 I'm going to slowly get over here. Last night, how do I, remind me how I move things? Arrow, OK. I thought about wanting to reframe this discussion, sort of like in retitling it, actually, the new American apartheid, the equalizing health care won't get rid of the new American apartheid. And my discussion actually flows through this. I'm going to talk stories. I'm going to give some numbers. And I'm going to frame it. And I'm feeling very emotional, largely because I'm a direct bit of fit. All my criticism of Title VI comes from a person who directly benefited from it. I was 16 years old when Title VI was passed. And my whole family history changed because of it. My father, who got college, who graduated from Jarvis Christon College in 1949, the year after I was born, who never held a white job until the Civil Rights Act of 1964. And except for the Civil Rights Act for 1964, would have never had a white job. That's what we called them. There were jobs to be had, but the jobs my dad drove taxi, college educated. And I hate it when I hear people say, black people don't appreciate education. I said, shit, you don't know what the hell you are talking about. Black people would get an education when they knew that there was nothing they could do with it. Both my parents graduated from a college knowing, living in the South. They had very little choices that they were going to be able to make with that degree. But my family nevertheless went to school. And that is true today. The kids have not changed. They go to school. They get an education knowing that as compared to white people in this society, they will not have the same opportunities. But they do it anyway. So don't criticize the young people for what they're doing in education. I want to talk about the legal system as a structure for change in health. Because there's only two ways we change this society, money and law. If you don't have the money, you better have the law. Because otherwise you're digging, you're spitting in the wind in your efforts. Everything in this society functions under the law. The law authorizes limits and authorizes behavior. We have racial inequalities because the law says that that is an acceptable thing. You can work on changing values all you want. But until the law says that's unacceptable, you are working against people. We like to say that we are a nation who believes in changing, solving disputes by the law. So when the law is quiet on something, you must realize that the law is authorizing it. When the law is quiet on something, the law is authorizing it. That's the only way you can look at it. You can't say, well, and you have to look at, how long has it been authorizing it? Why won't, hasn't it changed? There is a reason the law functions the way it does. And I'm going to go past this because I don't have time. I just want to make sure that everybody understands that when I talk about the law, I'm not talking about just statutes and cases. I'm also talking about regulations because they have the force of law and obviously state and federal constitutions. It is my belief that anti-discrimination law today is institutional discrimination. Title VI, which I benefited from, I was the first and the only black and every job I had in my lifetime. You do not understand the stress of being in a historically white institution all your life. But I am thankful to Title VI for that opportunity. But Title VI no longer can solve the problems we have. And if until we admit that, we will continue to have inequities in our society. And this is a, when I talk, I'm not going to get into this, but this is a framework that you can think about in terms of how historical and current deprivations and oppression leads to embedded racial inequality then leads to communities having no choice. Dayton, Ohio has 75,000 people within the city limits and one grocery store. One grocery store. But they have every fast food chain you can think of. Every fast food chain you can think of. But they can't put grocery stores. Of course, dollar general is taking over that space. So you can get all the processed foods you want on every corner because dollar general is serving cheap processed food which is within a half a mile of it. In Dayton, within a half a mile of wherever you are in that city, here's a dollar general. But dollar general doesn't have fresh foods. Dollar general doesn't have fresh meats. Dollar general just has processed foods. What did I do? Okay, I'm gonna get control of my motions. Not. Most racial inequalities is due to institutional discrimination. So when we talk, that's the only way I can look at that. And the law, this is an example. I said we were talking last night, we were talking about income and tax and I love tax law. I never got around to teaching it because I think tax law is an amazing example of the value system of an American society. There is no way to understand the tax code except in the values that it represents. Once you start saying why do businessmen get to deduct all of their lunches and why do you do not get to deduct your childcare, you begin to say, hmm, what do we value? Okay, and so wealth and income, the tax code, predatory lending, pre-day lending, sub-time mortgages, all these things that went fairly unregulated and disproportionately impacting black communities is because of the values. So I wanna say that anti-discrimination law isn't inadequate and I'm gonna go, I'm just gonna briefly say that the Patient Protection Act notwithstanding my friend Sidney's glowing over-representation of what it will do. The Section 1157 is little different from Title VI on its face. I think there are plenty of people who are hoping that when it gets to court, it will be interpreted in a way that allows all the things she says. But on its face, it doesn't allow that. And I don't have the luxury of thinking that a conservative white, mostly white court is going to suddenly say, oh, we've spent years interpreting Title VI in a way that limits race. And then now we're gonna get to this new law and even though the new law says connects it to Title VI, we're suddenly going to ignore all of the language of Title VI. So I don't think Patient Protection Act provides anything new. So when I think about distinguishing stereotype biases and prejudices, we have to look at the colorblind races who thinks they have no stereotype biases and prejudices but discriminate. And that's most of the institutional racism. And I wanted to get to this in terms of saying, I taught criminal law and tort law and discrimination law. And one of these areas are all areas where injuries occur. There are areas of law that are intended to protect people from injuries. Why then does criminal law and tort law allow litigation from everything, from intentional conduct, to we don't care what your state of mind was if you do ex-you responsible, period. But discrimination law is limited to a very narrow intentional definition. My answer is because in criminal law and tort law, the people who make the law saw themselves as potential victims. And they wanted to make sure that they and their families as victims would get into court. But in discrimination law, they saw themselves as potential victims of being unjustly accused. And so they wanted to limit the entry to court. So what do I recommend then? How much time I got? What? Oh, good. Okay, thank you. We need to disavow Title VI and realize that no matter how good it was, it is not effective, cannot be made effective. Just like we've had several civil rights act, it is time for a new civil rights act. Title VI, blessed so, needs to be laid to rest. And we need to have a law of law that recognize multiple forms of discrimination. Intentional, reckless, and negligent. We need to authorize medical testers and testers of other systems. We need to allow for individual and organizational right of action. That is one of the biggest problems into getting into court is the fact that there has to be an individual who has identified themselves as being discriminated against and injured. Why can't we authorize civil rights organizations to go into court to be private attorney generals to enforce the law against institutions? Why do they have to seek out an individual when they got the data? Why can't they just go into court? You know, and so we need to authorize that. I'm not gonna go through the rest of this because it'll be in my article. I want to kind, we need punitive damages. Don't let anybody tell you punitive damages is unfair. The only way organizations and institutional changes their behavior is when it costs them more in court than what they can predict. And they can predict non punitive damages. And that's how come they, they're quite happy to pay fines and settle because it's all very predictable. But punitive damages is not so much. Okay, I want to kind of end with this. I put to, my great grandfather was a slave, vanless Rand in Texas. And his wife, Narcissus, died from lack of healthcare during slavery. My grandfather, born right after slavery. And my grandmother, my grandmother died. And when my dad was 11 years old from lack of healthcare. My family lived through Jim Crow. I lived through Jim Crow. I went to two-room schools. I picked cotton. I used the bathroom on the side of the road because you couldn't stop at the toilets. When we traveled, we packed food because we knew there wasn't a restaurant we could go to. My school didn't integrate until the year after I graduated from high school. My mother, my mother died in 1957. Born in Black Woman's Ward in the Philadelphia hospital. My dad almost got killed by a white man who stuck a gun in his face because my dad drunk called his wife, honey, the white woman. My uncle, I was in the car. And my uncle pleaded, don't kill him. They just lost their mother. And what makes me really sad is not that history, but the realization that a new system of oppression has formed for my grandkids where people can walk up with guns and shoot them, where they can be put into jail because they're walking while black, because there's all kinds of legal oppressions that go with that felony conviction because they're inequities that can only be called the new American apartheid. And so I'm leaving you with this. The problem is that there is a new system of oppression around race. And if you work on only one part, healthcare, that would be like working on better healthcare for the slaves. That would be like working on better healthcare for people doing Jim Crow. Very good idea. And yes, you're going to help some people. But if you don't dismantle the system, all you're doing is enabling it. Thank you. My selves, you guys can take a moment to gather yourselves, but if anybody has questions, this is the time and the opportunity to ask our panelists anything. I'll see you in the back. Do I need this mic? Yes, it seems that we're at a paradox in terms of intervention. We've talked about patient relationships with physicians yesterday. We've talked about dismantling the system. And then we've talked about the issues around Title VI and intervention within that. What is actually going to take place is, I must round to indicated that it seems that we have reinvented or reimagining some form of Jim Crow. So my question is relevant to the issues around the inequities in medical work. What are we operating again in a band-aid approach or are these inequities are inevitable? And what is, and I also find that within the arena of law, school, that there's an issue around careerism. Young public interest advocate from St. Louis yesterday and the kid that when she was a young lawyer, that she, her ability was to want to litigate against these issues. It appears that today, when I interact or interface with law students, that it's more about other forms of career and not litigating it within the public interest spirit. Could you answer those two questions in terms of replication of a new apartheid and the tandem of a law student or within the activist community or activist law student? I teach race and racism in American law and one of the things that I learned from all these years of teaching is that systems of oppression happens one law at a time. And at some point people wake up and realize that the system of oppression is there. Slavery didn't start by a law that put all black people into slavery. It started by extending the indentured servant's contracts who broke a law and then they made laws that made children have the status of the women of their mothers. It's just one law on top of one law on top of another law. Jim Crow was the same way. The Jim Crow was layered laws fairly quickly. And what, and I guess what makes me feel so bad is that I was of the generation, if you look at my chart, I don't know if it's still up, but if you look at the chart, I benefited from, I went through sort of a reconstruction period after Jim Crow and benefited from that. But during almost from 1980 on, there has been law after law passed to put in a system, a new system of oppression and people, and so yes, I'm rambling. Yes, I think we have, we have a done deal. This is, you cannot think as, oh okay, we've got time to change it. No, you have a system of, we have a system of oppression in place and they're just making it worse now. And I think that the only way short of revolution, which would be a good way, and I'm not kidding, I think that short of a law that really makes all forms of racial discrimination illegal so that individual people will again begin because people don't like to be sued. And so if they have to become legally responsible for racial inequities caused by unintentional conduct, they will start putting in place systems of monitoring so that they will know. Right now, someone said, lawyers have taught people how to get around the title six. And how to get around it is just have some other reason for your behavior that you can articulate and people will let you do it. If we move to a system where the discrimination itself is an unacceptable period, regardless of your other reason, then people will begin to pay attention and stop discriminating. They'll find other ways to make money. The same question that I had. I'm sorry, sir, can we only have time for one more question so if anybody else has another one, if not, we'll come back to you. But does anyone else have another question? I see a hand here, right behind you. Hi, I'm Michelle Van Ryan. And first, I want to say this fabulous panel, really inspiring, all the talks. So thank you for that. What you just said about implicit, that if people are responsible and if institutions are responsible for the impact of implicit bias, then action will be taken. I just, I resonate to that, I do. And when I try to talk about it, so I work within a system in a hearts and mind way, right? So, and I was talking to my colleague, Kristen here, about being inside a medical care system and trying to hearts and minds people into change. And I keep waiting for the negligent laws, right? Where's the negligence laws? We know it's happening. We know it's creating tremendous morbidity and mortality. And what I keep coming against is, show me the individual who can sue. So, I was so excited as a healthcare person to get invited to this because I was like, okay, because from this hearts and minds thing, it's not working out real well. So, sometimes what I do, and I have a... That unintentionally, there's a group of people discriminating against them. Not them, me too, right? You think about it that way, don't you think there needs things put into place and monitor and correct? No. No. I think the fact of the matter is over the last 50 years, I've seen study after study reporting in the news and every time it's getting reported, white people go, oh my God, I can't believe that's happening. No, I'm saying it was happening to white people. If there was unintentional bias against white people. Yeah, but the problem is that the systems are not run. Okay. I mean, I think that if you... I don't think that implicit bias is the sole thing of white people, okay? No, obviously. Black people have implicit bias, 40% of black people don't like black people, okay? But black people don't run systems. And so, if you're talking about the systems in which all this is occurring, we have to talk about white people. I mean, yeah, implicit. And so the problem is is I think if you could show that white people were being implicitly biased against by white people it'd probably be resonated, but I'm not sure how you would show that when white people are benefiting from implicit bias, not being disadvantaged by it. Yeah, I'm talking about the will. The will to make the change. Just we have to reflect our structures. I'm so, I'm agreeing with you on that. Yeah, I understand. And I think the will to make the change is why I'm on for the law. I was a nurse for 20 years before I went into law school and I believe in law-changing behavior because I believe people obey stupid laws and they obey them without thinking about it. And because we are a people who like to obey the law, we will obey laws that we disagree with. So it seems to me that the will to change will come from a law that says you can't do that, they'll be pissed. But they will implement ways to make sure that it's not happening. I'm having to rate that law. That's a good point. Can I just say that I do not see the environment in which there is going to be fundamental legal change. I don't see it coming from the federal courts. I think there are very few states that in fact have judiciary that will experiment with progressive solutions. I do not see it coming from, I think that our politics right now is so frozen because of money. I just don't see, except for local change, some at the state level and some with municipalities, I do not see that we have any possibility either using the courts or Congress to get any kind of laws passed that would make this possible. I mean, perhaps that will change in decades to come, but right now, I do not see that we have a political climate in which any of this is even discussable, much less able to come to a vote. All right, and that's where we will begin.