The Healthcare Policy Podcast ® Produced by David Introcaso

Listen Now(As explained on the podcast home page, this is the seventh of eight interviews concerning federal healthcare policy reform.  This discussion is with Humana's Dr. Kate Goodrich and was conducted in late December.  As you will hear this podcast like all others is introduced by ProMedica's CEO,  Randy Oostra.  This series was produced in an effort to interest or persuade federal healthcare officials to pursue substantive healthcare policy reform.)Healthcare quality has been a significant federal policy concern for decades.  Despite substantial federal efforts to develop quality measurement and benchmarking performance programming, poor health care outcomes persist, Americans also experience high rates of medical errors that include diagnostic errors, avoidable infections and the mis- or over-use of antipsychotics.  Also too, the relationship between healthcare quality and healthcare spending, or value achieved for the healthcare dollar spent, remains largely unknown.  The result thereof is that there is significant variation in healthcare spending across geographic regions.  For these reasons and related others, MedPAC, in a rare instance of candor stated in 2014, "Medicare's current quality measurement approach is gone off the track."  During this 48 minute interview, Dr. Goodrich begins the discussion by providing an overall assessment of currently quality measurement performance.  She discusses the intent behind reforming the the Medicare Part B physician payment program's quality performance program, termed the Merit-based Incentive Payment System (MIPS), to CMS' proposed MIPS Value Pathway (MVP) program, including clinically-related episode based cost metrics, whether quality reporting remain mandatory, discusses how the industry can move to measuring for value or outcomes achieved relative to spending, the use or accounting for socio-economic factors in risk scoring quality measures/performance,  discusses patient reported outcome measures (PROMs) and concludes by briefly commenting on including climate crisis health effects in quality measurement and benchmarking.          Dr. Kate Goodrich is Senior Vice President of for Trend and Analytics within the Clinical and Pharmacy Solutions division of Humana, Inc.  Prior to coming to Humana, Dr. Goodrich served as the Director of the Center for Clinical Standards and Quality and Chief Medical Officers at the Centers for Medicare and Medicaid Services where she was responsible for 18 quality and value-based purchasing programs, quality improvement programs in all 50 states, development and enforcement of health and safety standards of all facility-based providers across the nation, and coverage decisions for treatments and services for Medicare.  Prior to CMS, Dr. Goodrich was on the faculty at the George Washington University Medical Center (GWUMC) and served as Division Director for Hospital Medicine.  She continues to practice clinical medicine as a hospitalist and professor of medicine at the GWUMC.  Dr. Goodrich earned her undergraduate degree at Rhodes College in Memphis, her MD at Louisiana State University Medical Center in Shreveport, LA and completed her residency training in internal medicine residency training at GWU. To read a transcript of this interview or to post a comment or question, please go to: https://commissiononhealthcare.org/.  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

Listen Now(As explained on the podcast home page, this is the sixth of eight interviews concerning federal healthcare policy reform.  This discussion is with Georgetown University Professor Judy Feder and was conducted in late November.  As you will hear this podcast like all other eight is introduced by ProMedica's CEO,  Randy Oostra.  This series was produced in an effort to interest or persuade federal healthcare officials to pursue substantive healthcare policy reform.)Unlike other rich countries, the US has no non-catastrophic long-term care (LTC) policy despite the following: the country is rapidly aging, by 2030 one in five Americans will be 65 or older; and, two-thirds of those 65 or older need or will need some form of LTC for an average of three years, 12% for five or more years.  While typically associated with aging, approximately 40% of those in LTC are under 65.  Among other realities: LTC is unaffordable to many since monthly nursing home fees can cost upwards of $10,000 per month; care quality on balance is poor as demonstrated by the COVID pandemic; beyond the long-standing problem of anti-psychotic misuse, a recent GAO study found 82% of nursing homes were cited for having infection prevention and control deficiencies; less than 10% of the middle income population age 45 or older own a commercial LTC insurance policy, in part, because insurers have substantially increased premiums over the past two decades; and, family care givers, or 30% of the adult population, moreover women, suffer related emotional, financial and physical hardship. During this 30 minute interview, Profess Feder discusses moreover recent efforts by the Congress to fashion a LTC policy in context of a 2018 proposal authored by Professor Feder and her colleagues, explains her more recent 2020 proposal outlined in the Journal of Aging and Social Policy and evaluates the Biden campaign policies to improve long term care.  Judy Feder is a Professor of Public Policy at the McCourt School of Public Policy at Georgetown University.  From 1999 to 2008 she served as it  Dean.  Professor began  her health policy research career at the Brookings Institution, continued at the Urban Institute and since 1984 has been at Georgetown.  In the late 1980s, she served as Staff Director of the Congressional Pepper Commission (chaired by Sen. John D. Rockefeller); from 1989-90 she served as Principal Deputy Assistant Secretary for Planning and Evaluation at the Department of Health and Human Services in former President Bill Clinton’s first term administration; as a Senior Fellow at the Center for American Progress (2008-2011); and, today, as an Institute Fellow at the Urban Institute.  Judy is an elected member of the National Academy of Medicine, the National Academy of Public Administration, and the National Academy of Social Insurance; a former chair and board member of AcademyHealth; a former board member of the National Academy of Social Insurance; a member of the Center for American Progress Action Fund Board and as a member of the Hamilton Project’s Advisory Council.  In 2006 and 2008, Judy was the Democratic nominee for Congress in Virginia’s 10th congressional district.  Professor Feder received her BA from Brandeis and her a MA and PhD from Harvard.The 2018 LTC policy proposal noted, titled, "A New Public-Private Partnership: Catastrophic Public and Front-End Private LTC Insurance" is at: https://www.umb.edu/mccormack.umb.edu/uploads/gerontology/Public_Catastrophic_Insurance_Paper_for_Bipartisan_Policy_Center_1-25-2018.pdf. The 2020 LTC policy proposal noted, titled, "COVID-19 and the Future of Long-Term Care: The Urgency of Enhanced Federal Financing," is at: https://www.tandfonline.com/doi/full/10.1080/08959420.2020.1771238. To read a transcript of this interview or to post a comment or question, please go to: https://commissiononhealthcare.org/.  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

Listen Now(As explained on the podcast home page, this is the fifth of eight interviews concerning federal healthcare policy reform.  This discussion is with Arnold Ventures' Dr. Mark Miller and conducted in late November.  As you will hear this podcast like all other eight is introduced by ProMedica's CEO,  Randy Oostra.  This series was produced in an effort to interest or persuade federal healthcare officials to pursue substantive healthcare policy reform.)As has been widely reported and debated the US spends substantially more than comparative countries on prescription medicines.  For example, Medicare Part B and D drugs cost approximately two to four times what comparable countries pay and spending is projected to continue to rise rapidly.  High prices are explained largely by economic rent seeking and anti-competitive practices including so called patent evergreening and pay-for-delay tactics.  As a result, medication nonadherence is epidemic, responsible for an estimated 10% of all hospitalizations.   Among Medicare beneficiaries, upwards of of 60% are nonadherent due in part to cost.  Among those that do adhere, a recent study published in the American Journal of Medicine an estimated 42% of cancer patients depleted their entire net worth within the first two years of treatment.   The interview begins with Dr. Miller providing a general overview of drug pricing, or what explains the failure of current drug pricing policy.  The discussion moves on to his discussing practices commonly exploited by comparative countries, i.e., negotiating drug prices or how such a policy could be formulated, exploiting an inflation rebate, basing prices on value or comparative effectiveness research, using international drug prices, or some percent thereof, to set US drug prices and questions whether the US is willing to take a drug of formulary due to excessive price.  He discusses the extent to which, like comparable countries, US drug pricing policy could or should apply to all patients.   Dr. Miller concludes his comments by identifying Arnold Ventures policy recommendations regarding FDA and patent reforms and whether price regulation can drive greater competition in pharmaceuticals.Dr. Mark E. Miller is currently the Executive Vice President of Health Care at Arnold Ventures, a philanthropy.   Previously, he served as Executive Director of Medicare Payment Advisory Commission (MedPAC), as Assistant Director of Health and Human Resources at the Congressional Budget Office, as Deputy Director of health plans at the Centers for Medicare and Medicaid Services, as health financing Branch Chief at the Office of Management and Budget and as Senior Research Associate at the Urban Institute.  Dr. Miller has extensive experience identifying emerging health care issues, developing policy solutions, working with policymakers, and engaging diverse stakeholders. Over the course of his career, he has been directly involved in the development of major health legislation such as the Balanced Budget Act; the Medicare Prescription Drug, Improvement, and Modernization Act; and the Affordable Care Act.  Dr. Miller earned his Ph.D. in public policy analysis at the State University of New York at Binghamton and his MA and BA in political science from Old Dominion University. To read a transcript of this interview or to post a comment or question, please go to: https://commissiononhealthcare.org/.  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

Listen Now(Please note: Because of poor sound quality, this interview was rerecorded on March 22nd.)  Discussing the climate crisis sooner or later begs the Gaia Hypothesis.  Simply explained, the Gaia Hypothesis, proposed in the early 1970s by James Lovelock and Lynn Margulis, argues all of planetary life works autonomously to maintain environmental conditions within a narrow range of habitability, or in a dynamic state of constancy, via a long list of biological self-regulating mechanisms.  In sum, Gaia Hypothesis argues the planet is self-regulating.  Gaia has been of particular interest relative to the what the climate crisis poses for our survival since it has been interpreted in two radically different ways.  One in which we have accountability or a moral duty to defend Gaia and another whereby the planet is resilient or immune from human-caused global warming.During this 38 minute discussion, Professor Ruse defines Gaia, discusses criticism thereof and comments on interpretations of the hypothesis.   Michael Ruse is the former, now retired, Lucyle T. Werkmeister Professor of Philosophy and Director of the Program in the History and Philosophy of Science at Florida State University.  Previously, he was Professor Emeritus at the University of Guelph, in Ontario, Canada.  He is the author of over 60 books.  He is currently the co-editor of the Cambridge Elements series in the Philosophy of Biology and co-editor of the Cambridge Handbook of Evolutionary Ethics (forthcoming).  He was the founding editor of the journal Biology and Philosophy and edited the Cambridge Series in the Philosophy of Biology.  He also co-edited two volumes with Oxford University Press on the philosophy of biology; co-edited the Cambridge Companion to the Origin of Species; co-edited the Oxford Handbook of Atheism; recently edited The Cambridge Encyclopedia of Charles Darwin and Evolutionary Thought; co-edited a volume on evolutionary theory with Harvard University Press; a volume on paleobiology with the University of Chicago Press; and, another on twentieth-century evolutionary biology with the American Philosophical Society.  He has appeared as an expert witness in a case in Arkansas against the teaching of biblical literalism (Creationism) in state-supported science classes.   He writes frequently on pseudo-science, as in The Gaia Hypothesis: Science on a Pagan Planet.   Most recently he has authored, Darwinism as Religion, a history of evolutionary theory as seen through creative writing, particularly as seen through fiction and poetry.  He is now writing a book on hatred.  Professor Ruse earned his undergraduate degree at the University of Bristol, his master's degree at McMaster University and his Ph.D. at the University of Bristol. Information on Professor Ruse's The Gaia Hypothesis, Science on a Pagan Planet, is at: https://press.uchicago.edu/ucp/books/book/chicago/G/bo10665496.html.Leah Aronowsky's just-published Critical Inquiry essay, "Gas Guzzling Gaia, or: A Prehistory of Climate Change Denialism," noted during this interview, is at: https://www.journals.uchicago.edu/doi/10.1086/712129. 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

Listen Now(As explained on the podcast home page, this is the fourth of eight interviews concerning federal healthcare policy reform.  This discussion is with Harvard economics Professor Michael Chernew and was conducted in late November.  As you will hear this podcast like all others is introduced by ProMedica's CEO, Randy Oostra.  This series was produced in an effort to interest or persuade federal healthcare officials to pursue substantive healthcare policy reform.)On background, the rapidly growing Medicare Advantage (MA) program currently provides care to 24 million or 36% of all Medicare beneficiaries at a cost of approximately  $275 billion annually.  Despite approaching its 4oth year, MA still does not, as initially intended, reduce Medicare spending.  Per MedPAC, this year overall MA benchmarks will average 107% of Medicare Fee For Service (FFS) spending.  This is due in part to MA’s quality performance program that pays bonuses to plans with a high Star rating and risk adjustment upcoding not fully offset by the program’s coding intensity adjustment factor.   More problematic is the fact that a September 2020 CBO budget outlook concluded Medicare’s hospital insurance trust fund will be insolvent as soon as 2024.   As MedPAC candidly recognized in its most recent report to the Congress, “unless changes are made . . . the cost of the Medicare program will become unsustainable” necessitating “dramatic changes to the Medicare program.”During this interview begins with Professor Chernew providing a general overview of the MA  program or how generally it can be improved.  He moves on to discussing  how MA financial benchmarking can be improved, e.g., reform benchmark quartiles, move MA into a value incentive program and reform the MA Stars program, comments on MA coding intensity reform, discusses reforms to MA's Quality Bonus Program (QBP), again, Stars, or via MedPAC's recommended Value  Incentive Program (VIP) program, comments on patient reported outcome measures, factoring social economic status in adjusting beneficiary risk and MA performance pay, equalizing MA and Medicare Fee For Service quality performance payments, how, if at all, MA and Fee for Service can compete on a level playing field, MA plans  participating in the MACRA Advanced Payment Model (APM) pathway, the MA Value Based Insurance Program (VBID) demonstration and comments on the pending insolvency of Medicare's hospital trust fund. Michael Chernew is the Leonard D. Schaeffer Professor of Health Care Policy and the Director of the Healthcare Markets and Regulation (HMR) Lab in the Department of Health Care Policy at Harvard Medical School.   Profess Chernew is also currently the Chair of the Medicare Payment Advisory Commission (MedPAC) while previously serving as the Vice Chair from 2012-2014 and a Member from 2008-2012.  In 2000, 2004 and 2010, he served on technical advisory panels for the Center for Medicare and Medicaid Services (CMS) that reviewed the assumptions used by Medicare actuaries to assess the financial status of Medicare trust funds.  He is a member of the Congressional Budget Office’s Panel of Health Advisors and Vice Chair of the Massachusetts Health Connector Board.  Dr. Chernew is also a member of the National Academy of Sciences, a research associate at the National Bureau of Economic Research and a senior Visiting Fellow at MITRE.  He is currently a co-editor of the American Journal of Managed Care.  Dr. Chernew earned his undergraduate degree from the University of Pennsylvania and his PhD in economics from Stanford University.  In 1998, he was awarded the John D. Thompson Prize for Young Investigators by the Association of University Programs in Public Health.  In 1999, he received the Alice S. Hersh Young Investigator Award from the Association of Health Services Research.To read this interview's transcript or to post a comment or question, please go to: https://commissiononhealthcare.org/.  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

Listen Now(As explained on the podcast home page, this is the third of eight interviews concerning federal healthcare policy reform.  This discussion with Dr. Amol Navathe was conducted in late December.  As you will hear this podcast like all others is introduced by ProMedica's CEO, Randy Oostra.  This series was produced in an effort to interest or persuade federal healthcare officials to pursue substantive healthcare policy reform.)    Medicare is projected to grow from 62 to 80 million Americans by 2030.   Largely because of the so called age wave, Medicare spending in sum is projected to double to $1.28 trillion by 2029.  Among other current policy problems, the Part A hospital trust fund is projected to be insolvent in three years.  Part B , or physician payments, intended under 2015 MACRA legislation to move eligible Fee for Service (FFS) clinicians into financial at-risk models, remains unproven, largely due to the fact only less than one in five clinicians participate.  Part B and Part D drug spending growth continues to plague Medicare program largely because Medicare, unlike the VA, is prohibited from exercising its purchasing power.   Medicare FFS is plagued by numerous other coverage problems including, for example, no long term care policy, no hearing, oral, vision and non-medical social support coverage.  In addition, CMS' Innovation Center's (CMMI) demonstrations have proven to be at best marginally successful and post-acute FFS care suffers numerous quality and reimbursement problems, for example, SNFs continue to over-prescribe anti-psychotics while 2018 marked the 19th consecutive year freestanding skilled nursing facility profit margins were in the double digits. During this interview Dr. Navathe begins by commenting on the Medicare program in context of the ongoing COVID-19 pandemic.  The discussion moves on to discussing policies to expand Medicare coverage, provides comment on the FFS Medicare Shared Savings Program, discusses the inherent problems with FFS payments and policy recommendations he and his colleagues outline in their December Medicare's "next decade" paper (cited below).   He concludes by commenting on post acute, particularly related to skilled nursing, under FFS Medicare.    Dr. Amol Navathe is an Assistant Professor of Medical Ethics and Health Policy, Co-Director of the Healthcare Transformation Institute and Associate Director of the Center for Health Incentives and Behavioral Economics, all at the University of Pennsylvania.  He is also presently a Commissioner of the Medicare Payment Advisory Commission (MedPAC).  He founded the academic journal, Health Care: The Journal of Delivery Science and Innovation, serving as its Co-Editor-in-Chief, as well as Founding Director of the Foundation for Healthcare Innovation.  His work on health care cost and quality improvement has been published in numerous leading journals, including Science, New England Journal of Medicine (NEJM), Journal of the American Medical Association (JAMA), Health Affairs, Health Services Research, Healthcare, and other leading academic journals.  Dr. Navathe completed his medical training at the Perelman School of Medicine and his post-graduate medical training at the Brigham and Women’s Hospital at Harvard Medical School.  He obtained his PhD in Health Care Management and Economics from The Wharton School at the University of Pennsylvania.Dr. Navathe's writings can be found at: https://ldi.upenn.edu/expert/amol-s-navathe-md-phd.His recent article December noted during this essay, "Medicare Payment Reform's Next Decade: A Strategic Plan for the Center for Medicare and  Medicaid Innovation," is at: https://www.healthaffairs.org/do/10.1377/hblog20201216.672904/full/. To read this interview's transcript or to post a comment or question, please go to: https://commissiononhealthcare.org/.  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

Listen NowPer the essay I posted last week concerning federal policy makers' indifference toward the health harm imposed on Medicare and Medicaid beneficiaries via the healthcare industry's carbon emissions, I thought it useful to discuss however limitedly why and how the US healthcare industry  can rapidly transition to the use of clean or renewable energy resources, i.e., wind, water and solar (WWS).  Possibly, if not likely, the leading US researcher on transitioning to 100% clean energy is Stanford's Professor Mark Jacobson.   For example, as early as 2009, in an article published in Scientific American, he and a colleague argued the barriers to a 100% conversion to WWS worldwide are primarily social and political, not technological nor even economic.  In a 2017 article published in Joule he and 27 colleagues summarized the development of what they termed “roadmaps” to transform energy infrastructures for 139 countries to 80% WWS by 2030.  In 2020 Professor Jacobson published a text titled, “100% Clean, Renewable Energy and Storage for Everything."  In it he explains in detail how the world can rapidly and entirely transition the world’s current combustion-based energy to 100% clean renewables and storage.  During this 34 minute conversation Professor Jacobson begins by briefly explaining clean energy's numerous advantages.  Beyond avoided human and environmental harm, substantial economic savings are accrued from costs associated with continuing fossil fuel combustion, land use savings (e.g., clean energy does not require an extraction industry), permanent job growth, substantially cheaper energy costs, reductions in large scale energy disruption, increased access to energy by up to four billion people currently in energy poverty, and a decentralized world power supply.  He then discusses generally how the US healthcare industry can convert to 100% clean energy in part by offering lessons learned from building his own 100% energy clean home and Stanford University's substantial transition to clean energy.  Professor Jacobson concludes by making comment on carbon tax policies.Mark Z. Jacobson is Professor of Civil and Environmental Engineering, Director of the Atmosphere/Energy Program, Senior Fellow at the Woods Institute for the Environment and the Precourt Institute for Energy and Co-Founder of The Solutions Project, 100.0rg and 100% Clean, Renewable Energy Movement.  His work provided the primary scientific justifications behind the Green New Deal and House bills H.R. 3314, 3671, and 330 and Senate bill S.987, all of which called for the U.S. to go to 100% clean, renewable energy.  In addition, his 100% roadmaps were the scientific basis behind the platforms of three presidential candidates and a major political party in 2016.  To date, he has published three textbooks and over 165 peer-reviewed journal articles.  He has testified four times before the Congress.   In 2005, he received the American Meteorological Society Henry G. Houghton Award.  In 2013, he received an American Geophysical Union Ascent Award and the Global Green Policy Design Award.  In 2016, the Cozzarelli Prize from the Proceedings of the National Academy of Sciences.  In 2018, he received the Judi Friedman Lifetime Achievement Award and in 2019 he was selected as "one of the world’s 100 most influential people in climate policy" by Apolitical.  He has also served on the Energy Efficiency and Renewables advisory committee to the U.S. Secretary of Energy.  He earned undergrad degrees in civil engineering in economics and a masters in environmental engineering from Stanford and was graduated from UCLA with a Ph.D. in Atmospheric Science.(The sound quality of some portions of this discussion are poor, my apologies.) Information on Prof Jacobson's 2020 text, "100% Clean, Renewable Energy and Storage" is at: https://www.cambridge.org/highereducation/books/100-clean-renewable-energy-and-storage-for-everything/26E962411A4A4E1402479C5AEE680B08.His 2009 Scientific American article is at: https://www.evwind.es/2009/11/16/a-plan-to-power-100-percent-of-the-planet-with-renewables-by-mark-z-jacobson-and-mark-a-delucchi/2259. His 2017 Joule  article is at: https://www.sciencedirect.com/science/article/pii/S2542435117300120.Prof. Jacobson's 2015 Energy and Commerce testimony is at: https://web.stanford.edu/group/efmh/jacobson/Articles/I/15-11-19-HouseEEC-MZJTestimony.pdfHis Stanford webpage, that contains a significant amount of information, is at:  http://web.stanford.edu/group/efmh/jacobson/Articles/I/15-11-19-HouseEEC-MZJTestimony.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

Listen Now(As explained on the podcast home page, this is the second of eight interviews concerning federal healthcare policy reform.  This discussion with Dr. Berenson was conducted in mid-November.  As you will hear this podcast like all others is introduced by ProMedica's CEO, Randy Oostra.  This series was produced in an effort to interest or persuade federal healthcare officials to pursue substantive healthcare policy reform.)    US healthcare prices, moreover in commercial markets, have for decades been significantly higher than in comparative countries.   In addition, the US healthcare market suffers wide price heterogeneity or significant price discrepancy.   Total US healthcare spending, per capita spending and spending growth are in multiples of most other rich countries.  While there will remain debate regarding how to best calculate prices or interpret price signals, there is consensus the healthcare industry suffers a significant pricing problem.   As Uwe Rinehardt and his colleagues concluded in a widely referenced 2003 article, “it’s the prices stupid.”  Unlike the US, developed countries throughout the world, control for price via a mix of policies that correct for market failure and constrain price growth.   During this interview Dr. Berenson begins by explaining what largely explains, or which industry sectors largely explain, healthcare's pricing problem.   He discusses the extent to which stimulating market competition and fielding new payment models can work, explains most comparative countries stimulate competition via regulating prices and explains the opportunity to address providers charging outlier prices, or prices significantly higher than Medicare rates, by placing upper payment limits, setting all payer rates as done in Maryland and as in other states, for example Montana, limiting payments or providing differential payment updates.  He notes the success of rate regulation and competition via the Medicare Advantage program, whether Medicare Advantage should participate in ACA marketplaces and comments on the extent to which more affordable prices paid can be offset for providers by increased utilization.               Dr. Robert Berenson joined Urban as an Institute fellow in 2003.  In 2012, Dr. Berenson completed a three-year term on the Medicare Payment Advisory Commission, the last two years as vice chair.  From 1998 to 2000, he was in charge of Medicare payment policy and private health plan contracting at CMS.  Previously, he served as an assistant director of the White House Domestic Policy Staff under President Carter.   Dr. Berenson is a board-certified internist who practiced for 20 years, the last 12 years in a Washington, DC, group practice.  While practicing he helped organize and manage a successful preferred provider organization serving the Washington, DC metropolitan area.  He is coauthor of The Managed Care Blues & How to Cure Them with Walter Zelman, and Medicare Payment Policy and the Shaping of U.S. Health Care, with Rick Mayes.  He publishes frequently in numerous publications, including the New England Journal of Medicine, Health Affairs, New York Times, and New Republic.   Dr. Berenson is a graduate of the Mount Sinai School of Medicine, a fellow of the American College of Physicians and on the faculty at the George Washington University School of Public Health.For a transcript of this interview go to: https://commissiononhealthcare.org/. The Brookings/Schaeffer two-part healthcare price regulation series noted during this interview is at: https://www.brookings.edu/events/are-u-s-health-care-prices-too-high-too-low-or-some-mix-of-the-two/ and https://www.brookings.edu/events/health-care-price-regulation-and-public-options-assessing-approaches-to-increasing-the-public-role/.  To read this interview's transcript or to post a comment or question, please go to: https://commissiononhealthcare.org/.  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

Listen NowLast year Island Press published Planetary Health, Protecting Nature to Protect Ourselves, considered the first textbook for the field of planetary health.  As the title suggests, the work provides an overview of our planet's health under the Anthropocene era.  As the work notes, per work by the Global Footprint Network we have been increasingly living beyond our environmental means, or  beyond the earth's carrying capacity, since 1970.   Of nine planetary boundaries, including climate change and ocean acidification, we have crossed two and two more are considered to be in a zone of uncertainty.  This is due to the fact no country today meets the needs of its population at a globally sustainable level of resource use - and this is due in turn to a global economic system that assumes natural resources are inexhaustible, or that no amount of resource use would reduce the quantity or quality for future generations.  As the coeditors write in afterword concerning COVID-19 the pandemic, the current state of planetary health “reflects a rupture of the human relationship with the natural world," i.e., as Charles Yu as stated, we live under the fiction or shared illusion "that we are separate from nature." Dr. Frumkin begins this 35 minute conversation by discussing the antcedents for the book (see chapter 2).  He goes on to explain his and his colleagues' expectations for the work or what it may accomplish, discusses what findings he found surprising, provides an overview of the books' biodiversity discussion, discusses how/why our economic model explains the current state of our planet's health, makes comment about the health care industry's role in addressing planetary health and the relevance of the Gaia hypothesis.  Howard Frumkin, MD, DrPH, is Emeritus Professor of Environmental and Occupational Health Sciences at the University of Washington School of Public Health. 2010-2016. Immediately previously, he led the Our Planet, Our Health program at the Wellcome Trust.  From 2005 to 2010, he served as Director of the National Center for Environmental Health and Agency and for the Toxic Substances and Disease Registry (NCEH/ATSDR) at the CDC and as Special Assistant to the CDC Director for Climate Change and Health.  From 1990 to 2005, he was Professor and Chair of Environmental and Occupational Health at Emory University’s Rollins School of Public Health and Professor of Medicine at Emory Medical School.  Dr. Frumkin has served numerous boards and committees including the NASEM Committee on Measuring Community Resilience, on the Steering Committee of the Planetary Health Alliance (Harvard University), on the advisory committees to the Global Consortium on Climate and Health Education (Columbia University), the Medical Society Consortium on Climate & Health (George Mason University), the Canadian Urban Environmental Health Research Consortium (University of Toronto), the National Environmental Education Foundation, the American Public Health Association (as Chair of APHA’s Science Board), the Association of Occupational and Environmental Clinics (AOEC) (including a term as President), and the Washington Global Health Alliance.  He has published or edited over 200 scientific journal articles, chapters, and books.  Beyond Planetary Health, he is also editor the text, Environmental Health: From Global to Local (3rd edition, 2016).  Other books include Making Healthy Places: Designing and Building for Health, Well-being, and Sustainability (2011), and Urban Sprawl and Public Health: Designing, Planning, and Building for Healthy Communities (2004).   Dr. Frumkin is a Fellow of the American College of Physicians, the American College of Occupational and Environmental Medicine, Collegium Ramazzini, and the Royal College of Physicians of Ireland and a member of the Washington State Academy of Sciences.   He earned his MD degree from the University of Pennsylvania and his DrPH and his MPH from Harvard. For information on Planetary Health go to: https://islandpress.org/books/planetary-health.Concerning biodiversity or depreciating (literally) the value thereof, see this just published report titled , "The Economics of Biodiversity, The Dasgupta Review" at: https://www.cisl.cam.ac.uk/news/news-items/cisl-responds-to-the-economics-of-biodiversity-the-dasgupta-review.  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

Listen Now(As noted below on the podcast website this discussion is the first of eight interviews concerning federal healthcare policy reform.  This discussion with Dr. Woolf was conducted in early November.  As you will hear this podcast, and all seven others, are introduced by ProMedica's CEO, Randy Oostra.  This series was produced in an effort to interest or persuade federal healthcare officials to pursue substantive health care policy reform.)   Devoted listeners of the podcast will recall I interviewed Dr. Woolf in early 2013, or soon after the Institute of Medicine published,  "US Health in International Perspective, Shorter Lives, Poorer Health," a report in which Dr. Woolf served as the lead author.  As the 2013 report demonstrated, Americans are, compared to our peers in comparative countries, more disease burdened throughout our lifespan leading to earlier mortality.   This is true even for Americans whom are white, educated and insured.  Since the IOM report was published, US population health has not improved.  It has worsened.  Added to continuing epidemics in opioid overdoses and suicides, a long list of disease conditions, or over 30, have contributed to Americans experiencing shorter lifespans.   The greatest decline has been in midlife or among young and middle-aged adults, or from age 25 to 65.   US life expectancy stopped increasing in 2010 and have been decreasing since 2014.  Needless to say the effects of the ongoing COVID-19 pandemic is exacerbating this problem.   Systematic causes for our country's comparative health disadvantage include, beyond deficiencies in medical care, the prevalence of risky behaviors, socioeconomic inequalities, unhealthy environmental conditions and detrimental public policies.    During this interview Dr. Woolf begins by discussing the effects the COVID-19 pandemic is having on US population health.  He goes on to discuss what explains our shorter life expectancy or our comparative health disadvantage, where geographically we see the greatest declines in life expectancy, he explains that even rich Americans are dying comparatively earlier, explains five systemic problems or factors that determine our health status, and notes the economic implications or poorer population health.      Steven H. Woolf, MD, MPH, is the C. Kenneth and Dianne Wright Distinguished Chair in Population Health and Health Equity Director Emeritus and Senior Advisor at VCU's Center on Society and Health in the Department of Family Medicine & Population Health, at Virginia Commonwealth University.  Among other credentials, Dr. Woolf has served as scientific adviser and member of the U.S. Preventive Services Task Force, has consulted in Europe as a visiting scholar, is a past North American editor of the British Medical Journal and was elected to the Institute of Medicine, National Academy of Sciences in 2001.  Dr. Woolf has published more than 170 articles in a career that has focused on evidence-based medicine and the development of evidence-based clinical practice guidelines, with a special emphasis on preventive medicine, cancer screening, quality improvement, and social justice.  Dr. Woolf, a clinical epidemiologist, he received in BA at the University of Missouri, his MD degree from Emory University and his MPH from Johns Hopkins.  in 1987. He is board certified in family medicine and in preventive medicine and public health.For a transcript of this interview or to post a comment or question, please go to: https://commissiononhealthcare.org/. Concerning Dr. Woolf's more recent, related publications, see, for example, these 2018 BMJ and 2019 JAMA articles: https://www.bmj.com/content/362/bmj.k3096 and https://pubmed.ncbi.nlm.nih.gov/31769830/ 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