Your Voice is All it Takes to Make a Doctor’s Visit Available to Texas’s Uninsured

Dorothy: [00:00:00] Why would any state as big and as wealthy as Texas have the worst health care for its poorest citizens? And what would it take to make a doctor’s visit available to every person? Listen to this woman who has changed minds and made history and will tell you what you can do to do the same.

Let’s Talk About Your Breasts. A different kind of podcast presented to you by The Rose. The Breast Center of Excellence and a Texas treasure. You’re going to hear frank discussions about tough topics. And you’re going to learn why knowing about your breast could save your life. Join us as we hear another story and we answer those tough questions.

Hi, I’m Dorothy Gibbons, and I’m the CEO and co founder of The Rose. And we’re here today to talk about your breast. And our guest today is Elena Marks. She is one [00:01:00] phenomenal woman. And I know as we continue in our discussion, you’re going to hear some things that you may, may not know about her, we hope. And, uh, just welcome Elena.

Thank you for joining us.

Elena: Thanks so much for inviting me.

Dorothy: So Elena, I know you’re not going to remember this, but the first time I ever heard you talk was at a Catherine Stream awards ceremony. And you were our guest speaker. You were the person and you actually broached the subject of the limited amount of Medicaid for women in Texas.

I was stunned. Nobody wanted to talk about that back then. So, has this healthcare, the issues and the difficulty and, and, getting health, and I know health care is not health, but getting that, has that always been an interest of yours?

Elena: I think I’ve always had an interest in social justice, and an understanding [00:02:00] that everybody didn’t start from the same place, and that everything wasn’t fair. And I wound up working in the health space, uh, really kind of accidentally by doing some volunteer work, legal work for Planned Parenthood. So that was my first introduction to the women’s health space. And that was such an, an easy entree to working on what for me were social justice issues if I had somehow fallen into education or housing. I think I might have done the same kind of work. Trying to seek the same outcomes, but I could have done it in a different field, but I really accidentally wound up in in the world of health and health care.

Dorothy: Oh how interesting and and you have as president and CEO of the Episcopal Health Foundation, you have made incredible strides and and [00:03:00] I guess, you know, some people say you’re revolutionary. I mean the very idea of telling us that health care isn’t health and in helping us to understand and I say us, I mean everyone, uh, get past that thing of there’s a lot more to being healthy than there is just having health care. And I think was that that was coming from you, that was an original.

Elena: I don’t know that it’s an original. My training, my educational training is in the area of public health. Which when I went to school to get a master’s in public health, I didn’t understand that public health was its own field and that what it really attends to is the health of populations, your city, your state, your county, your country.

And I thought it meant publicly funded health care. And so I learned about the field of public health Uh, and that its focus is on upstream [00:04:00] prevention and making sure that people have the things they need in order to live a healthy life and access to health care and medical services is one of those things. It’s a really important thing but it’s actually only 20 percent of what leads to your health outcomes and your health status, um. But so much of our system is geared around healthcare, where people use the terms healthcare and health interchangeably, that the earliest work I did in this space really was about access to healthcare.

Now it was access to preventive care and primary care as opposed to hospital care. Uh, and I still spend a lot of time on access to basic preventive and primary care services. Um, but that’s where I started doing my work. And although I understood the [00:05:00] limitations of health care in delivering health, there was such a deep, birth of opportunity for low income people to access preventive care, the kinds of screening services that The Rose offers, um, that there was a lot of work to be done in that space. So I really did start out in the access to healthcare space and over time moved myself upstream.

Dorothy: Ah. That’s so interesting. Give us an example of this upstream thinking.

Elena: Well, it’s it’s the idea that um, If we help people live a healthy life you live in a uh, uh, housing that is safe and affordable. It doesn’t have mold, it doesn’t have pests, which cause, uh, asthma and all sorts of other respiratory and skin diseases. Um, then you won’t need a certain kind of healthcare because you’ll have avoided that. [00:06:00] If you live in an area that has a lot of, uh, air pollution, Then you are also exposed to conditions that are going to impact your health If you don’t have access to healthy food because you can’t afford it. You’re working two jobs. There’s not a an affordable Whole Foods in your neighborhood, the opportunity for you to have the kind of diet that will Uh, reduce the risk for diabetes and hypertension and help you control those conditions if you do end up developing them, you just don’t have that. And so we, um, spend so much of our emotional attention in this country and virtually all of our health resources dealing with really sick people.

We spend a lot of money on things like, um, amputating limbs from diabetics, as opposed to preventing people from [00:07:00] developing type 2 diabetes in the first place, or managing the chronic condition so that it doesn’t get worse and worse and worse. And, and the solution to most of those problems lie not in the doctor’s office, but in the community, in the conditions in which people live.

And the more I, I guess the farther I got in creating access to health care, um, the more I saw, okay, that’s really great that people get to go to a clinic, but by the time they get there, sometimes they’re already sicker than they should have been. And the clinic can do wonderful things to provide them screening and diagnostic capabilities and medicines. But they may have intervene too late to actually prevent something from happening to a person.

Dorothy: And so many [00:08:00] times, especially in our, in our underserved populations, there’s not even that knowledge that there are different ways of doing it. It’s just the way it always was. It’s not going to change. So I, I think that thinking that we can change environments can, could be huge.

Elena: Yes. And it’s not a secret. I mean, when you, when you start talking to people, if you show them the diagrams that those of us in the field use that show the drivers of health, um, and what their percentage contribution is, and you see how little medical care is, and you see how much, um, more important things like income, and racism, and safety, and all of these non medical factors— No one ever says, well, that can’t be true.

Everyone says, well, of course that’s true. The, the problem that, that I see and what we’ve been working at Episcopal Health Foundation to [00:09:00] rectify is that we’re still spending all of our money way downstream on acute care when people are really, really sick and we’re not moving the money upstream as quickly as we could and as, as I think we should.

Dorothy: Well, the Episcopal Health Foundation has certainly moved that needle quite a bit, but we’re going to need more help than that.

Elena: Yes, and what we’ve really tried to do and I think our greatest success or what I’m most proud of is that we’ve changed the conversation so that we’re no longer just talking about health care as if that is health. And once you change the conversation, you open people’s minds to the possibility of spending resources differently. And it’s not really a radical idea. There are many other western developed countries that spend a fraction of what we do on health care and spend more [00:10:00] than we do but on social services and other investments in humans and their communities things like. Um parental leave, uh, and, uh, and other things that make it easier for people to live healthy lives and raise children in a healthy environment.

Um, they do this in a way that produces better health outcomes than we have. The U. S. ranks really low among wealthy, western developed nations in terms of our health outcomes and yet we are spending twice as much as other countries and we spend that money on acute medical care and, and our thesis is we’re spending it in the wrong places. If we could move some of those dollars to, um, prevention, including community prevention, then we would have a healthier population. And at the same time, we might be able to reduce some of those [00:11:00] spiraling health care costs.

Dorothy: My goodness, that would be incredible. I know we’ve had several, uh, guests that have talked about the importance of like food, nutrition, even knowing what, what to have to eat. And, and it’s amazing how little emphasis is really on this is healthy. This is good for you. This is, and you can have access to it, of course. But, and also, another, another theme that you touched on is the, the issues of raising children, of having that space to raise children, of mothers not so burdened with those problems of being single headed, of household, or in a low income area, but actually having that chance to raise their children in the way that would give them that, that start, that, that comfort. Pretty, still, I think that’s all pretty radical, if you, if you think about.

Elena: It. It’s only radical in this country. I [00:12:00] know. It’s not, it’s not radical in a lot of other countries that make space for parents to um, bond with children, to raise children, that provide a lot of resources for very high quality child care from the earliest days of life. It’s not radical. It’s just not done here.

Dorothy: Good point. Good point. Good point. So, you picked the most interesting state to be in. You know, I try real hard not to, um, sound so discouraged at times about our healthcare policies in Texas, but there are many, many ways that it just isn’t favorable to women. There’s, there’s so many areas that we could be really, really moving forward with, but we’re not. Do you, do you have any hope for that?

Elena: I don’t know, Dorothy. I don’t know what it’s going to [00:13:00] take. I see us moving backwards. I’ve watched over the last decade as, um, the, the funding and opportunity for women to get basic reproductive, um, Uh, health care and screening services, including cancer screenings and, uh, mammograms and cervical cancer screenings and watch the state in a political battle, uh, reduce the available funding by hundreds of millions of dollars so that we’ve seen clinics closed, certain politicians can score certain points with their base.

Um, now we’ve seen that abortion is effectively illegal in Texas. And, um, the, the repercussions of that we’re already seeing where women with ectopic pregnancies, are not able to get treated because the doctors are rightfully afraid that they’re going to go to jail, [00:14:00] uh, or pay civil fines or lose their licenses because that’s the message they’re getting from, uh, state leaders. This is the tiniest of silver linings, but if you’re going to remove the right of women to be able to terminate a pregnancy that they don’t want in theory, you’d do a lot of investment around helping women first of all not become pregnant if they don’t want to be pregnant. And second of all have having a healthy pregnancy healthy birth outcomes, and healthy postpartum care, and I’m not seeing that movement. So you, it just seems to me you can’t have it both ways. Well, I guess you can have it both ways, but we, we are moving way backwards in the state, uh, relating to women’s health.

Dorothy: We certainly are, certainly are. The, um, I know you’ve told us many times this is about policy, [00:15:00] this is about really being much broader than we ever thought we needed to be, but— Still going to take some, somehow those policies to be changed. Do you have any one area that you think we could jump in there and work on?

Elena: Well, there’s a possibility that we could at least expand Medicaid postpartum for a year for women. There is a ton of evidence about the value of making it, possible for women who have given birth to be seen in the medical community, uh, for a full year after birth, that the costs and the benefits, um, uh, the, the costs, um, are outweighed by the benefits tremendously.

Dorothy: And right now it’s only—

Elena: Well, it’s, it’s two months and the legislature last year begrudgingly passed, um, uh, a six month, um, expansion. [00:16:00] But, they wrote it in a way that conflicts with federal law and the feds are trying to make it very easy for all states to expand their eligibility postpartum to 12 months. And many other states have taken the feds up on it. You don’t have to go through this cumbersome waiver process. Um, because you’re doing what the federal government is encouraging you to do and they’re paying more than half the cost of it Uh, texas didn’t want to go that route. The the ask for six months with certain limitations has been declined. So far by the federal government Uh, and so we don’t have that extension right now because we are still in post pandemic times. There’s what they call the public health emergency in place and what that has meant, is that, and this is something that started under Trump and has continued under Biden but is expected to end. But what it did [00:17:00] was say that anyone who was enrolled in Medicaid or CHIP meaning, uh, mostly kids disabled people and pregnant women Uh could not be disenrolled while the public health emergency was in place.

So as a practical matter for women who have given birth since 2020 They’re still covered by Medicaid, uh, because the public health emergency, uh, kept them enrolled. Uh, the, the Medicaid rolls in Texas went from about 4 million to almost 5 and a half million people because the state was not allowed to disenroll people.

That is expected to end. And when that happens, the state will go through a process to verify eligibility to determine whether all of these people who are enrolled and have been continuously enrolled can stay enrolled or not. And those of us who [00:18:00] work in the safety net community understand that there’s a great likelihood that a million people will end up being kicked off of Medicaid, uh, or CHIP. And the solution for that is to expand Medicaid the way 38 other states in this country have done.

Dorothy: And I thought last year. Here before what, when the Health Foundation did such an excellent job of explaining why and giving— it it took away all the emotional stuff. This is the economic and the financial and all the other reasons why it makes sense to do this. And I felt like, for once we as as lay people could actually talk about it without getting into uh, we ought to it’s a moral thing, It’s a right thing to do, and that was so helpful but still didn’t move them very far. I know, I know you said we did [00:19:00] something, but—

Elena: We improved things, we got closer to Medicaid expansion in the last session, closer than we’ve ever gotten. There was a bipartisan coalition in the Texas House ready to do a Medicaid expansion. And from what I understand the word came down from the lieutenant governor and the governor that that wasn’t going to happen and if that was pushed other important issues would be jeopardized. And so the financial questions have all been answered in the early years you would hear opponents of Medicaid expansion saying we’re not sure it’ll work and we’re afraid it’s gonna cost too much.

Well, there’s a boatload of evidence now from all the states that have expanded that’s actually profitable for the government. And you create access to health care for people who otherwise don’t have access. Once that data was out last year, we [00:20:00] had the hope that it would take the economic argument off the table, and it did. But that drove it into ideology and once we got to ideology and um elections coming up and um, uh republicans playing to their base who are ideologically opposed to what they often describe as giving people something for nothing. Um, we, we lost the battle because if you look at it from that perspective whether these people deserve subsidized health care and you believe they don’t deserve it, you lose in Texas.

Dorothy: Oh, you lose big time. I so remember the, the Medicaid nightmare for many of our ladies who were on, uh, the state programs, breast and cervical cancer program, and [00:21:00] how they had no understanding that they had to re enroll every six months. Chemotherapy would be stopped midstream. Uh, it was, it was a nightmare and our navigators spent more time helping them to get that through and to remind them and to keep it going than they even had time to work on resources. I mean, we, it was, it was awful. And, and it, You know, even in the Breast and Cervical Cancer Program, which is a program that every state offers, it is, it is backed by, it started with the CDC, it’s backed by the feds, even that, most states are at 250 percent poverty level.

Is Texas? No. 200%. And I just, I just want to, I just want to go screaming, we are one of the few that are at 200%, and the difference in what that means to women who are working, families who are working, you know, it, it just has [00:22:00] such a, a, a total impact on who we can get in. We’ve had women who make 100 more a year, not be able to pass the criteria and that we have to go and depend on our community to help us get pro bono care to get that woman treatment that that is so frustrating and I you know, it’s i’m so glad that that you have kept us going and keeping us encouraged that there might be something at the end of the road. But it is all going to be policy. It’s going to have to change or we’re going to lose too many people.

Elena: Right, we’re going to lose people we don’t need to lose and, and it’s not just the individual, they have families. And if they’re moms and they have kids, what happens to the kids?

Dorothy: Right, right.

Elena: I don’t know who we think we’re doing a favor to. The administrative burdens you described, the state could fix that if they wanted to.

Dorothy: [00:23:00] Yes.

Elena: There are a lot of administrative hurdles in the medicaid program, which i’m more familiar with than the bccp program um. And one of the things actually the legislature did last session was alleviate some of the burden that the state used to enroll people for only six months and then at six months they started requiring monthly check ins and filing of paperwork.

And if you are a low income family doing the very best you can to get your kids to and from school and get yourself to and from a job. And you move more frequently than people who’ve owned a home for years and years, um, you’re likely to slip through the cracks and the only way you find out is when you take your child to the doctor and the doctor discovers that you’re no longer covered.

And the legislature, um, has stopped the state from doing that every single [00:24:00] month, um, and, and that when the public health emergency ends should make a difference, but the state has the authority to make the process more or less cumbersome, and our state often makes the process — all processes extremely cumbersome to enroll and to stay enrolled and that’s in my opinion part of the strategy to keep the costs down.

Dorothy: Yes. Yes. And, uh, this is fact. The number of breast and cervical cancer providers in the state of Texas has dropped. And it’s all because no one can afford to keep that administrative going and it’s just a very expensive program to run. And, and it, I keep thinking this was the one hope we had in that area. Think how many other, you know, areas that women need help. That, I can’t tell you how many times I have someone call, we’ve got ovarian cancer, we’ve got [00:25:00] other kind of cancers, can you help? No. Breast and cervical was it, you know, so.

Elena: Well, and for the women, from what I hear from providers who, try to participate in the Healthy Texas Women program that was supposed to provide, uh, at least reproductive services. It’s so cumbersome that providers don’t really want to participate. Some of the public health departments do. Um, they probably have to. Um, but the state makes it harder than it has to in order for women to find out that they’re eligible to get them enrolled and for providers to get paid for the important services they’re providing.

Dorothy: It is it’s very and it only goes up to the age of 44. So in our world That’s not going to cover, you know, because our, most of our women are 45 and above, not all, but most. So, it’s, [00:26:00] I have, I’ve had that argument thrown at me so many times, you know, where there’s Texas Healthy Women. No, there’s not.

Elena: Not really.

Dorothy: It’s almost like, why are we even calling it that? It makes no sense.

Elena: It makes no sense.

Dorothy: But then, a lot of things about policy and, legislative process and all that make no sense, and most of us just, um, and I, and I have to really thank you for the note you sent me. I was so discouraged. And you said, it’s okay, we’re, we’re moving that rock. And I thought, now, for me, that was a big deal that you reached out anyway, because I think I said that to my Grants Officer. But oh gosh, I was. It was like, we’ve done this, I’ve done this for so many years, going to Austin. And I just—

Elena: It doesn’t have to be this way, that’s the thing that’s so sad. Texas is a very wealthy state. Um, there is [00:27:00] plenty of money to fund this and to fund education and other services that families need to thrive. Kids are our future. If we can’t take care of them, if we can’t raise them properly, our future looks pretty bleak.

Dorothy: So true. So true. We could talk about this for a very long time, but I can, I can feel myself getting, over to the edge, but that’s okay. We, we need to talk about it and we can’t take the easy route because there’s too much depending on it really right now. Too much. What else would you tell us as voters or as advocates or women to to try and approach or do or to help make this change happen?

Elena: Let your voice be heard. Well, first of all vote. Vote. Vote. Vote. Vote. Inform yourself on who the candidates are and what their [00:28:00] positions are if there are groups uh that you trust who put out voter guides or endorsements. You can look at that. The league of women voters usually has a very good guide that explains in a non partisan way uh, what the issues are and candidate positions on various issues. And find candidates whose values and positions align with yours. If you don’t vote, you, and you’re eligible to vote, you are giving up your ability to talk. And legislators listen to people who live in their districts and vote for them. And you can write letters to them. And you’ll get a form letter back as opposed to something warm and cuddly. But they pay attention to the letters and calls and texts and emails that come into their offices because they, they do want to know what their constituents think.

Dorothy: Absolutely. And, and that is [00:29:00] such a good point. We may get a form letter, but somebody’s counting that letter.

Elena: Somebody’s counting it. Same with the phone calls. Somebody’s counting the responses from people who live in that district. If you don’t live in that district, they probably don’t care unless you’re a big check writer. In which case, you probably don’t need to send in your form letter, which is another um sad state of politics. And in our state in particular.

Dorothy: Oh, and I I remember reading somewhere that uh, this right to vote this ability to vote this ability to have a choice I mean the united states is like, you know, we we think that’s we take it for granted and two percent of the whole world even has anything like that. And here we are willing to throw it away, right?

Elena: Yeah.

Dorothy: It just.

Elena: Right. Yeah, not to not go and vote but we also and this is another thing that that I personally, I’m critical of Texas about, uh, Texas is making it [00:30:00] increasingly hard to vote.

Dorothy: True. So true.

Elena: And in other parts of the world, as you see democracy opening and growing, the idea is you make it easier for people to vote. Now, people ought to be legally registered to vote. I have no qualms about that, but making it so that there are fewer opportunities for people to vote, particularly older people who now don’t automatically get a mail-in ballot for disabled people, for whom going to the polls can be quite an ordeal, for people working three jobs. It’s really hard. It can be hard to vote. And we ought to be making it easier for everyone to vote, not harder for anyone to vote. And you can do that and at the same time have integrity in your voter rolls so that the people who are voting actually are legally entitled to vote.

Dorothy: I remember one of the best suggestions I ever heard from a group of young people was, [00:31:00] This ought to be a national holiday. The day that we need to go vote ought to be where we can, we can go and it’s, it’s, I don’t know how they worded it, but it’s like it’s so important that we need to have that time to go and we need to not have to worry that we’re going to lose three hours of work.

Elena: Exactly. And we, we give our staff, our staff is allowed to go vote during work hours because we want them to vote. We don’t care who they vote for, how they vote, but participating in our democracy is what keeps it alive.

Dorothy: So true. So true. So let’s let’s talk about Elena in just a moment. I know, I know that my gosh, you’ve you’ve written so much you’ve lectured so much you you’re such a wealth of knowledge on everything to do with health care and health access and and turning turning the tide in this ability to stay healthy, especially in Texas, but [00:32:00] you’re coming to the end of a an incredible career as President and CEO of Episcopal Health Foundation. And, I know you’ve received thousands of awards, but the most recent one was the, uh, Texas Primary Care Consortium’s Primary Care Champion.

Elena: Oh, that was a great one.

Dorothy: It’s a great one.

Elena: Close to my heart.

Dorothy: Yes, because you’ve done so much work in that primary care space. And that is an area that we’re so lacking.

Elena: Yes.

Dorothy: Yes. Uh, in fact, we, even with what we do, we can’t find the doctors that can give that overall health care, especially to our low income women. And, uh, that’s, that’s been such a challenge. We have women come in and, and many of, several of our doctors have said, we’re the first doctor they’ve seen in five years. Our first doctor they’ve seen since they gave birth. And so they want to talk to us about their other problems. And yet when we, [00:33:00] you know, they don’t know where to go, they don’t have that access. And if we had more primary care, it would be so different. And especially the rural communities. And I, I, I want to get back to the other, but, you know, when the Episcopal Health Foundation came along and said, we’re going to really pay attention to those rural communities, that’s what opened up our whole mobile mammography program.

We finally had, had a partner that would help us get into those communities. And so many times, you know, the, the poverty that we see here, we can go through certain neighborhoods and we go, okay, this must be a poor neighborhood. Poverty in, in the rural area is behind the gate. And you may never know that that family’s in trouble or, because it’s, it’s just a different world.

And to drive an hour and a half to have a mammogram, that isn’t going to happen. So again, I’m so grateful for the, uh, Episcopal Health Foundation for letting us expand in [00:34:00] that way because. Oh my goodness. We’ve taken it so far. It’s been it’s been incredible and Elena, we have just opened up the east texas hub in Lufkin, we have 80 partners waiting for a day.

Elena: I bet. I’m, not at all surprised. And there’s a big cancer center there from one of the hospitals, but uh Guess they’re not serving the people who can’t pay.

Dorothy: Thank you for saying that um There really isn’t easy access for the uninsured. We— there’s just not. And and I think the other thing that that you’ve allowed us to do is to actually partner with the existing clinics or community centers that are there so that they have this more total care for for their women. And we’ve also learned that it’s kind of, it becomes a community thing. People get behind it. It’s a big day. There’s, there’s a celebration when the mobile comes into town. I mean, [00:35:00] and then, and, and that is encouraging because then it becomes, we’re going to take care of our neighbors. We’re going to really, make this happen and that that’s been a uh, incredible incredible boost to us.

Elena: That’s fantastic. But now it’s a boost to us because, you know, we sit in our office in downtown Houston, you guys are the ones out there actually meeting people’s needs. So that’s how we accomplish our goals. It’s through organizations like The Rose.

Dorothy: Yes, and you’ve funded so many so many different programs. But now you’re bringing this to an end.

Elena: Yes

Dorothy: How did you know?

Elena: For me. Not for the organization.

Dorothy: I know. For you. I mean, you’ve, you’ve announced that you’re retiring. Now, I don’t believe that for a minute, but you’ve announced that you’re retiring from that position.

Elena: Yes.

Dorothy: That you brought in Ann Barnes. Wonderful. Dr. Barnes is wonderful. How did you know it was time to make that decision?

Elena: So, I’ve never held a job longer than [00:36:00] six years. So, I will have been at EHF almost nine years, like eight years and ten months. Um, uh, as my tenure comes to a close. Um, And I frankly didn’t know when I started. I would have surprised myself to say, oh, you’ll be there nine years later. I came to, to build it. Uh, I’m the founding CEO. And so I had the great gift of imagining, um, with the board, what we could do and that was creative and fun and exciting and building uh strategic plans building an amazing staff and and developing a body of work And that’s really that’s what I loved was was putting it together and so It’s together. It’s a fantastic organization. It can go on for a really [00:37:00] long time. Even if Ann Barnes weren’t coming in Immediately behind me. I mean, we’re we’re a machine right now. Um And so I felt like it was the organization was strong and stable also our planning cycle uh is such that next year would have been when we would do strategic planning and so it felt like I ought to make way for a new leader to get in in time to learn the organization, and be in a position to lead the next strategic plan. Um, I didn’t want to Uh write a strategic plan and then walk out the door and leave it for someone else to do. And so for for me and for the organization, it just it it felt like the right time.

Dorothy: Did it take long to come to that decision?

Elena: Um, I you know, I came to it several times and then i’d let it go [00:38:00] I mean it didn’t come you know until you say it out loud like to your board. It’s not necessarily real. Um, uh, and I don’t know that I would have done it any sooner, but I shouldn’t have done it any later. I mean, I, in hindsight, the timing is, is for me, is right. Um, and I think for the organization. So, no, I mean, I, I, I feel really good about it.

Dorothy: Yeah, well, we’re so happy for you, but what are, what are your plans now? You’re not really retiring, are you?

Elena: No, I’m not really retiring, but I’m really retiring from having a big full time job that um, was all encompassing the way the foundation has been, in a really positive way, but, um, ready not to have that level of responsibility. So I’ll be back at Rice at the Baker Institute, uh, and [00:39:00] working on a very part time basis, but working on these same issues, um, that this is my passion, it’s become my expertise. And I want to continue pushing on system reform so that we move dollars upstream, so that we are spending money out in the community on preventive care and on primary care, um, much more so than we are today, uh, to, um, uh, delay when people need acute care, we’re all going to need acute care at some point in time. I mean, that it’s inevitable. It’s not, we’re, we’re never going to avoid um, the hospital, pretty much. I mean, there’s occasionally you hear of a person who dies in 103 like that, but there aren’t many of those. Um, and so I, I want to continue to push the system along with others. It’s not my original idea, um, to push the system to invest upstream because that is what is in our interest as a [00:40:00] community.

Dorothy: Well I for one am so glad to hear that. I was afraid, no she can’t be going away. I’m so glad that you’re still going to be involved. It, it’s a, once it becomes your passion, you just, you can’t just walk away from it. I, I understand that it’s um, but it’s still, it’s still a change for you. And you are going to do some traveling, didn’t you?

Talk about that a little bit or are you going straight into something else?

Elena: No, I I’ve got a couple of months until uh, I have to show up at the Baker Institute. I need the break. I’m looking forward to having a little bit of time where i’m not responsible work wise to anyone for anything and that that will feel really good. Um, but I hope to travel more in general. My husband is already retired. My kids are grown. Uh, two of them live in Denver, so i’ve got a ready made place to go visit. Uh, and I just I I want to I want to work on the issues [00:41:00] I care about without all the trappings. I mean, Dorothy you run a large organization, you know, you’re you’ve got people you’ve got dollars. You’ve got responsibilities. And I have loved building it. But I will not miss running it.

I will miss the people because I love our staff I love our board. We were really gifted. I was really gifted to get this board who has been so supportive of everything we’ve done even when it’s pushing the edge. And I just couldn’t have asked for anything more so I will miss all of them. I’ll be able to do enough of the work that I won’t miss the work and then the rest of it the sort of like running an organization. I’m not gonna miss that.

Dorothy: I, I am starting to really appreciate that. But it. But like you said, I’ll know when it is. And and when, you know, you know, i’ve heard that from so many women. But you know part of our society part of [00:42:00] what we have to do as, “older women.” quote quote. Is to make sure that that we do stay active. You know, this is, I, I believe older women are are part of our national treasure right now We have all this information.

Yes, we have all this power from once we have the money to back it up. So, you know if we just go away and do nothing, that’s that’s going to be a huge loss. I I I have really felt this so strongly for so long and heard so many women say. You know, I just, I, I hate to think about not being out there, but they also know there has to be some self care in there.

There has to be some time for themselves and their family. And certainly all of us who have worked when our children were growing up or through teenage years know that, uh, you make a lot of sacrifices to, to work and, and with your family has to make a lot of sacrifices. So. Yeah, well, I’m I’m [00:43:00] really happy for you. It’s that’s going to be great.

Elena: Thanks. I’m looking forward to the next chapter.

Dorothy: So, so what are your dreams for your children?

Elena: Oh. That they’re happy and healthy and surrounded with people they love, who love them.

Dorothy: So isn’t it interesting is that everything’s about that that support that love. That surrounding. We, we seem to have moved off that, “I want them to be successful, I want them to be this, I want them to be that.”

To me, that’s encouraging that we’ve started to embrace that there is more than just work or climbing that ladder for all of us, but especially, wouldn’t it be wonderful if we could leave that kind of world for our grandkids and our kids and.

Elena: Yeah, it would be.

Dorothy: So this is one that you didn’t see, so I’m just going to ask it anyway. Knowing what a practical, down to earth person you are, [00:44:00] if you could be anyone from any time in the world, living or dead, who would, for 24 hours, you don’t have to be them forever, just 24 hours, who would you be?

Elena: For 24 hours so that I just experience a slice of their life, or so that I would do something different?

Dorothy: Either one. Either one.

Elena: I don’t know. I mean, there are so many, you know, probably my mom early in her life before I knew her. I would probably want to see her life up close.

Dorothy: Oh, I love that. Yeah. That is the first time someone has mentioned, has said, my mom. That, that is so true. We don’t know. We really don’t know that woman only as mother.

Elena: Exactly.

Dorothy: We don’t know what was going on with him. That’s beautiful, Elena. Well, any closing words, any words of [00:45:00] encouragement, any marching orders you want to give us as you start this different phase in your life?

Elena: Get in there and fight the good fight. The things that are important to you will happen only if you work for them. Uh, and that includes sustaining them. We are seeing, um, rights being taken away. And if we want a future that’s better than the past you have to keep working at it. Even when you think you’ve won.

Dorothy: So true Thank you for that. Well, this wraps up another Let’s Talk About Your Breasts, and we’ve been with Elena Marks, and she has just been so extraordinary and helping us understand what the difference of health and health care is and what we, as just regular folks can do, to start making some changes that we so need in our state or anywhere. So thank you Elena for being with us. [00:46:00] And until next time. We’ll see you then.

Elena: Thank you.

Post-Credits: Thank you for joining us today on Let’s Talk About Your Breasts. This podcast is produced by Freddy Cruz Creative Works, and brought to you by The Rose. Visit TheRose.org to learn more about our organization. Subscribe to our podcast. Share episodes with friends, and join the conversation on social media using #LetsTalkAboutYourBreasts. We welcome your feedback and suggestions. Consider supporting The Rose. Your gift can make the difference to a person in need. And remember, self care is not selfish, it’s essential.