The Healthcare Policy Podcast ® Produced by David Introcaso

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

Due to the federal government’s ongoing failure to effectively address the climate crisis, over 50 subnational entities have been taking increasingly aggressive steps to mitigate carbon pollution. Recently, Vermont (VT) and New York (NY) passed legislation to hold the oil and gas industry financial responsible for extreme weather events supercharged by their greenhouse gas (GHG) emissions. (Eleven other states are presently working to do the same.) The VT law tallies up the financial damage and then determines proportional responsibility; NY identifies in advance a damage amount and then proportionally bills responsible fossil fuel companies. VT and NY’s legislation is based attribution science. Simply explained, the methodology attempts to measure to what extent anthropocentric warming caused by fossil fuel use of specific entities supercharges extreme weather events. Last month, Stanford’s Dr. Christopher Callahan and Dartmouth’s Dr. Justin Makin published, “Carbon Majors and the Scientific Case for Climate Liability in the journal “Nature.” The authors calculated the trillions of dollars in economic losses attributable to the extreme heat caused by emissions from individual companies or carbon majors. For example, emissions attributable to Chevron caused between $791 billion and $3.6 trillion in heat-related losses between 1991 and 2020. Drs. Callahan and Mankin’s April 24 “Nature” article is at: https://www.nature.com/articles/s41586-025-08751-3 (subscription is required).A summary of the article is freely available via “The Guardian,” at: https://www.theguardian.com/environment/2025/may/05/cost-of-emissions-from-five-major-australian-resource-companies-more-than-900bn-study-finds. Info on Dr. Callahan is at: https://profiles.stanford.edu/326897 and for Dr. Mankin, at: https://geography.dartmouth.edu/people/justin-s-mankin. 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

Despite the fact US healthcare has $7.6 trillion market cap and is beyond capital intensive, industry executives have been loathe to divest in fossil fuels. For example, per “The Lancet’s” 2023 and 2024 annual “Countdown on Health and Climate” reports, between 2008 and 2023 of the 1,613 institutions committed to divesting in fossil fuels, only 28 were healthcare institutions and since 2018 only one has committed to doing so. Among numerous other reasons why this is, to be polite, disturbing, if not evil, is because: fossil fuel investments substantially explain healthcare’s massive carbon footprint at over 600 MMT of CO2e annually; anthropocentric warming poses the greatest threat to human health; failure to divest make a mockery of the Hippocratic Oath; and, among other ironies of the 12 S&P 500 economic sectors the energy sector was the worst performer by far since 2010. Information regarding the First Do No Harm campaign, including their sign-on letter, is at: https://firstdonoharm.earth/. 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

US healthcare costs and spending are extreme made evident by the fact healthcare at a $5 trillion annually accounts for roughly half the global healthcare market. This reality led Princeton’s Nobel Prize Economist Angus Deaton to conclude in 2020, “the industry is a cancer at the heart of the economy.” Though healthcare costs are projected to rise 7 to 8%, this year, cost growth over the past 15 plus years plus has not on average exceeded GDP growth - made evident by the fact that while the 2020 Medicare Trustee report concluded the Medicare hospital trust fund would be bankrupt by 2026, the most recent report concluded 2036. Prof. Buntin’s recent writing on the topic, “The Value Zeitgeist, Considering the Slowdown in Healthcare Spending Growth,” coauthored by Harvard’s Ellen Meara and Dartmouth’s Carrie Colla, was published in “The New England Journal of Medicine” on April 12th. Prof Buntin’s recent publications are at: https://hbhi.jhu.edu/expert/melinda-buntin. 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

At present, measles, one of the most contagious communicable diseases for which there is no treatment, disproportionately sickens - and kills - preschoolers. The outbreak is present today in 21 states ranging from Alaska to Vermont. As of last Friday, this year has already seen 607 confirmed cases, 72% of cases were among those age 5 to 19 and 97% of those infected were either unvaccinated or their vaccination status is unknown. For comparison, for five-year period ending in 2024 the average number of annual measles cases equaled 105.The measles, mumps, and rubella (MMR) vaccine is exceptionally effective and when immunization is greater than 95%, herd immunity is achieved. Having previously attained this percent measles was considered officially eliminated in the US in 2000. Achieving measles elimination was considered an historic public health achievement. Today however approximately 40 of states have vaccination rates below 95%. As a result, public health officials, for example in West Texas, expect the outbreak to continue for the remainder of this year, if not beyond.Concerning the federal government’s response this past Sunday when asked about the outbreak , President Trump stated, “It’s so far a fairly small number of people relative to what we’re talking about,” adding, “this is not something new.” Beyond cutting CDC staff and state funding to monitor infection/disease transmission, the White House is withdrawing the US from the World Health Organization (WHO) that in part managed a networks of labs, entirely funded by the US, to track measles cases around the world. HHS Secretary Robert Kennedy, a man with an anti-vaccination history, recently stated the measles vaccine is the “most effective way to prevent the spread” of the disease, however, he continues to frame vaccination as a personal choice and suggest the vaccine can cause just as much harm as the disease itself. Hours after making his “most effective” comment, the Secretary highlighted the work of doctors treating infected children with steroids and an antibiotic. The Secretary has also noted cod liver oil and Vitamin A as treatments. 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 Trump administration has made no secret it intends to aggressively enforce immigration laws, made evident by the recent arrest of a Columbia University grad student and green card holder on Columbia’s campus. Since the White House has repeatedly stated it intends to deport roughly all 12 million undocumented immigrants, this presents an immediate problem for healthcare providers who, in part, have legal and ethical obligations to all their patients. This is particularly true ironically for HHS-regulated Federal Qualified Health Centers (FQHCs) who serve 32 million largely racial/ethnic minorities who, because they are largely poor and medically disenfranchised, are disproportionately in need of healthcare. One day after assuming office in January the acting Department of Homeland Security rescinded decades of prior policy that essentially stated the federal government would not take immigration enforcement action in “protected areas” that included healthcare facilities - and schools like Columbia University. Ms. Smith’s most recent writing on the topic, “ICE in your Healthcare Facility? No Need to Freeze,” is at: https://www.dorseyhealthlaw.com/ice-in-your-healthcare-facility-no-need-to-freeze/. 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

Two weeks after being sworn in, last Friday HHS Secretary Robert Kennedy announced, “effectively immediately, the [1971] Richardson Waiver is rescinded and is no longer policy of the Department.” He explained his decision by stating “the extra-statutory obligations of the Richardson Waiver impose costs on the Department and the public, are contrary to the efficient operation of the Department, and impede the Department’s flexibility to adapt quickly to legal and policy mandates. “ The waiver, issued by President Nixon’s HEW Secretary, Elliot Richardson, effectively meant HHS would use the 1946 Administrative Procedure Act’s “notice of proposed rule making” (NPRM) process broadly and its “good cause” exception sparingly. (The APA essentially governs the process by which federal agencies develop and issue regulatory rules.) Secretary Kennedy rescinded the waiver citing APA language that exempts rule making, effectively public input, from matters “relating to agency management or personnel or to public policy, loans, grants, benefits or contracts” and permits departments to forgo public comment for “good cause” or when the procedure is “impracticable, unnecessary or contrary to the public interest.” Though Secretary Kennedy’s decision will almost certainly be challenged in court, in the near term HHS can make significant, and now unquestioned, regulatory changes to, for example, the Medicare and Medicaid programs. Sec. Kennedy’s one page, March 3 Federal Register notice is at: https://www.govinfo.gov/content/pkg/FR-2025-03-03/pdf/2025-03300.pdf. 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