AHLA's Speaking of Health Law

Conversations with Health Law Leaders: Social Determinants of Health

July 09, 2021 AHLA Podcasts
AHLA's Speaking of Health Law
Conversations with Health Law Leaders: Social Determinants of Health
Show Notes Transcript

David S. Cade, Executive Vice President and CEO of AHLA, sat down with three prominent health law leaders on May 25, 2021 to discuss how we, as a community, can improve equity in health care and health law practice. In this episode, Lindsay F. Wiley, J.D., Professor of Law and Director of the Health Law and Policy Program at American University, Washington College of Law, speaks to the social determinants of health. Wiley focuses her research on access to health care and healthy living conditions in the U.S. and globally.

Watch the full conversation here. Access full video and audio recordings of the proceedings at americanhealthlaw.org/racialdisparitiesinhealthcare.  

To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.

Speaker 1:

On May 25th, 2021, David Cade , executive vice president and C of a h l a , interviewed three prominent health law leaders about how we as a community can improve equity in healthcare and health law practice. This three part series presents each recorded interview, full video and audio of the proceedings are available@americanhealthlaw.org slash racial disparities in healthcare .

Speaker 2:

So, welcome Lindsay . Um, and just for the record, so we capture who we're talking to, would you introduce yourself and tell us your title and what you do?

Speaker 3:

I'm Lindsay Wiley . I'm a professor of law and director of the Health Lawn Policy Program at American University, Washington College of Law.

Speaker 2:

Right . Well, I'm glad that you're here today. We're sitting here today under the large umbrella of racial disparities in healthcare. That's a pretty large umbrella. And I know in your work and in your advocacy, this umbrella fits within even a larger umbrella of racial and the social injustice, racial issues in this country, let alone the health disparities. So tell us a little bit about why this matters to you.

Speaker 3:

Hmm . My focus is on thinking about the ways that health is shaped by the conditions in which we live and work , uh, and learn. And that's something that's really personal to me because of my family background and seeing, you know, relatives of mine in different parts of the country, experience very different living in working conditions that affect their health and have affected , uh, their life expectancy and their ability to be around for their grandchildren. Um, and thinking about that also in the context then of racial disparities and racial injustices that my relatives were not experiencing that compound those same factors. Um, you know, I, I work in the healthcare space and I also work in the public health space and a lot of my focus is on it trying to connect the two to integrate public health and social justice goals into healthcare regulation and health, health policy.

Speaker 2:

In fact, well before the pandemic, you saw the connection of healthcare and public health. And in fact, if I recall, if your teaching, you do bring the two schools together, cuz the schools are even separate, not just where you are and, and around the country. So the light bulb went off in you a long time ago to see that connection. How has covid or has Covid allowed you to bring those communities even closer together?

Speaker 3:

I think the Covid 19 pandemic has just raised awareness among professionals in so many different sectors, and also among the general public about how interconnected we are and how connected our health is to the conditions in which we live and work. And how vitally important it is to integrate these discussions about healthcare and health reform and public health and racial justice and social justice, and see how all of those issues relate to each other. How it's really not possible to address only one , uh, subset of those questions without thinking about the others.

Speaker 2:

Do you think people are getting the message?

Speaker 3:

I think they are. What I worry about is that there's, we're at this moment of racial reckoning and this moment of seeing public health as something with deep importance to each of us individually. But there's a risk here that the conversation will, that the , the energy will dissipate , um, that will feel like we've put this behind us. Um, and one of the ways that that can happen is if there's a moment where we adopt some minor reform and then feel like we've taken care of that. And when I say we in this instance, I mean, you know, those of us who have power, who have voice , um, I think it's so important for us to continue to see this as an evolution, as a dynamic process that is gonna continue for the rest of my career, for the rest of my lifetime. Um, that can't be just something that we sort of check a box and move on to another issue.

Speaker 2:

So it sounds like you may be worried that in this pandemic, this perhaps eve of pandemic, that we in our society will have a quick fix some progress, but it's not gonna go as far as you want.

Speaker 3:

I think that is my worry. Um, I I , we've seen that with past crises , right? We've had , we've been in these kinds of moments before where it feels like something big has to change and too often that results in incremental forms that can reforms, that can actually , um, hinder progress in the long term by letting us all feel a little more comfortable than we do in this moment right now of reckoning.

Speaker 2:

Well, and these are tough issues and I, I don't disagree with you, I just want to test a little bit more. These are tough issues and maybe what I'm hearing you say is we as a society have difficulty dealing with tough issues, racial injustice, tough issue, and as a result of our inability to really grapple with tough issues and grapple with our past, a quick fix puts a sav and allows people to move

Speaker 3:

On. I think that's right. Exactly. And I'm not opposed to incrementalism. I think that's necessary for many of these issues to think about the specific steps that we have to take to get where we need to go. But I want that incrementalism, those steps to be intentionally steps toward a bigger endpoint , um, a more ambitious endpoint of a more just and equitable health system. And when I say health system, I don't just mean the healthcare system, I really mean a , an integrated health system that is serving population level goals in indivi in , in addition to individual needs. I , I , you know, the phrase that I've started to use with some of my collaborators is confrontational incrementalism. The idea that yes , um, you know, sometimes we have to compromise and sometimes we have to take those small steps first, but we always have to keep our eyes on how this is furthering our long-term goals.

Speaker 2:

We always have to keep our eye on the long-term goals, means that we have to have a shared vision of the long-term goal with confrontational incremental change. Not everybody has a shared vision on the long-term goal. Yes,

Speaker 3:

That's absolutely the case. And, you know, I'm somebody who , uh, has, has always worked across kind of partisan divides. One of the things that brought me to public health in particular is that it's not always crystal clear what those partisan divides will be with respect to public health issues. It often depends on , uh, the political , uh, dynamics in the moment of a crisis and who, you know, what is the party affiliation of the various leaders who are in power and then they're criticized. You know, it's , it's , it's not that there's an ideological commitment to not wearing masks, for example. It's often , uh, more more influenced by, you know, the , the political party of the person asking you to wear a mask. So I like that. Um, things aren't set in stone in terms of the politics around public health. Uh , on the other hand, these are issues that are really very emotional for us on a personal level for all of us, regardless of our politics or ideological commitments. And so things get heated. I think that's an understatement after the last year. Uh, we have to find ways to engage in these conversations , uh, and to help everyone in the discussion see that this is at the interface of the personal and the political , um, and about community, about what we owe to each other as members of a community, what our community as a whole , um, should be promising to each of us as individuals about, you know, what we're gonna be able to do together collectively to assure the conditions that are required for people to be healthy.

Speaker 2:

So I love the fact that you're using the word community and you've used it a couple of times. And I, I sit in that, I like that word. I think I share your sense of community capital C big community, all of us. Not everybody sees community as large as you do. Mm-hmm . <affirmative> , uh, how are you, you reaching people outside of your community to get them to be part of the community?

Speaker 3:

I think one of the things that's exciting about this moment in health policy is that there are , um, there are debates happening at multiple levels of community, right? There are local debates , uh, about things like whether we're gonna have a special taxation district to fund our public health department in some places. The question is whether we are going to have a local public health department. There are parts of the country that have never had that before at the local level that are now developing it because they see the benefits of having that infrastructure close to home. And so, while there may be disagreements about how big that community gets and, and whether we are a global community, right at the, at the, at the highest level, you know, now with vaccination , uh, debates about allocation of scarce resources, we're really having to grapple with that question. But what I'm interested in is integrating all of those levels of community, even, even at the level of a neighborhood. Um, I think there's an opportunity to encourage people to see the ways that they are interconnected with their neighbors, with the other people who are served by the same public health department or hospital system , uh, with the others in their state, with the others in our country, and then globally. But moving up that kind of ladder, seeing that bigger view that that can be challenging.

Speaker 2:

And I imagine it's challenging cuz as I hear your example, your example starts at the local level. Your example didn't start at the federal level or at a national level. And where we sit here at the American Health Law Association serving the nation, I'm at the national level, and yet through our membership, we're at the local level. You're seeing success at the local level. H how does that move the national agenda when you're here at the local level? Can you get to the national level with your confrontational incrementalism? Can you get there?

Speaker 3:

I think it's tough on some of the issues that you and I work on and care about. I think, you know, what I would like to see happen at the federal level is more space for state and local experimentation. And so, you know, I'll , I'll, I'll nod to my, my friend and collaborator Liz McKowski . And her line is ERISA reform is health reform. Uh , so thinking about ways to open up some space for experimentation, but with checks, with guardrails to ensure that that experimentation is moving in the right direction toward covering more people, toward better healthcare for more Americans. Um, whether those local reforms then open up more space at the federal level for big reforms remains to be seen. I think we're more likely to see big reforms in the healthcare space , uh, at the state level in the next several years than at the federal level.

Speaker 2:

And if I keep on my head , I'll put on my big government hat for a minute mm-hmm . <affirmative> , um, local reform, and she said we might see more movement at the state level that also could mean less movement at the state level. That is our fabric right now with healthcare delivery. You would agree. So we have some states offering this and some states not offering that with that level of incrementalism. How do we get to where Lindsay wants us to be as a community?

Speaker 3:

I think the biggest drawback of this patchwork approach of state experimentation is that it exacerbates geographic disparities. Right? We've seen that with Medicaid expansion first and foremost over the last decade. And we've seen it in the pandemic in just this really concrete , um, upsetting way to see, you know, public health supports and restrictions and mandates vary so much , um, by from jurisdiction to jurisdiction. But it's pretty baked into the kind of system, the political and legal system that we have in this country. I think there are ways to take advantage of the opportunities that that creates , um, by, by kind of pulling off a proof of concept in a particular state where the politics are amenable to trying something big and new. Um , but we do have to be really cautious about making sure that, I think particularly the financing , um, for healthcare reform has to come at the federal level because this isn't something that many states , uh, have the ability to really, really move forward with on their own.

Speaker 2:

And in your view of healthcare reform, did you, and do you see it embracing public health reform?

Speaker 3:

I'd really like to see that embracing is a tricky term here. I I wanna make sure there's a partnership , uh, and an integration of public health goals into healthcare , financing, reimbursement structures , uh, and, and reforms in terms of healthcare access. But I, I worry sometimes that the healthcare industry is such a behemoth that there's a , a , a risk that the kind of population perspective that public health brings to the table can get drowned out by a more individualistic perspective. That is the kind of the common mode of discourse in , in the healthcare space. Uh , so partnership. Uh , but I wanna make sure that that population perspective isn't lost.

Speaker 2:

And going back to something you said a moment ago, sort of ERISA reform is healthcare reform, is ERISA reform public health reform?

Speaker 3:

I think it can be. I think it can be. I think there are lots of opportunities that we're currently , um, foregoing to serve public health goals through things like Medicaid expansion. And we're seeing that play out in real time , including in the pandemic. Uh , you know, the idea that access to testing, access to vaccination, even access to treatment and diagnosis, right in , in , in the healthcare system for everyone benefits everyone. That a year on your own approach where it's like, I've got my good healthcare access, so I'm okay. Um, doesn't, that only takes us so far when our health is interconnected the way that has been demonstrated with Covid .

Speaker 2:

And that's a lesson from Covid that our healthcare is interconnected. We are a very forgiving and forgetful community. When the sunny days come and we're no longer wearing our mask and we're back to the theaters and things, are we gonna remember how interconnected we really are? If we don't, it's our progress going to stall.

Speaker 3:

There's a risk that we return to normal after the pandemic and move on From this moment of reckoning, both racial reckoning and public health reckoning , uh, we've seen that happen. We saw that happen with Ebola, right? Even the risk of an Ebola, a big Ebola outbreak in the US highlighted that when a single individual who turned out to be infected with Ebola was turned away from the emergency room with inadequate care and sent back to a community where he put others at risk , um, that could have been a moment where we really had a reckoning about , um, ensuring meaningful access to high quality care to protect us all. And we largely let that pass us by.

Speaker 2:

Well, and that's kindly stated. We largely let that pass us by. It's true perhaps that we did not learn the public health lesson and, and implement change following Ebola. We didn't do it. So what lesson are we learning here as a result of Covid ? What lessons are there for us to embrace? And then what change do you see? So, you know , can you, can you learn from what we did with Ebola and other instances that, you know, where there was a moment we were scared, we reacted in the moment, but perhaps in completely, we have another moment here. We're acting in the moment. We're wearing masks. We're not wearing masks. We have the vaccines. Some take them, some don't. What are the covid lessons and and what do you see from the public health lens that are gonna be long lasting for systemic change?

Speaker 3:

I think I'll start with what I'm optimistic about and , and a past example that sort of shows what's possible. So in , in the moment after September 11th, which wasn't just about jet liner attacks, but also at around the same time anthrax attacks and concerns about bioterrorism and biosecurity, we saw massive reform at the state level to modernize public health law and pay attention to public health authorities at the state level. Unfortunately, those were incomplete reforms. And what we've learned during the Covid pandemic is they didn't address the kind of scenario that we're facing , uh, with this pandemic where there's asymptomatic spread where it's not, you know, individually targeted public health strategies, were inadequate. We're now in a new moment of public health reform. What I'm optimistic about is that it's an opportunity to , to integrate public health reform with that healthcare reform conversation that was already really going full blast just , uh, on the , on the eve of the pandemic. Um, what I worry about is that there's also a moment now of backlash against public health. And that's not something I've seen after Ebola or after September 11th, because here a lot was done. And, you know, many of the choices that were made were excellent and, and the best possible choice under conditions of uncertainty. But there are real concerns about overreach as well. What I worry about is that at the state level, we're seeing , um, you know, other forces, you know, other interests take advantage of this opportunity to curtail public health powers to curtail support for public health , um, financing. Uh, and that could have implications that range far beyond public health emergencies , uh, in , in ways that could really affect the entire health system by diminishing authority and financial support for addressing more routine chronic , uh, public health concerns, like healthy eating and physical activity or tobacco use.

Speaker 2:

And do you do , why is that? I agree with you. I'm seeing it. I have the same worry. And I wonder why, and I, and I get your , how you juxtapose nine 11. We did see some systemic change. Uh , you cannot get on the plane without going through a metal detector that is probably with us forever. So why are we encountering a backlash now and what can we do about it?

Speaker 3:

Well, and I think the public health changes after September 11th were less visible than the kind of airport security changes. But the public health changes after September 11th were a massive influx of funding into public health, emergency preparedness and public health law modernization and real law reform at the state level to pass new , uh, statutes , uh, authorizing local public health authority. But , uh, the , this backlash now is because those a authorities have been used in ways that confront , uh, powerful economic interests and that touch a nerve about, you know, debates about personal responsibility versus shared community responsibility. Um, and questions about what we owe each other in a society in terms of, of curtailment of our own, you know, freedom to go about life as, as we please versus , um, our responsibility to protect each other from

Speaker 2:

Risks. That's your sense of community, again, how we see community versus any one of us as an individual. And that perhaps is at one of the prongs in the challenge that you, that creates worry for

Speaker 3:

You. Yeah, and I think that question of community and mutual interdependence, that really to me is a bridge between the healthcare reform debates and the public health authority debates. Because in the public health space, we're debating, you know, do I owe you the obligation to wear a mask to protect you even if I feel safe? Right? It's not just about me and my personal decisions on the healthcare side, it's a question of, you know, what are the conditions, what are the things that, that my neighbor might experience in terms of a health scare or a crisis with their personal health or a family member's health that trigger an obligation of collective responsibility to finance that right? To make sure we're all in this together. And that we provide that assistance not just through these kind of individual mechanisms like, you know , set up a GoFundMe or ask for charitable donations, but through the very structures that define our health system, right? Through , uh, access to coverage and access to care and affordability of that care.

Speaker 2:

Right ? And one of the things you also pointed out in this is financing money. You have to pay for a neglected system, right? It , it takes money to bring it up. And that's one of the challenges is where's the money and is it gonna be offered in such a sustained way that it can address the neglect that has caused us to have such a challenging, inadequate system

Speaker 3:

And the financing that's going into our health system? It is generous. It has been very generous over the last, you know, decades. The concern has been, there's infighting about where that money should be dedicated and where it's best used. You know, to give one example, in the years, immediately after the September 11th terror attacks , um, uh, there was investment in public health and then again, at the kind of affordable Care act moment, big investment in public health. But those funds are rated again and again because they're there, they're tempting, right ? Um, and, and they've been rated to finance healthcare access, you know, enrollment , uh, drives for the p the , uh, health insurance exchanges , um, you know, to get people to sign up or, or other things that Congress has not financed to the level that it had indicated it would. The public health funding becomes this kind of piggy bank that get that we go to again and again, and then when we need it in a public health emergency, it's not there. We also have seen in this crisis how expensive it is to not pay attention to those investments over time. We've seen now , um, a much a very effective vaccination drive in many ways, right? It's remarkable what we've been able to do mm-hmm. <affirmative> , but what that has cost us compared to what it would have looked like if we'd invested even six months earlier in developing infrastructure for vaccination instead of having to pay through the nose, you know, to do it in this kind of just in time fashion that we've seen in, in the early months of 2021. There should be a lesson there as well. I , I don't know that we're learning those lessons.

Speaker 2:

I don't , I don't know. I wonder, I I I wonder if we're learning that I perhaps one of the things that makes us unique and remarkable is great in a crisis, but as you said, it costs you long-term vision. Investment isn't always there or if the funds are there, it's rated for short-term crisis. Yeah. So we haven't yet figured out that it is in our best interest to invest in the long term , which would allow us to have the infrastructure when something happens. I'm not sure everybody's getting the lesson. Lindsay has the lesson. So how are we you getting that lesson out into the community? Are there people who hear you? Are there people who agree with you?

Speaker 3:

Adopting that long-term horizon can be a really tough sell, particularly in a political environment where people are looking for identifiable wins within kind of an election cycle timeframe. Right. And we've seen this again and again, it's not just a, it's not a recent development of our political polarization. It's a basic feature of our system. Uh, I think public health has a lot of lessons to offer to healthcare reform and to debates about racial justice as well. Public health has been grappling with this, what we call the prevention paradox since its existence. Right. Um, we can save lives at pennies on the dollar with upstream interventions, but we don't always know which lives they are. It's , uh, it's impossible to point to any given person and say, this person lived a life that was 15 years longer and of higher quality of life throughout those years because the tobacco taxes were high enough when he was 14 that he didn't take up smoking. Right. You , you can't put a face on a lot of these upstream interventions. So in public health, a lot of the entire mindset of the profession, of the, the field and the discipline is summarized by what we call the upstream downstream parable. And the idea is that there's a village and the villagers notice , uh, bodies floating down the river and they immediately mobilize. Everyone in the village is completely dedicated around the clock to pulling bodies outta the river and trying to resuscitate people. And they save lives and they see the face of the person they've saved, but they're so focused on that immediate response to the crisis that nobody thinks to go upstream and see what's pushing the bodies into the river. And public health is that upstream perspective. Uh, but so much of what we tend to do with anything related to health is personalize it and need to put a face on it. We see that as something that's incredibly intimate and individual, right? Our health is very personal, but from a public health perspective, we're able to take a step back and see the bigger picture, see what are those structural factors, political factors, legal factors that are the social determinants of health at the population level, where there are opportunities to really improve quality of life, to improve the quality of our communities to , uh, to, to in , in implement cost effective interventions. Right? But you don't get that , um, that thrill of this is the life I've saved. This person's life has been saved by my efforts , um, that you do with the rescue orientation

Speaker 2:

Downstream. Well now you open a door about caring and empathy and compassion. The villagers cared. They tried to resuscitate those who were coming down river and they were doing what they could to save some lives. And there was great heroism, I suspect and glee when they did. But you have to care if the people coming down river are just coming down river and the community doesn't care, there's no heroism , there's no forward thinking, looking up river, why are these people coming down? So you have to care and you have to have curiosity as to wonder why and go and look.

Speaker 3:

Yeah .

Speaker 2:

And even though that's a different community, that's upriver, you have to care enough and have compassion enough to want to address that problem before it comes to your shore. Do we have a community that has that level of compassion? And I asked that question because one of the , the things you mentioned when we first set out is in your teachings and in your own personal advocacy, racial justice is a huge part of who you are and what you do in advocating for equality and diversity and inclusion. And so where are we as a society? Are we up river , down river ? I suspect we're in both places. And are the people down river who are coming together with great heroism, doing enough? Do we as a society take the time to look up river and wonder what is going on in that community? Why are folks coming down river? Why are folks dying? Do we have curiosity and compassion in this country to want to address the larger issues which may not be ours? Because in your, in your parable, the people in that village were not dying. Mm . Others were. So how do you see our community? And if we are not a compassionate, caring community, what are we gonna do?

Speaker 3:

I think it's, it's so critical to frame these issues in terms of care and responsibility. The risk is that caring, responsible people can grow numb to what they're seeing others experience and can other them. Right? I'm comfortable because of segregation in my community. Most of my neighbors are comfortable and safe. I can't cope with tackling, engaging with what's happening in other communities. And if I frame it that way, if I frame it as something that's happening to someone else, someone else's loved ones, another town that's not mine, there's a real danger that we continue this divide, this socioeconomic divide and racial divide, and that we don't see the ways in which our health is interconnected across those divides, and that we have to break down those divides to really move forward in a way that's gonna have benefits for everyone.

Speaker 2:

How do you do that?

Speaker 3:

I think it starts young. I think I'm really encouraged when I talk to young people about these issues, and they are idealistic and they are caring, and they feel an enormous sense of responsibility to each other across these divides that their parents and grandparents created in this world. Whether we can foster that rather than muting it and dulling it as they grow up and come into positions of voice and power , uh, is on us as the, as the generations that come before

Speaker 2:

Them. Well, and you have a unique role if you're a professor. So many people who have a touchpoint are not in the classroom , uh, at any level. And if we take as part of the proposition, no one is born with hate in their heart. Somewhere along the line it happens. I don't know if people are born with empathy in the heart. I believe so. I see it in the love I see in children engaging in playful activities in the playground. Somewhere along the line, people stop caring or it's the other, or they get tired maybe. Um , or believe that the problem is too great. Um, so for where we sit here at the association and trying to create space for the dialogue, for the openness for folks to come and share and learn, to learn best practices, to learn ways of self-advocacy for your organization or your community , um, we want to be very active in that space and to give voice, to find ways to help bridge that gap. Um , are there other things that even we in our larger community, in the health law profession could be or should be doing to help give voice to extending the voice of the community?

Speaker 3:

I think the American Health Law Association has an enormous platform, and I'm thrilled to see that you're using it to, to give voice to these issues and these perspectives. I would encourage your members to come into the classroom, to engage with younger people, to engage with the people who are the future of this field. Not only to share their wisdom and perspective, but to hear and to learn from young people who are idealistic, who see a future for themselves and their children and their grandchildren. Uh, that is more just, that is more equitable, where our communities are integrated and are caring and responsibility cuts across the socioeconomic and racial divides , um, to experience that perspective and be open to it while also imparting wisdom and equipping them with the expertise and the skills that they're gonna need to bring that to fruition.

Speaker 2:

So just in that moment, there's an excitement that comes out of you for the words that you just used about , um, the youth and inviting our members to invest time in the classroom. And was that excitement always within you on these topics?

Speaker 3:

Always.

Speaker 2:

But I see it always,

Speaker 3:

Always, this, this work for me has always been something that bridges my role as a teacher and my role as a community builder in the health law field , um, and my advocacy work and the reform work that I do.

Speaker 2:

And you have not lost the spark. You have not lost, you're not coming here sitting with me. Um, with any sense of woe would sorrow you come here to sit and to share with such enthusiasm. So you have not been otherized, you have not lost your passion.

Speaker 3:

Well, I have. I, I sit in a comfortable place and it would EAs be easy for me to be comfortable about that. I, I feel in this moment , um, after , uh, more than a year of devastation, devastation that could have been prevented. Um, you know, we had the know-how, right? And I, I had a front row seat to know that we knew what to do to stop this from happening and didn't. Um, but my only response to that is to say that this is an opportunity to come together and do better next time and move forward together in a way that builds on the lessons that we're learning right now. I'm worried , um, I I'm not , uh, optimistic without worry about what could happen next in this moment. And the backlash is, you know, the potential for backlash here is , is high. But, you know, I have an opportunity because of the training that I've had, because of the community that I'm part of, of health lawyers and how , um, and the energy and expertise in that, in that community , uh, to be part of something really big going forward. I think we're on the cusp of a decade or more of, of big change in the health law policy space. I'm excited for that opportunity. Um, but I'm coming in with my eyes open.

Speaker 2:

Well, I share your optimism and I think for us, your classroom, as you've invited folks in, I say the same thing about my classroom. If we can together invite folks into our classrooms, while you may have more of the youthful attendees sitting before you , um, those other health law professionals who come into our classroom, virtual or otherwise , uh, to hear the importance of being a connected community and how together we can address these issues and improve healthcare overall , um, then maybe we can get to where you think we can be in the next 10 years.

Speaker 3:

I feel like you and I can do it together.

Speaker 2:

David, I think we said I think we can <laugh> . I think we can. Lindsay , I want to thank you so much for spending time with us today.

Speaker 3:

Thank you. It's been an , an

Speaker 2:

Honor Yeah. And for staying in the fight.

Speaker 3:

Same to you, David. Right ? Thank you. I value being a member of the same community with you.

Speaker 1:

Thank you for listening. If you enjoy this episode, be sure to subscribe to a H L A speaking of health law wherever you get your podcasts. To learn more about a H L A and the educational resources available to the health law community, visit American health law.org .