The Healthcare Policy Podcast ® Produced by David Introcaso

Listen NowIn testimony before the House Energy and Commerce Committee in 2007, the FDA's Dr. David Graham stated, "15,000 elderly people in nursing homes [are] dying each year from the off-label use of antipsychotic medications for an indication that the FDA knows the drug doesn't work.  The problem has been known to the FDA for years and years.”  Eleven years later, Human Rights Watch published a report titled, “They Want Docile: How Nursing Homes in the US Over-Medicate People with Dementia."  The report found in 2016-2017 "massive use" or abuse of anti-psychotics, e.g., Seroquel, Haldol and Risperdal, that have serious side effects including sudden cardiac death.  In testimony before the Ways and Means Committee last November Nov., Richard Mollot, Executive Director of the Long Term Care Community Coalition, concluded, “the use of antipsychotics in nursing facilities is “so extensive that it puts the US in violation of . . . international conventions and covenants on torture and cruel, inhuman and degrading treatment or punishment.”  Dedicated listeners may recall I interviewed Diana Zuckerman on this topic in December 2012 and in February 2018 interviewed Hannah Flamm author of the Human Rights Watch Report. During this 30 minute interview, Dr. Dolin discusses report specifics including its findings regarding the extent of overuse and misuse, what explains overuse, the success of CMS' voluntary program to reduce misuse and the consequences of Trump administration's decision to place a moratorium on skilled nursing facility regulatory enforcement and decisions to reduce civil monetary penalties.  Dr. Dolin also explains why majority staff did not offer recommendations in the report and opines on whether the report will lead the Congress to, finally, address the misuse of anti-psychotics in nursing homes.   Rachel Dolin, Ph.D., is Democratic Professional Staff with the Committee on Ways and Means, Subcommittee on Health.  She is the principle author of "Under-Enforced and Over-Prescribed."   Previously, Dr. Dolin was a 2017 David A. Winston Health Policy Fellow.  Previously still, she was a National Science Foundation Graduate Research Fellow from 2013-2017.  Prior to her doctoral work she was employed as researcher for L&M Policy Research in Washington, D.C.  Her work has been featured on NPR, in Health Affairs and in other peer-reviewed journals.  Dr. Dolin received her B.A., magna cum laude, in Political Science and History from Tufts University and completed her PhD in Health Policy and Management at the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill. The Ways and Means "Under-Enforced and Over-Prescribed" report is at: https://waysandmeans.house.gov/sites/democrats.waysandmeans.house.gov/files/documents/WMD%20Nursing%20Home%20Report_Final.pdf. Richard Mollot's November 2019 testimony before the Ways and Means Committee is at: https://waysandmeans.house.gov/legislation/hearings/caring-aging-americans.Dr. David Graham's 2007 testimony is at: https://www.govinfo.gov/content/pkg/CHRG-110hhrg35502/html/CHRG-110hhrg35502.htm. 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 NowFrom an ethical perspective our nation's response to the COVID-19 pandemic has been disastrous.  For example, as has been widely reported, our nation has failed to protect the most vulnerable among us, for example, nursing home residents have suffered approximately one-third of all COVID-19-related deaths.  As for other disenfranchised, African Americans have been were more than twice as likely as non-Hispanic Whites to die of COVID-19 complications.  Health care providers have been and continue to be inadequately protected requiring them to work in lethal environments.  Instead of providing service workers, moreover minorities, health insurance, sick leave and a livable wage, we now define them “essential workers” and give them a hand clap.  As for our the federal government's response, the president's sensitivity goes so far as his recently stating “it is what it is” - that the urban dictionary defines as a business phrase that can literally be translated as “f**k it.”  As for the Congress's response, 75% of direct and indirect CARES Act moneys went to corporations and any forthcoming or additional federal response must include COVID-related legal immunity protection for the health care industry.  The nation's response to the pandemic exposes the rift that continues to exist between medical ethics, that requires the health care industry to support the betterment of public health and a responsibility to seek policy reforms that are in the best interests of patients, and health care delivery ever-increasingly designed to generate financial profits.   During this 30 minute discussion Dr. Binkley provides, in sum, an assessment of the extent to which the federal policy makers and the health care industry have lived up to their ethical obligations in response to the pandemic and what reforms national policy makers should take in providing health care that satisfies or at least approximates ethical norms.     Dr. Charles Binkley is currently the Director of Bioethics at Santa Clara University's Markkula Center for Applied Ethics.   Previously, Dr. Binkley was a practicing hepatobiliary and pancreas surgeon with the Kaiser Permanente Medical Group. in San Francisco.  He also served as Chairman of the Kaiser's San Francisco Medical Center Ethics Committee, President of the Professional Staff, and Chief of Inpatient Quality.  Dr. Binkley also served on the Committee on Ethical, Legal, and Judicial Affairs of the California Medical Association, as well as on the Board of Directors of the San Francisco Medical Society, and on the program committee of the Society for Surgery of the Alimentary Tract.  Dr. Binkley is also a Fellow of the American College of Surgeons.  Dr. Binkley has been an invited speaker at medical centers and hospitals in the United States and internationally, and acted as an ethics consultant to the American Gastroenterological Association.   His writings have appeared in the Journal of the American College of Surgeons, Annals of Surgery, Molecular and Cellular Biology, Cancer Research, Verdict, and Bioethics.net.  After completing his undergraduate degree in Classics and Philosophy at St. Meinrad Seminary, Dr. Binkley attended Georgetown University School of Medicine, graduating magna cum laude.  He completed his surgery residency at the University of Michigan, spending two years as an NIH-sponsored Gastrointestinal Surgery Fellow.Information on the Markkula Center is at: https://www.scu.edu/ethics/Don Berwick's "moral determinants" June JAMA essay noted during this discussion is at: https://jamanetwork.com/journals/jama/fullarticle/2767353 Crosby and Annas's NEJM essay regarding medical ethics and human rights in immigration detention centers, also noted during this discussion, is at: https://www.nejm.org/doi/full/10.1056/NEJMp2003050?af=R&rss=currentIssueThe Alexander Cockburn's essay, "Elder Abuse, Nursing Homes, the Coronavirus, and the Bottom Line," appears in the September 2020 issue of Harper's Magazine.Though unmentioned, see also, Osmundson and Nathan's, "COVID-19 and the Limits of American Moral Reasoning," in the July 30 issue of The New Republic, at: https://newrepublic.com/article/158660/covid-19-limits-american-moral-reasoning For information on the AMA's code of medical ethics go to: https://www.ama-assn.org/delivering-care/ethics   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 NowBecause the economy and the Medicaid program run counter cyclically or are negative correlated (when the economy falters, Medicaid enrollment increases ), to no one's surprise the COVID-19 pandemic's effect on the economy has put the Medicaid program in jeopardy.  The US is experiencing the worst unemployment rate since the Great Depression causing state budgets, heavily reliant and income and sales taxes, to crater.  (States, in sum, are looking at over $500 billion in revenue shortfalls between FY 2020 and FY 2022.)  Simultaneously, Medicare enrollment is increasing, a Kaiser Family Foundation study found enrollment could increase by as much as 24 percent by this coming January, just as state funding for it dries up.   All this explains why the Congress in March increased the federal government's Medicaid match or its funding share (termed FMAP) by 6%.  The House in May, under its HEROES Act, increased the federal government's match to 14% and in addition appropriated more than $1 trillion to state and local governments, including $915 billion in flexible aid—which can be spent for any purpose.  However, Senate Majority Leader Mitch McConnell failed to take up the HEROES Act.  The president's executive actions this past Saturday, even if they prove legal,  ignore the Medicaid program.   For FY 2021, that began July 1 for 46 states, the aggregate revenue shortfall exceeds $300 billion.   This 27-minute interview begins with Dr. Molina's assessment of COVID-19 care under the Medicaid program and effects the pandemic is having on Medicaid and overall health care utilization.  Dr. Molina moreover discusses the federal government's response to the pandemic, whether the federal government should fund a greater portion of Medicaid spending and, alternatively, the Trump administration's proposal to block grant federal Medicaid funding.  He discusses state budget options to sustain adequate Medicaid funding.  We conclude with Dr. Molina's work with United States of Care's, specifically its OpenSafely campaign.  Dr. J. Mario Molina is former CEO of Molina Healthcare that provides healthcare to low-income individuals, moreover Medicaid recipients and so called Medicaid-Medicare duals.  He is also the former founding Dean of the Keck Graduate School of Medicine in Claremont, California.  Currently, Dr. Molina work is focused on advocating for universal healthcare coverage and development next-generation medical technologies.  His volunteer experience includes serving as Founders’ Council member of the United States of Care, board trustee for Johns Hopkins Medicine, Director for Homeboy Industries, Director for Aquarium of the Pacific, visiting committee member for Harvard Medical School, board of governors’ member for the Huntington Library and inaugural board member of the Financial Solvency Standards Board of the California Department of Managed Care.  Dr. Molina is a Los Angeles native and graduate of Cal State Long Beach and the Keck School of Medicine at USC.Information on United States of Care is at: https://unitedstatesofcare.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 NowFederal policymakers have struggled unsuccessfully since at least the 1980s to create a national long term care (LTC) policy.  LTC coverage is available however it can only be obtained by pursing a complicated asset depletion process to qualify for coverage under the Medicaid program.  (Medicare is frequently assumed to provide LTC.  It does not.)  The 2010 Affordable Care Act's CLASS Act, that would have created a voluntary, public long-term care insurance option for employees, was determined in 2011 to be actuarially unworkable and in 2013 was repealed.  The 2013 American Taxpayer Relief Act's Commission on Long Term Care produced a report that contained service delivery and workforce recommendations but did not reach agreement regarding financing.  Though most comparative countries provide for LTC, the US remains without despite the fact with a rapidly aging population the demand for LTC services will significantly increase this decade and beyond (e.g., the number of Medicare beneficiaries is expected to grow from 55 to 80 million this decade), private LTC is largely unaffordable and less than 10% of the middle income population age 45 or older owns a commercial LTC insurance policy.        During this 28-minute interview, Prof Feder begins by explaining why the 2013 LTC C0mmission failed to reach agreement regarding financing a LTC policy.  She moreover discusses or unpacks her and her colleagues 2018 paper (noted below) that, in sum, proposes a public catastrophic insurance along with a gap-filling private long term services and supports (LTSS) insurance, i.e., who is eligible, when, the amount of the benefit, how paid and financed.  She discusses recent Congressional efforts by Rep. Frank Pallone and others to legislate a policy and provides comment regarding the recently-released Biden campaign proposal regarding caregiver support (also noted below).     Judy Feder is a Professor of Public Policy and, from 1999 to 2008 served as Dean of what is now the McCourt School of Public Policy, at Georgetown University.  Prof. Feder's health policy research began at the Brookings Institution, continued at the Urban Institute, and, since 1984, has been pursued at Georgetown.   Prof. Feder previously served as the Staff Director of the Congressionally-formed Committee on Comprehensive Health Care, known as the Claude Pepper Commission in 1989-90; served as Principal Deputy Assistant Secretary for Planning and Evaluation at the Department of Health and Human Services; as a Senior Fellow at the Center for American Progress (2008-2011); and, today as an Institute Fellow at the Urban Institute.  Prof. Feder 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 and former board member of the National Academy of Social Insurance; and, a member of the Center for American Progress Action Fund Board and of the Hamilton Project’s Advisory Council.  In 2006 and 2008, Prof. Feder was the Democratic nominee for Congress in Virginia’s 10th congressional district.  Prof. Feder earned her B.A. from Brandeis and her Master's and Ph.D. from Harvard.  The 2018 paper, "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 Biden campaign's July 21 "caregiving and education workforce" plan is at: https://www.documentcloud.org/documents/6998636-07-20-20-Caregiving-and-Education-Workforce-Plan.html. 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 NowOur planet is currently experiencing its sixth mass extinction.  Over the past 450 million years the planet has experienced five previous mass extinctions.  Each of which destroyed or extinguished between 70% and 95% of all plants, animals and micro-organisms.  While these five previous extinctions were moreover the result of volcanization, the current extinction crisis is human caused.  According to the UN's Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (or the IPBES), the five main causes of the current mass extinction are, in descending order, man-made changes in land and sea use; man's direct exploitation of animals and plants; man-made or anthropocentric global warming, i.e., the climate catastrophe, and man-made pollution. It should go without saying policy makers cannot coherently address human health without simultaneously recognizing or accounting for the state of the biosphere.  Nevertheless, federal policy makers refuse to discuss the ongoing extinction of life on earth.  For example, the House Select Climate Crisis Committee recently released report (I've cited in a previous post) fails to make any mention of the ongoing mass extinction or the loss of biodiversty nor did the committee discuss the issue during any of its hearings this Congressional session.  During this 25 minute conversation, Professor Paul Ehrlich discusses moreover findings he and his colleagues make known in their two recent PNAS articles, findings by the UN's IPBES, e.g., half or more of all wildlife has disappeared from the planet over the past 50 years due in part to human caused reductions in geographic range, the relationship between the climate catastrophe and the extinction crisis, the decline in genetic variation moreover in foodstuffs, ever-increasing desperate efforts by the scientific community to bring this issue to the public's attention and comments on national policy makers perverse and tragic indifference to human-caused biological annihilation on the planet.   Paul R. Ehrlich is President of the Center for Conservation Biology (CCB) and Bing Professor of Population Studies at Stanford University.  He is also co-founded the Millennium Assessment of Human Behavior (MAHB) with his wife, Anne (policy coordinator of the CCB) and Professor Donald Kennedy.  He is also Co-founder with Peter H. Raven of the field of co-evolution.  Professor Ehrlich is a fellow of the American Association for the Advancement of Science, the American Academy of Arts and Sciences, the American Philosophical Society, the Beijer Institute of Ecological Economics, and a member of the National Academy of Sciences.  Professor Ehrlich has received several honorary degrees, the John Muir Award of the Sierra Club, the Gold Medal Award of the World Wildlife Fund International, a MacArthur Prize Fellowship, the Crafoord Prize of the Royal Swedish Academy of Sciences (given in lieu of a Nobel Prize in areas where the Nobel is not given), in 1993 the Volvo Environmental Prize, in 1994 the United Nations' Sasakawa Environment Prize, in 1995 the Heinz Award for the Environment, in 1998 the Tyler Prize for Environmental Achievement and the Dr. A. H. Heineken Prize for Environmental Sciences, in 1999 the Blue Planet Prize, in 2001 the Eminent Ecologist Award of the Ecological Society of America and the Distinguished Scientist Award of the American Institute of Biological Sciences, and in 2009 the Margalef Prize in Ecology and Environmental Sciences.  Professor Ehlich earned his Ph.D. from the University of Kansas.  Professor Ehrlich's June 2020 Proceedings from the National Academy of Sciences article titled, "Vertebrates on the Brink as Indicators of Biological Annihilation and the Sixth Mass Extinction," is at: https://www.pnas.org/content/117/24/13596.His related PNAS July 2017 article titled, "Biological Annihilation Via the Ongoing Sixth Mass Extinction Signaled by Vertebrate Population Losses and Declines" is at: https://www.pnas.org/content/114/30/E6089.  The UN's IPBES 2019 report, "Global Assessment Report on Biodiversity and Ecosystems Services," is at: https://ipbes.net/global-assessment. The November 2019 letter by over 11,000 scientists published in BioScience warning of the climate emergency is at: https://academic.oup.com/bioscience/article/70/1/8/5610806.  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 NowThe Trump administration has strongly supported alternative insurance plans in the individual market or those that do not meeting regulatory requirements, for example providing what are defined as "essential health benefits," under the Affordable Care Act.  (While the administration claims the ACA reforms are responsible for higher premiums, research shows price increases are largely due to the uncertainty caused by unending efforts to repeal the ACA, the elimination of the individual mandate and the White House's decision to end subsidies to marketplace plans.)  In 2017 the president issued an Executive Order instructing federal agencies to expand the scope of what are termed Short Term Limited Duration Insurance (STLDI) plans.  (A related rule was finalized in 2018, various entities filed suit opposing the final rule's STLDI expansion and this past Friday, the DC US District Court ruled 2-1 in favor of the government.)  Related to STLDI plans and much less discussed are what are termed Health Care Sharing Ministries (HCSMs).  Though these are not defined as health insurance plans, for example they do not guarantee payment of claims, they are marketed as such.  While HCSM plans are growing in number and in subscribers they are neither regulated at the federal nor state level.  Nevertheless, the Trump administration has recently published a proposed IRS rule that would treat HCSMs the same as health insurance, i.e., allow individuals to deduct their monthly HCMS fee from their personal income taxes or be reimbursed under a Health Reimbursement Arrangement.     During this 21 minute conversation Prof. Volk begins by discussing the history of HCSMs.  She describes or defines HCSM plans, what benefits they offer, how they're financed and marketed.  She explains the adverse selection problem they present, why they are neither regulated at the federal or state level and the recently proposed IRS regulations that would, if finalized, grant tax advantages to those purchasing HCSM plans. Ms. JoAnn Volk is a Research Professor at the Georgetown University Center on Health Insurance Reforms (CHIR). There she directs research, authors papers, and provides technical assistance on state and federal regulation and legislation governing private health insurance, including health insurance marketplaces under the Affordable Care Act.  Prior to joining Georgetown, Ms. Volk represented the AFL-CIO before Congress and the Administration on a broad range of health care issues. Before that, she conducted health care research at Abt Associates and served as an aide to the Speaker of the New York State Assembly.  Ms. Volk serves as a consumer representative to the National Association of Insurance Commissioners and is a member of the Committee on Performance Measurement at the National Committee for Quality Assurance (NCQA).  She earned an MA in Public Policy from Johns Hopkins University and a BA from Franklin and Marshall College.  The related November 2019 Congressional Research Service paper concerning HCSMs and STLDI plans is at: https://www.everycrsreport.com/files/20191113_R46003_be3db11a1571c61865168353aefa8cb572dc32dc.pdf.   Prof. Volk's 2018 Commonwealth Fund HCSM issue brief is at: https://www.commonwealthfund.org/sites/default/files/2018-08/Volk_hlt_care_sharing_ministries.pdf. Prof. Volk's June 2020 CHIR Blog post regarding the proposed HCSM IRS rule is at: http://chirblog.org/new-federal-guidance-requires-taxpayers-subsidize-health-care-sharing-ministries/.For a discussion of the July 17th US District Court's decision regarding the administration's final STLDI rule, see Katie Keith's July 19th review at: https://www.healthaffairs.org/do/10.1377/hblog20200719.720906/full/.  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 NowBeing endemic in the US, racism is pervasive in health care.  It explains everything from the fact that the black to white infant mortality ratio has never dipped below to 2:1, to more generally, disproportionate un- and under-insured rates, compromised access, non-referrals, accelerated aging and and excess deaths.  More pernicious than interpersonal racism, structural or systemic racism, where the failure to provide equal benefit to racial and ethnic minorities, is embedded in health care along with education, employment, environmental, housing, transporation and numerous other federal policies.  As I've noted recently, this explains why COVID-19-related deaths among African American and Hispanics are far greater than among non-Hispanic whites.  (Before George Floyd was killed, he suffered a COVID-19 infection.)  Listeners will recall structural racism was an theme in my January 9th interview with Prof. Andrea Freeman regarding her recent book, Skimmed: Breastfeeding, Race and Injustice.  During this 30-minute conversation, Prof. Yearby begins by defining the difference between structural and institutional racism.  She provides examples of structural racism, for example, home health workers (moreover women of color) are not protected under, for example, the 1938 Fair Labor and Standards Act, she discusses the link between hospital closures and race and the ongoing effect structural racism is having on minority communities during the current pandemic, i.e., how it compares to the H1N1 pandemic.  She concludes by discussing solutions to address or mitigate structural racism in health care and how proposed federal legislation to limit employer liability for COVID-19 infections could be justified.         Ms. Ruqaiijah Yearby is a Professor, Member of the Center for Health Law Studies at Saint Louis University School of Law and also the Co-founder and Executive Director of Saint Louis University’s Institute for Healing Justice and Equity.  She is also a Co-Principal Investigator of the Robert Wood Johnson Foundation grant entitled, “Are Cities and Counties Ready to Use Racial Equity Tools to Influence Policy?”  She, too, serves as a Research Consultant and Board Member for the RWJF grant “Investigating Conceptions of Health Equity and Barriers to Making Health a Shared Value.”  Her work has been cited in The Oxford Handbook of Public Health Ethics (2019), Dolgin & Shephard, Bioethics and the Law (4th ed 2019), Mark Hall, et al, Health Care Law and Ethics (9th ed 2018), Implicit Racial Bias Across the Law (Cambridge Univ. Press 2012), The Oxford Handbook of Bioethics (2007).  Professor Yearby earned her BS in Biology from the University of Michigan, an MPH from Johns Hopkins School of Public Health, and her JD from Georgetown University Law Center.  Professor Yearby's publications are available at: https://papers.ssrn.com/sol3/cf_dev/AbsByAuth.cfm?per_id=549981. Per my noting of critical race theory (CRT), or its mention in a July 2nd Health Affairs blog, see: https://www.healthaffairs.org/do/10.1377/hblog20200630.184036/full/.Concerning the federal government's response to date to the COVID-19 pandemic, listeners would be remiss if they did not read Part I of Robert Brenner's "Escalating Plunder," in the May-June issue of the New Left Review, at: https://newleftreview.org/issues/II123/articles/robert-brenner-escalating-plunder.  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 NowThe current public health emergency brings into stark relief US health care’s ineffectiveness.  As previously noted, with 4.25% of the world’s population, the US currently accounts for 26% of worldwide COVID-19 infections and deaths.  Concerning our response to date, Harvard's Ashish Jha recently stated, "we may end up being the worst of any country in the world in terms of our response."  Despite outspending all other OECD countries 2 to 1, or currently $4 trillion annually (and expected to grow to $6 trillion by 2027) , the effect the pandemic is having should not be unexpected.   In the first major attempt to rank health care performance globally, the World Health Organization (WHO), in 2000, ranked the US health care 37th in the world.  More recently, a 2017 Commonwealth Fund study ranked US health care’s performance last among 11 rich countries.  With a current projected COVID-19 death toll of over 200,000 by October 1st, per the University of Washington's Institute for Health Metrics and Evaluation, the question begged is what will federal policy makers learn from the pandemic, or more specifically what will they do to substantially reform how health care is currently defined, delivered and funded.  During this 28-minute conversation Mr. Oostra begins by providing a a brief overview of ProMedica, he then discusses moreover several structural problems or flaws confronting US health care delivery and financing, including failure to address social determinants and the failure to deliver adequate long term care, he explains the need for a national health care reform commission, it's scope and membership, Congressional member and staffs response to date to the proposal and industry support thereof.    Randy Oostra is President and Chief Executive Officer of ProMedica, an integrated health care provider headquartered in Toledo, Ohio.   He presently serves on the board of trustees of the Local Initiatives Support Corporation, the Health Research and Educational Trust and The Root Cause Coalition which ProMedica founded.  He also serves on the board of trustees for his alma mater, Northwestern College in Orange City, Iowa and organizations in northwest Ohio including the Regional Growth Partnership, Toledo Museum of Art and the Toledo Symphony.  Randy is also a member of the Ohio and Michigan Hospital associations and is a fellow of the American College of Healthcare Executives.  Among other awards he is the recipient of the Jefferson Award for Public Service and the Ohio Hospital Association’s Donald R. Newkirk Award.  Randy holds a doctorate in management from Case Western Reserve, a master’s degree in Health Care Administration from the University of Minnesota, a master’s degree in Management from the University of Wisconsin, and a Bachelor of Science degree in Biology from Northwestern College.Concerning a national commission, see, Randy Oostra, "Achieving Healthcare Reform Requires a Congressionally Mandated Commission," Modern Healthcare (January 25, 2020) at: https://www.modernhealthcare.com/opinion-editorial/achieving-healthcare-reform-requires-congressionally-mandated-commissionFor more on ProMedica go to:  https://www.promedica.org/pages/home.aspx. 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 NowSince I've received and answered questions via email concerning podcast interviews and related health care policy questions over the past eight years, I thought it might be it might be useful to attempt answering listeners via a podcast program.  This podcast addresses questions I received via my solicitation a few months ago.  Joe DiLauro, the gentleman whom introduces the podcast and thanks listeners after each interview, and moreover my audio engineer, poses the questions.During Part II of this discussion, 24 minutes length , I address questions concerning differences between the two presidential candidates, expectations for the next Congress, the relationship  between economic inequality and health, additional comments regarding the climate crisis, what I've learned over the course of 200 plus podcast interviews and advice I'd give those interested in pursuing a health care policy career.   Part I of this conversation was posted May 27th.   As for my bio . . . , over approximately the past 25 years I have done health care delivery, financing, policy research and evaluation in Washington DC.  My bio includes having served as Health Policy Adviser to the U.S. House of Representatives Majority Leader, Rep. Steny Hoyer.  I also spent eight years working in the US Department of Health and Human Services serving as the Evaluation Officer for the Agency for Healthcare Research and Quality (AHRQ) and as a Public Health Analyst in the Office of Assistant  Secretary for Planning and Evaluation (ASPE).  I have acute care experience having worked at DC General and post-acute experience having worked with the National Hospice and Palliative Care Organization.   My consulting clients have ranged from the American Heart Association and the American Public Health Association to UnitedHealth Group.  Among other awards I received a three-year W. K. Kellogg National Leadership Fellowship.  I have taught as a adjunct at Georgetown and at George Washington universities and over the past eight years, beyond producing over 200 interviews via this podcast, have authored over 50 health policy-related essays.  My BS, MA and Ph.D. degrees were earned at Rutgers and Arizona State.   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 NowThe COVID-19 pandemic has had particularly fatal effect on seniors or the frail elderly residing in Long Term Care (LTC) facilities, e.g., in a Skilled Nursing Facility (SNF_ or in assisted living.  As of last week approximately four in ten COVID-related deaths had occurred in these residences.  For example, in Virginia, as of mid-May approx. 60% of all COVID 19 related deaths have occurred in a SNF, among other states, in Minnesota , 80% of deaths have occurred in SNF and residential care homes.  Beyond LTC residents being immuno compromised, federal regulations concerning SNFs have, again, proven to be inadequate.  The question begged here is what can family caregivers, or those who have Power of Attorney or serve as Medical Proxy, do to protect their family members living in LTC - particularly if the facility is locked down or preventing family visits.During this 30-minute conversation, Ms. Powers discusses among other related questions: what family members should know about the LTC facility in which their relative resides; beyond LTC facility’s precautions, what added/additional safety steps can the family caregiver take, e.g., if they've not should they pursue obtaining legal Power of Attorney (POA) and health care proxy authority; considering the extent to which the pandemic has adversely affected their family member's LTC facility, should, or how should, family caregivers evaluate proactively relocating their family member; can family members refuse to have their relative tested for COVID-19; if the relative tests positive for COVID 19 is the family caregiver, POA, medial proxy required to tacitly accept their relative being transferred to a hospital; and, if not, what are appropriate, proactive options can they take or what de facto dvanced care plans/planning should family caregivers make? Ms. Mary Paier Powers has been practicing law since 1984. Her practice focuses primarily on Estate Planning, Probate matters and Elder Law. She is a native of the Pioneer Valley where she was born and raised,  Ms. Powers began her career as a trust officer for Bank of New England West.  She next worked at Monarch Life Insurance Company, where she provided legal support and documentation on various life and disability income plans.  In 1993, she opened her own estate planning, probate and elder Law practice.  In 2019, Ms Powers formed Powers Law Group with her husband and son in West Springfield and Springfield, Massachusetts.  Ms. Powers graduated from Trinity College in Vermont and received her Juris Doctorate from Western New England University School of Law. Per my mention, the CDC guidance, "COVID-19 Guidance for Shared or Congregate Housing," is at: https://www.cdc.gov/coronavirus/2019-ncov/community/shared-congregate-house/guidance-shared-congregate-housing.html.  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