Over the past two years, there have been countless tragic stories about the separate and unequal nature of Medi-Cal (California’s Medicaid system). These reports have highlighted numerous disadvantages, overall difficulties, financial hardships, and outrageous delays that far too many Californians and especially those from communites of color face.

From excessively high amounts of amputations at MLK Hospital due to uncontrolled diabetes, to unreasonably long wait times to see specialists with some patients dying, to layers of private insurance company profit through skimping on services, the stories have demonstrated how Medi-Cal is an apartheid system.

California’s Medi-Cal reimbursement ranks 48th out of 50 states as per the Medicaid Fee Index and pays California physicians and hospitals half of what Medicare pays. Because payments are so low, very few doctors and hospitals serve the nearly 13 million enrolled Californians. In fact, some disadvantaged communities have ten times fewer doctors than more affluent cities. And a 2015 survey found a ratio of only 39 full-time primary care doctors per 100,000 Medi-Cal patients.

As a former oncologist, I have witnessed and participated on both sides of this unequal system. When I practiced at Cedars Sinai in Beverly Hills, I treated few, if any Medi-Cal patients. But, when I practiced at Dignity California Hospital in downtown Los Angeles, I treated mostly uninsured and Medi-Cal patients. In fact, a 2021 Lown Institute report found MLK Hospital received 75% of its total patient revenue from Medi-Cal versus 10% for Cedars Sinai. And 94% of patients treated at MLK were of color, but only 36% at Cedars Sinai.

When I started caring for more uninsured and Medi-Cal patients, I noted a disproportionate number of cancer patients who presented with advanced disease. It was clear that this was largely due to an overall lack of access to timely healthcare and overall delays in getting the necessary workup that I rarely witnessed with my former private insurance patients. A recent 2021 Health Policy Survey by the California Health Care Foundation (CHCF) found that 59% of all Californians below the 200% poverty line had to wait longer than was reasonable for a medical appointment.

And while patients struggle to find doctors willing to see them due to minuscule payments, several of California’s Medi-cal insurers continue to reap huge financial windfalls while state regulators have found their patient care to be less than optimal. Given that these insurers get to keep whatever they do not spend on patients, it is preversely in their best interest to delay, deny, and minimize care.

From 2014 to 2016, California’s Medi-cal insurers made over $5.4 Billion in profits with HealthNet (a unit of Centene) reporting over $1.1 Billion and Anthem $549 Million in profits all off the backs of California tax-payers. Of note is that these two plans also had some of the worst quality rankings.

As the current healthcare system is unfair to the millions of Californians enrolled in Medi-Cal, tens of millions of other Californians are also struggling with their healthcare needs.

Of the estimated 2.7 million uninsured California residents, approximately 1.5 million are not eligible for financial subsidies or Medi-Cal. To date, over 75,000 Californians have died due to COVID-19, and a Lancet Commission study reported that one-third of all COVID-19 deaths in the U.S. were linked to a lack of health insurance.

But for the majority of Californians who receive their healthcare through an employer sponsored plan (ESP), the average employee contribution has increased 55% and average deductibles have increased 111% over the past 10 years, despite wages and inflation remaining relatively flat.

Yet despite contributing more of their paycheck towards their ESP, a 2020 Commonwealth Fund study showed that 42% of all Americans and 26% of those covered by an ESP were underinsured, meaning coverage was not adequate to protect them from financial ruin due to out-of-pocket expenses.

The 2021 CHCF survey also found that a direct consequence of high healthcare costs, co-pays, and deductibles was 51% of all Californians postponed or skipped care due to cost. And of those who delayed care, 41% said it only made their condition worse.

This same study noted the top five of six causes of financial worries were unexpected medical bills, out-of-pocket costs, treatment for COVID-19, monthly health insurance premiums, and prescription drug costs.

It is no wonder that 82% of Californians in this study said that it was extremely and/or very important for Sacramento to focus on making healthcare more affordable and that this should one of the Governor and Legislature’s top two priorities.

Sadly, the only significant healthcare legislation that Sacramento has passed in 2021 is AB 133 which would expand Medi-Cal to Undocumented Californians over the age of 50. It is estimated this bill will add 235,000 more Californians to the Medi-Cal system. While this may make Sacramento feel like it is doing something, without any increased reimbursement to an already overburdened system, the Governor and legislature are simply sweeping the healthcare mess under the rug, and if anything further decreasing access to care. If they truly believe this is really a great solution like so many of them tout to their constituents, perhaps they should trade in their own private insurance and enroll in Medi-Cal as well.

This inadequate access is the basis for a major civil rights lawsuit against the state of California claiming Medi-Cal as separate and unequal. Despite a two-year fight by the State, an Alameda County Superior Court ruled in favor of allowing the lawsuit to proceed.

Sacramento can do far better. AB 1400 introduced by Assemblymember Ash Kalra would establish a comprehensive state run single-payer coverage system. It would streamline payments, greatly reduce per-capita healthcare spending, obtain bulk discounts in medical good, prescription drugs, and services and use these savings to provide enhanced benefits and coverage with no co-pays or deductibles. It would eliminate Medi-Cal and provide everyone with the same equal access to high quality care. Opponents will falsely claim that we cannot afford it, but a 2016 UCLA Center for Health Policy Study showed that public funds already account for 70% of all state healthcare spending. And multiple independent analyses including a 2018 study from the conservative Mercatus Institute have all found single payer systems to save billions of dollars compared to the status quo while insuring everyone. The real question for Sacramento is can we really afford not to?!

As someone who has practiced radiation oncology for 20+ years, I must admit that my overall knowledge of the risks of benzodiazepines was very limited to what I had learned during my second-year pharmacology class and what had been passed along to me during my clinical training.

Whenever I had a patient who was anxious and unable to tolerate an MRI or too nervous to tolerate their daily radiation treatment, I would on rare occasion prescribe Xanax, Ativan, or Valium to be taken one hour prior to their procedure to help alleviate their symptoms. And while I seldomly prescribe this class of drugs for my patients, I was shocked to recently learn of the significant side effects that can result from their use, and especially their prolonged use, that were never mentioned to me when I first began incorporating these drugs into my practice many years ago.

And though I have never prescribed benzodiazepines for longer than a brief 5–10 day course, I unfortunately witnessed first-hand what prolonged usage could cause. After my father-in-law was prescribed a long-term course of Klonopin for restlessness and insomnia, he slowly developed progressive irritability, hand tremors, shaking, hallucinations, confusion, cognitive difficulty, and his sleeplessness only got worse. During the next year, he spiraled into a rapidly downward clinical course requiring 24 hour home health care and multiple visits to the emergency room for cognitive impairment, uncontrolled twitching, and frequent falls.

It was only after my wife, TV Journalist Lisa Ling, decided to do a story on Benzodiazepines for CNN that I became familiar with their gross misuse and overuse. Benzodiazepines are the most commonly prescribed medications for anxiety, sedation, and sleep.

A recent study from the University of Michigan found that over 30.6 million U.S adults reported using a Benzodiazepine last year. As the use of benzodiazepines, such as Xanax and Valium, is on the rise, so is the number of overdose deaths related to them. A Centers for Disease Control and Prevention trial found that Benzodiazepines contributed to in 30% of prescription drug overdose deaths in 2013, second only to opioids, which were involved in 70% of overdose deaths.

And according to the Substance Abuse and Mental Health Services Administration (SAMHSA), the number of people who required hospitalization due to benzodiazepines increased from 46,966 in 2005 to 89,310 in 2011 and over 185,000 people were hospitalized due to benzodiazepines in combination with opioids and/or alcohol.

In addition to the inappropriate use and over prescription of Benzodiazepines, another problem is that very few prescribing physicians like myself have ever heard of or been trained on how to deal with benzodiazepine withdrawal syndrome. If anything, most physicians have been falsely led to believe that using this class of drugs was relatively innocuous and quite safe. It is clear that the pharmaceutical industry had either underappreciated or understated the potential side effects until recently. This is especially true when it comes to their use in the elderly.

What is known now is that prolonged exposure leads to tolerance and dependence, and that a chronic usage may lead to the development of withdrawal like symptoms most notably between doses. When attempts are made to reduce the dosage or stop the drug completely, patients can exhibit withdrawal like symptoms which can mimic serious medical and psychological conditions such as schizophrenia, dementia, seizures, and mania. If a physician is unaware of this phenomenon, the benzodiazepines may be restarted which only exacerbates and further solidifies the dependence. This is what happened to my father-in-law, and because his doctors did not know about these effects (particularly in the elderly) they attributed all of his symptoms to aging and dementia and recommended palliative care.

It was only after a new physician decided to take him off all his meds and several months of his body detoxing, that his withdrawal symptoms went away. Three years later he is back to normal and as sharp as ever.

While it would be easy to criticize and blame his physicians for not knowing the effects of prolonged benzodiazepine use or to be familiar with the potential for withdrawal, I too had no idea.

I have come to strongly believe that there needs to be far better training in medical school and residency on the risks, benefits, and proper usage of benzodiazepines like we have finally begun to see inplemented for Opioids. Physicians need to understand that this class of drugs was never intended for chronic use and in doing so, need to be trained how to properly wean patients off. And patients should look at avoiding this class of drugs as much as possible and look at other natural options such as Cannabis instead for sleep. If the medical community does not educate itself we stand the risk of failing to do no harm.

As the sun begins to set on California’s two-year legislative session, it will officially signal the death of the Healthy California Act better known as SB562. After Assembly Speaker Anthony Rendon called SB562 “woefully incomplete” and banished it into legislative purgatory, it became quite obvious when none of its original co-sponsors or any other elected official emerged to fight on its behalf, that this would be its ultimate fate.

For all the “woefully incomplete” arguments made against 562 of it not having a funding mechanism, being dependent on federal waivers, and costing too much, Sacramento needs to explain its own hypocrisy. Why did the same assembly take up AB 1184 without providing any funding mechanism? Why did Sacramento rubber stamp Governor Brown’s fiscally irresponsible and grossly over-budget bullet train project and initiate construction without the guaranteed federal dollars and waivers that are desperately needed to complete it? How can Sacramento continue to call SB562 too expensive while ignoring the fact that our state already spends $368 Billion a year on healthcare of which 71 cents is already paid for by California taxpayers? And how can Sacramento continue to ignore and fail to address State Controller Betty Yee’s latest report of a $91.5 Billion unfunded healthcare retiree liability which increased $14 Billion from the year before, or our states’ $24 Billion annual school retiree healthcare liability?

Despite the empty talk by elected officials of being open to single payer, what was “woefully incomplete” in Sacramento was their political will. When the original Cap and Trade Bill (AB 398) died in the California Assembly, it was only through the sheer political will of the Governor, Speaker, and Senate Pro Temp to carry out a “gut and amend” which led to its ultimate passage. Sadly SB562 was not fortunate enough to be offered an honest legislative effort to address legitimate criticisms and concerns or be afforded a similar fate.

As bold as California has been on so many issues, Sacramento has failed to seize this opportunity to lead on real healthcare justice, and would like nothing more than for this movement to dissolve so they can get back to preserving the coporate status quo. They incorrectly assume that like prior single payer efforts, which fizzled without any political retribution from the electorate, that they can continue to ignore the will of their constituents and the harm and frustration many Californians face each day from our existing dysfunctional healthcare system. But, this healthcare movement is very different than before and is only growing stronger and at a far faster rate than insurance premiums.

While Sacramento sweeps SB562 under its legislative rug, it cannot hide from the following facts:

California’s Medicaid system, which currently covers roughly one-out-of-three Californians, remains extremely vulnerable to a heartless Congress hell bent on greatly reducing its Federal funding obligation.

Nearly 3 million Californians, including 250K kids remain uninsured.

With no insurance rate regulation, insurance premiums in CA have increased approximately 250% since 2002, while inflation has gone up 40% and wages for most Californians have remained stagnant. It is no wonder that the number of people who have difficulty paying their monthly premiums has increased from 27% to 37% in 2015 to 2017. Meanwhile, 53% of Californians worry they cannot pay their medical bill if they get sick, and 60% report that it is too difficult for them to afford healthcare in general.

For those who continually confuse universal coverage with actual access to care, they fail to grasp the prevlance of underinsurance. The number of people who report having difficulty with deductibles has increased from 34 to 43% during the last two years. And 44% of people with high deductible expenses will actually delay seeking care.

Coupled with the fact that 37% of people WITH insurance who had medical problems reported borrowing money from family and friends, 34% reported being unable to pay for food or rent, 63% used up all their savings, and 28% recently had a medical bill turned over to an agency, more Americans are afraid of paying for care than they are of getting seriously ill.

And for all the success of Covered California relative to the rest of the US, premiums will go up another 9% this year while 66,000 Californians will only have access to one plan and 216,000 will have access to just two. At the same time, 75% of all Covered California plans continue to have narrow networks.

While there is no perfect healthcare system, most agnostic experts agree that a single payer system, unlike our current system that continually increases cost while decreasing access to care, would indeed save money while increasing coverage and overall access.

As SB562 dies a cowardice death, rather than become dejected or disillusioned, activists should find great solace in what was accomplished. For the first time we had an unprecedented collection of new and lifelong activists of all ages, nationalities, religions, vocations, and socioeconomic groups, come together to demand something far better. This translated into advocacy, organizing, and canvassing in every single assembly district in California and has forever elevated single payer into the public consciousness. In the process, it has ultimately helped both statewide and federal efforts.

Recent attempts to have single payer removed from the California Democratic Party platform were soundly defeated, and due to an overwhelming groundswell of support created by SB562, Kamala Harris listened to the majority of her constituents and was emboldened to be the very first US Senator to co-sponsor Senator Bernie Sanders Medicare-for-all bill S.1804.

With a sustained majority of Americans supporting a single payer Medicare-for-all plan and 74% among Democrats, it has even become a litmus test in most democratic primaries. And in fact, a new Health Tracking Poll by the Kaiser Family Foundation now finds that three-quarters of voters say that a single government plan or Medicare-for-all should be considered, is very important, or the single most important factor in the upcoming election.

So rather than hide from it or view it as a political liability, more elected officials are boldly embracing it and more candidates are proudly running as Medicare-for-all candidates. For the very first time, we now have a Medicare-for-all congressional caucus with 72 members along with 123 co-sponsors of HR676 (the House Medicare-for-all bill), and one-third of Democratic senators who support S.1804 .

Still, many view corporate Democrats, not Republicans, as the real obstacle to making this a reality. Max Fine, who helped to create Medicare as a member of John F. Kennedy’s Medicare task force recalls how Democrats moved away from Ted Kennedy’s bill to cover all Americans with government health insurance towards a private insurance solution with absolutely no interest in Medicare-for-all. Fine went on to say “Single payer is the only answer and some day I believe the Republicans will leap ahead of Democrats and lead in its enactment, just as Bismarck in Germany and David Lloyd George and Churchill in the UK.” In fact, some Republicans have already begun to make the case for single payer and even question if our current profligate spending on health care is a conservative value.

For those in Sacramento and beyond who behave like climate change deniers when it comes to healthcare, it is simply getting harder for them to continue to justify a broken and unsustainable system.

But due to the obscene financial resources that are spent by the for-profit medical-industrial-complex (led by the pharmaceutical and insurance industries) to buy our elected officials, relentless organizing and electoral pressure is the only way we will ever break this vicious hold.

To my fellow activists, now is not the time to let up. If anything, we must utilize the organizing success created by SB562 to serve as an unbreakable foundation from which to continue to educate, advocate, mobilize, and eventually translate into undeniable political capital both in Sacramento and D.C.

And if our next Governor is truly commited to keeping California fifth largest economy golden, it would be wise to acknowledge the tremendous burden healthcare costs place on employers and employees alike. As businesses spend more and more on healthcare for their employees and less on wages, capital improvements, and R&D, their employees have begun to feel the brunt as well. In 2018, the average worker will contribute $4200 towards their employer sponsored plan. It is no wonder that Charlie Munger has referred to our “cockamamie” current system as the “tapeworm of American competitiveness”.

We must do everything to ensure that our next Governor’s previously stated commitment towards single payer is not “woefully incomplete”. And we must do everything we can to ensure that each of our state and congressional representatives (especially Democrats) come to support single payer as well.

And as the Centers for Medicare and Medicaid Services Administrator, Seema Verma, has repeatedly labeled single payer as “socialized medicine” and vowed to reject any state waivers for such a plan, it is one more reason for us to do everything we can to wake up and mobilize an apathetic electorate to end this presidential reign of horror.

The harm that countless Californians and Americans face each day at the hands of our broken and immoral system is sadly not going away and neither are we. Sacramento may be able to ignore it, but we simply cannot.

Like our nation’s evolution on marriage equality that had a dramatic sea change in less than a decade, a similar sea change is happening with regard to single payer. So keep up the fight and continue to make your voices heard while spreading the single payer gospel.

We are on the right side, the moral side, and ultimately the winning side.

For more information log on to www.pnhp.org

In 1951, my mother came to the US on a merchant marine ship as a refugee of the Korean War. Through the generosity of a local church group in New York City, she was awarded a full scholarship to Adelphi College. She would eventually graduate from Adelphi and go on to earn a Masters degree in early childhood education from Columbia University Teacher’s College.

During one of her practical student teaching rotations in Harlem, my Mom met a dynamic individual by the name of Shirley Chisholm. She would end up hiring my mom and helping her successfully apply for her green card.

Ms. Chisholm was an incredible leader and visionary who had a profound impact on my mom and her colleagues. She insisted that all of her teachers take Spanish language classes to better understand and relate to the influx of Latino students who were coming to Harlem from Puerto Rico and the Dominican Republic. This was not a federal or state requirement, but rather an enlightened recognition by Ms. Chisholm of the multiculturalism that was rapidly evolving. Ironically, today my Spanish is far more proficient than my Korean.

Several years later, Ms. Chisholm would become the very first African American woman elected to the US House of Representatives and my mom would be hired as the educational director of the Newark, NJ Head Start program, where she would serve for 20+ years.

It was here that my mom would often take my sister and me to volunteer during our school breaks to meet her students, most from disadvantaged communities of color. It was here where my mom made clear that we were no better or worse than them, just more fortunate.

My mom often recounts how, right before she came to the US, her late father told her that she would soon see Black people whose ancestors were brought to the US against their will as slaves. And how they were treated as second class citizens. To this day, my Mom says that the most uncomfortable time for her in America was when she went to Richmond, Virginia back in the late 1950’s to visit her sister who was living there. During her trip, she had to stop to use the restroom and was shocked to see segregated facilities monitored by an attendant. She also remembers the middle door of buses that had to be used by Blacks to sit in the back and vividly recalls seeing a young attractive Black woman arrested at a Lord & Taylor’s in Manhattan soley for trying on a hat.

She wanted to make sure that her kids never viewed people differently strictly because of the color of their skin.

Growing up in Northern New Jersey during the early 1970’s, my sister and I experienced our share of racial taunts as the only Asian kids in our entire elementary school, and I certainly got into my share of fights. My best friend was Chris, who, along with his sister, were the only African American kids in our school.

Despite the racial taunts, neither Chris nor I ever viewed each other as my “Black” or “Asian” friend. Remarkably, as youngsters, we were truly able to look beyond the color of our skin. Chris was recently elected to the Board of Education for this very same school district almost 40 years later.

As I got older, the degree of racism I personally endured and experienced became less and less. I did my best to assimilate and excel educationally and professionally and I believe this helped. But I continued to witness racism through the prism of many of my friends of color.

My best man and friend, Tony, is the son of the very first African American attorney in the Justice Department Anti-trust division and his mother is the first African American woman elected to the Fairfax County Board of Supervisors in Fairfax, Virginia. I’ve personally witnessed Tony’s inability to successfully hail a taxi on numerous occasions in the District of Columbia after dark.

To say racism no longer exists is naïve and simply wrong. It may not be as blatant, but subliminal and unconscious bias, which profoundly affects others, absolutely exists.

A recent study by the Yale University Child Study Center asked over 130 preschool teachers to watch video clips of students in classrooms and look for signs of “challenging behavior”. The clips did not actually show any challenging behaviors, but it became quite clear that many teachers were anticipating trouble. The study showed that the teachers in this study spent significantly more time looking at Black children than at White children and the most time looking at Black boys despite the lack of any “challenging behavior”.

This led the lead researcher of this study, Yale professor Walter Gilliam, to conclude that “Implicit biases do not begin with Black men and police. They begin with Black preschoolers and their teachers, if not earlier. Implicit bias is like the wind: You can’t see it, but you sure can see its effects.”

This could very well explain why Black children, despite being only 19 percent of all preschool children, made up 47% of those who received suspensions in 2013–14.

The true impact of such disproportionate bias goes far beyond preschool. Such early suspensions can dull any child’s enthusiasm for learning and school, unfairly label and condemn them to stigma as a “trouble maker,” and lead to loss of confidence and increased rebelliousness. It can also begin the painful path to chronic truancy and a life of criminal behavior. At a time when these young children are the most innocent and impressionable, it is tragic to think that some lives were forever damaged by racial bias.

As the parents of two young beautiful girls, my wife and I feel an immense responsibility to expose our children to racial and economic diversity and to teach them to love all of their neighbors equally regardless of the color of their skin or their religion.

I believe that if we can expose our children to racial diversity from a very early age, before prejudices take root, just as my mom did for my sister and me, we can help to build a much less racially biased world. I also believe that if we can also help equip our kids with de-escalation techniques and help them develop conflict resolution skills, just like we teach them to look both ways before crossing the street and to wash their hands after going to the bathroom, than we can set them up to live and participate in a far less hostile and emotionally charged world.

As parents, we must acknowledge and address our own unhealthy biases. After all, it is our kids who will grow up to become police officers and preschool teachers. Just like the fundamentals of reading, writing, and arithmetic, we must also make it a top priority and conscious effort to open our kids’ eyes and hearts to the beauty and wholeness of racial diversity. Coupled with a better understanding of conflict resolution and de-escalation techniques, this could have a profound effect on our world. God knows, our society truly needs this now more than ever.

We must not blind our kids from the recent awful events, but rather gently use them to teach our kids about their root causes and to let them know this is not the way our world should be.

And Asian Americans can no longer stay silent on issues of race especially as it pertains to Black lives. Despite the atrocities committed against the earliest Chinese immigrants in the 1850’s or with the internment of Japanese Americans during World War II, Asian Americans were never brought here against their will as slaves nor have they had to endure a litany of blatantly systemic racist policies that pereptuated a legacy of inequality.

Recently, I learned of tension that had arisen between my Korean American friend and her Mom. Back in the 1980’s, her father was killed during a robbery of their family store by an African American assailant. The scars and trauma remain and it is hard for her Mom to embrace the concept of Black Lives Matter. This is also true for many others who suffered harm during the Koreatown riots 20 years ago and now for those who recently lost their businesses during the latest wave of civil unrest. Their pain is inconceivable and resentment understandable, but if we are to truly move forward and heal as a society and avoid any future destruction, we need to advocate and fight for a just and equitable society now more than ever. Police reform, in and of itself, is not enough. We must be equally outraged with the gross long term inequities in education, healthcare, housing, and employment and translate this collective outrage into real systemic change. If we truly care about Black lives, we must look far beyond lives lost to police brutality to the root causes of lives lost to COVID-19 and to socioeconomic inequalities perpetuated by a history of racism and racist legislation.

We must acknowledge that all lives cannot really matter unless Black lives equally do, and we must do our best to educate and raise our kids to not only understand this, but to make sure they too never accept a status quo that does not.

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Kids, race, & bias: A thank-you note to my mom. (Updated June 2020). was originally published in Asian American Book Club on Medium, where people are continuing the conversation by highlighting and responding to this story.