The Healthcare Policy Podcast ® Produced by David Introcaso

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

In mid-June Columbia's Professor Frederica Perera and Stanford's Dr. Kari Nadeau published a review article in The New England Journal of Medicine titled, "Climate Change, Fossil-Fuel Pollution, and Children's Health."  The article provides an overview of the numerous health harms inflicted on children around the world resulting from fossil fuel combustion's released of massive amounts of airborne fine respirable particles, additional health harms resulting from an increasingly destabilized climate, resulting health disparities and an overview of medical practice recommendations to minimize related health risks to children.  Concerning health harm, last year Harvard along with three UK universities concluded fossil fuel pollution was responsible for eight million deaths or 18% of total global deaths in 2018.  In the US, pollution resulting from fossil fuel’s use accounts for nearly 60% of total excess deaths.  During this 38-minute interview Professor Perera and Dr. Nadeau begin by providing an overview of the numerous adverse health effects imposed on children resulting from both fossil fuel combustion and the innumerable harms resulting from global warming.  The authors identify solutions to mitigate the climate crisis, opine on efforts by the professional medical community to address the climate crisis, notes the work the Medicaid program needs to do to address related health harms to children, comment on their own university's efforts ,       Frederica P. Perera is Professor of Environmental Health Sciences and serves as Director of the Columbia Center for Children's Environmental Health.  Her areas of specialization include prevention of environmentally related developmental disorders and disease in children, cancer prevention through the use of novel biomarkers, environment-susceptibility interactions, and risk assessment.  Her recent research is also addressing the multiple impacts on children's health and development of fossil fuel combustion--both from the toxic pollutants emitted and climate change related to CO2 emissions.  She is the author of over 350 publications, including 300 peer-reviewed articles, and has received numerous honors.   She received her Ph.D, DrPH and MPH from Columbia University and her BA from Harvard. Dr. Kari Nadeau is the Naddisy Foundation Endowed Professor of Medicine and Pediatrics and Director of the Sean N. Parker Center for Allergy and Asthma Research at Stanford University.  Among other current activities she is currently working at the World Health Organization on air pollution and climate change policy.   In collaboration with colleagues she has been awarded many patents, started 4 biotech companies, and worked in industry to shepherd two drugs through the FDA to approval. She also is an author of the Lancet Countdown in Global Climate Change 2020 and the book: The End of Food Allergy (published 2020).   Dr. Nadeau received her MD and PhD from Harvard Medical School through the NIH MSTP program. She completed a residency in pediatrics at Boston Children’s Hospital and a clinical fellowship in allergy, asthma and immunology at Stanford and at University of California, San Francisco. 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

(P)Luck moreover details the nine year collaboration between identical twins, Dr. Alfred Sadler and Blair Sadler, an attorney, via their work at NIH,  Yale, the Robert Wood Johnson Foundation and the Hastings Center on Bioethics to advance national organ donation and transplantation policy, create the Physician Assistant profession, advance national emergency medical care and address related bioethical issues.   The work also provides insights regarding related challenges these fields face today and provides a list of lessons learned applicable to present day health care problems. During this 39 minute discussion, Dr. Sadler and Mr. Sadler begin by explaining the purpose of the work and how and why they chose to collaborate after completing medical and law school.   The conversation moves on to an overview of their collaborative efforts, they discuss challenges still facing organ donation and persisting ethical issues, for example, related to the ongoing pandemic and conclude with comments concerning a few of the 15 lessons learn they identify.              Alfred Sadler, MD, ScD (Hon) FACP, is the Co-Founder of the Physician Assistant Program at Cal State University, Monterey Bay and is the President of the Cypress Foundation - dedicated to improving physician and PA workforce in the tri-county area where he lives.  He was trained in surgery at the Hospital of the University of Pennsylvania and in internal medicine at the Harvard Medical School and at Mass General Hospital  He practiced primary care in Monterey County for nearly forty years with an emphasis on underserved populations.  He is a a member of Alpha Omega Alpha and in 2018 was recognized as Physician of the Year by the Monterey County Medical Society.  He is a coauthor of The Physician Assistant: An Illustrated History. Blair Sadler, JD, is a Senior Fellow at the Institute for Healthcare Improvement and a member of the faculty at the University of San Diego's Rady School of Management.   A graduate of Amherst College and the University of Pennsylvania Law School, he was a law clerk for the Superior Court of Pennsylvania.  From 1980 to 2006, he was President and CEO of the Rady Children's Hospital in San Diego.  He has served on the board of the Hastings Center for 12 years and is a member of the board of Health Care without Harm, an environmental health advocacy organization.  He chairs the Board of Access Youth Academy in San Diego.Information on their work is at: https://www.bookdepository.com/P-Luck-Alfred-Sadler/9781735873176?ref=grid-view&qid=1654425267966&sr=1-6.   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 certainly aware of never ending US gun violence.  For example, since 37, moreover 4th grade children, were shot with 19 killed in Uvalde, Texas on May 24th, there have subsequently been at least 14 subsequent mass shootings killing at least 10 and wounding another 61.   Over the past ten years, or since the Sandy Hook , there have been 950 subsequent school shootings.   Concerning federal policy, via the so called (Jay) Dickey amendment the Congress effectively banned the CDC from researching gun violence between 1996 and 2020.  Presently, it does not appear the Senate will act to pass substantive and widely popular policies designed to reduce gun violence.   As the British journalist, Dan Hodges, concluded in 2015, "in retrospect, Sandy Hook marked the end of the US gun control debate.  Once America decided killing children was bearable, it was over."During this 36 minute conversation, Mr. MacMillan begins by providing an overview of the Center's mission and its work along with the Center's weekly newsletter, the roots of the problem, suicide reporting, his preliminary impressions regarding the Uvalde shooting, his related interaction/experience with the medical community, status regarding the Center's work informing policy reform and the specifics of his "better gun violence reporting" initiative.          Mr. Jim MacMillan is the Founder and Director of the Philadelphia Center for Gun Violence and its parent organization, the Initiative for Better Gun Violence Reporting.  Previously, Mr. MacMillan was a Journalist in Residence at Swarthmore College, a Fellow at the Philadelphia Social Innovations Lab at the U. of Penn and a Practitioner in Residence at the Institute for Global Leadership at Tufts University.  Mr. MacMillan was also an Ochberg Fellow with the Dart Center for Journalism and Trauma at Columbia University and a Knight Fellow in Medicine/Health Sciences Journalism with the Knight-Wallace Fellows at the U. of Michigan.  Previous faculty appointments include the U. of Missouri School of Journalism, Swarthmore College, NYU's Carter Journalism Institute and Klein College of Media and Communication at Temple University.  During his prior photo journalism career, Mr. MacMillian spent 17 years at the Philadelphia Daily News and with The Associated Press working in Boston and Baghdad during the war in Iraq.  His teams war reporting was awarded the Pulitzer Prize. Information on the Philadelphia Center for Gun Violence is at: https://www.pcgvr.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