The Healthcare Policy Podcast ® Produced by David Introcaso

Because healthcare today can be increasingly defined as commodified, expedient, financialized, myopic, reductionist and failing to transcend politics, the question of healthcare’s ethics or the roll ethics plays should play is increasingly begged. For example, last October Health Affairs launched an “Ethics and Health Systems Change” series that to date has simply complained about private equity and corporate medicine, federal immigration and gender care policies and de-professionalization. What fidelity does healthcare have to normative ethics when, for example, 27 million Americans and counting are uninsured, over 100 million lack a primary care provider and over 90 million cannot afford care if they needed today. Dr. Jain, President and CEO of the SCAN Group and SCAN Health Plan, discusses the causes of healthcare’s ethical erosion and how begged ethical issues or questions can be addressed. The two Forbes articles authored by Dr Jain and discussed during this interview are at: https://www.forbes.com/sites/sachinjain/2025/09/22/ethical-erosion-how-good-people-lose-their-way-in-healthcare/ and https://www.forbes.com/sites/sachinjain/2025/01/21/who-me-ethical-erosion-and-the-deafening-silence-of-americas-healthcare-leaders/. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

This past summer CMS, more specifically CMMI, announced a six-year Medicare Part A demonstration that would require hospitals in six states to submit claims for prior authorization (PA) approval by non-medical, CMS-contracted, 3rd party entities using enhanced technologies, i.e., AI, for 17 medical items and services. Private/commercial Medicare or Part C Medicare Advantage plans have for years extensively used PAs though data suggests Medicare Advantage PA use has been excessive, e.g., a very high percentage of PA denials are reversed upon appeal) and widely viewed as a tool to enhance profit taking. CMMI-contracted tech/AI companies will be compensated based on a share the money saved from PAs contractors’ deny though subject to meeting quality criteria. The WISeR demo has attached a fair amount of criticism, e.g., 12 Senate Democrats and 17 House Democrats each wrote letters to HHS/CMMI noting their concerns that include the demo will present patient roadblocks, cause some patients to abandon care, risk denying necessary care, inflict substantial administrative burden on clinicians, perversely incent AI contractors and they argued Americans do not want AI involved in their healthcare decisions. The July 1 Federal Register WISeR notice is at: https://www.govinfo.gov/content/pkg/FR-2025-07-01/pdf/2025-12195.pdf.The CMS/CMMI WISeR website is at: https://www.cms.gov/priorities/innovation/innovation-models/wiser.Liu and Wadhera’s NEJM Perspective essay re: the WISeR demo is at: https://www.nejm.org/doi/abs/10.1056/NEJMp2510451. Don Berwick and Andrea Ducas’s STAT opinion essay re: the WISeR demo is at: https://www.statnews.com/2025/07/25/medicare-advantage-prior-authorization-cms-innovation-center-wiser-project/. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

The World Health Organization (WHO) defines patient safety as “a framework of organized activities to reduce risks, lower the occurrence of avoidable harm, make errors less likely, and minimize their impact when they occur.” Over this past summer the HHS Office of the Inspector General (OIG) published three patient-safety reports. (Since 2008 the OIG has published at least 24 related studies.) One published in July found hospitals failed to capture half of harm events that occurred among hospitalized Medicare patients, few were investigated and even fewer led to hospitals making PS improvements. These findings were sadly unsurprising since the OIG previously found in 2008 that 27% of Medicare patients experienced harm during hospital stays, a decade later, or in 2018, still 25% experienced harm. In an July 24 OIG letter to CMS Administrator, Dr. Mehmet Oz, the OIG noted in part that while CMS and states require hospitals to publicly report just 15 of 94 harm events, hospitals reported only 5 of 15, or 5% of all 94 harm events. HHS has yet to publicly respond to the OIG’s recent reports much less recognize them. Dedicated podcast listeners may recall I’ve previously discussed patient safety in 2015, 2017 and in 2020.A summary of the HHS OIG’s adverse events/patient safety work with a list of its publications can be found at: https://oig.hhs.gov/reports/featured/adverse-events/. Information regarding Mr. Millenson is at: https://millenson.com/.Mr. Millenson’s recent medical errors essay in Forbes is at: https://www.forbes.com/sites/michaelmillenson/2025/09/12/lessons-from-the-medical-error-that-orphaned-a-cabinet-secretary/. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Recently published research by Prof. Wrigley-Field and her colleagues found that between 1980 and 2023 the total number of US excess deaths equaled 14.7 million. Between 2010 and 2023 excess deaths ranged between 120% and 130% higher compared to other HIC (High Income Countries). Possibly more disturbing the authors found US excess deaths were moreover among working-age adults, for example, in 2023 excess deaths among US adults aged 25-44 were 2.6 times higher than in other HIC. That same year excess deaths remarkably made up almost 23% of all deaths and 46% of excess deaths were among people younger than 65 years. The causes of excess deaths since 1980 have on balance largely been the result of preventable cardiometabolic causes and drug overdoses. About these findings, Prof Wrigley-Field’s coauthor, Prof. Jacob Bor, commented, “if the US simply performed at the average of our peers, one out of every two US deaths under 65 years is likely avoidable. Our failure to address this is a national scandal.” Prof. Wrigley-Fields writings discussed during this podcast are at: https://jamanetwork.com/journals/jama-health-forum/fullarticle/2834281https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2829783https://www.annualreviews.org/content/journals/10.1146/annurev-soc-031021-105213 This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

The greatest threat to human health is us. Humans are the only species capable of self-annihilation. For at least the past 30 years it has been acknowledged that the earth is presently experiencing its sixth mass extinction entirely caused by anthropogenic GHG emissions. Per research published in 2023, current generic extinction rates are 35 times higher than expected background rates prevailing in the last million years under the absence of human impacts. Research published in Proceedings, the National Academy of Sciences (PNAS) in 2022 concluded, “There is ample evidence that climate change could be catastrophic. We could enter such “endgames” at even modest levels of warming.” “Facing a future of accelerating climate change while blind to worst-case scenarios is naïve risk management at best and fatally foolish at worst.”Mr. Kellis’s August article (and related podcast), “Why Should Extinction Medicine Be a Specialty?” appears in the recent AMA Journal of Ethics special issue on extinction medicine, at: https://journalofethics.ama-assn.org/issue/existential-health-care-ethicsThe recent SSRN pre-print on extinction medicine is at: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=5109482The recent IPPNW-AMA Journal of Ethics webinar on the ethics of human extinctions: To sign up for the Extinction Medicine Reading Group, a new IPPNW Medical Student Movement initiative that will promote international, intergenerational, and interdisciplinary discussion on writings on the science, ethics, and medicalization of human extinction, go to: https://forms.gle/pLspc5URhu9VcuS37Mr. Kellis can be reached via : www.devinkellis.com This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

On July 23rd the United Nations’ International Court of Justice (ICJ) announced its highly-anticipated climate advisory opinion. The opinion represents a watershed moment because the court ruled states or countries are accountable for contributing to anthropogenic warming or for their GHG emissions. Consequently, the ICJ concluded countries are legally obligated to ensure the climate is protected from GHG emission, if not, countries - and private actors such as healthcare - can be held culpable for failing to do so. Though an advisory opinion the ICJ ruling has significant implications for US healthcare largely because US healthcare annually accounts for a massive amount of GHG emissions at over 600 MMT of CO2e and the federal government has neither enacted legislation nor promulgated regulations that require healthcare mitigate its GHG emissions. Not surprisingly, healthcare has ignored the 2023 UN resolution that requested the ICJ opinion and now the opinion. The ICJ opinion is at: https://www.icj-cij.org/case/187/advisory-opinionsThe Columbia University Sabin Center’s Climate Change Law Blog ICJ symposium writings are at: https://blogs.law.columbia.edu/climatechange/category/blog-series/ This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

The climate crisis is not a tragedy. It’s a crime. The July 4 signing of HR1, is the latest if not the greatest climate crime considering the current state of the earth’s energy imbalance or the ever-increasing amount of atmospheric GHG emissions that trap infrared radiation (heat) causing planetary warming. It’s estimated the OBBBA will over just the next five years add an extra seven billion tons of GHG emissions into the atmosphere - equal to more than one-years’ worth of total annual US carbon emissions. While it had been projected the US would reduce GHG emissions this decade by upwards of 43%, or get close us to a 50-52% reduction to align with the 2015 Paris Accord, the OBBBA will now reduce carbon emissions this decade by just 17%. The legislation rescinds virtually all IRA renewable energy tax credits while further subsidizing fossil fuels. Prof. Jacobson’s considerable contribution to understanding and addressing climate breakdown can be found at: https://web.stanford.edu/group/efmh/jacobson/. Information regarding his most recent book, “No Miracles Needed” (U. of Cambridge Press, 2023), is at: https://web.stanford.edu/group/efmh/jacobson/WWSNoMN/NoMiracles.html. Prof. Jacobson’s LinkeIn page is at: https://www.linkedin.com/in/mark-jacobson-1b58b38/. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Last week’s signing of the OBBBA serves as federal policymakers’ latest reverse Robin Hood effort, or to redistribute wealth from the poor to the rich. Per a February RAND report, over the past 50 years $79 trillion in wealth has been redistributed from the bottom 90% of Americans to the top 1%. The 2017 Trump tax cult left billionaires $6 trillion richer and the OBBBA, otherwise termed the Bill for Billionaires Act, is expected to achieve similar of not greater results largely because the number of billionaires has dramatically increased to nearly 2,000 over the past decade. The legislation is (partially) offset moreover by cutting Medicaid spending by upwards of $1 trillion that is expected to lower Medicaid enrollment by 11 million and cause 17,000 premature deaths annually. SNAP spending will be reduced $300 billion leaving three million even more hungry. The bill will add an estimated 3.8 trillion to the deficit, atop the $8.4 trillion left by the first Trump administration. Financing the deficit that approximates $1 trillion annually represents more than the DoD’s budget or money that could be spent on other things - like healthcare. Largely because of increasingly regressive tax policies and unaffordable healthcare, studies conclude the bottom 60% of US households by income are unable to achieve what is s defined as a "minimal quality of life" or one in which families can afford adequate housing, healthcare, child care and food. See these two related research efforts by Prof. Ferguson, “Political Investments” at: https://www.phenomenalworld.org/interviews/thomas-ferguson/ and Ferguson, et al., “How Much Can the US Congress Resist Political Money?” at: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3593916. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Anthropocentric warming, the greatest threat to human health and survival, disproportionately threatens children. Children pay the greatest climate penalty. Per the World Health Organization, children suffer more than 80% of climate crisis-related injuries, illnesses & deaths being more vulnerable to carbon-polluted air, extreme heat, drought and innumerable other climate-charged disasters and diseases. Nevertheless, the US healthcare accounts for an ever-increasing amount of carbon pollution and refuses to divest in fossil fuels. As for federal policymakers, the White House and Congressional Republicans remain intent on committing ecocide. To the surprise of no one, in late May Our Children’s Trust, on behalf of 22 plaintiffs age 7 to 25, sued President Trump and five administrative offices and departments arguing in part several White House Executive Orders will increase fossil fuel use and dismantle climate research, warnings and response infrastructure. The lead plaintiff in Lighthiser v Trump stated White House policy amounts to a “death sentence for my generation.” The WCC handbook available at: https://www.oikoumene.org/news/wcc-publishes-resource-on-legal-tools-for-climate-justice. The Lighthiser v Trump complaint is at: https://climatecasechart.com/case/lighthiser-v-trump/.Among related discussions, I interviewed the Michael Burger at Columbia University’s Sabin Center for Climate Change Law in May 2020 and again in June 2024 and Andrea Rodgers with Our Children’s Trust this past January. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Frequent listeners of this podcast are well aware healthcare emits an immense amount of carbon pollution at over 600 million metric tons annually. This is substantially due to energy waste or inefficiency. For example, hospitals, that account roughly 35% of the industry’s GHG emissions, loses or forgoes tens billions in annual revenue or explicit and implicit lost opportunity costs. Healthcare pays in several ways for its energy inefficiency. Among other reasons, though one of the world’s most high tech sectors, healthcare still largely consumes electricity produced by burning fossil fuels. Heat-generated electricity is significantly less efficient than use of renewable energy technology that avoids converting heat to electricity or work. Renewable energy is increasingly more price efficient (that explains why 92% of new electricity produced in 2024 was via renewables). Healthcare utilization or demand is increased as a result of healthcare’s carbon pollution and hospitals already face market headwinds, moreover the fact inflation-adjusted payment rates have been stagnant to negative for several years. Information on Eneration can be found at: https://www.eneration.com This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com