In March, thirty-three-year-old Doctors for Bernie cofounder Uma Tadepalli moved home to Durham, North Carolina to practice a model of medicine she’d learned in San Francisco. The model, called Programs of All-Inclusive Care for the Elderly (PACE), “was born in the Cantonese-speaking Chinese community there in the seventies,” she says. “They were seeing older adults in their community failing to thrive in nursing homes, and they thought, ‘There’s gotta be another way.’”
Under the PACE model, older adults live at home with their families and in their communities, but each day they’re transported to a day center where their health needs are also met by medical professionals, from doctors and nurses to physical therapists to recreational therapists. They have all their meals on-site, as well as wraparound services from pharmacy to nutrition. Plus, it’s a social experience, Tadepalli says, “like camp or school.”
Tadepalli is full of enthusiasm for PACE. “Every older adult has a village supporting them,” she says, and “it’s this kind of beautiful, democratic way decisions get made” between patients and an interdisciplinary team of providers. The cherry on top is that PACE is publicly financed through Medicare and Medicaid. She was excited to put it into practice back home in North Carolina. But the timing of Tadepalli’s move couldn’t have been worse. Almost as soon as she arrived in Durham, the coronavirus pandemic was in full swing.
“COVID-19 just lays bare all the dynamics that existed before in an organization or in a system,” Tadepalli says. In the case of her work, there has been a swift and intense breakdown in the PACE model of care and an exacerbation of existing economic and racial inequalities among both patients and health care workers.
It’s these inequalities, in both the medical system and throughout society, that Doctors for Bernie was founded to address. Tadepalli and fellow Democratic Socialists of America (DSA) member Scott Goldberg started the group in November 2019 “to see who would come out of the woodwork, who was riding the Bernie train in health care, and maybe try to start a long-term group because there wasn’t a multi-issue political home for health workers on the Left. It just didn’t exist.”
But now it does exist. After the conclusion of Bernie Sanders’s 2020 presidential run, Doctors for Bernie became the DSA Health Workers Collective, which describes itself as “a political home for all health workers building solidarity across disciplines to collectively fight for a health system that values people (patients and workers) over profits.”
Tadepalli has been convinced of the need for single-payer health care — a comprehensive, universal public health insurance program that covers everything and everyone, funded through progressive taxation and free at the point of service — since she was a medical student in the early years of the Obama administration. “Once I started to learn about single-payer, I made a commitment to myself that if there’s one thing I want to be a part of in my life, it’s making that happen in our country.”
In 2010, Tadepalli did a stint as an organizer for Physicians for a National Health Program (PNHP), which had been organizing for single-payer health care for two decades already. During that time she traveled to Vermont, where there was a state single-payer campaign underway, and met Senator Bernie Sanders, who was one of its biggest proponents. “It was only ten years ago, but single-payer was not on anyone’s radar. It was a no-brainer, but everyone just said it was politically infeasible.” The Vermont single-payer campaign lost, and single-payer remained out of the question until Sanders’s first presidential campaign in 2016, when it was rebranded Medicare for All.
In the decade after her visit to Vermont, Tadepalli ended up working with the Cambridge Health Alliance, where many of the main researchers are founders and members of PNHP. After that she worked in San Francisco, a city with extreme inequality and a large and concentrated homeless population. “That very much politicized me,” she says. It reminded her of the desperate poverty she had witnessed when she went as a child to visit India with her immigrant parents. “Leaving your home and stepping over bodies. It was like, ‘How is this happening?’ It was a capitalist dystopia.”
In search of political answers, Tadepalli went to her first DSA meeting in 2018. “Early on, I read some documents from the DSA Medicare for All campaign that talked about how a path forward for single-payer would involve organizing and strikes specifically in health care industries. And that really stuck with me.” Since then, she’s had an awareness that labor organizing in health care was going to be necessary to transform the health care system.
The culmination of this years-long political development was the creation of Doctors for Bernie during Sanders’s second presidential campaign. “We decided to go with ‘doctors’ because of whatever credibility that lends,” Tadepalli says, “but we explicitly wanted it to be for everybody,” including health care workers who aren’t doctors. Over the course of the campaign, the group grew to more than eight hundred members, about half of whom were attending physicians. A quarter were non-physicians, and a quarter were medical students.
When Sanders ended his campaign, Doctors for Bernie had no intention of disappearing. Instead, it folded into DSA and renamed itself the Health Workers Collective, making a more explicit effort to unite doctors and non-doctors in a group intended for all of those who work in health care.
The group places a strong emphasis on the unique power and leverage that health care workers have in the current system and the need to organize to fully realize that power. In order to win Medicare for All, she says, “workers in health care have to develop a consciousness that they are workers and pivot toward labor organizing.”
In particular, Tadepalli says the goal is to “build solidarity between different types of health workers, and create a sectoral organizing network. We want to move away from craft unionism, where workers are pitted against each other, to industrial unionism, where the workers are all united.” In other words, doctors, nurses, caregivers, pharmacists, technicians, and everybody else who works in health care should be organizing together. “We’re laying a foundation for a renewed anti-austerity labor movement that will drive a third Reconstruction,” says Tadepalli, “and we’re figuring out the role of the largely professional membership of DSA in that mass political project.”
As for the status of the Medicare for All movement in the aftermath of the second and final Bernie Sanders presidential campaign, Tadepalli says the coronavirus pandemic has kept the idea from slipping off the map. In fact, the concurrent public health and economic crises are exposing the deep flaws and fractures in our health care system and the pressing need for a new one. “Millions of people losing their jobs and losing their health insurance is showing people that our employment-based health system doesn’t make sense,” she says. “We need Medicare for All.”