The Healthcare Policy Podcast ® Produced by David Introcaso

At least one in four girls suffers childhood sexual abuse. For example, the Department of Justice (DoJ) concluded Jeffery Epstein trafficked over 1,000 girls, some as young as 14. Nevertheless, six years after Epstein’s reported suicide, the Trump Administration’s 2026 budget proposes to entirely delete a subsection of federal law that requires DoJ’s Office of Violence Against Women to be “a separate and distinct office” and proposes to cut the Office of Violence Against Women’s budget by nearly 30%. Per the CDC’s Adverse Childhood Experiences (ACEs) study, launched over 25 yrs ago, at least 1 in 4 girls and 1 in 20 boys are sexually abused. Among numerous other sobering stats, ACEs-related health consequences cost the US an estimated $14.1 trillion dollars annually in direct medical spending and lost healthy-life years. Dr. Frank Putnam, a child and adolescent psychiatrist at the U. of North Carolina’s Medical School who has spent his 35-year professional life investigating the effects of childhood sexual abuse on child development and adult outcomes, has recently completed “Old Before their Time” an autobiographical account of his research work and findings. In Dr. van der Klok’s introduction to the book, he states childhood sexual abuse “embeds itself in a child’s mind, body and behavior and is expressed across generations.” Deterrence “is the most powerful target for the prevention of mental illness and for reducing premature death from common illnesses.”Information regarding “Old Before Their Time” is at: https://www.amazon.com/Old-Before-Their-Time-Investigating/dp/1032974826. Dr. Frank Putman’s bio is at: https://www.med.unc.edu/psych/people/frank-w-putnam-md/. 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 US has effectively always suffered a physician shortage. Last year the AMA estimated a shortage of 86,000 by 2035. US policymakers have since 1965 addressed this problem by recruiting foreign born physicians (termed Foreign Medical Graduates or FMGs), mostly from Southeast Asia, largely India. Today FMEs, that account for 25-30% of the physician workforce, are disproportionately employed in Health Professional Shortage Areas or HPSAs in which there remains or persists a strong demand, e.g., HRSA recognizes over 7,500 primary care HPSAs. Nevertheless, Prof. Alam concludes stratifying our medical system can be interpreted in part as a cover up to a problem of long-term disinvestment in rural healthcare and minority health. Simply growing the work force has had, Prof Alam argues, both a minimal impact on the equitable distribution of US healthcare resources while intensifying global health inequalities resulting from substantial brain drain.Information about Prof. Alam’s book is at: https://www.press.jhu.edu/books/title/53838/care-foreigners?srsltid=AfmBOopgVAOX_1s9S7NaIMoKsXgrUS2htC4_HaE0zTYDrfQJltnIpRK7. 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

Over roughly the past year Prof. Blumberg and her Georgetown Center for Health Insurance Reform (CHIR) colleagues have been researching healthcare providers and payers increasing use of third-party entities they collectively termed “middlemen” with whom providers and payers contract to provide various supportive administrative or financial services. For example, payers frequently use of Third Party Administrators/TPAs and providers of Revenue Cycle Managers/RCMs. The use of middlemen is a problem because these entities are “rent seeking,” meaning they profit without creating new or additional value, thereby reducing economic efficiency and competition and driving prices up. In CHIR’s October report titled, The Complex Web of HC Fin Interests & Their Implication for Even Higher Spending,” Prof. Blumberg and her colleagues concluded relationships with middlemen have “resulted in a complex web of cost increasing incentives, money flows, and conflicts of interest. The complexity is so tremendous that it is virtually impossible to capture the entire picture of the existing financial relationships.” (Listeners may recall interviewed Leigh’s Prof. Katz-Olson in March 2022 regarding her related work, “Ethically Challenged, PE Storms US Health Care.” CHIR writings discussed during this interview include:https://chir.georgetown.edu/events/why-health-care-costs-are-rising-the-role-of-corporatization-and-bipartisan-solutions-to-increase-affordability/https://chir.georgetown.edu/events/why-health-care-costs-are-rising-the-role-of-corporatization-and-bipartisan-solutions-to-increase-affordability/https://chir.georgetown.edu/evidence-on-private-equity-suggests-that-containing-costs-and-improving-outcomes-may-go-hand-in-hand/https://chir.georgetown.edu/third-party-administrators-the-middlemen-of-self-funded-health-insurance/https://chir.georgetown.edu/independent-dispute-resolution-process-2024-data-high-volume-more-provider-wins/CHIR’s publication page is at: https://chir.georgetown.edu/search/?filter=publications 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

Even though PC is the only component of healthcare shown to increase life expectancy and is crucial to achieving healthcare equity, outcomes, quality and value PC remains on life support. For example, an August National Academy of Medicine report concluded, “despite PC’s essential value for the health of the nation, more than 100 million people across rural and urban communities in the US are experiencing a calamitous lack of access to primary care.” Among numerous problems: PC accounts for less than 5% of total healthcare spending; there are too few primary care clinicians and too many, at 7,501, HRSA PC shortage areas; PC clinicians are inadequately reimbursed and maldistributed. Consequently, PC struggles to adequately address prevention, the social determinants of health, integrate care particularly behavioral health services and ultimately achieve optimal value. In “Wonderful and Broken,” Prof. Brennan discusses how PC care can be improved and organizations that are at least on the path toward stable and effective PC delivery. (Listeners may recall I interviewed Prof. Brennan in October 2024 regarding his just published previous work, “The Transformation of American Health Insurance” & that this is at least my 5th PC discussion dating back to 2013.)Information on Prof Brennan’s book is found at: https://www.press.jhu.edu/books/title/54051/wonderful-and-broken?srsltid=AfmBOor4SJMCBvCYWck_6Aobdxk-ZUJgusnceOxxT-eghoU8CkPc3kMl. 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

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