The Healthcare Policy Podcast ® Produced by David Introcaso

(This interview is dedicated to my friend Randy Lee, a dedicated public health nurse, who passed away earlier this week.)   Justin Smith in his book published earlier this year, The Internet is Not What You Think It Is, argued the internet is addictive, its use of algorithms leaves our lives warped and impoverished and despite these problems there is little or no federal regulatory oversight.  Concerning the internet’s effects on children, Dr. Linn argues in her recently published work, Who's Raising the Kids, that our digital landscape essentially invades children’s privacy in order to use their personal information to drive endless consumerism.  Children’s screen use, that amounts to upwards of 7.5 hours on average per day - substantially longer for poor and minority children - is having profound negative effects on children of every age.  Generally by threatening childhood development and more specifically Dr. Linn noted by, for example, driving childhood anxiety, conflictual relationships with parents and family stress, depression, diminished language development, eating disorders, erosion of creative play, materialistic values, obesity, precocious sexuality, sleep disturbances, underachievement in school and youth violence.During this 35 minute interview Dr. Linn begins by explaining how Mattel's Aristotle (never commercially launched) and Epic's Fortnite are designed to drive revenue.  She discusses how digital games erodes or undermines children's creative play, how the use of various marketing tools or approaches drive every digital experience leading to a purchase, for example, by creating "frictionless" online experiences.  She discusses the influence corporations have in formal education programming via Sponsored Education Materials (SEMS), discusses what parents can do to monitor children's screen use, what federal policies have been proposed to protect children's privacy and regulate how digital game design and what action the American Psychological Association has taken.               Dr. Susan Linn is currently a Research Associate at Boston Children’s Hospital and Lecturer on Psychiatry at Harvard Medical School.  She has lectured on the importance of creative play, the impact of media and marketing on children and the use of puppetry as a therapeutic tool in venues throughout North and South America, Europe, Asia, and the Middle East.   From 2000 to 2015 Dr. Linn was the Founding Director of Campaign for a Commercial-Free Childhood.  Dr. Linn and her puppets appeared in several episodes of Mister Rogers’ Neighborhood.  She has written and appeared in a number of video programs designed to help children cope with issues ranging from mental illness to death and loss. This Secret Should Be Told, a syndicated TV program for children about sexual abuse won her a coveted Action for Children’s Television and earned Dr. Linn a New England Emmy Award.  With Fred Rogers’ production company, Dr. Linn created the acclaimed educational video series Different and the Same: Helping Children Identify and Prevent Prejudice.  Different and the Same has been used in classrooms in all 50 states and won numerous awards including the two top prizes from the International Communication Film and Video Competition and the Media Award from the Association of Multicultural Educators.  Her book, Consuming Kids helped launch the movement to reclaim childhood from corporate marketers.  Her work has been featured on Good Morning America, Today, Sixty Minutes, Dateline, The Colbert Report, and the acclaimed documentary The Corporation.  Among other honors, Dr. Linn received an UNIMA-USA citation for excellence; a special award for puppet therapy from Puppeteers of America; A Champion of Freedom Award from the Electronic Privacy Information Center; The Creative Leadership Award from the Puppet Showplace Theater; and, a Presidential Citation from the American Psychological Association for her work on behalf of children.Information on Who's Raising the Kids is at: https://thenewpress.com/books/whos-raising-kids.  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

Listeners are aware I recently posted two articles related to decarbonizing the healthcare industry.  One regarding Inflation Reduction Act (IRA) tax credits and another arguing CMS update two, 2016 regulatory rules to allow providers to use for solar microgrids for their emergency power supply.  Listeners are also aware I’ve conducted well over 25 climate crisis-related interviews over the past several years.   For these reasons, this discussion is an attempt to help providers know better how to develop renewable energy power for their own use, specifically solar plus storage microgrids, i.e., what operational advantages solar microgrid power offer, how these renewable energy microgrids are funded and constructed and benefits they offer providers and the patients they treat.  With me to discuss this topic is Mr. Andrew MacCalla, the CEO and Co-Founder of Collective Energy.   As a related aside, please note on December 8th the National Academy of Medicine launched, under its "Grand Challenge on Climate Change, Human Health and Equity," its “Climate Community Network” initiative.  For related information please go to: https://nam.edu/programs/climate-change-and-human-health/climate-communities-network/. During this 33 minute interview, Andrew begins by describing Collective Energy's goal, i.e., moreover to prevent patients from dying via power outages.  He explains reasons for the increasing need for reliable or uninterrupted power, e.g., outages are more frequent and lasting longer.  He provides a general description of planning and installing solar/clean energy microgrid power using a recent installation at a community health center in New Orleans, explains how and why this work is becoming increasingly turn key, how financing is achieved, i.e., how construction can require no out of pocket costs in part via use of forthcoming Inflation Reduction Act tax credits, and the return on investment to the provider or community health center and the benefits to the provider's patient population.                    Mr. Andrew MacCalla is the the Co-Founder and CEO of Collective Energy Company, a social business specializing in bringing clean and reliable power to non-profit community health centers in the US and abroad.  Andrew is also the Principal Advisor to Direct Relief’s Power for Health Program.  He previously served as the Vice President of Emergency Response and New Initiatives at Direct Relief that provides over $2.5 billion in medical resources and over $100M in grant funding to people in over 100 countries and 55 US States and territories annually.  Andrew spent two years living in Haiti after the 2010 earthquake and was on the ground overseeing responses to emergencies like Hurricane Sandy in New York, Typhoon Haiyan in the Philippines, the Ebola crisis in W Africa, the Syrian refugee crisis, Hurricanes Harvey, Irma, Maria, and Dorian, wildfires in CA, and the Covid19 pandemic. Andrew also led the team in Puerto Rico who have implemented over 400 recovery projects on the island since Hurricane Maria.  He has also overseen numerous post-disaster infrastructure and energy projects, including the installation of over four megawatts of solar and battery storage for critical health facilities and community water wells that lost power after Hurricane Maria hit Puerto Rico.  In the Bahamas, Andrew led efforts to repair and rebuild health facilities that were damaged or destroyed in Hurricane Dorian.  Mr. MacCalla studied philosophy at University of California, Santa Barbara and earned a MA in Public Policy and Management at the University of Melbourne.  He has written numerous articles for the Huffington Post and The Sacramento Bee.  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

Having posted over 25 related climate and health-related interviews over the past several years, podcast listeners are aware that the healthcare industry effectively exists in a harm-treat-harm cycle where providers cause patients harm via their greenhouse gas (GHG) pollution - that requires treatment causing providers to emit more harmful GHG pollution added - that leads to more patent harm - that leads to . . . .    In September I posted an article that appeared in Health Affairs in which I argued CMS design a Medicare Part A hospital Value Based Payment program and a similar program under Medicare’s Part B physician Quality Payment Program that financially incent healthcare providers to reduce their GHG emissions.  Doing so, I argued, would measurably lower Medicare and Medicaid beneficiaries burden of disease, improve their care outcomes and safety, advance health equity, improve the industry’s financial sustainability and help heal the planet.  Reforming insurance payments is also the interest of the Dutch healthcare policy researcher, Dr. Jeroen Struijs, who is presently in the US working with Harvard faculty to identify insurance value based purchasing methods that can incent the health care industry to reduce its GHG pollution.   During this 33-minute interview, Dr. Struijs begins by providing an overview of his research work.  The discussion moves on to Dr. Struijs explaining what's driving aligning payments with industry greening and the lack of effort to to date by insurance carriers to align payments or reimbursement despite inherent efficiency motives.  He identifies possible reasons why insurance carriers have not to date aligned payments, discusses the role or importance of development and use of sustainability quality metrics and  patient incentives.  Regarding financial incentives, he identifies opportunities via the Part B Medicare Shared Savings (ACOs) Program and in the private/commercial markets where payers can more readily or immediately address greening providers.  The discussion concludes with Dr. Struijs commenting on provider accreditation, provider curriculum reform and lessons learned via related overseas efforts.                    Dr. Jeroen Struijs, Ph.D., D., M.Sc., a 2013-14 Dutch Harkness Fellow in Health Care Policy and Practice, is a Senior Researcher at the Centre of Prevention and Health Services Research, National Institute of Public Health and the Environment, where he has been conducting research since 2000.  He is also Associate Professor at Leiden University's Medical Center.  Prior to his work in health policy, Dr. Struijs was a practicing physiotherapist.  Dr. Struijs’ research covers a broad range of topics surrounding payment reform and innovations in the organization of health care systems, particularly in primary care.  Dr. Struijs has published peer-reviewed articles in journals such as Health Affairs, Health Policy, and New England Journal of Medicine.  He is member of the editorial board of the International Journal of Integrated Care, and board member of the International Foundation for Integrated Care.  Dr. Struijs holds a Ph.D. degree in health services research from University of Amsterdam, and two master’s degrees: one in health sciences from Maastricht University; and, one in health services research from Erasmus University Rotterdam.  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

After heart disease cancer is the leading cause of mortality in the US at over 600,000 deaths annually.  Not surprisingly cancer care costs are considerable at approximately $210 billion of which approximately 10% is paid out of pocket.  This explains why in part up to 30% of Medicare beneficiaries without subsidies do not fill their anticancer prescriptions.  To make matters worse, the COVID pandemic has significantly compromised cancer diagnosis and treatment that are expected to produce negative ripple effects.  While  President Biden’s “Cancer Moonshot,” aims to cut cancer death rates by 50% over the next 25 years, last year the CDC projected that because of the growth and aging of the population the annual number of cancer cases will increase nearly 50% between 2015 and 2050.  During this 33 minute interview Ms. Goldsmith discusses the CancerCare's work, in sum, the organization provides free professional support services and information for cancer patients.  We move on to discuss the relationship between CancerCare's work and the Medicare hospice benefit, problems with employer based coverage for cancer diagnoses, complications associated with timely cancer screenings, work CancerCare does to help their patients/clients afford their medications.  Ms. Goldsmith comments on President Biden's Cancer Moonshot initiative, drug pricing policies recently passed under the IRA, challenges her organization faces in raising financial assistance funding and the increasing demands on the organization's workforce.            Patricia J. Goldsmith joined CancerCare in 2014 as Chief Executive Officer.  Ms. Goldsmith previously served as Executive Vice President and Chief Operating Officer at the National Comprehensive Cancer Network (NCCN).  Previously still,  Ms. formerly served as Vice President for Institutional Development, Public Affairs and Marketing at the Moffitt Cancer Center in Tampa, Florida – an NCCN Member Institution.  Before joining Moffitt, she developed and directed all managed care activities for the University of South Florida College of Medicine.  A frequent national meetings and symposia, Ms. Goldsmith has also served on Congressional panels.  Ms. Goldsmith has studied at the Pennsylvania State University, the University of Missouri Bloch School of Business and the Harvard School of Public Health.  She was a winner of the 1999 Distinguished Women in Business Award sponsored by the Business Journal of Tampa Bay and also was named the 1999 Leukemia Society Woman of the Year.  Most recently, Ms. Goldsmith was named to Forbes 50 Over 50 Vision List which was established in partnership with Mika Brzezinski’s “Know Your Value,” and highlights women over the age of 50 who have achieved significant success.Information on CancerCare is at: https://www.cancercare.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 summer the planet once again experienced record temperatures, droughts, wildfires and extreme weather events.  Nevertheless, according to a recent report by the International Energy Agency and OECD, global public subsidies of fossil fuel subsidies nearly doubled from 2020 to $700b in 2021.  The US economy still remains significantly dependent on coal use; it generates approx. 20% of the country’s power or almost twice as much as the electricity generated by wind and solar.  (To compare in the UK, 1.5% of power production is coal-fired.)  Though the planet is currently projected to warm to well over 2.5C this century, per a recent report by United in Science global warming has already reached the lower end of five end game negative climate tipping points.  (Think, for example, a collapsing Greenland ice sheet.)  This finding led the UN Secretary General, Antonio Guterres, to state, “the report shows climate impacts heading into uncharted territory of destruction,” what he termed climate carnage.    During this 33-minute interview Dr. Miller begins by discussing the work of the Global Climate and Health Alliance.  She goes on to discuss the impetus for a fossil fuel non-proliferation treaty, identifies organizations that have signed on including the World Health Organization, analogizes the treaty to the WHO Framework Convention on Tobacco Control, discusses what role the UN may play in forwarding a non-proliferation treaty, and what we currently know about what if any interest the White House and HHS are receptive to a non-proliferation treat.  We conclude with Dr. Miller's interpretation of why only a trivial fraction, as low as 1%, of Americans believe the climate crisis is the most important problem facing the country.     Dr. Jeni Miller is Executive Director of the Global Climate and Health Alliance, where she coordinates the joint efforts of national, regional and international health organizations addressing climate change.  The Alliance works to minimize the health impacts of climate change and to maximize the health benefits of climate solutions, through leadership, advocacy, policy, research, and engagement.  On behalf of the Alliance, Dr. Miller co-chairs the WHO-Civil Society Working Group on Climate and Health.  In addition to her work at GCHA, Dr. Miller currently serves as Immediate-Past-Chair of the Environment Section of the American Public Health Association.  She has two decades’ experience working on policy- and systems-change strategies to improve community environments for health, in leading initiatives addressing childhood asthma, childhood obesity, climate change, health equity, and healthy community redevelopment.  Dr. Miller received her doctorate from the University of California, Berkeley.The Global Climate and Health Alliance's related article is at: https://climateandhealthalliance.org/press-releases/international-health-organizations-call-for-fossil-fuel-non-proliferation-treaty-to-protect-lives-of-current-and-future-generations/. The fossil fuel non-proliferation treaty website is at: https://fossilfueltreaty.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

Is at: https://substack.com/inbox/post/75107864. It opens with: In summarizing Professor Jedediah Purdy’s recent book, Two Cheers for Politics, The New Yorker’s Adam Gopnik recently wrote, “He [Purdy] is angry at the elites who supervise the bureaucratic capitalist state on behalf of their overlords while keeping up an elaborate masquerade of equality of opportunity.”   “Keeping up the masquerade of equality” accurately defines CMS’s continuing pretense to value or prioritize health equity. 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 few years federal policymakers have instituted healthcare price transparency.  Until last year, healthcare prices were largely, if not altogether, unknown to patients.   As of this past July 1 most group health plans and issuers of group or individual health insurance are required to publicly disclose pricing information.  As of this past January 1, providers were no longer able to surprise or balance bill patients for care they unknowingly received from providers outside their insurer’s network.  As of January 1, 2021 hospitals have been required to provide clear & accessible pricing information about the items and services they provide.  Though price transparency is sound in theory, what effect, if any, it will have on patient or consumer decision making, reducing price growth and influencing care delivery and innovation are largely unknown.    During this 36 minute conversation , Mr. Albright begins by briefly describing work done by Zelis.  He moves on to discuss/explain why healthcare price transparency took so long, what specific price data are hospitals and payers required to publicly disclose, how will employer-based insurers use the transparent data, he comments on hospital compliance or lack thereof, related state price transparency efforts and concludes with a comment regarding how and why price transparency will finally be realized.       Mr. Matthew Albright is currently Chief Legislative Affairs Officer at Zelis.  Prior to joining Zelis, Matthew oversaw the certification program at the Center for Affordable Quality Healthcare (CAQH) and Committee on Operating Rules for Information Exchange (CORE) to ensure conformance with the requirements of the Patient Protection and Affordable Care Act (PPACA).  He also served as Director of the Administrative Simplification Group for the Centers for Medicare and Medicaid Services (CMS).  In this role, Matthew was responsible for drafting the regulations that implemented Section 1104 of PPACA which specifies the requirements of the Health Insurance Portability and Accountability Act (HIPAA) administrative transactions.   Matthew is a published author on bioethics, has written numerous state and federal regulations, and taught as adjunct faculty at St. Martin's University and Pierce College in Washington State.   Mr. Albright earned a Master of Divinity from Harvard University with an emphasis in Bioethics, a BA in Religion Studies from the College of Santa Fe and a BA in Print Journalism from the University of Southern California. 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

During its recent August 3rd hearing titled, “A System in Need of Repair: Addressing Organizational Failures of the U.S.’s Organ Procurement and Transplantation Network," Senate Finance Committee Chairman, Ron Wyden (D-OR), characterized efforts by the federally-contracted not for profit, UNOS (United Network for Organ Sharing) regarding organ procurement and transplant as grossly mismanaged and incompetent.  After a two plus year investigation that included reviewing over a half million pages of documents, the committee found efforts by UNOS and nation's over 55 Organ Procurement Organizations (OPOs), rife with inefficiencies, medical errors and poor leadership, that combined helps to explain why, conservatively estimated, over 6,000 Americans, disproportionately minorities, die annually awaiting an organ.  Listeners will recall I interviewed Alfred and Blair Sadler in early June.  They, in part, discussed their work at NIH in the late 1960s drafting the Uniform Anatomical Gift Act.During this 37-minute interview Mr. Segal begins by describing Organize's mission.  He next provides an overview of how the process of human organs are procured and transplanted, largely the work by UNOS and OPOs, identifies and discusses more substantive problems associated with the transplant process including the lack of financial, performance, transparency and regulatory pressures placed on OPOs.  These leads to Mr. Segal defining policy reform opportunities including requiring OPO's to report standardized process data and what action Senate Finance and the Congress should take, moreover, the Organ Procurement and Transplantation Network (OPTN) contract, under which UNOS is contracted, be significantly revised.                   Mr. Greg Segal is the Founder and CEO of patient advocacy group, Organize.  The non-profit advocates for structural reforms to increase the supply of lifesaving organ transplants every year.   Mr. Segal started Organize after his father waited five years for a heart transplant.  Organize served as Innovator in Residence in the Office of the Secretary of the U.S. Department of Health and Human Services from 2015-2016.  The group's research has been heavily cited by the ongoing Congressional investigations from the Senate Finance Committee and the House Oversight Committee into the U.S. organ donation system.  Mr. Segal's writings regarding the need for data-driven reforms to organ monopolies have appeared in MedPage, Health Affairs, CNN, STAT and JAMA.   Information on Organize is at: www.organize.org.Documents related to the Senate Finance Committee's August 3rd hearing is at: https://www.finance.senate.gov/hearings/a-system-in-need-of-repair-addressing-organizational-failures-of-the-uss-organ-procurement-and-transplantation-network.   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

Two weeks ago Senate Majority Leader, Chuck Schumer, announced the $739 billion Inflation Reduction (IRA) Act of 2022, compromise legislation agreed upon by Senator Manchin.  The bill includes just a few of the healthcare policy reform provisions House Democrats included in House legislation passed late last year, moreover extending expanded ACA marketplace insurance subsidies and allowing the Medicare program to negotiate drug prices.  The IRA also includes, as has been widely reported, $369 billion in tax credits over ten years intended to accelerate the adoption of renewal energy.   (Some have suggested the bill should be more appropriately titled The Temperature Reduction Act.)   The legislation likely, if not in fact, represents the last chance Congressional Democrats and the Biden Administration have to pass health and healthcare related policy reforms this Congress under reconciliation rules - that expire September 30th.  During this 40 minute interview Jeremy begins by describing NACHC's mission.  He goes on to discuss extending ACA insurance subsidies in context of the patients his community community health, or Federally Qualified Health Centers (FQHCs), serve, how might the Medicaid funding cliff be addressed, i.e., approximately 16 million current enrolls would lose their coverage at the end of the current public health emergency, and provides comments on extending telehealth coverage expansion, workforce shortages and the climate crisis.        Jeremy Crandall is the Director of Federal and State Policy for the National Association of Community Health Centers, where he works to address policy issues concerning Medicaid funding, 340B prescription drugs, FQHC payment and delivery reforms, behavioral and telehealth policies and primary care workforce issues.  Jeremy previously spent six years working on state-based issues at the Blue Cross Blue Shield Association and at the Pew Charitable Trusts.  For eight years prior still he worked in Maryland state politics with Attorney General Brian Frosh and State Delegate Heather Mizeur.Information on NACHC is at: https://www.nachc.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

Toxic Debt, An Environmental History Justice History of Detroit, just published by North Carolina University Press in its Justice, Power and Politics series, is largely a history of failure by federal, state and local government officials to regulate the auto industry’s extremely harmful environmental and consequential human health effects.  This failure is substantially explained by the replacement of the, though imperfect, New Deal order with neoliberal policies.  (Re: neoliberalism, see, for example, Gary Gerstle, “The Rise and Fall of the Neoliberal Order,” published by Oxford University Press.)  As a result, Professor Rector documents largely post-Depression consequences experienced by the Detroit's  African American community.  Beyond low wages and ghettoization, Detroit’s African American population has disproportionately suffered adverse health consequences via industrial policies that knowingly caused unrelieved exposure to toxic air and water (think: Flint) and more recently health harms resulting from the denial of domestic water services, what Prof Rector terms, “the dehydration of Detroit.”  This 43 minute interview begins with Professor Rector providing a brief overview of environmental harms during the Gilded Age or later 19th century.   The interview proceeds to his discussing numerous health harms African American workers suffered with increasing automation of the auto industry and the industry's non-response for half a century, the UAW, positive and negative effects of the New Deal, discusses related waste as energy policy, i.e., specifically Detroit's incinerator and its health harms imposed on African Americans, an overview of the Flint water crisis and the larger dehydration of Detroit problem  (and its health effects) and its interrelationship with financial deregulation in Detroit.              Josiah Rector is a Professor of Urban History at the University of Houston specializing in 20th century U.S. urban environmental history, the history  of the environmental justice movement, and the history of capitalism.  He was previously a Visiting Professor of U.S. and Environmental History at Northland College from 2017-2019.  He also has extensive experience in public history.  He coordinated public history internships through the Next Gen Humanities Ph.D. Program at Wayne State University in 2017-2018 and he co-organized the Michigan Humanities Council’s Third Coast Conversations: Dialogues about Water Program for the Charles H. Wright Museum of African American History in 2018-2019.  He has published articles in The Journal of American History and Modern American History and he is currently planning a book on the political ecology of urban environmental disasters in the United States since World War II.   He earned his Ph.D. in History from Wayne State University, and his dissertation received the Urban History Association’s Michael Katz Award for Best Dissertation in Urban History, 2016.Information on Professor Rector's book is at: https://uncpress.org/book/9781469665764/toxic-debt/. 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