have health care either.

I pay them so they can get on their spouse's uh plan, whatever that extra money is or, or I pay for it directly. All my mother's home care care workers were not provided healthcare by their employer.

So I got them all on Obamacare and I paid the difference between what they had to pay and, and what the difference was. It was the first time in their lives, they had been working in home care for 20 years that they had a physical exam.

What a difference that made for them. That's remarkable.

They had in uh being able to have health insurance and all of them had their kids on the Chip program, which I helped to develop the children's health insurance program.

Their kids were covered either on Medicaid or on the Chip program, but they themselves didn't have coverage. But what a difference it made in their lives.

I didn't know your involvement on the Chip program. I as a pediatrician, I've seen many, many kids that have taken advantage of the Chip program and it's been a world of difference for them.

So thank you for, for that. I didn't care, collapsed on us when we weren't able to get universal healthcare.

In the nineties, we pivoted quickly. Uh working with Senator Hatch and Senator Kennedy and developed the kid care program.

Now, that was for working-class kids. It was our intention.

If Al Gore got elected to take care of their parents, that's what Obamacare did. Obamacare basically is for working class families.

It needs to go deeper into the middle class because so many families um don't have access to insurance because they're not as we found out in the unemployment system, they're not uh uh they don't get insurance through their employer because they're in the gate economy or something else.

So Obamacare, we will build on that Obamacare platform. Uh Depending on what happens in November, that's too long of an answer for it.

No, it's, it's good and it's a bit of uh an important history lesson as well. I think people often forget that things build on other things.

And so uh that's part of why I was so excited to have you here because you've seen the continuity and the, and the long vision on that.

Uh Donna, any final words for our audience before I let you go. No, II think it's going to be the golden age of health care.

I think we're about to go into a dramatic change in American healthcare, not just because we're going to cover everybody.

Um But I think we're going to move a little from our focus on uh we're gonna focus again on, on low tech because we've learned that going back to washing your hands makes a difference.

And if you look at how we've extended people's lives in this country. It's actually been through building codes, through sanitation, uh through immunizations.

Uh that's had a bigger impact than all the high tech stuff. And I'm a, you know, I am totally supportive of high tech and great science and all of that.

But uh we've, we've now taught a generation that washing your hands makes a difference that wearing a mask, that social distancing that the fundamentals of public health and everybody has to integrate that into their practice in the future.

It's a great, a great parting lesson. Uh I would add nutrition to that, which I know you care deeply about as well.

But thank you. Thank you so much.

II think not smoking by the way. And there's a long list of nots exactly not smoking anything that's a good way for it.

Donna. Thank you so much for taking time to do this with me.

It means it means a lot to uh to me and to our listeners. I appreciate it.

My pleasure. Thank you very much, Representative Leyla for being with us today.

I'm Risa Desai. Thanks for checking out today's show.

Remember to do your part to flatten the curve and raise the line. We're all in this together.