The Healthcare Policy Podcast ® Produced by David Introcaso

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

In February the CDC released its latest Youth Risk Behavior Survey findings.  Somewhat needless to say the data is discouraging.  For example, in 2021 40% of high school students, 60% of high school female students and 70% of high school LGBQ students reported feeling sad or hopeless. Among other findings, 22% of high school students had seriously considering suicide, 18% made a suicide plan and 10% had attempted suicide - these percentages are the highest reported since the first Youth Risk Behavior survey was first fielded in 2011. During this 36-minute interview Dr. Trede and Ms. Shapiro begin by discussing Youth Risk Behavior Survey findings concerning sadness and hopelessness, data concerning girls, LGBQ students and suicidality generally. They discuss timeliness of care and care integration, self harm, therapeutic approach, alternative therapies, the importance of modeling pro social behaviors, and they note subject areas to improve behavioral health policy including policies to help remove the stigma associated with behavioral health and improve family support.    Dr. Felix Trede serves as the East Boston Neighborhood Health Center/South End Community Health Center Behavioral Health Clinician and Training Coordinator.  Dr. Trede began his career as a clinical case manager/rehabilitation specialist with Bay Cove Human Services in Boston in 2008.  He joined the Behavioral Health team at SECHC as an intern in 2014 before joining as a full-time staff member in 2018.  He earned his Psy.D. at William James College.Ms. Laura Shapiro serves as an East Boston Psychiatric/Mental Health Nurse Practitioner.  Laura’s career in pediatric and community health nursing begin in 1999 when she graduated with her BSN from Simmons College. As an RN, Ms. Shaprio worked as a school nurse for the City of Medford.  During that time, she received an M.Ed in educational administration from Bridgewater State University and began her PMHNP studies. She graduated from Northeastern University in 2013 with an advanced practice degree and completed her practicum at Lynn Community Health Center where she provided psychiatric consultations at their school-based health centers.  In 2021, she began working at EBNHC as a mental health nurse practitioner.  Laura also sees patients in private practice and is an adjunct faculty at Northeastern University's Accelerated Bachelor of Science in Nursing program.The CDC’s Youth Risk Behavior Survey is at: https://www.cdc.gov/healthyyouth/data/yrbs/yrbs_data_summary_and_trends.htm. Information regarding the East Boston Neighbor Health Center is at: https://www.ebnhc.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

This past March 20th the United Nation's Intergovernmental Panel on Climate Change (IPCC) published its fourth and last sixth assessment cycle (AR6) report.  This last report integrates the main findings of the IPCC's three, sixth assessment working group reports published over the past 18 months.  The report has been informally termed the “last warning” since the IPCC 7th assessment work will likely not be published until after 2030 - at which time we’ll know whether we have succeeded or not in reducing CO2e emissions by approximately 45% in order to limit avg global warming to the preferred Paris climate accord goal of 1.5C.  Among other conclusions the IPCC authors warned, “There is a rapidly closing window of opportunity to secure a livable and sustainable future for all.”  “The choices and actions implemented in this decade will have impacts now and for thousands of years.”   The UN Secretary General, Antonio Guterres, termed this last report “a clarion call to massively fast-track climate efforts by every country, every sector and on every timeframe.”  An excellent summary of the AR6 fourth report was published in late March by Carbon Brief, at: https://www.carbonbrief.org/carbon-briefs-definitive-guide-to-the-entire-ipcc-sixth-assessment-cycle/.This 35-minute interview Ms. Willis discusses Malaria No More's work, related/relevant IPCC findings and those in context of her attendance last month at a climate/health summit meeting in Abu Dhabi held in preparation for subsequent related discussions during this coming December's IPCC COP 28 meeting also taking place in the UAE.  Ms. Kelly Willis is currently the Managing Director of Strategic Initiatives at Malaria No More.  Ms. Willis has more than 20 years of experience working in infectious disease and global health, helping to build permanent capacity in health systems throughout sub-Saharan Africa and Southeast Asia, in roles including Senior Vice President at United States Pharmacopeia, Executive Director of Accordia Global Health Foundation and through her consulting firm Willis Solutions LLC.  Ms. Willis's field experience includes several years living in East Africa where she helped launch and support the Infectious Diseases Institute at Makerere University and led a multi-year research program to better understand the impact of medical training programs on standards of care and health outcomes.  Prior to that, Ms. Willis spent five years in multiple finance and economics management roles at Pfizer where she also served as a Global Health Fellow in Uganda.   She holds a Distinguished Alumni award from Michigan State University where she earned a BA in French and an MBA in Supply Chain Management.The IPCC report is at: https://report.ipcc.ch/ar6syr/pdf/IPCC_AR6_SYR_SPM.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

In June 2021 I argued in STAT News that HHS require healthcare providers to publicly disclose their GHG emissions that in turn would help enable the healthcare industry to decarbonize.  In order to do this, I argued the the Environmental Protection Agency's (EPA’s) Energy Star Portfolio Manager tool be exploited.  Already well over 50% of hospitals use Energy Star to better manger their energy consumption, i.e., improve their energy efficiency.  Energy Star, an online energy benchmarking tool widely used to track commercial building energy consumption - that accounts for 20% of US GHG emissions - was jointly created by the Department of Energy (DOE) and the EPA in 1992 under authority of the Clean Air Act.  Energy Star has become the standard against which approximately 40 cities and other governing jurisdictions throughout the US, and authorities overseas including the European Union, measure mandated GHG emission reductions.   Energy use is particularly a concern to the US healthcare industry.  Among other things, while representing less than 5% of the total area in the commercial sector, healthcare facilities account for over 10% of total energy consumption.  This is largely due to the fact US hospitals are on average more than two times more energy intensive as European hospitals.   During this 37-minute interview Mr. Reed begins by explaining why Energy Star was created.  He proceeds to explain that any building can be benchmarked, how Energy Star Portfolio Manager scores buildings, the meaning thereof and the meaning of an Energy Star "certified" score.  He notes scoring can automatically calculate GHG emissions.  Mr. Reed next provides an overview of what data elements are required for scoring, discusses the use and benefit by healthcare industry by profiling Memorial Hermann Health System's success, provides Energy Star performance data, for example, savings from avoided energy costs, avoided greenhouse gas emissions and public health benefits, potential use by community health clinics and potential effects of related Inflation Reduction Act provisions.   Mr. Clark Reed has been a national program manager for ENERGY STAR® at the US Environmental Protection Agency (EPA) since 1997.  His work supports hospitals and other healthcare providers, Fortune 500 companies, and numerous other companies in use of ENERGY STAR to create energy management programs that substantially improve energy performance and reduce greenhouse gas emissions.  He has managed the EPA's efforts to establish an ENERGY STAR score for acute care hospitals, medical offices, and senior care communities.  Mr. Reed has also served on the American Hospital Association's American Society for Healthcare Engineering's (ASHE's) Operational Excellence task force and the steering committees of the U.S. Green Buildings Council and the Green Guide for Health Care.  Mr. Reed writes regularly on energy issues for numerous trade publications.  He hold an an MA in environmental policy from Tufts University and a BA in economics from the University of Washington.  He lives in a certified net zero energy home in Maryland with his wife and son.For more information on Energy Star go to: https://www.energystar.gov/. 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