The Healthcare Policy Podcast ® Produced by David Introcaso

According to the non-profit Mapping Police Violence, since 2013 when experts first starting tracking police shootings, last year was the deadliest year on record with 1,176 law enforcement gun deaths, or more than three people per day and nearly 100 per month.  In 2022 Blacks were three three times more likely to be killed by police than Whites.  However in, for example, MPLS and Chicago, Black shooting deaths were respectively 28 and 25 times more likely than White.   In her recently published book by Viking Press, Prof. Schwartz explains how the corruption of the 4th amendment and Civil Rights law, the creation of the legal fiction “qualified immunity” and other reasons make it nearly impossible to police the police.  During this 38-minute interview, Prof. Schwartz begins by discussing the case of Ornee Norris. She in turn explains the courts’ undermining of 4th amendment’s protection from unreasonable searches, civil rights protections, specifically section 1983 of the 1871 Civil Rights Act, and the Supreme Courts 1967 creation of, in Pierson v. Ray, of qualified immunity, discusses the case of systematic violence by Vellejo, CA, police, the failure by governments to learn from these cases, efforts by states to pass laws ending qualified immunity, notes the value of Freedom of Information Act (FOIA) requests, and finally comments on the issue of the militarization of the police. Joanna Schwartz is Professor of Law at UCLA School of Law and the Faculty Director of the David J. Epstein Program in Public Interest Law and Policy.  She was a recipient of UCLA's Distinguished Teaching Award in 2015 and served as Vice Dean for Faculty Development from 2017-2019. Beyond Shielded, her recent scholarship has been published in the Yale Law Journal, Stanford Law Review, University of Chicago Law Review, Columbia Law Review, New York University Law Review, Michigan Law Review, Northwestern Law Review, Georgetown Law Journal, UCLA Law Review, and elsewhere. She has also written for The New York Times, The Washington Post, The Los Angeles Times, USA Today, The Atlantic, The Boston Review, and Politico, and has appeared on NPR’s Fresh Air, CBS Sunday Morning, PBS NewsHour, ABC News, CNN, MSNBC, and elsewhere. Professor Schwartz is also co-author with Stephen Yeazell and Maureen Carroll of a leading casebook, Civil Procedure (11th Edition). Professor Schwartz was graduated from Brown University and Yale Law School. She clerked for Judge Denise Cote of the Southern District of New York and Judge Harry Pregerson of the Ninth Circuit Court of Appeals.   This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

US healthcare emits a massive amount of carbon pollution at approximately 600 million tons annually or roughly 9% of total US greenhouse gasses.  Because of the rapid increase in climate crisis-related harms projected economic losses worldwide over the next few years are estimated in the trillions.  Consequently, the US is beginning to follow Brazil, Canada, France, Japan, Switzerland and the UK in mandating GHG emission and climate-risk disclosures.  Most noteworthy, in April 2022 the Security Exchange Commissions (SEC) issued a proposed rule, anticipated to go final this month, that will require publicly traded companies to disclose information about climate-related financial risks and financial metrics to inform investors in making corporate investment and voting decisions.  Just recently the California governor signed a “Climate Accountability Package,” the White House in late September charged the OMB to work with fed agencies to measure GHG emissions in order to calculate impacts on fed programs and the European Union has moved related reporting regulations that will impact American companies doing business overseas. During this 34 minute interview Ms. Hanawalt begins by outlining the proposed SEC climate disclosure rule. She next outlines CA’s “Climate Accountability Package (S253 and S261) that address CA reporting for different sized private and public companies and discusses related European Union regulatory rules. Ms. Cynthia Hanawalt is the Director of the Sabin Center’s financial regulation practice. Her work supports regulatory and policy responses to climate-related financial risk at the federal and state level and includes a focus on the complex intersections of ESG and antitrust law with sustainability goals and climate resiliency measures. Ms. Hanawalt is affiliated with Columbia Climate School and the Initiative for Climate Risk & Resilience Law. Prior to joining the Sabin Center, Ms. Hanawalt served as Chief of the Investor Protection Bureau for the New York State Office of the Attorney General and was a litigation partner at the firm Bleichmar Fonti & Auld. She was graduated from Columbia Law School where she was a Harlan Fiske Stone Scholar and Duke University where she received the William J. Griffith University Service Award.For more information regarding climate disclosure see these Sabin Center writings:https://blogs.law.columbia.edu/climatechange/2023/08/08/new-california-legislation-would-be-a-major-step-forward-for-climate-disclosure/https://blogs.law.columbia.edu/climatechange/2023/03/28/global-consensus-is-emerging-on-corporate-scope-3-disclosures-will-the-sec-lead-or-lag/ This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

US healthcare spending is extreme currently at approximately $4.3 trillion.  The single largest payer of healthcare services is Medicare at roughly $900 billion annually or 21% of total healthcare spending.   In this edited volume, recently published by Johns Hopkins University Press, Dr. Moffit along with eleven other contributors including Joe Antos, Douglas Holtz-Eakin, Brian Miller, Mark Pauly and Gail Wilensky, lay out the conservative version of Medicare reform.  In sum, the authors argue federal policymakers reinvent Medicare as a defined contribution or premium support program or at minimum substantially expand the Medicare Advantage program (Medicare Part C), or Medicare coverage provided by private insurance companies.  The interview begins by Dr. Moffit commenting on whether healthcare services can be defined as a market commodity. He discusses the problem of healthcare pricing, measuring for value in healthcare, improving Medicare Advantage benchmarking, remedying Medicare Advantage coding intensity via retrospective risk adjustment and risk transfer pools and competing fee for service Accountability Care Organizations (ACOs) against Medicare Advantage. Dr. Robert Moffit is a Senior Fellow in Domestic Policy Studies at The Heritage Foundation specializing in health care and entitlement programs, moreover Medicare. Dr. Moffit also serves on the Maryland Health Care Commission as an appointee of Gov. Larry Hogan and he is a member of the advisory board of the Buckley School of Public Speaking in Camden, South Carolina. He brings to the reform effort experience as a senior official of the U.S. Department of Health and Human Services (HHS) and the Office of Personnel Management (OPM) during the Reagan administration. Dr. Moffit is a co-author of “Why Obamacare Is Wrong for America,” (Harper Collins, 2011). He was a contributor to “A Time for Governing: Policy Solutions From the Pages of National Affairs” (Encounter Books, 2012) and “Controversial Issues in Social Policy” (Allyn and Bacon, 2003), a university textbook on public policy. He has published in numerous professional and specialty journals among them Health Affairs, Health Systems Review, Harvard Health Policy Review, Inquiry, Journal of Law, Medicine and Ethics, National Affairs, New England Journal of Medicine, Postgraduate Medicine, and Journal of Medicine and Philosophy. His analysis and commentary have been cited or published by The New York Times, The Wall Street Journal, The New York Post, The Washington Post and The Washington Times. He holds a master's degree and a doctorate in Political Science from the University of Arizona. He received his bachelor's degree in Political Science from LaSalle University in Philadelphia. Information on “Modernizing Medicare,” is at: https://www.press.jhu.edu/books/title/12839/modernizing-medicare. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Over the past several decades healthcare has increasingly defined patients as medical consumers.  For example, healthcare advertising is today a $22 billion annual business; federal policymakers have over the past few years instituted regulations requiring both hospitals and commercial health plans to make pricing information public; and, provider quality performance information is increasingly publicly reported.   The question begged is to what extent have efforts to define patients as medical care consumers been successful - or even legitimate.  In “Remaking the American Patient,” winner of the prestigious Bancroft Prize, Prof. Tomes explains how over the past century the public or patients have increasingly been defined as medical consumers and evaluates whether medical consumerism, or medicine as a commercial product, has served the public or patients’ interests and/or has transformed American healthcare for the better.During this 37-minute discussion Prof. Tomes begins by explaining what prompted her to write the book. She discusses the inherent problems with defining patients as consumers and medicine as a commodity, what explains the origin of patient/medical consumerism (largely uniquely American), discusses the 1973 Patients Bill of Rights as an exemplary patient empowerment effort and the ongoing or never-ending tension between medical professionalism and patient consumerism. She concludes by summarizing her findings and what capacity there is to resolve the conflict between professionalism and consumerism or change the paradigm. Prof. Nancy Tomes is Professor History at Stony Brook University. Her publications include: Madness in America: Cultural and Medical Perceptions of Mental Illness Before 1914, with Lynn Gamwell (Cornell, 1995), The Gospel of Germs: Men, Women and the Microbe in American Life (Harvard, 1998), and Remaking the American Patient: How Madison Avenue and Modern Medicine Turned Patients into Consumers (UNC, 2016); plus two co-edited collections, Medicine's Moving Pictures, with Leslie Reagan and Paula Treichler (Rochester, 2007), and Patients as Policy Actors, with Beatrix Hoffman, Rachel Grob, and Mark Schlesinger (Rutgers, 2011); and a website, "Medicine and Madison Avenue," on the history of health-related advertising, developed in collaboration with Duke University Library's Special Collections.  Prof. Tomes was graduated from the U. of Pennsylvania with a Ph.D. in History. Information on “Remaking the American Patient,” is at: https://uncpress.org/book/9781469622774/remaking-the-american-patient/. 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

Professors Albritton Jonsson and Wennerlind’s recently published book, “Scarcity” by Harvard University Press, offers interpretations of a key concept in economic theory: scarcity, or the belief we live in a world of limited resources and therefore must master the natural world to meet desired needs.   The authors state, “the book does not offer a critique of the usefulness of the neoclassical concept of scarcity, instead, the problem we highlight is that it has been far too successful,” that is “by promoting optimal use of resources and maximum economic growth, it has fostered a world in which the economy and nature are on a collision course.”  As a result our economic success has endangered both our health and survival via the use of fossil fuels to power our economy.   This 37-minute interview begins with brief descriptions of two umbrella categories of scarcity the authors define: Cornucopian; and, Finitarian. They identify subcategories within these two categories and thinkers throughout history who can be categorized into sub-categories of scarcity of, e.g., enlightened, capitalist and neoclassical and neo-Aristotelian, Utopian, Malthusian, Romantic, Socialist and Planetary. The authors comment on Diamandis and Kotler’s argument regarding negativity bias. They discuss the benefit of taking a long view, here 500 years, to free today’s thinkers of taking alternative views of the world to challenge current dominate neoclassical view of scarcity and economics and discuss the book concluding on the the concept of repair. Frederik Albritton Jonsson is an Associate Professor of History at the University of Chicago and Carl Wennerlind is a Professor of History and Chair of the History Department at Barnard College at Columbia University. The authors bios are at: https://history.uchicago.edu/directory/fredrik-albritton-jonsson and and https://history.barnard.edu/profiles/carl-wennerlind. Information on the book can be found at: https://www.hup.harvard.edu/catalog.php?isbn=9780674987081. 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

Dr. Young’s novel, “2060” tells the story of Willis Smith, a data analyst employed by IntegraHealth Pharmaceuticals. Mr. Smith is assigned to identify a surviving meta-quad, a patient that has survived four naturally occurring cancers.  In his search Willis meets the owners of Mekong Gardens Senior Care Center who offer a distinctly different healthcare formula.   The story arc peaks when the owners of Mekong Gardens’ care model is exposed and its owners are required to explain their alternative care model, or why they had been defrauding the Medicare program.  The novel is accompanied by a 36-page afterward that provides invaluable context for the novel.  Dr. Richard Young, a native Texan, is the Associate Program Director and Research Director at the John Peter Smith Hospital Family Medicine Residency Program in Fort Worth. He has also worked in emergency departments for much of his career. Dr. Young has served on various committees and commissions for the Texas Academy of Family Physicians and the American Academy of Family Physicians. He has had the privilege of training over 700 family physicians and teaching countless medical students. His publications have moreover concerned the nature of family medicine and the cost and processes of the U.S. healthcare system. In 2012 he published American HealthScare to help educate Americans about the difficult truths we face to better manage healthcare cost growth. This work resulted in his creating a related the blog www.healthscareonline.com.  Dr. Young earned his undergrad degree in chemical engineering at UT, Austin, he graduated from medical school at the University of Texas Health Science Center in San Antonio and completed his family medicine residency at John Peter Smith Hospital.   This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

On background, listeners are aware that the US healthcare industry emits an enormous amount of GHG pollution, that hospitals are the largest contributor to industry emissions, that they are substantially energy in-efficient and that the industry’s emissions alone cause innumerable and unrelenting health harm - disproportionately impacting are Medicare seniors and Medicaid children.  Despite these facts the healthcare industry on balance remains solidly uncommitted to decarbonizing. Finally, listeners are now likely well aware early this week the earth reached unprecedented temperatures and that last month was the warmest June globally in recorded history.During this interview Ms. Roschnik begins by providing an overview of the International Hospital Federation’s mission, members and its recent foray into environmental sustainability, or reducing greenhouse gas emissions. She discusses related sustainability programming, including master classes and running a learning lab. She discusses the upcoming October meeting in Lisbon, training tools including a sustainability accelerator tool, recognizing and addressing carbon emissions from all three scopes, the economics of decarbonizing, US exemplars, sustainability interest by health insurance carriers and accrediting organizations, NHS’s related efforts, use of EPA’s Energy Star energy efficiency program, and the benefit of embedding or integrating sustainability in hospital planning and operations. Ms. Sonia Roschnik is the Executive Director of the IHF’s Sustainability Centre in Geneva, Switzerland. She also currently serves on the Board of the Climate Action Accelerator and is an honorary member of the UK’s Faculty of Public Health. Ms. Roschnik worked previously as the International Climate Policy Director for the Centre from Health Care Without Harm. Previously still, she was Director of the NHS Sustainable Development Unit (2018–2020).  Ms. Roschnik is the author of the global roadmap to decarbonize healthcare (2021) and worked in collaboration with the World Health Organization (WHO), United Nations Framework Convention on Climate Change (UNFCCC), and the UK presidency of the UN Climate Change Conference of the Parties (COP26. She holds a Master of Science degree in Systems Thinking and is a UK-registered occupational therapist.The IHF is at: https://ihf-fih.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

Professor Larry R. Churchill, Emeritus Professor of Medical Ethics at Vanderbilt, discusses “Biotethics Reenvisioned,” a just-published book he co-authored with Wake Forest Professor Nancy M. P. King and UNC Professor Gail E. Henderson. The authors, appropriately, argue “bioethics needs an expanded vision” or beyond one that has predominately focused on patient autonomy, beneficence and nonmaleficence.  The field needs to take “a more robust role” they write and begin to address upstream issues including social determinants, health disparities, structural racism, or in sum begin to meaningfully address social or distributive justice.  The field needs to move beyond what the authors’ term “lifeboat ethics” or “lifeboat framing” where issue beyond the bedside are largely if not completely ignored. The impetus for their thinking is largely, no surprise, the COVID pandemic that according the CDC has to date been responsible for 1.35 million excess deaths. During this 31-minute interview Professor Larry Churchill begins by defining “lifeboat ethics.” He discusses the harm or damage caused by the failure by the bioethics filed to address upstream justice issues resulting from social determinants, He briefly discusses scholars, e.g., Charles Taylor and Norman Daniels, who have productively commented on the social dimensions of justice and his sense of how their lifeboat framework criticism been received by the profession. We discuss at some length the book’s last and lengthiest chapter “Bioethics and the Global Warming Crisis” and what bioethicists working on issues of social justice can do to educate, improve public literacy and inform policy. Larry R. Churchill is Professor of Medical Ethics Emeritus, Vanderbilt University Medical Center. Prior to Professor Churchill taught at the University of North Carolina at Chapel Hill where he was Chair of the Department of Social Medicine. Professor Churchill is a member of National Academy of Medicine and a Fellow of The Hastings Center. He is the author of seven books, including Ethics for Everyone: A Skills-Based Approach (2020, Oxford University Press). Churchill’s work has been featured in popular media such as USA Today, The New York Times, Bill Moyers’ Journal, and the Alex Gibney documentary Money-Driven Medicine. Information on the book is at: https://uncpress.org/book/9781469671581/bioethics-reenvisioned/. 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

As this hour-long documentary explains US hospital care, and healthcare in sum, is largely volume-driven that over-emphasizes expensive specialty versus spending-efficient primary care.  There exist few constraints on commercial healthcare pricing despite the fact hospital prices have little correlation to care quality or value, defined as outcomes achieved relative to spending.  Prices also vary significantly - even within the same city.  Healthcare today can be largely defined as a profit-maximizing business.  Hospitals, and clinical care professionals as well, are geographically maldistributed and the problem is growing as safety net and rural hospitals continue to close.  That healthcare by its very nature does not constitute a competitive market has been made worse by 1980s deregulation.  As result, about a third of the 100 million adults in the U.S. with healthcare are in debt to hospitals.  Healthcare delivery exhibits significant gaps in health equity and providers waste $10s of billions on administering a chaotic insurance plan marketplace.  This discussion will remind listeners of my interview with Brian Alexander in June 2021 regarding his book, “The Hospital: Life, Death and Dollars in a Small American Town.”During this 34-minute interview, Mr. Potter begins the discussion by commenting on hospital prices, private equity and three current federal regulatory policies to limit price growth: medical loss ratios (MLRs); price transparency; and, site-neutral payments. Discusses non-profit hospital community benefit policy, measuring hospitals for value, and Maryland’s All-Payer model that sets and globally budgets Maryland’s hospital prices. Mr. Wendell Potter is a former health insurance company executive who became an industry reform advocate. Time Magazine called Mr. Potter, “the ideal whistleblower.” Mr. Potter left his position as a Cigna Health insurance executive in 2008 after what he has described as a crisis of conscience. Today, Mr. Wendell is President of two organizations: the Center for Health & Democracy; and, Business Leaders for Health Care Transformation. Both work in sum to end the employer-based health insurance system and guarantee health care for all Americans. You will find his writings on Substack via his HEALTH CARE un-covered newsletter.   For information on the documentary go to: https://fixithealthcare.com/. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

More than likely the most important legislation the Congress will pass this year or this session is the multi-year fam bill that is projected to cost $1.5t over the next 10 years.  A significant component of farm bill leg is Title IV that addresses nutrition assistance, namely the Supplemental Nutrition and Assistance Program (SNAP) that serves 42 million Americans, including one in every four children.  SNAP benefits were expanded during the COVID pandemic.  As of two months ago however expanded SNAP benefits expired.  Presently Congressional Republicans are looking go cut SNAP funding by weaponizing the debt ceiling vote. (Listeners may recall I discussed SNAP policy with the CBPP in March 2020.)    During this 30-minute conversation Ms. Bergh begins by providing an overview of current state of hunger and food insecurity. She proceeds to discuss the recent “food cliff” resulting from sunsetting expanded COVID emergency SNAP benefits this past February, discusses House Republican’s April debt ceiling legislation that included cuts to SNAP programming and what SNAP reforms advocates are proposing. We conclude with comments regarding SNAP participation, the Biden administration’s hunger conference last summer and pledge to end hunger and diet related-diseases by 2030 and the current state of the farm bill’s legislative process. Ms. Katie Bergh is a Senior Policy Analyst on the Center for Budget and Policy Priorities (CBPPs) Food Assistance team. Prior to joining CBPP, Ms. Bergh worked as a Senior Policy Advisor for Rep. Chellie Pingree (D-ME), where she managed her work as a member of the House Agriculture Committee and House Appropriations Subcommittee on Agriculture, Rural Development, Food and Drug Administration, and related agencies. Previously, Ms. Bergh spent six years as a staff member for the U.S. Senate Committee on Agriculture, Nutrition, and Forestry under Senator Debbie Stabenow (D-MI), where she handled the committee's work on domestic and international food assistance programs for the 2018 farm bill.  Ms. Bergh holds a BA in Biology from Kalamazoo College and an MPP from the London School of Economics and Political Science.As an example of the CBPP’s latest SNAP reporting, see this May 9th document: https://www.cbpp.org/blog/roundup-analyzing-house-republicans-harmful-debt-ceiling-and-cuts-bill. 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