The Healthcare Policy Podcast ® Produced by David Introcaso

Listen Now2020 was yet another record setting temperature year tying 2016 as the warmest on record.  2020 was strikingly warmer than 2019, by about .75 degrees Fahrenheit, and some parts of Arctic were warmer by more than 10 degrees Fahrenheit.   2020 also set a US record for $1 billion climate disasters numbering 22 and totaling $95 billion damages (the previous records were 16 in 2017 and more than double the 41-year average of $45 billion).  Seven of the 22 events were hurricanes or tropical storms several others were wildfires that, for example, burned over 10 million acres in CA or double the previous record of 4.1 million acres in 2018.  Despite increasingly extreme climate-crisis events and the mounting health harms caused, including vector-borne diseases (think: COVID-19), federal policy makers remain non-responsive including, for example, MedPAC (Medicare Payment Advisory Commission) and MACPAC (Medicaid And CHIP Payment Advisory Commission).  These two independent Congressional commissions, given broad authority to address issues affecting Medicare and Medicaid beneficiaries or our most vulnerable citizens: children; pregnant women; and, the elderly, have never discussed, much less mentioned the climate crisis despite the fact these programs bear the lion share of climate crisis-related health care costs.     During this approximately 30 minute conversation Dr. Lamaye briefly describes the NRDC's Science Center's work.  He moreover explains the current knowledge gap between climate crisis-related health effects and recognizing or accounting for these effects, it, he describes or unpacks work published in 2019 in GeoHealth in which he and his colleagues calculated the costs of ten 2012 climate crisis events including Hurricane Sandy, i.e., moreover how costs were calculated, what costs were incurred and the limitations of this research, and makes recommendations for how research to measure climate crisis-related health impacts can be, or need be, improved.    Dr. Vijay Limaye is a Climate and Health Scientist at the National Research Defense Council's (NRDC's) Science Center.  His work largely concerns quantifying, communicating and reducing risks associated with the climate crisis with a particular emphasis on the public health burdens of air pollution and extreme heat.  He leads the Science Center's economic valuation work that demonstrates the significant health costs of the climate crisis and works to defend the science that underpins the Clear Air Act.   Prior to NRCD, Dr. Limaye worked at the US Environmental Protection Agency (EPA) where he focused on Clear Air regulatory implementation, air quality, quality monitoring policy, risk communication and citizen science.  Dr. Limaye speaks Spanish and Hindi, has published several research studies on the health impacts of the climate crisis in the US and in India.  He received his undergrad degree from the University of California, Berkeley and his Ph.D. in environmental epidemiology from the University of Wisconsin, Madison.Dr. Limaye's Health Affairs article discuss during the interview is again titled, "Estimating the Costs of Inaction and the Economic Benefits of Addressing the Health Harms of Climate Change,"  (Subscription required.) His 2019 GeoHealth article, freely available, discussed during this interview is again titled, "Estimating the Health-Related Costs of 10 Climate Sensitive Events During 2012," is at: https://agupubs.onlinelibrary.wiley.com/doi/full/10.1029/2019GH000202.Re: NOAA's $1 billion 2020 climate disasters, see their 15-page January 8, 2021 memo at: https://www.noaa.gov/stories/record-number-of-billion-dollar-disasters-struck-us-in-2020.  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 NowListeners are aware social determinants significantly explain one's health, as much as 80%.  Principally among these is economic status.  Wealth positively correlates with health.   As listeners are, or should be, well aware 250 fifty years of slavery and a century and a half of institutionalized racism has resulted in median black household net worth equal to one-tenth that of median white household net worth - due, in part, to blacks having comparative lower rates of upward mobility and higher rates of downward mobility.   (Even white high school dropouts accumulate more wealth than Black college graduates.)  This past October, after 208 years of publication, the prestigious The New England Journal of Medicine finally recognized the reparations issue by publishing a "Prospective" essay by Mary Bassett and her colleagues at the Harvard Center on Health and Human Rights titled, "Reparations as a Public Health Priority."   The authors concluded, “It is left to those of us in medicine and public health to argue that now is the time to act," i.e., address reparations, because they stated further, “addressing the black-white wealth gap through reparations is about saving lives."During this 40 minute conversation, Prof. Darity and Ms. Mullen discuss moreover reparation efforts or compensated emancipation by President Lincoln and the Radical Republicans during the 1860s.  They discuss related state level reparations efforts and their limitations.  They discuss state and federal policies that prohibited blacks from accumulating wealth, e.g., post Civil War black codes, Jim Crow, limitations under the Homestead Act and the GI Bill and among others numerous efforts to deny blacks credit worthiness.  The authors also respond or answer several of the more common criticisms levied against reparations and explain how reparations can be calculated.     Prof. William A. (“Sandy”) Darity, Jr., is the Samuel DuBois Cook Professor of Public Policy, African and African American Studies, and Economics and the Director of the Samuel DuBois Cook Center on Social Equity at Duke University.  He was the Founding Director of the Research Network on Racial and Ethnic Inequality at Duke.  Previously, he served as Director of the Institute of African American Research and Director of Graduate Studies at the University of North Carolina at Chapel Hill.  Prof. Darity was a visiting scholar at the Russell Sage Foundation (2015-2016), a fellow at the Center for Advanced Study in the Behavioral Sciences (2011-2012) at Stanford, a fellow at the National Humanities Center (1989-90) and a visiting scholar at the Federal Reserve’s Board of Governors (1984).  He received the Samuel Z. Westerfield Award in 2012 from the National Economic Association, the organization's highest honor, Politico 50 recognition in 2017, and an award from Global Policy Solutions in 2017.  He is a past president of the National Economic Association and the Southern Economic Association.  Prof Darity has also taught at Grinnell College, the University of Maryland at College Park, the University of Texas at Austin, Simmons College and Claremont-McKenna College.  He has served as Editor in Chief of the latest edition of the International Encyclopedia of the Social Sciences and as an Associate Editor of the 2006 edition of the Encyclopedia of Race and Racism (2013).  He has published or edited 13 books and published more than 300 articles in professional outlets.  Ms. Kirsten Mullen is a folklorist and the founder of Artefactual, an arts-consulting practice, and Carolina Circuit Writers, a literary consortium that brings expressive writers of color to the Carolinas.  She was a member of the Freelon Adjaye Bond concept development team that was awarded the Smithsonian Institution’s commission to design the National Museum of African American History and Culture.  Under the auspices of the North Carolina Arts Council she worked to expand the Coastal Folklife Survey.  As a faculty member with the Community Folklife Documentation Institute, she trained students to research and document the state’s African American music heritage. Kirsten was a consultant on the North Carolina Museum of History’s “North Carolina Legends” and “Civil Rights” exhibition projects.  Her writing can be found in museum catalogs and journals, and in commercial media—and includes “Black Culture and History Matter” (The American Prospect), which examines the politics of funding black cultural institutions.  For information on "From Here to Equality," go to: https://uncpress.org/book/9781469654973/from-here-to-equality/.Mary Bassett and colleagues' The New England Journal of Medicine essay is at: https://www.nejm.org/doi/full/10.1056/NEJMp2026170.   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 NowCatastrophic climate crisis effects continue to accelerate.  Atmospheric carbon concentrations are now measured at 417 ppm, the greatest concentration of atmospheric carbon in our  existence.  This year will again prove to be one of warmest on record.  This year is also a record-breaking Atlantic hurricane season, with 30 named storms to date, and a record breaking year for wildfires.  In the Arctic, the albedo effect from the now inexorable loss of summer ice (currently, the Arctic is projected to be completely free of summer ice by 2035) will be equal to the release of 1 trillion tons of carbon equivalents into the atmosphere.  Northern permafrost, that holds almost twice as much carbon than is currently in the atmosphere, is thawing 70 years earlier than previously predicted.  A warming planet is also causing the planet to experience unprecedented and accelerating biological annihilation, e.g., NOAA just reported as much as 98% of  coral cover, that helps support over 25% of all marine life, remains along the Florida coast, vector borne diseases including COVID-19 continue to proliferate, the Trump administration, has defined its legacy by rescinding approximately 100 environmental regulations and as dedicated listeners are also aware a federal court ruled earlier this year that Americans do not have a constitutional right to a survivable climate.    During this 36-minute interview, my 15th on the climate catastrophe, Dr. Rachel Cleetus discusses moreover what the Biden administration, and the incoming 117th Congress, will need to accomplish to keep the planet from warming beyond 1.5C.  Dr. Rachel Cleetus is the UCS's Climate and Energy Program Policy Director.  She leads the program’s efforts in designing effective and equitable policies to address climate change and advocating for their implementation.   Among other expertise, she is an an expert on the United Nations Framework Convention on Climate Change (UNFCCC) process and has been attending international climate negotiations since 2009.  She has co-authored numerous reports and articles including the recent UCS reports Underwater: Rising Seas, Chronic Floods, and the Implications for US Coastal Real Estate; Surviving and Thriving in the Face of Rising Seas Building Resilience for Communities on the Front Lines of Climate Change; and The US Power Sector in a Net Zero World: Analyzing pathways for deep carbon reductions.  Prior to joining UCS, she worked as a consultant for the World Wildlife Fund, conducting policy-focused research on the links between sustainable development, trade, and ecosystems in Asia and Africa.  She also worked for Tellus Institute in the energy and environment program.  Dr. Cleetus has been quoted widely, including by the Associated Press, Reuters, The Boston Globe, The Washington Post, Christian Science Monitor, CNN, Politico, USA Today, and U.S. News & World Report, and has appeared on Al Jazeera America, The Today Show, and National Public Radio.  Dr. Cleetus holds a PhD and an MA in economics from Duke University and a BS in economics from West Virginia University.Dr. Cleetus's related blog post noted during this discussion is at: https://blog.ucsusa.org/rachel-cleetus/biden-climate-prioritiesThe UCS's "warning to humanity," also noted during this interview, is at: https://academic.oup.com/bioscience/article/67/12/1026/4605229  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 NowComputer or cybercrimes against health care providers, moreover hospitals, disenable computer networks holding them for ransom, frequently for a bitcoin fee.  Though these attacks date back at least 30 years they have become increasingly prevalent since 2010.   Last month, Universal Health Services, with 400 locations moreover in the US, suffered a cyberattack.  Recently too, the first known death resulted from a ransomware attack in Germany when a patient did not survive transfer to another hospital.  Earlier this month, COVID-19 vaccine trials were delayed by ransomware attack.  Likely the most costly ransomware attack was to the UK’s NHS in 2017 that amounted to an estimated $120 million in IT costs and lost productivity.   In 2020 state legislatures introduced more than 280 cybersecurity-related bills, enacting several.  The US Senate and House passed seven cybersecurity bills this past Congress, however, none specifically addressed the HC industry and none became law. During this 29 minute conversation, Mr. Barlow explains the effect ransomware products have on clinical computer systems, the frequencies of these computer crimes in the health care sector and how they are resolved or at what price to the hospital or other provider organization.  He discusses how these attacks can be prevented and what national regulatory and legislative actions have been or should be taken, e.g., what ransomware-related lessons the health care sector can learn from the federal government procurement process.   Mr. Caleb Barlow is the President and Chief Executive Officer of CynergisTek, an information security and privacy consulting firm focused on the healthcare IT industry.  Prior to joining CynergisTek, Mr. Barlow led the IBM X-Force Threat Intelligence organization.  He has also led the integration efforts of on multiple IBM acquisitions.  In 2018, Caleb invented the Cyber Tactical Operations Center which is a first-of-its-kind training, simulation, and security operations center on wheels.  Mr. Barlow's has a broad background having led technical teams in product development, product management, strategy, marketing, and cloud service delivery.   He has appeared on the TED stage, TODAY, and regularly appears on national news broadcasts.  Mr. Barlow's work has appeared in The Wall Street Journal, The Washington Post, USA Today, The New York Times, and dozens of other publications.  He has testified before the Congress and before the United Nations by invitation of the President of the U.N. General Assembly.  Mr. Barlow has been in leadership roles at two successful startups, including Syncra Systems which is now part of Oracle, and Ascendant Technology which was acquired by Avent.  Caleb also holds multiple patents in the field of Unified Communication.For information on CynergisTek go to: https://cynergistek.com/The Treasury Department October 1 advisory concerning facilitating ransomware payments noted during this conversation is at: https://home.treasury.gov/system/files/126/ofac_ransomware_advisory_10012020_1.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 NowThe ongoing COVID-19 pandemic has placed a spotlight on the social determinants of health (SDOH) - generally defined as health access and quality, education, economic circumstances, food security, social conditions and environmental factors.  It is estimated SDOH determine as much as 60% of one's health status, whereas formal medical care accounts for just 10%.  Concerning economic circumstances, forty years of wage stagnation among lower income workers has left 45% of Americans with either no health care insurance or insurance with out of pocket expenses so high they avoid seeking care when, for example, they develop COVID-related symptoms.  Federal health care policymakers, providers and insurers have however slowly begun to take interest in addressing SDOH as a way to improve health care outcomes and costs.  For example, Medicare Advantage (MA) plans, which enroll more than one-third of all Medicare beneficiaries, have recently been given regulatory authority to offer MA beneficiaries supplemental benefits beyond medical care such as meal delivery, home modifications and personal care services.  Recently as well, the 2017 tax bill contained a provision that created Opportunity Zones (OZs) designed to attract long term investment via tax incentives to address social and economic realities in high poverty communities. During this 32 minute conversation, Mr. Gorman provides an overview of his investment firm, Nightingale Partners, explains the OZ provision in the 2017 tax law and moreover details how OZ investments can be and are being used to address social determinants of health including housing, food security, transportation and the use of community health workers.  He also explains how providers and plans can exploit OZ legislation and the extent to which MA plans are making use of recent supplemental benefit regulatory reform. Mr. John Gorman is the Founder and former Executive Chairman of Gorman Health Group.  Previously, Mr. Gorman served as Assistant to the Director of Health Care Financing Administration’s (HCFA, now CMS) Office of Managed Care.   During the 1993 debate on national health care reform, Mr. Gorman served as chief lobbyist on health care financing issues for the National Association of Community Health Centers.  Mr. Gorman's career in Washington began as Press Secretary and Staff Director for Congressional Representative John Conyers, Jr. (D-MI), then Chairman of the Government Operations Committee.  Mr. Gorman currently serves on the Board of Directors of Henry Ford Health System’s Health Alliance Plan in his home town of Detroit and serves as a Senior Advisor to Premier, Inc., a hospital purchasing cooperative.  The CDC's SDOH website is at: https://www.cdc.gov/socialdeterminants/index.htmInformation on Nightingale Partners is at: https://www.nightingalepartners.org/Information on OZ's is at: https://www.irs.gov/credits-deductions/opportunity-zones-frequently-asked-questions 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 NowCollectively termed subnationals, numerous academic institutions, states, cities and other local governments, companies, NGOS and other entities across the country have independently pledged to go green or become climate neutral.  Ironically, the industry most lagging in this effort is health care despite the fact that, after the food industry, health care is the largest emitter of carbon dioxide equivalents at over 650 million metric tons annually, or approximately 10% of total US greenhouse gas emissions.  Also too, despite the fact, per research published in PLOS One in 2016 by Mt. Sinai researchers, the health harm caused by the health care industry's carbon emissions causes upwards of 98,000 deaths per year – just in the US.  (The US health care industry also substantially lags behind other prominent US industries in publicly reporting its carbon emissions.)  Two weeks ago, however, Kaiser Permanente, the US's largest integrated, non-profit healthcare provider, became the first provider to achieve carbon neutral status.  In its September 14th press released announcing the achievement, Kaiser stated it had erased its annual 800,000 ton carbon footprint.  "As physicians, the press release stated further, "climate change is absolutely in our lane.”  (Listeners will recall I interviewed Kaiser's Kathy Gerwig about her organizations climate neutral efforts in May of 2019.  This is my 14th climate crisis-related interview.) During this 30 minute interview, Mr. Whitman provides an overview of his organization and its success to date, e.g., number of companies his organization has certified over the past year and number he expects to reach this coming year.  He describes how climate neutral status is achieved by satisfying Scope 1 through Scope 3 criteria.  He explains corporate motivations to achieve climate neutral status and the financial costs of doing so (they're in sum largely dependent on type of company) and he offers policy suggestions for faster or more rapid adoption of renewable energy.Mr. Austin Whitman is currently CEO of Climate Neutral.  Mr.  Whitman has served as both Vice President of Climate Change Capital, and as Vice President of M.J. Bradley & Associates, two leaders in climate-focused investing and asset management.  In 2019, Austin founded Climate Neutral, a 501(c)(3) nonprofit, aiming to accelerate the de-carbonization of global emissions through their achievable certification framework.  The framework certifies brands who measure their carbon footprint, offset it with verified offsets to net-zero, and create future reduction strategies. Information on Climate Neutral is at: https://www.climateneutral.org/The PLOS One article is at: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0157014Kaiser's September 14 press release is at: https://about.kaiserpermanente.org/community-health/news/first-carbon-neutral-health-system-in-us 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 NowPatient safety, or preventable patient harm, remains a significant threat to patients, particularly seniors, now over 20 years after publication of the landmark IOM report, “To Err is Human."  The country’s failure to contain COVID-19 (SARS-CoV-2) stands in marked contrast to successful containment of SAR-COV-1 (and MERS and H1N1).  This failure has assuredly increased incidences of patient harm and preventable or excess deaths.   Among other explanations, a recent Harvard Business Review study concluded PPE shortages persist.  Beyond patient harm this has contributed to the death of over 600 clinician as of this past June.  A Kaiser Family Foundation study concluded as of mid-August, long term care setting deaths have numbered more than 70,000 or 45% of all COVID-19 deaths.  Worse still, research recently published in Nature found when uncounted and indirect deaths, the number of COVID-19-related deaths in the US is significantly higher.  Per the CDC, the number of excess US deaths since February 1st number 208,000.  (Listeners will recall I interviewed Paul Epner, CEO of the Society to Improve Diagnosis in Medicine (SIDM), on the related topic of wrong, delayed or missed diagnoses.)  During this 30 minute conversation Dr. Mayer provides a brief explanation of the Patient Safety Movement Foundation and notes his current effort to bring attention to patient harm or medical errors by walking across the US.  (You can follow him "@WalkForPTSafety.")  Moreover, he discusses the state of patient safety during the ongoing epidemic, what improvements have been made to reduce patient harm and what factors continue to explain compromised patient safety.  He also discusses what progress has been made in reducing avoidable sepsis infections (the leading cause of US hospital deaths), what federal policies would help reduce the number of medical errors and concludes by highlighting the work of MedStar's Institute for Quality and Safety.      David Mayer, MD, is Executive Director of the MedStar Institute for Quality & Safety (MIQS) and as CEO of the Patient Safety Movement Foundation.  Previously, Dr. Mayer served as Vice President of Quality and Safety for MedStar Health.  Previously still, Dr. Mayer was employed by the University of Illinois Medical Center in Chicago as Co-Executive Director of the UIC Institute for Patient Safety Excellence and served as Director of UIC Masters of Science Patient Safety Leadership Program, Associate Dean for Education, and Associate Chief Medical Officer for Quality and Safety Graduate Medical Education.  Concurrent with these roles, he served as Vice Chair for Quality and Safety for the Department of Anesthesiology, where he was an Associate Professor of Anesthesiology and Director of Cardiac Anesthesiology.  Dr. Mayer also founded and has led the Annual Telluride International Patient Safety Roundtable and Patient Safety Medical Student Summer Camp for the last thirteen years.   In addition, he has served as Director of Medical Affairs of the Hospital Products Division of Abbott Laboratories and was president and Founder of Esurg Corporation.   Among other awards, Dr. Mayer was listed on the Becker’s Hospital Review 2017 and 2018 lists of Top 50 people leading patient safety.  He has been selected by the International Society for Quality in Healthcare (ISQua) as an International Quality and Safety Expert.  He is the 2013 Founders’ Awardee from the American College of Medical Quality, winner of the University of Illinois/American Association of Medical Colleges Humanism in Medicine Award and was recognized by the Institute of Medicine in Chicago in 2010 with the Sprague Patient Safety Award.  He has received grant funding from the United States Department of Education, the Agency for Healthcare Research and Quality, and the Anesthesia Patient Safety Foundation.   Dr. Mayer attended the University of Illinois at Chicago for both his undergraduate and medical degrees.  He completed his internship and residency at Michael Reese Hospital and Medical Center followed by a fellowship in cardiac anesthesia. Information on the Patient Safety Movement Foundation is at: https://patientsafetymovement.org/The Harvard Business Review article noted is at: https://hbr.org/2020/09/why-the-u-s-still-has-a-severe-shortage-of-medical-suppliesThe Kaiser Family Foundation study is at: https://www.kff.org/coronavirus-covid-19/press-release/covid-19-outbreaks-in-long-term-care-facilities-were-most-severe-in-the-early-months-of-the-pandemic-but-data-show-cases-and-deaths-in-such-facilities-may-be-on-the-rise-again/The Nature study cited is at: https://www.nature.com/articles/d41586-020-02497-wCDC's work on COVID-19 related excess deaths is at: https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.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 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