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Abdul reflects on how our healthcare system got here. Then he talks to Rep. Pramila Jayapal about the new Medicare for All bill in the House, and what it it tells about the lessons we have to learn from this pandemic.

Transcript

Dr. Abdul El-Sayed: America Dissected is brought to you by Marguerite Casey Foundation, which launched the Freedom Scholars Award last fall in partnership with Group Health Foundation. Dr. Darrick Hamilton is one of 12 scholar activists who received the award for their work cultivating intellectual infrastructure that is rooted and nurtures movements toward freedom. He’s a Professor of Economics and Urban Policy, and the founding director of the Institute for the Study of Race, Stratification and Political Economy at the New School. I asked Professor Hamilton about his work and what it means to have a political economy that does not treat Black people and white people the same, a reality that has led to the disproportionate death rates we’ve seen from Black people in this pandemic.

Dr. Darrick Hamilton: Black people make up about 13% of the US population, and with more than 200,000 COVID deaths occurring already, this would suggest that we’ve lost already more than 50,000 Black lives, and a surplus of 25,000 of them that would not have occurred if we had a political economy that treated Blacks and whites the same. This links to a larger political and economic vulnerability whether we’re in a pandemic or not, where we have the immoral devaluation of Black lives that’s been ingrained in our political economy and impacts the ways in which we respond to a pandemic. This is the work that I’m working on: trying to address these structures and create a more fair, equitable and secure economy for everyone.

Dr. Abdul El-Sayed: The Marguerite Casey Foundation has more information about 2020 Freedom Scholar Dr. Hamilton, and all of the members of its first cohort, on their website at www.Caseygrants.org. Follow the foundation on Twitter at Casey Grants.

Dr. Abdul El-Sayed: Cases are ticking upward in states around the country as variants pull ahead in the race with the vaccine. Governors, meanwhile, are going full steam ahead with aspirational thinking, rolling back the all-important protection measures, like masking. Vaccine manufacturer AstraZeneca stumbled in its rollout of its vaccine efficacy data, facing a rebuke from the government’s independent data analysts, and revising its numbers. This is America Dissected. I’m your host Dr. Abdul El-Sayed, reminding you that normal isn’t just a place in our imaginations.

Dr. Abdul El-Sayed: This pandemic was a shock to the system, in every single way. It pushed us all back on our heels, forcing us to take stock of everything from how we educate our children, to how we buy our food, to how we get around, and, yes, how we get health care. Some of these systems did OK, because of vote by mail, for example, the 2020 election had one of the highest turnouts in history, even though Republicans are now trying to limit voting access because their candidate got whomped. But many of our systems fundamentally failed. None failed quite as spectacularly as our health care system, though. The one system we needed most in a global pandemic. Imagine being the richest, most powerful country in the world, and watching your nurses and doctors trying to care for dying people in garbage bags. Imagine having the world’s highest rate of un-insurance in the middle of a pandemic15 million people in total—because we tie health insurance to employment. Now, if you didn’t experience it, imagine being one of those people, scared to death that you could get the super deadly virus and not have the insurance you needed to get health care. Imagine watching your local hospital go bankrupt or shut down in the middle of the pandemic, as happened to 47 hospitals across the country, and wondering where you or a loved one would get care if you got sick. None of this happened anywhere else in the world, only in America. But here’s the thing, for most of us, this janky health care system is all we’ve ever known, so we think it’s just normal. But normal shouldn’t mean having to fight with your insurance corporation, whose CEO makes millions of dollars a year, to get the care you already pay for. Normal shouldn’t mean having to worry about your insurance if you turn 26, or get a job, or lose a job, get married, get divorced, move to a new place, or any other way people routinely lose their health insurance. Normal shouldn’t mean that 2/3rds of the people who go bankrupt every year, go bankrupt because of health care. So how do we get this, quote unquote “normal?” Well, it’s an accident of history. The first insurance program was a simple agreement between a hospital in Texas and a local teacher’s union way back in the 1920s. To protect the teachers from unexpected costs if they got sick, they agreed that for 50 cents a month, the teachers would get all of the health care they needed at the Baylor University Medical Center. By the way, that 50 cents a month would be $7 a month in today’s dollars. The average health insurance premium today, though, is $448 a month. At the time, the model was far better than the alternative, and became what we know of today as Blue Cross Blue Shield. But that model didn’t really take off until World War Two, when a federally-mandated national pay freeze was instituted to stop employers from poaching workers by offering higher pay, something they did to protect the war effort. Employers got smart though and they began searching for other ways to attract employees, what we now call, quote unquote “benefits” like health insurance. The IRS later decided that plans like this would be tax exempt, a massive incentive for employers. With that decision, employer-sponsored health insurance plans went from being just a perk to the norm. And our broken, uniquely American employer-based system of health insurance was born. The employer-based system always had holes. From the jump, that plan just didn’t work for two groups of people, in particular: seniors who are retired and facing the highest health care needs of their lives, and low-income folks who worked in jobs that didn’t offer these kinds of benefits. In the ’60s, under President Lyndon B. Johnson, the government created Medicare for seniors, and Medicaid for poor folks, to address these people left behind by the employer system. But let’s be clear about something. The gaps in the employer-based insurance system have only gotten worse, particularly now. People aren’t as likely to stay in the same job for their whole lives. Wages have stagnated, and employers have figured out how to offshore and automate good jobs that would have come with health care in the past. More people, particularly young people, are working gigs that don’t even come with benefits. These holes keep getting bigger. There’s another problem, too. The industry itself has just gotten greedier. That’s why prices for hospital care and medications have skyrocketed. Since 2010, even after the ACA passed, annual health care costs have grown 4-5% every year. To make sure they keep making money, the health insurance industry has created gimmicks like deductibles and co-pays that push those costs back onto people if they get sick. These are what drive people into bankruptcy today. If the main word in insurance is “sure,” people can’t really be sure they’re safe from unexpected costs that health insurance was created to protect us from way back in the 1920s when those teachers signed that deal with the Baylor Hospital. Fast forward to the COVID-19 pandemic, millions of people lost their jobs, and when they did that, they lost their health insurance too. Sure, the Biden administration has done what it can to subsidize the cost of staying on health insurance. But that doesn’t really solve the problem at the center, that we have a for-profit insurance industry that keeps health care costs rising, and a rickety employer-based system that keeps people at risk of losing their insurance if they lose a job. That’s the old normal, and we need a new one. Today, we’re talking to someone who wants to build just that. Our guest is Representative Pramila Jayapal, representative from Washington’s Seventh District, and Chair of the Congressional Progressive Caucus. Two weeks ago, she introduced a Medicare for All act in 2021. She’s here to help us dissect what a new normal could look like, after the break.

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Dr. Abdul El-Sayed: Our guest today, returning to the pod, is Representative Pramila Jayapal. She is a progressive champion in the House of Representatives, and most recently, she reintroduced Medicare for All back in to Congress. And we are having that conversation today. Representative Jayapal, thank you so much for joining us.

Rep. Pramila Jayapal: Thank you Abdul, so great to see you.

Dr. Abdul El-Sayed: You know, folks are looking at this moment and they’re saying: well, you know, Joe Biden is president now and it seems like he’s not interested in Medicare for All, if health reform in any way. So tell me, why do we need to be talking about Medicare for All right now?

Rep. Pramila Jayapal: Well, it is just more crucial than ever because we have seen what COVID-19, what a pandemic did to us with the broken health care system that we had. I want to be very clear, as you know very well, that it was broken long before COVID hit—87 million people who were uninsured or underinsured. But when COVID hit, I think a lot of the arguments that people had been making about why we needed to preserve that broken system really went through the door. We saw, first of all, 27 million people lose their health care because they lost their job because of the crazy system we have that ties health care to jobs. We saw Black, brown, indigenous and poor people disproportionately getting infected with COVID-19 and then dying. And Public Citizen has just released a report that shows that 40% of those who were infected with COVID had no health insurance, 30% of those who died had no health insurance. And so the reality of what that broken system did—and that doesn’t even include some of the underlying pieces of the situation with COVID hitting and going straight to people who had not been able to take care of their health care needs for so long because of that broken system, that just makes you even more vulnerable to the disease, whether it’s your asthma, respiratory issues or cancer, diabetes, whatever it is. So I think this moment shows us more clearly than it has ever done, and it takes all the excuses off the table for people who think that somehow that system we had, or have, is better than a Medicare for All system. So that’s why it’s so important, because there are still people who are falling through the cracks. Even now in the midst of a pandemic, we have not fixed health care in this country. And I’m just so thrilled with the momentum that we built over the last many years, over the last session, having the first hearings ever, that allowed us, Abdul, to introduce the bill a couple of days ago with more than half the Democratic caucus on board as original co-sponsors. This wasn’t getting to that place by the end of the session, this is what we’re starting with. And in addition to that, we’ve got 14 committee chairs who are signed on, five of the six committees of jurisdiction the chairs are on, including Frank Pallone, the chair of Energy and Commerce, who is getting on the bill for the first time. We have members who are here in the last session and worked on the bill because they weren’t sure that it was the right thing to do, who are now convinced seeing the deaths and the illnesses in their districts, that it is now time. And so we’ve got a number of new members who have come on. And it’s not all progressives. There are people beyond the Progressive Caucus who are signed on to this bill who really believe that health care is a human right, and we need to do this now.

Dr. Abdul El-Sayed: That’s really fantastic news. And what an astounding idea, Congresswoman, that in the midst of a pandemic, everybody should have stable, secure access to health care. And it’s amazing that the momentum that you’ve talked about is starting to, to really trickle down into support for the bill in the House. And yet there still remain many Democrats who don’t believe in this idea. What is it going to take beyond a pandemic that took 540,000 lives and devastated millions more livelihoods, to get these folks on board with the recognition that because we are the only high-income country in the world that does not guarantee access to health insurance, we keep our people insecure to the costs and probably worse, the illnesses, that not having health insurance exposes them to. What’s it going to take to get the whole Congress on board?

Rep. Pramila Jayapal: Well, unfortunately, any big transformative change of a system takes time. And the reason I was so keen on having legislative hearings last year, which had never happened in the House of Representatives, on Medicare for All, is because I think many of our colleagues, charitably, don’t know what’s happening in other situations, look the other way because they’re perhaps getting a lot of funding from drug companies, private insurance companies, and they don’t want to take on the fight. Because it is going to be a fight. There are a lot of special interests who are making enormous amounts of profits off of the current system, even as people are dying. And you see those people coming out with ad campaigns, million dollar, multimillion dollar ad campaigns in targeted districts to make sure people not only don’t sign on to Medicare for All—by the way, don’t sign on to the public option, now, the fight, they’re starting the fight around the public option—because they have an interest in keeping things the way they are. So the way I think we have to deal with it is is multifold. One, I’ve got to do work here in Congress and that’s what I’ve been doing over the last two years, to really educate people about what is happening, the seriousness of it, and why it can’t be fixed with bites around the edges, incremental changes. That is not going to do it. It is going to require transformation of our system. But any big transformations, people feel uncomfortable with. And so we have to do the work to educate them. Secondly, it requires people in the districts—I mean, one of the people who came on board, Ted Deutch, who hadn’t been on before, I had multiple conversations with him, we talked about the specifics of the bill—but honestly, I think, you know, seeing people dying in his district who had been advocating for Medicare for All, and realizing that there really is no other answer. That kind of advocacy from people on the ground in districts with personal stories really, really makes a difference. And we need to do it in districts where we don’t already have people who are on board. Right? We need to target those particular districts. Third, I think we have to be willing to build new coalitions to take on these private insurance companies and drug companies. And that has been happening over the last two years. We have the largest number of labor unions now signed on to Medicare for All, even more than we had last time around. We have a business coalition that Wendell Potter and others have formed so that we have small, medium and even large businesses saying: you know what, we would much rather have a Medicare for all system, we’re happy to pay some of the money we already pay for health care for our employees. And those kinds of coalitions are really important because they drive a wedge into the narrative that nobody wants Medicare for All, that employers don’t want Medicare for All, that labor unions don’t want Medicare for All. And then we’re building a new racial justice coalition. We had Patrisse Cullors, one of the founders of the Global Network for Black Lives, who was on our rollout call the other day, because I really do think that if we’re going to say—and you have been such a powerful spokesperson for this—that we care about racial equity in the country and certainly in health care, then we have to be willing to understand that our current system leaves out Black, brown, indigenous, poor people across this country. There is no hope for them with the current system we have. No amount of subsidies is going to take care of this. We actually need to transform the system from a for-profit system to a system of care.

Dr. Abdul El-Sayed: So, you know, you mentioned the power that major corporations, particularly the insurance industry and the pharmaceutical industry, have had in shaping the narrative about Medicare for All. And you know, Insurance has spent 151 million dollars just last year on lobbying across 845 different lobbyists. The coauthor of my book, Medicare for All, which you generously wrote a forward to—we really appreciate—argues that H.R.1 is the Medicare for All law before Medicare for All right. That unless we get meaningful democracy reform and we are able to a) empower the votes of people who are systematically left out of our democracy and b) blunt, the power of money in politics, then it’s going to be very, very hard to get this done. What are your thoughts on the link between democracy reform and corporate power in achieving Medicare for All.

Rep. Pramila Jayapal: That, oh it’s about as strong as it can be. I mean, this is a multi-strand tie. And I think that there’s no question that that is absolutely essential, not only on health care, by the way, but on everything, on addressing climate change, on addressing so many of the issues that we face today: racial inequity, income and wealth inequality. So I really believe that H.R.1—and that’s why it’s called H.R.1, because it’s the first bill is the most important bill—because it underlies everything else. And it not only gets money out of politics, but it strengthens our voting system. Along with that, I would say we need to pass H.R.4, which is the John Lewis Voting Rights Act, which is also very important if we are going to make sure that every person’s voice actually counts and that districts aren’t gerrymandered in the way that they are today, where, you know—and so those those things are absolutely critical. Now to pass H.R.1, let’s get to another root cause, which is the arcane and racist procedures of the Senate that give power to the minority, give power to the minority in the Senate. Basically, we’ve handed over control of the Senate to Mitch McConnell again because of the filibuster. And so we are working very hard in the Progressive Caucus to eliminate, in an ideal world, reform the filibuster so that we can actually pass bills like H.R.1, like H.R. 4 and ultimately health care reform, many pieces of it could fit under reconciliation. But why are we twisting ourselves into pretzels to try to get an unelected parliamentarian to rule based on a séance with a dead guy named Byrd—I won’t take credit for that, that’s Peter DeFazio calls it “the Senate having a séance with with a dead guy” to try to get these things to fit into something called reconciliation. So I know that’s a bit of arcane Senate procedure, but it’s really important for people to understand that the rules in the Senate were set up by white Southern segregationists who wanted to stop civil rights from moving forward in this country. And they have continued to be used to block populist policies, whether it’s a $15 minimum wage, whether it’s Medicare for All, whether it is action on climate change.

Dr. Abdul El-Sayed: That’s a, that’s a really, really important point about the power of the filibuster, and the need to address it, and the impact of all of this arcane Senate rule built around protecting white supremacy, and the ways that it continues to get in the way of progress. I want to get back to the question of corporate money, because one of the hard parts, I think, is that oftentimes when we think about our democracy, we forget the fact that the firewall between our economy and our democracy has never been weaker. And one of the things that’s somewhat curious—and I get this question all the time—is you’ve got congresspeople who support on paper Medicare for All, and at the same time take gobs and gobs of money from the corporations who are dead-set on opposing it. How do we take on that that problem? How do we square that circle? Because I think when the rubber hits the road, and we are in a position to finally pass this law, I think you’re going to see a lot of folks, a lot of folks maybe behaving in ways that that their positions on paper might suggest otherwise. So how do you deal with that and how do we think about that problem?

Rep. Pramila Jayapal: Well, you have to start. And four years ago, when I ran for Congress, Abdul, I think I was one of only three members of Congress who said I wasn’t going to take any PAC money. Now, I don’t know what the number is, but it’s substantially more than that. It’s dozens of members who are saying they’re not going to take PAC money. And even for the Progressive Caucus, I mean, we didn’t have much in the PAC, but there wasn’t a prohibition on taking corporate PAC money for the Progressive Caucus some years ago. Now there is. And I think, and Citizens United and others have been doing a really good job of helping to show how, again, popular it is for people to run on not taking corporate PAC money. So that number is growing and growing. But in addition, there’s legislation we need to pass. It’s going to be very difficult. I won’t lie because a lot of these people don’t want to stop taking that money, and they’re afraid of what that means for their campaigns. H.R.1 does a lot of that. Elizabeth Warren and I have another anti-corruption bill that is about making sure we stop the revolving door. I mean, it’s not just the money. It’s also you walk outside the doors of our offices—not outside mine, because everyone knows I don’t take corporate PAC money—but there are lobbyists lined up to tell you why their way is the right way, and oh, and by the way, there’s a check that goes along with that. And so we have a lot of work to do to change the influences, to get money out of politics, to get candidates, to elect candidates. It’s not just progressives, by the way. There are a lot of people in swing districts who don’t take corporate PAC money anymore either. Again, because it’s not just a progressive issue, it’s a populist issue. People want to know that their elected representative is representing them, and not the wealthy corporate interests.

Dr. Abdul El-Sayed: That’s right. That’s right. Well, I really appreciate that perspective because I think it’s important for us to identify the money on the other side of the status quo. Status quo doesn’t just happen because it’s always been the status quo. It is supported vociferously by a whole set of—a whole industry of folks who used to do the job that you’re doing. Right? And that’s the crazy side of it. So thinking a little bit about where we are now, the Biden administration, you know, they, I think, surprised a lot of folks who see the world similar to you and I, with these, frankly, revolutionary childhood tax credits, that I think upend a 40-year neo-liberal governing consensus that says that government is part of the problem. And they’ve basically said we are going to engage with, pursue a new approach to thinking about and taking on poverty in this country. And this is this is basically, for folks who haven’t read about this, this is, in effect, a guaranteed minimum income for kids. And that’s a big deal. And at the same time, we see in the same bill the American Rescue Plan, a sort of rethinking of the neo-liberal paradigm on poverty, and a doubling down on the neo-liberal paradigm when it comes to health care in the form of COBRA subsidies. And don’t get me wrong, I think it’s really important for folks to have health insurance right now, but maybe it’s better not to do it by subsidizing the corporate insurance industry that maintains the status quo that puts so many people at risk in the first place. How do we get the administration to be thinking with the same degree of boldness about health care? What’s it going to take for them to be expanding public insurance, and really pursuing even that public option that you and I spent a lot of time working with, with our campaign on back in the summer of 2020?

Dr. Abdul El-Sayed: Yeah, I was thinking about this as well, because it was one of the, you know the American Rescue Plan was such an amazing bill, putting money in people’s pockets with the survival checks, the expanded unemployment insurance, the child tax credit, lifting half of kids in poverty out of poverty—we have to make it permanent, by the way, it just goes for a little bit of time here. And yet at the same time, as you say, I mean, we expanded subsidies, we added COBRA. There are more people who will get health care. We said nobody should pay more than 8.5% of their income—which, by the way, was something you and I helped negotiate on that task force. So there are a few things in there, but it does not change the paradigm. And I think the problem is the Democratic Party under Barack Obama have yoked ourselves to the Affordable Care Act. I mean, we are very firmly tied to the Affordable Care Act as a party. It is Barack Obama’s legacy. It is Joe Biden’s, you know, part of his legacy. It is part of Speaker Pelosi’s legacy. And we should be clear, it did a lot of good—it expanded health care for tens of millions of people—but it is still in that framework, and it never really left that framework. And so I had thought that with COVID, that would be a moment for people to say: OK, we are ready to reexamine the entire health care system. But again, we come back to money and politics. We come back to all these corporate lobbying groups that have a lot of influence within the administration. And we come back to: is this the fight that the administration wants to take on? Because they already feel like they took it on for the Affordable Care Act, and as you remember, they lost the House in the wake of that vote. There was a push for a public option at the time—which was not as good as the public option you and I designed over the summer when we were working on the task force—but it was a public option. It failed. It got taken out of the bill, and a lot of people lost their votes. And so that is still central to people’s memory, both the attachment to the Affordable Care Act, which was a major change in their minds—not a paradigm shift, but a major change in health care—and then at the same time, the consequences of doing that. And so the easier route for them in their minds, is to just continue with the same system, but try to expand the subsidies, which, of course, just is more money to the insurance companies for doing it. No real movement on pharmaceutical drug pricing—one of the most popular, populist policies across the country. Why would every one—Republican, Democrat and Independent— not want to say: nobody in America is going to pay more for their prescription drugs than in any other country? That’s what we negotiated into the Biden Sanders Unity Task Force. But even that is difficult to pass here. And again, it goes to the power of money in politics, and it goes to, frankly, some of the corruption that exists in the ways in which lobbyists are embedded into the Democratic Party, into the Administration, and continue to advocate for that status quo.

Dr. Abdul El-Sayed: Yeah, I, I really appreciate that point. And one of the frustrations that I feel like is missed in their diagnosis of the situation is that, you know, the Partnership for America’s Health Care Future, which is a junta between all of these different trade groups representing health care, after they built out, they created this system, this means of opposing Medicare for All, it’s not like they shut it down when Senator Sanders didn’t win the primary, they just shifted gaze from Medicare for All to the public option. And what that tells us is that opposition is sort of a one-zero thing: you either have opposition or you don’t. They’re not going to dial it down because you went from Medicare for All to the public option. And so at some point, if you know you’re going to get opposition—and yet this moment has shown us that people need real health reform that doesn’t tinker around the edges, but takes on the rot in the middle of the system—then maybe we should just take on the whole thing, right? Rather than either avoiding the fight and failing to take on a problem that, that many Americans—I would say, if not all Americans—are suffering in some way from given the cost of health care, or take up take up the whole fight and decide that you’re going to fix the problem. Right? So it’s somewhat frustrating because I feel like we continue to miss the boat here. You know, as you think about next steps for this congressional session, what are your plans over the next couple of years to continue to drive the fight for Medicare for All and continue to build consensus around this this incredible idea?

Rep. Pramila Jayapal: Well, we sort of have a two-pronged approach, right? Here in Congress, we’re going to continue to lay the legislative record. I mean, people that think you can just pass a major bill that transforms the health care system without doing hearings, without going through a markup process, without all of that legislative work, are fooling themselves. Nothing like that has ever happened before, not for Social Security, not for Medicare. So we have to do that work inside Congress. That’s why the hearings were so important last year. This year, we have commitments from Frank Pallone and Nydia Velazquez, a small business, to do hearings again. And this time, I don’t want them to be just on health care generally. I want them to be on the bill. I want to actually show that we have a plan. Now, people can disagree with parts of it. Sometimes people say to me: why is it a two year transition, maybe it should have been longer? And my response is always: great, let’s talk about that. If we ever get to the point where we’re talking about should it be two years or four years, I’d be very happy to have that conversation. So we need to go through the fact that this is not just necessary, it’s possible. We have a real plan for how to do this, and we can go through the legislative process of making it better. I’m perfectly fine with that. So that’s one piece. The second piece is that we are continuing the grassroots work and our partners around the country—and I know you’re very much a part of that, Ady Barkan is very much a part of that, Public Citizen, National Nurses United—and just people across the country are working on a campaign to get more resolutions passed, particularly in red states or districts where a representative is not yet signed up—to really educate people at the grassroots, to build the drumbeat, and the momentum for Medicare for All, and to educate even their own communities about how this is possible, because everyone’s been pummeled by those ads on TV. And so everyone worries about, you know: are these things true, am I going to lose my health care? So people do need reassurance and education. Third, we are continuing to build these coalitions that I mentioned. There was in the last presidential, as you know, some challenges within some unions who have negotiated plans, and they’re worried about losing the benefits of those plans and the quality of those plans. And so we need to bring them into our fold. We need to talk to them about what that transition can look like, and how we make sure that workers don’t end up losing at the end of the day, things that they bargained for over the last many years. And same thing with businesses. The more big businesses we can get to say: hey, this is an economic issue for us, every other country that we’re competing with is providing health care for their people and yet we are not, which means that we as employers have to make the choice to provide health care and that is extremely expensive, extremely cumbersome and we’d rather support a Medicare for All-type system and we’re willing to even pay into it. So that’s another piece. Now, underlying all of this, we are going to continue to have the Budget Committee build on the work of the Congressional Budget Office that did come out with a very good report about how much money Medicare for All will save us. And just looking at the economic issues for the country, we cannot afford to pay what we are paying for health care. It is unsustainable as a country and to have such terrible results, to be so far down on critical indicators of our peer countries, and so we’re also making the economic argument. So all of those things are happening at the same time. And then we will—just like you and I negotiated—try to get some foundational elements of Medicare for All into the system. Let’s lower the Medicare eligibility age to 50, and cover all kids up to 25. Let’s do that because that brings more people in. If we are going to move a public option, let’s make sure it’s truly public, and have it administered by Medicare as candidate Biden agreed to. And let’s take on the cost of prescription drugs. Let’s have a no deductible plan. Let’s do auto enrollment. These were some of the things that you and I worked on last summer, that candidate Biden agreed to. Now we need to get some political weight put behind it and actually make real on those promises, because those do get us closer to Medicare for All.

Dr. Abdul El-Sayed: Well, we’re grateful we have such a champion in Congress for that fight, and really grateful to you for coming and joining us, and talking to us a little bit about what we can look forward to over the next couple of years. That was Congresswoman Pramila Jayapal. She is the Congresswoman from the Seventh District in Washington, and Chair of the Congressional Progressive Caucus. Also just recently dropped the Medicare for All bill, which we’ll look forward to tracking. Thank you so much for joining us, Congresswoman.

Rep. Pramila Jayapal: Thank you for all your great work, Abdul.

Dr. Abdul El-Sayed: As usual, here’s what I’m watching right now: early last week, AstraZeneca released the results of a trial claiming that their vaccine was 79% efficacious. Late that night, the Data Safety and Monitoring Board of the National Institute for Allergy and Infectious Diseases, issued a statement calling some of their data outdated. Since, the company has revised their analysis showing a 76% efficacy, which is still extremely high. But it’s a reminder that efficacy is different than effectiveness. Efficacy is how a vaccine performs in a perfect study, but effectiveness is how it performs in the real world. And to be effective, a vaccine has to be taken. And given the fact that vaccine hesitancy remains the single biggest hurdle to deploying our vaccines at scale, this doesn’t help. People have to trust the company to trust their product, and this rocks the boat. Ultimately, like all of the other vaccines, AstraZeneca’s will be subjected to extremely stringent analysis by the FDA, and at the fastest, it won’t be cleared for emergency use until May, after which we will likely have enough of the other vaccines to vaccinate everyone anyway. Meanwhile, case transmission has gone up over the past two weeks, reflecting spikes in cases in hot spots like Michigan, where B117 has been spreading like wildfire. Here, hospitalizations among people aged 40 to 49 was up 800% last week. It’s a reminder that these variants are serious, and that young people aren’t immune. Get vaccinated, and before and after: mask up, back up and wash up. We’ll be doing an episode on the experience of getting vaccinated. If you’d like to be featured, send us an email with a voice memo of your vaccine experience to Americadissected@Crooked.com. That’s all for today. And if you want to learn more about Medicare for All, I invite you to check out my book with Dr. Micah Johnson, Medicare for All: A Citizens Guide at medicareforallbook.com.

Dr. Abdul El-Sayed: America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Veronica Simonetti mixes and masters the show. Production support from Tara Terpstra, Lyra Smith and Alison Falzetta. The theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Sarah Geismar, Sandy Girard and me: Dr. Abdul El-Sayed, your host. Thanks for listening.