The Truths We Hold: An American Journey

Chapter 7 primarily focuses on the American healthcare system, its shortcomings, and Harris’s personal experiences with her mother’s cancer diagnosis and treatment. The chapter begins with Harris recounting the moment her mother informed her and her sister about her colon cancer diagnosis in 2008.

Harris then delves into a comprehensive critique of the US healthcare system, highlighting its high costs and poor outcomes compared to other advanced economies. She discusses issues such as rising premiums, expensive prescription drugs, and the financial burden of medical bills on American families. The chapter emphasizes disparities in healthcare access and outcomes, particularly for marginalized communities and people of color.

She alsos explores the impact of the Affordable Care Act (ACA), and the Republican efforts to repeal it. She argues that repealing the ACA would result in millions losing health insurance and allow insurance companies to deny coverage based on pre-existing conditions. Harris advocates for Medicare for All as a solution to many of the healthcare system’s problems.

Harris also extensively addresses racial disparities in healthcare, presenting statistics on mortality rates and life expectancy gaps between Black and white Americans. The chapter highlights that Black infants face double the mortality rate of white infants, and Black women are three times more likely to die from pregnancy-related complications. Harris attributes these disparities to factors including historical discrimination, toxic stress in low-income neighborhoods, and unequal treatment in medical settings. She emphasizes the role of implicit bias, citing research showing that 75% of people—regardless of race—demonstrate an unconscious preference for white people. To combat these issues, Harris proposes mandatory implicit bias training for medical students and calls for increased diversity in the medical profession, noting that as of 2013, only 9% of US physicians were non-white. She uses examples such as famed tennis player Serena Williams’s post-pregnancy complications to illustrate how racial bias in healthcare affects even high-profile individuals, underscoring the pervasive nature of the problem.

The opioid crisis is another significant topic in the chapter. Harris outlines the history of the epidemic, criticizing pharmaceutical companies and government policies that contributed to its escalation. She highlights how pharmaceutical companies flooded communities with opioids, citing that between 2007 and 2012, three major drug distributors made $17 billion by saturating West Virginia with these drugs. Harris criticizes the federal government's inadequate response, pointing out that when the administration declared the opioid crisis a public health emergency in 2017, the fund used to address it contained only $57,000. She proposes several measures to address the crisis, including declaring a national state of emergency and treating substance use disorders as a public health issue rather than a criminal justice matter. She advocates for a comprehensive approach, including providing access to medication-assisted treatment, creating federal standards for substance use disorder treatment, and reinstating the DEA’s authority to pursue pharmaceutical manufacturers and distributors.

Throughout the chapter, Harris interweaves personal anecdotes about her mother’s illness with policy discussions. She describes the emotional journey of caring for her mother, including the difficulty of accepting her mother’s impending death. Harris shares her personal challenges with coordinating her mother’s care and navigating the healthcare system. She proposes the idea of patient advocates to help individuals and families dealing with serious illnesses. The chapter concludes with Harris recounting her mother’s final days and passing. She reflects on her mother’s lasting impact and expresses her deep love and admiration for her, emphasizing how her mother’s influence continues to shape her life and work.

Chapter 8 focuses on the cost-of-living crisis in America and its impact on the middle class. Harris discusses the fact that many working families struggle to make ends meet, despite holding full-time jobs. She highlights issues such as the high cost of healthcare, childcare, and housing.

The chapter emphasizes that for many, the American Dream has become increasingly unattainable. Harris references historical events, such as Dr. Martin Luther King Jr.’s support for the Memphis sanitation workers’ strike in 1968, to illustrate the ongoing fight for dignity in work and fair compensation. Harris points out that, adjusted for inflation, the federal minimum wage is lower now than it was in 1968 and shares examples of letters she receives from constituents, detailing their financial hardships. These stories illustrate the widespread nature of the cost-of-living crisis and its impact on families across the country. Harris emphasizes that many Americans are living paycheck to paycheck, unable to afford unexpected expenses.

Harris proposes several solutions to address economic issues, including her LIFT Middle Class Act. This legislation would create a new middle-class tax credit providing eligible families with up to $6,000 annually, or $500 per month. Families could receive this credit as a monthly stipend rather than waiting for a year-end refund. Harris frames this as a different kind of safety net, aimed at preventing hardworking people from falling out of the middle class or helping them attain it. She also emphasizes the need for affordable housing, noting that in cities like Denver and Phoenix, less than 1% of homes on the market are affordable on an average teacher’s salary.

Harris addresses the gender pay gap, noting that women earn on average $0.80 for every dollar earned by men. This disparity is even more pronounced for women of color, with Black women earning $0.63 and Latinas earning just $0.54 for every dollar earned by white men. Harris provides specific figures to illustrate the impact: A Black woman working full-time, year-round, earns over $21,000 less annually than her white male counterpart (221). She argues that this wage gap affects not just the individual women, but their entire households, perpetuating broader economic inequalities.

The chapter traces the historical context of the current economic situation, discussing how the relationship between productivity and wages changed significantly in the 1970s and 1980s. In the three decades following World War II, productivity improved by 97%, with workers’ wages growing by 90%. However, this changed dramatically in subsequent decades. Between 1973 and 2013, while productivity improved by 74%, worker compensation rose by just 9%. Harris critiques the shift toward prioritizing shareholder value over worker compensation, exemplified by the Reagan administration’s economic policies, which included tax cuts for corporations and shareholders, opposition to minimum wage increases, dismantling of organized labor, and reduced government oversight.

Harris addresses the impact of the Great Recession, the rise of predatory for-profit colleges, and corporate practices such as stock buybacks. She describes how the recession led to job losses and communities becoming “ghost towns.” Harris shares her experience as Attorney General of California, taking on Corinthian Colleges Inc., a for-profit college that targeted vulnerable individuals with false promises of education and job placement. She also criticizes the practice of stock buybacks, noting that between 2003 and 2012, S&P 500 companies spent 91% of their earnings on buybacks and dividends for shareholders, leaving only 9% for investments in areas like research and development or workers’ wages. Harris argues that these factors have contributed to the erosion of the middle class and the concentration of wealth, with the richest 1% of American households now owning 40% of the nation’s wealth.

Harris discusses future challenges, including automation’s potential impact on jobs and the economic consequences of climate change. She cites research suggesting that automation could displace 2.5 million jobs annually in the short term, with industries like trucking potentially losing millions of jobs to self-driving vehicles. Regarding climate change, Harris notes the economic toll of extreme weather events, citing $300 billion in damage caused by such events in 2017 alone. She emphasizes the urgency of addressing these issues and proposes solutions such as investing in post-high school education and making debt-free college a reality. Harris argues that education beyond high school is no longer optional, and public education funding should not stop after high school. She also advocates for rebuilding the nation’s infrastructure, including roads, bridges, broadband internet in rural areas, and renewable energy projects.

Harris advocates for the importance of organized labor, arguing for a rebirth of unions to protect workers’ rights and improve wages and benefits. She notes that less than 7% of the private workforce is currently represented by unions, and recent Supreme Court rulings are likely to further reduce public sector union membership. Despite this, Harris argues against accepting the demise of the labor movement, emphasizing unions’ role in lobbying for workers’ interests and compelling management to provide better wages and benefits. She also calls for tax reform, suggesting that large corporations and wealthy individuals should pay their fair share to support economic improvements. Harris frames this as both a moral imperative and a practical necessity for fixing the economy and addressing the challenges facing the country.