THE VFA PIONEER HISTORIES PROJECT

Debbie LeVeen

“I was interested in pushing for social change from the ground up.”

Interviewed by Judy Waxman, Oral Historian, August 2023

JW:  Tell us where you are. And also, would you tell us when and where you were born?

DL:  I’m in Berkeley, California. I was born in Bridgeport, Connecticut, in November 1941.

JW:  Great. So, we need to know a little about your childhood, ethnic groups, siblings. Were your parents’ influences? Tell us something about your childhood.

DL:  I was born in 1941. I would say I had a very happy childhood. I eventually had three siblings. I’m Caucasian, you can see. My parents were a good Republican family. My father was a Quaker, and conscientious objector during the war, so we didn’t lose him. We eventually moved to Montclair, New Jersey, and then to Philadelphia with my father’s work.

I credit a lot to my high school, which was also my father’s high school, a private school called Germantown Friends in Philadelphia, and it was at a time when I think my mother was very oriented towards me having boyfriends. I was very much a thinker, a ponderer, and I got to Germantown Friends and that was what we did. We went to Quaker meetings once a week and were asked by the people on the facing bench, the elders who would come, or the faculty, to think about this, think about that.

Our class was always discussing issues and it was a time when a lot of things were beginning to happen. I graduated in ’59 and went on to college at Smith. Majored in religion, of all things, although I was thinking about the importance of political science, which I ultimately got a PhD. Ironically, given today’s situation, political science is important because you study how society makes decisions about what it wants to do. That’s faded a bit.

After college, I went into the Peace Corps and went to Ghana. We were Ghana Four; the fourth group to go to Ghana. It was an incredibly exciting experience. It gave us a picture of a society where people were warm towards each other and supportive of each other. Anyway, it was a very good experience getting to know Ghanaians, seeing the country. It’s very different now. We were lucky to see it then. Although it’s not a bad place, it’s just it’s so much more developed, and we had it at a sort of idyllic time, in a time when everybody loved the United States.

JW:  This was early ’60s?

DL:  This was 1963 to ’65.

JW:  Okay.

DL:  So, it was just, as I said, an idyllic time. I remember we were being asked about the Vietnam War, and at the time, I totally was, “Well, we have this domino theory. That’s why we’re there.” I remember once in class, I was teaching French, of all things, and because Kwame Nkrumah didn’t want Peace Corps people teaching potentially controversial subjects, like English or History or anything like that, we taught math and French. I remember once talking about wild animals. The word in French, ‘fauve’ and they said, “Well, you have wild animals in America.” And I said, “Really?” And they said, “Well, you know, like dogs. I’ve seen them biting children.”

JW:  We do have wild dogs, true.

DL:  So, I got married there and went back with my husband to UCLA, where we went into African Studies, thinking we were going to go back to Africa and continue to be involved. I mean, 1967, coming home from the Peace Corps, thinking, “modernization.” It is so amazing to think back to how we used to think, right? How did I think in 1967? So we went into African Studies, but then transferred to the University of Chicago. My husband did economics, and I did political science.

JW:  May I ask you, was he American?

DL:  Yes, American.

JW:  And he was a Peace Corps volunteer?

DL:  He was also a Peace Corps volunteer.

JW:  Oh, I see. Okay.

DL:  Our headmasters, well, his headmaster in particular, wanted to save money, and if he could work with my headmaster and find us a house together, that would be ideal. We had a house that had two wings, so we thought, “Oh, we can say this is perfectly safe for two people,” but it was also a nice, nurturing place to be for a couple of years, get to know each other without too many family influences.

So, when I came back, when we went to Chicago, I kind of shifted my focus. Instead of thinking of going back to Ghana or somewhere in Africa to do research and continue to be involved in, quote, “modernization,” I shifted to looking at ethnic politics in American cities. I had been interested in ethnic identity as a kind of organizing focus. This is, again, extremely ironic. In Ghana, and the idea that tribes might, as they move, as they became involved in the political process, might organize a tribal identity.

Then, in 1967, ’68, ’69 I guess it was, as I began to think about my dissertation, I thought, “Well, I could look at ethnic identity as a kind of organizing resource in American cities,” which it was becoming, obviously, with all the movements. The Black Power movement, and Latino, Puerto Rican, and even in Chicago, Hillbilly – Appalachian, White hillbilly – organizing. It was a fascinating time to be looking at that. And again, I think of it as being so ironic. Imagine looking at ethnic identity as a political organizing resource. I mean, look at what it’s done in the world. It’s just a terrible source of division.

JW:  Well, let me ask you this; at this time, you’re talking about ’69, around then. Were you aware of women organizing on behalf of themselves, too, or not?

DL:  A faint awareness. It wasn’t something that was significant to me. Yes, I did. It’s horrible when you can’t remember what you were thinking at the time. So, yes, I was aware of it, but it wasn’t my focus. As I began my research, I researched in the uptown neighborhood of Chicago, I was fascinated by what was going on there. All the young patriots, the Young Lords, the Voice of the People, which was sort of a rainbow group but really led by a “Hillbilly” preacher. People organizing for housing, for the local health center. The war on poverty had health centers, should be run by people. They had a model cities program there, urban renewal was being planned, and by that point, people knew how to organize against urban renewal. So, it was an amazing time.

I got a Ford Foundation Ethnic Studies dissertation grant, and I’d said I was going to compare the use of ethnic identity among American Indians, Black people, and Appalachian Whites. It was the first year of their fellowships, and they just had to get them out the door. I had no idea how I was going to do this, and I cannot find a copy of my proposal, so I don’t know what I thought I was going to do.

I ended up focusing on the American Indian and on a specific protest group, the Chicago Indian Village. I met its leader at a time when he was hospitalized for hepatitis and delighted to talk to people and delighted that I was a political scientist. It was like, “You’re not an anthropologist, you’re a political scientist who is doing things politically.” He loved talking politics. My dissertation was called, Heroes and Hustlers. He was a shrewd pool player, an organizer, and a really committed Native organizer.

Many of the Indians in Chicago, which was a relocation center, many came from Wisconsin, from Ojibwe and then the Menominee tribe. But there were also Indians from the Sioux. There were some Navajo because it was a relocation center. So anyway, I looked at this, I became very involved, and I became a resource. And that was always the way I did research, sort of getting involved, working with people. I brought my tape recorder to meetings that they managed. They would hold a protest, generate a meeting, I’d be there with my tape recorder. I’d type up the stuff and sort of follow what happened.

They were formed just after the Alcatraz takeover and they were really part of this wave from Alcatraz in 1969 through Wounded Knee, 1973, of takeovers and occupation strategy. They took over a number of sites continuously from the spring of 1971 through the end of 1972. And it was, for me, just a very exciting experience. They eventually generated a federal task force to deal with the problems of urban Indians, and I loved being able to be sitting in on those meetings, calling the White House to see if we could offer the Indians a piece of land, things like that. To me, it was very exciting.

JW:  Let me ask you this. Were women part of these discussions? Sorry to keep going back to that, but I’m curious if the representatives were men and women.

DL:  Yes. The short answer is yes. They would bring the emotional energy and say, “You’re not listening to us. You’re not taking care of us. Look what’s happening.” But at that point, for Native people to be speaking out was unusual. Without going into the whole kind of context, the main thing is that most Indian people, 70% maybe in Chicago of the roughly 16,000 Indian people, I would say 70% to 80% were, quote, “marginalized.” Never really put down roots, did day labor jobs when they could get them, were depressed.

They were drawn into the city by promises of jobs and housing and so forth, and when they got there, they weren’t equipped for the jobs. There wasn’t adequate training. The housing that was available in uptown was terrible, and there was no incentive to maintain apartments. And so, when Mike, who was the leader – his sister Betty was an alcoholic though she recovered during the process and became an alcoholism counselor, but in any case, she had lived on skid row for a long time, and brought her quote, “troops.” So, they were the people that were ideally suited to maintaining a 15-month series of occupations. They weren’t giving up a job. People with jobs would come when the occupation started. It was exciting, but it was this kind of marginal group that was there all the time. Anyway, that was my first experience.

I continued to do research, finished my dissertation, helped start a Native American policy group, and then my first sabbatical, I guess was about 1980, when I decided I wanted to learn more about the healthcare system. I wanted to learn more about women’s health and the women’s healthcare movement. And partly, it was because my graduate students in public administration, the women, were talking about feminism. And I’m thinking, “What’s feminism? Kind of like, what really is it? What really is it?” That decade, that next 15 years, I was very involved in looking at midwifery, the women’s health movement, legislative efforts coming out of the midwifery, research, and advocacy that was going on at the time.

JW:  So, you were teaching then?

DL:  Yes, I started teaching at San Francisco State in 1973. I taught in Urban Studies, but taught policy courses. I taught a course on poverty, a course on social policy which did involve feminist kind of issues, women’s work, women’s poverty, single parent families or female headed families.

JW:  I want to ask you, last you were in Chicago, when did you get then to San Francisco?

DL:  We moved out here at the end of ’70 and I had my first and only child in the spring of ’72. I came out here then and began teaching at San Francisco State in ’73. I started writing my dissertation right away and then started teaching. I had planned to go on and study economic development in Native communities, because that’s what the Chicago Indian Village, the leader, had been interested in. Had he decided to just do economic development and run businesses, he would have been very good at it, but he was also committed to Indian needs and pushing ahead on those.

I had been planning to do that and I decided, “You know what? I don’t really know economics. How can I study economic development?” Then I got interested in women’s health and shifted. At that point, I was sort of going through a chronology, I was thinking that what I see about myself at that point, before I became involved, was that I was and always have been, really an academic. And even though I was a very rigid I would say, single payer advocate…

JW:  Excuse me, you’ve got to explain to our audience what single payer is.

DL:  That’s a good question.

JW:  Would you like me to explain?

DL:  Well, single payer basically, it’s a somewhat complex concept. It’s a label, and when I say rigid single payer, it’s like we have to just have government run health care. Medicare for all. Well, most important is, as I see it, is get rid of private insurance. They are the villains in the story. Get rid of them. And if you keep private insurance involved in any way at all you’ve sold out. It doesn’t count. And that was what I call sort of rigid single payer. And then there was a more nuanced single payer, which is I think where California is now.

Although the single payer movement for the most part remains focused on a system without private insurance. We are now at a point where we’re moving towards a unified financing system, but it might work through private insurance. I go back to Jacob Hacker in 2007 with his concept of the public option and I found that very appealing, thinking, “We can transition.” Somewhere along the line I said, “We’re crazy to think that we have to get rid of private insurance in order to provide coverage to everybody and begin to control costs.” I’d be happy to talk later about where California is today, it’s amazing.

JW:  Right. I just wanted to make sure whoever’s listening knows where you are.

DL:  Medicare for all makes sense to me, and we talk about enhanced Medicare for all because it would have to be expanded to cover women and children and young people. But Medicare for all does contract with private insurance, it’s more expensive, there are real problems, but it offers a vehicle for moving forward, for negotiating prices and things like that. Anyway, I think single payer advocates, some, are beginning to say, “Maybe we should move that way, see if there’s a way with only nonprofit insurance companies and strictly regulated.” California is moving towards all payer systems, if all insurers pay the same price for the same goods that’s a start.

JW:  Yes, a big step forward.

DL:  That’s right.

JW:  Let’s get off those details. I’m sorry I distracted you, but I thought the audience would want to know.

DL:  What I was going to say, when I sort of look back, I say I was always an academic. I loved learning. I feel like teaching gave me a front row seat to study the things that were most interesting to me. But I was also always, when I look back, something of an activist. Starting in high school, student government. In college, I remember being involved in a conference on current events. I think it was called Challenge. It was a big deal. And then in graduate school, we were very involved in anti-war activities, Vietnam protests. At the University of Chicago, the political science department shut down after Kent State. They said, “We cannot continue. Debbie, you go organizing tabling on the campus.” That was my Spring academic work. So, there was a lot of activism.

And then with the Native American involvement I became involved in, I think I helped start this Native American policy group. People working on Native American policy to discuss policy issues, advocate. So, there’s always been a kind of activism and advocacy. As I did more research, it became more the basis for advocacy. That was kind of what became the thing I did.

I think I wrote to you that in my class were Jo Freeman and Nancy Hartsock. She was out there. It was like, she pushed. I think I was a very demure woman; I just was. My mentors were male faculty members. I did not become an outspoken feminist. I was always kind of continuing to work with people. Anyway, Jo Freeman was just blasting away out there. No concern whatever for how she appeared to men. That, to me, was always an important thing. And so, I just never would have cut loose the way she did. She was a friend. I liked her. But watching her political style, I didn’t identify with it.

And then, Nancy Hartsock was a very interesting political theorist. She was a feminist political theorist. Her feminism was this quiet, strong, smart, political analysis, theoretical analysis. So, they were both in my class. I could have learned a lot from them about feminism, but at the time, I was completely involved with Uptown and the Chicago Indian Village.

And then in 1980, I finally made this shift and said, “I’m going to study the women’s health movement.” It wasn’t what I had on my sabbatical application, but when I submitted my sabbatical report, everything was okay. I’d made this major transition, this major leap, and a friend of mine got me interested in midwifery. I was interested in social change, pushing for social change from the ground up, and that’s what the Chicago Indian Village and these other protest movements were doing.

Native people were demanding rights that they had from the government and demanding more response. You’ve dealt with Black people, you’re dealing with Hispanics, Latin American people; Hispanics I guess you could say, most broadly. They would go and challenge people on their affirmative action programs, and they’d say, “Oh, yes, Indians are definitely, Native Americans are a part of them” and, “Well, do you have any working here?” “Well, let’s see.” You know, and they didn’t. Mike was so skillful. “You have made a promise here. You’re not keeping it.”

But then meeting the midwives, it was like, you’re just doing it. You’re doing it with your own hands. You’re catching babies in people’s homes. You’re doing the change you want to implement. What you need is to avoid legal attacks and try to get legal protection for what you’re doing. So, I got interested in midwifery. I thought, this is a fascinating subject. And then this friend said, “You know, the midwives at Highland Hospital,” there was a new midwifery service there, and Highland Hospital was a county hospital, “They’re looking for somebody to help them do research.”

I don’t know when they decided to unionize, but they were a new service. They found the obstetrical group that they were working with to be not sufficiently supportive of midwifery care, and I saw a great distinction between midwives and midwifery care. So, we’ll hire midwives, but you have to keep seeing patients fast, you can’t spend enough time with them. I mean, can you really do midwifery care? And they were demanding midwifery care.

JW:  All right, tell us what that is. What’s midwifery care?

DL:  Midwifery care is the commitment to spend time with women to provide very personalized care. It’s a commitment, first, to birth as a natural process, and enabling women, assisting women, empowering women, to birth their own babies. It includes very careful prenatal screening, because high risk women need to be under an obstetrician’s care. But if midwives have a relationship with an obstetrician, and not necessarily that it’s a supervising person, but a collaborative referral relationship, if you’ve done that, if you know how to monitor for problems, then you deal with problems and you provide a supportive birthing experience to women who aren’t at high risk for problems.

I remember when I started reading about midwifery births and compared them to my own, I would weep. What an exciting experience, to be involved as the baby is born, have a midwife there giving you support. And that was the midwifery model, the midwifery care. And the obstetrician’s group, one of their members made the statement that became kind of a battle cry. He said, “Why provide Cadillac care when Chevy care will do?”

JW:  Because they were only women and babies, right?

DL:  Exactly. And the midwives just happened to be, almost all of them – it was a group of six women – red diaper babies. Meaning their families were connected to the Communist Party or Socialism. They were strong women and knew what they wanted, and went after them not in an outspoken way, but just an assertive way. They knew what was important and they were going to push for it.

I spent about a year doing research with them. What they wanted me to do research on, was the cost effectiveness of midwifery services. I visited midwifery services around California. I never studied it in a technical way, but I interviewed the obstetricians who worked with them. In the early ’70s there was a lot that was pushing the childbirth reform movement. It was women who wanted a more natural childbirth. I think it was a slowdown in the birth rate and a need for patients, and a couple of the doctors said, “We really needed patients and we thought midwives could help bring them in.” These were doctors who were supportive of midwives.

But in two cases at least, it was sort of like, “We don’t really like to do all the shit that midwives do. Let them sit with a patient and we’ll do the high-risk stuff. That’s what we’re trained for.” The medical profession controlled midwives in terms of whether they could practice, what the scope of practice would be, the requirement for supervision by a physician, whether you got hospital privileges, whether you could do home birth, all of this. So, they had the control, and they could benefit from the midwives without necessarily wanting to provide all of the support that they needed.

I think today, I haven’t kept up with what’s happened since the mid ’90s in terms of midwifery legislation or so on, but I know that today, and I think maybe even nationally, there’s support for Doulas. In California, Medi-Cal can be used to reimburse Doulas. So, they’re doing what the midwives used to do, and they come in and support a woman. I don’t know if they do prenatal care, I think they become involved closer to childbirth, but to be there and support a woman through the childbirth experience. Really looking at the whole experience and understanding the kind of male dominated medical system was really important to me. And then as a political scientist, I was very interested in the sort of political economic context.

In Europe they kept midwives. And for years, the person who was from California, but he was head of the Maternal Child Health for the World Health Organization, he came to various meetings that I was at, and he would say things like, “Why do they have a lower infant mortality rate than we do? Because 90% of the births don’t have a doctor in the room. They just have midwives.”

JW:  And they have a lower infant mortality rate?

DL:  Right. Because they have less interventions, they’re less likely to go quickly to saying, “The baby’s in distress, we need to do a c-section,” that sort of thing. And of course, they have universal care. They have good prenatal coverage as well. So, that to me, was interesting. In the United States, midwives were prohibited around the beginning of the 20th century, and it was as the obstetrical profession began to establish itself. It was not just a competition issue; it was an image issue. If any old granny midwife can deliver a baby, then why do they need our professional training?

JW:  The male doctor.

DL:  Exactly. The male doctor, the male dominated profession. And so, midwives were prohibited, and then slowly came back in through service in underserved communities like the Frontier Nursing Service. And slowly people began to see the benefits of midwifery. That they had very good birth outcomes, even though they were dealing often with women who had less care and were less well off.

JW:  Did you find out they were cost effective? That was your study, right?

DL:  That was my study. I think, as I said, cost effective was very generally defined, but yes, absolutely. The doctors welcomed them in terms of the work they could do.

JW:  They charged less, in other words.

DL:  Well, they were paid less. They weren’t sort of independently charging. They were hired, negotiated or whatever, and the doctors could charge more for what they did, and the hospital or doctor, whoever was hiring the midwives, could pay them less. So, yes, they were, definitely, yes.

JW:  I did interview a friend of mine from high school, who in the ’60s, she was a nurse and became a midwife, got certified. She had an independent practice though and did home births. She was in Philadelphia. Was there that kind of practice in California that you were aware of?

DL:  Definitely. A lot of the midwives that I worked with were trained on home births and came into the hospital. This is the particular group I worked with closely, I interviewed a lot of other groups, but I think the highland group was unusual in terms of red diaper babies and having had experience with home births, and came into the birthing experience feeling that doctors overreacted. They didn’t understand the range of the childbirth experience and that women could really do more than doctors expected. But it took a long time to certify women who were not certified as nurse midwives.

One of the things I did that was most exciting to me, and it’s funny just thinking about talking to you, I sort of rummaged around and found some old papers. It’s like, “I wrote this? I wrote this?” I worked with a coalition for the Medical Rights of Women, one of the groups I worked with, and the Perinatal Health Rights Committee. And working with them, or because I was a sort of consumer advocate, I was appointed to this alternative birthing methods study committee that was set up by the state legislature by John Baskins. This was 1985. That committee sort of ran from spring of ’85 through the spring of ’86, I guess, with all the interviews and supports and hearings around the state.

The purpose was to explore barriers and try to make recommendations for dealing with them, explore the need for, and then barriers to women who wanted alternative birthing choices. So, it was fascinating. I mean, we held five hearings around the state, and we heard testimony from all kinds of women who had had home births and spoke up for them, and wanted to have it be easier, from midwives who needed support, and needed not to be afraid of running against the law, being prosecuted for something. It was wonderful. And listening to doctors, too, pro and con. I just found those hearings really exciting.

You could see the need for midwifery, and you could sort of feel the power of these women. I would say I felt the power of women in any group of midwives, and particularly the lay midwives, when I would meet with, what they became called, the home birth midwives, lay midwives, quote, “direct entry midwives,” anything other than nurse midwives. They had a tremendous sense of their own power as women. And I really could feel that and appreciated it and admire it. So that was an amazing experience for me. I loved doing that. And out of that, I think, came some meetings, I just have a recollection of a meeting at the San Francisco airport, talking to the lobbyists for the midwife association, talking about, “What’s our next strategy to get some legislation?” It took until 1993 to get legislation passed in California to allow lay midwives to practice.

JW:  Oh, that’s not true all over the country, I assume. I think that’s still advanced.

DL:  Yes, it may be. And this was ’93. I’m not sure what the situation is. It’s like you look back at something you were deeply involved in, and you say, “I wonder what happened. What is happening today?” I know from time to time I’ll see a report on the benefits of midwifery birth. I also got involved in studying the malpractice crisis and the way that affected midwives, and it was so illogical. The midwives had much better birth outcomes, but they had terrible trouble getting malpractice insurance. The insurers wanted to charge them as much as they charge doctors. They’re doing births. We should charge you the same amount. Well, they don’t make anywhere near as much as the obstetrician.

JW:  Ridiculous. Yes.

DL:  That leads to another thing that has occurred to me in my ripe old age, which is that one of the assumptions I implicitly made as an academic, and I think I felt more explicitly, was if we can show that something makes sense, people will be more likely to do it. How can you justify teaching if you’re not trying to show, first of all, how to think about it. How to think about whether something makes sense, but then also operating in a belief that if you could show it makes sense, it’s easier to persuade people to do it.

I think that was part of why I was such a rigid single payer advocate. It’s like, look at what we would save if we went to single payer, if we got rid of all the administrative costs. But I thought about that, and I thought about, you’ve got to look at the politics. You’ve got to see what’s possible. I like what you said about your work during the development of the ACA, which is you benefit from people that are to the left, pushing the more challenging position, the more strident position, but ultimately, you’ve got to find a way to move forward.

JW:  Right. And that’s how we operate, I think, from my 50 plus years of doing advocacy. We do things a step at a time in this country. And so, get as much as you can, is what I tell young people, and then get a little more after that.

DL:  Exactly. And then come back for more. Absolutely. But keep the ideal out there also. This is what really makes sense, but let’s do this first, or let’s start here, we can agree here. I’m going to be fascinated to see what happens in California, but we can talk about that a little bit more.

JW:  So, after this period of interest in midwives, did you continue, well, you obviously were a feminist at that point. Did you continue any activism?

DL:  My activism shifted. While I was working with the midwives, I became involved in the sort of perinatal advocacy network in the Bay Area, especially in Oakland, where we started collecting census data on infant mortality. And that data, I hate to speak of it as a goldmine, but it was. Because advocates for more effective maternity care could go to the legislature and say, “Black women are dying at six or seven times the rate of White women. You look at the Black districts and you look at the White districts, and we need to do something.”

The Coalition to Fight Infant Mortality was formed, and Jerry Brown authorized the Oakland Perinatal Health Project. That was in the ’70s. That’s what allowed the creation of the Highland Midwifery Service. Oakland also had a very strong network of community health clinics. Very strong advocacy work there, and very progressive legislators, so I was very excited by all of that. My friends would sit around talking about, “Well, we’ll get Tom Bates to carry that bill. We’ll write the bill, but he’ll carry it.” And it was like, “Really? That’s how it happens?” I mean, I really loved seeing all that. I got involved in that network and out of that, somehow that merged into the single payer advocacy effort.

I was involved with them, and joined the local organization working on single payer advocacy when we first had our first single payer initiative in 1993. I stayed involved in that, and that was doing advocacy, doing house parties, and tabling and iron boarding and all that stuff for single payer. In my teaching, it was all looking at national health reform efforts and at the healthcare system, which totally fascinates me still. I stayed involved in studying health reform in the national health system and the Affordable Care Act. I did all that.

I retired in 2006, and from 2006 until 2015, I was heavily involved in research, doing presentations. My research was all of the think tanks briefs, and things like that. Which I would then sort of translate into things that I could present to community groups. I taught some OLLI courses. You’re familiar with OLLI-Osher Lifelong Learning Institute?

JW:  We have that here in DC. Yes.

DL:  What fun to be able to teach a course for total fun. You don’t have to grade papers, which is the worst part. So, I did that, and I wrote a book chapter. I just had a lot of fun. And because I had become an ACA supporter, I was like the lone voice in sort of the East Bay network of single pay advocates. So, I got invited to a lot of things to speak for the Affordable Care Act. While it was being developed, I was so excited about the public option, and then that went away.

JW:  The public option, being that there would be a federal option that people who didn’t have other insurance could opt into. But that was a little too radical for our Congress.

DL:  It almost got there. Maybe you didn’t see it almost getting there. It seemed to me there were some last-minute maneuvers, including the death of Edward Kennedy.

JW:  That was crucial to what happened.

DL:  Yes, it was. They couldn’t get it back. I was so taken by Jacob Hacker’s concept, and it wasn’t just insurance as a last resort. It was going to be more attractive than private insurance. He had a kind of Pied Piper vision; offer better insurance, the employers will move into it, it will get more powerful. So, it looked like a good thing. I kept working on all of that, and what’s happening today, if you want me to say very briefly, California took the ACA and pushed it as far as they could and then added to it.

In terms of coverage, they expanded coverage to, for example, now include undocumented people in Medi-Cal. I mean, step, after step, after step. California has this wonderful organization called Health Access, which is a very broad group of consumer organizations representing all different kinds of interest groups, ethnic groups, unions, all kinds of advocacy groups, and they have consistently kind of pushed forward. There’s at least one single payer group that has been part of their coalition and I became involved with them, The California Physicians Alliance. I guess I became involved through one of my speaking things, got to know their executive director, and we really got along well. He understood my question, which was, “Why can’t we help people enroll in our state exchange, Covered California, while we’re still working on single payer?”

JW:  Yes, that would be a good idea.

DL:  Right. Well, the strong single payer advocate said, “No, we cannot do anything with private insurance.” But this guy, who is great, worked to sort of move towards doing that and restructured the board of, I guess he was PNHP at the time; Physicians for a National Health Program. They have the most restrictive definition of single payer. So, he was working with the California branch of PNHP, and eventually what he was doing was not acceptable and he had to sort of break away.

The California Physicians Alliance, which was one of the first single payer advocates in organizations in the late ’80s, and had been here all along, sort of took over what he had been doing, or his position, I guess I should say. I was intrigued by them because they were willing to work with this broad health access coalition, which had done the step, by step, by step, and really gotten a long way. They’re willing to do that and still push for single payer.

JW:  Let me ask you again, were women involved in this? I mean, were there women leaders in any of those organizations?

DL:  My problem is that I don’t have a very strong feminist lens. It’s getting a little stronger. If I look at a picture of a meeting and I see mostly men, it does. But let me think, some, yes. When I think about it, a lot, but not all.

JW:  So, a feminist lens on what any of these national programs or whatever should be, wasn’t really there, is kind of what you’re saying.

DL:  Well, wasn’t there for me. Certainly, you could say that Medicaid has a strong feminist lens.

JW:  Yes, because it’s mostly women and children.

DL:  And recognizes those needs. I mean, they get elevated. Women and children need that coverage. But it’s an interesting question you’re asking, and I would have to kind of go back and think about it but go through the organizations. There have been some outstanding women, but that’s different from saying that there was a strong women’s presence.

JW:  Because I do want to say on my own behalf and my own organization, the National Women’s Law Center, that worked on the Affordable Care Act, there’s a lot of feminist wins in the Affordable Care Act. I mean, what services are covered for one thing, who’s covered, how they’re covered, that they don’t pay more than men anymore for the same plans.

DL:  Right.

JW:  Obviously, I’ll say again, we have a way to go, but we have a lot of good stuff in there for women.

DL:  Yes. And, you know, it’s interesting, I did do at some point some research on that, probably for a presentation somewhere, and began to pull together some of the literature on women in the ACA. I think my focus was always low income, and I didn’t always associate low income with women. In fact, in terms of internalizing the poverty level, I always went to the four-person family, even though in many reports it was the three-person family. That’s a sign of my non-feminist thinking, because the four-person family is more unusual. And why have I not gone more into the reasons for women’s poverty, disproportionate poverty, and all of that? One could, it’s a huge subject. It’s an important subject. But I think I was always focused so much on the particular policy issue without looking at the gender issues. So, you see, I told you when I first emailed you, I’m not a terrific feminist.

JW:  You’ve done your share. I will say that. Let me ask you this, then, in closing. What would you say about your activism in those years, on behalf of midwives and women and obviously birth outcomes. You were very involved, did a lot on that subject. Do you have some statement about that work to sort of sum up where we are?

DL:  It’s not easy for me to sum up in the sense that I haven’t kept up in any way. However, the fact that Doulas are covered, the fact that there continue to be reports on the effectiveness of midwives, and particularly in serving low-income women, all of that. I think the women’s movement accomplished a great deal in bringing midwifery back. I mean, it was women initially saying, “We want a different birth experience” that got it going, and increased, or really generated the interest among obstetricians in hiring midwives. Because they saw that this was what women were wanting, and maybe if they had a midwife or two, they’d bring in more patients.

So, it was really the women’s movement that made it happen. And that has continued, I think, to keep midwives to expand. Then there’s I think, no doubt, a lot of policy analysis to say if you have midwives working with low-income teen mothers, there’s certainly research that midwives are much more effective with teen mothers. I think that as they’ve expanded their presence, their effectiveness has become clearer and it kind of reinforces an interest. And the fact, again, that Medi-Cal would cover Doulas.

JW:  Yes, Medi-Cal being California’s Medicare.

DL:  California’s Medicare.

JW:  But also, you know, we have a lot more female obstetrician/gynecologists.

DL:  That’s true too. Absolutely.

JW:  And I think that’s a product of the same movement.

DL:  Yes, it is.

JW:  Women caring for women.

DL:  Yes, it is. We also have a lot more female doctors, physicians in general.

JW:  Right.

DL:  I want to say just one thing, if I can. This is back to what California is doing. California set up under Gavin Newsom and the legislature, a Healthy California for All Commission. This was 2021. They invited the top representatives of foundations and community advocacy groups. Some scholars; William Shao, who did the single payer movement for Taiwan and the report for Vermont. It was an amazing group. It was about 18 people. There were online hearings. It was zoom. It was COVID, which was a huge advantage because I did used to drive to Sacramento, to advocate for single payer and this, that, and the other thing. I made a lot of trips, so I was able to sit and watch these, and it was wonderful. It was fascinating. It was a wonderful group.

They had been charged with developing a system of unified finance. A system that would cover all Californians quality care, et cetera, under unified financing. And the final report defined unified financing as a system that provided standardized benefits. Everybody would get the same package of benefits, and unified financing meant standardized payments, too. So that’s great. You have these recommendations, and what happened next, was that the governor put money in the budget to continue to look at this.

And meantime, what used to be Office of Statewide Health Planning and Development, OSHPOD, became what’s called, HCAI, Healthcare Access and Information Office. And so, they have been developing an all-payer claims database. They’ve been charged with doing that. Now there’s an office within this new Healthcare Access and Information. There’s an office within that called, the OHCA, Office of Healthcare Affordability, which one of its charges is developing a global health budget. A global health spending target. I’ve sat in on a couple meetings, I haven’t been on all.

The people here are even more expert, and they also have an advisory committee that’s got all the stakeholders. I mean, it should be very interesting to watch. But what interests me, is they’re down in the weeds now, the meetings I listen to, “How do we define health spending? What do we include? What don’t we include? What does the data allow us to do?” That’s exciting to me. It’s kind of like, we had a report, we had recommendations, and now there’s really some follow up.

JW:  There’s serious consideration, that’s great. When you say, “What’s in and what’s out,” I will just briefly say, my son does affordable housing. And they have come up with a plan with their hospital that serves mostly low-income people to build housing for the folks that are always in the emergency room. So, have a social worker in the housing units so that the hospital will probably save money. And hopefully, presumably, the people will be healthier if they get a range of resources, including housing. And the question comes up, who pays for it? Is it health care or is it something else? Housing that will help people’s health. Interesting question.

DL:  Yes, the whole social determinants of health.

JW:  There you go.

DL:  Huge issues. I’ve seen a number of headlines I haven’t stopped to read, but about hospitals getting into building housing. Hospitals themselves dealing with the frequent flyers in the emergency department.

JW:  Exactly.

DL:  And the cost of that.

JW:  Is it Medicaid? Does Medicaid pay? Anyway, it’s a lot of real questions, but that, you know, can really become something important and make people healthier.

DL:  Where is he working?

JW:  He’s in Boston.

DL:  Well, I remember years ago, Boston was one of the first places where I read about a health clinic working on all kinds of housing issues.

JW:  He’s been involved in that for a while. Well, this is a little bit of a tangent, so I need to bring us back to you and say I’ve had a great time, I’ve loved your story, and I appreciate you sharing the whole thing. Do you have any closing remarks you’d like to say?

DL:  I would just say I’ve been an activist in other areas as well, on local hospital issues and so on. Just a funny little thing, is that I am back working on my dissertation story, because the Newberry Library in Chicago, which has one of the largest collection of Native and Indigenous materials in the country, has a Native librarian and she’s working with Chicago’s Native Youth and one of their organizations, and they were interested in the Chicago Indian Village. She learned about my dissertation and called me over a year ago and said, “Are you the person who wrote that dissertation?” And so, I thought I would write a kind of a summary, since the dissertation is so long.

I’ve been working on that, and in the process, tapping back into what’s going on in Indian Country and sort of seeing some of the things that Mike Chosa, the leader of the Indian Village had been advocating so strongly, are coming to fruition. In the 1970s, they didn’t have the skills. Today, there are Indian people who have the skills to develop housing complexes for Indian people, and the Land Back movement. So anyway, it’s amazing.

JW:  What goes around comes around. And it will again in all these areas, I’m sure.

DL:  Well, I’ve enjoyed talking to you very much. I really appreciate it.

JW:  I’m thrilled you did it.