The Healthcare Policy Podcast ® Produced by David Introcaso

Latest Episodes:

310th Interview: John Washington Discusses His Just-Published, "The Case for Open Borders" Oct 31, 2024

The human rights/public health crisis known as US border policy serves as further proof of what Richard Hofstadter termed in 1964 the “paranoid style in American politics.” To his credit Mr. Washington’s work attempts explain the recent phenomenon of closed or militarized borders here and around the world. Closed borders, Mr. Washington explains, are responsible for untold human suffering that cannot be legitimately explained as efforts to protect our economy, government budgets, our environment and our sense of sovereignty or nationalism. They do not limit migration, protect communities from crime and violence or dystopian-level anarchy, are counterproductive in addressing racism/modern-day Jim Crowism and the climate crisis and fail to serve any ethical purpose.

Information on “The Case for Open Borders” is at: https://www.haymarketbooks.org/books/2199-the-case-for-open-borders.

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

Prof. Daniel Goldberg Discusses His Recently Published, "Tackle Football and Traumatic Brain Injuries" Oct 22, 2024

Beyond roughly 1,700 NFL players, five to six million children participate in tackle football. As a collision sport, brain (or TBI) and other neurological, bone, joint, ligament, muscle, organ and tendon injuries are commonly occur and frequently develop into long-term chronic conditions, particularly chronic pain. Not surprisingly, the avg life expectancy of an NFL lineman - who played as few as one game - is just 55 years of age. Prof. Goldberg’s book examines how the NFL has for decades masterfully, successfully employed a set of strategies or scripts termed the “Manufacture of Doubt,” to avoid governmental regulation. The NFL’s success constitutes a an ongoing serious public health problem in it circumvents the precautionary principle upon which the entire field of public health is based - that is precautionary measures should be taken in the presence of a high stakes human health hazard even if definitive proof is lacking.

Information concerning Prof. Goldberg book is at: https://www.press.jhu.edu/books/authors/daniel-s-goldberg.

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. Troyen Brennan Discusses His Just-Published Book, "The Transformation of American Health Insurance, On the Path to Medicare for All" Oct 06, 2024

Harvard Chan School of Public Health’s Dr. Troy Brennan argues in sum that because government Medicare, Medicaid and ACA marketplaces have grown and evolved, meaning the feds have improved their ability to competently regulate the healthcare market, employer-sponsored commercial plan coverage has become both comparatively unaffordable and increasingly irrelevant. Primarily for these reasons Dr. Brennan argues the US is headed toward or on the path to federally-sponsored and regulated healthcare administered by private or commercial payers. That is it appears increasingly likely the US will finally realize universal, socialized, single payer healthcare insurance or what he defines as Medicare For All, or more specifically Medicare Advantage for All in which commercial insurance plans serve a strictly administrative role.

Dr. Brennan’s book can be found at: https://www.press.jhu.edu/books/title/53759/transformation-american-health-insurance.

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. Charles LeBaron Discusses His Just Published Book, "Greed to Good, The Untold Story of CDC's Disastrous War on Opioids" Sep 26, 2024

This century drug overdose deaths have equaled roughly 1.1 million largely due to overdose deaths among men that increased from 15,000 to 80,000. As Dr. LeBaron notes drug overdose fatalities this century have exceeded the sum of all service member deaths in all wars in US history. The vast majority of drug overdoses were opioid related that, e.g., increased from 50,000 to 82,000 between 2019 and 2022. While opioid drugs have been available for decades, the opioid - or the opioid use disorder epidemic is strongly correlated with opioid prescribing. As Dr. LeBaron notes between Purdue Pharma’s 1996 introduction of OxyContin and 2010, opioid prescriptions and overdose deaths increased fourfold, or in almost exact parallel. The CDC, only agency charged with controlling epidemics, published in 2016 its “Guideline for Prescribing Opioids for Chronic Pain in the US.” Tragically, the guideline was quickly weaponized, by payers and states. This led to significant decreases in prescribing that in turn led to dramatic increases in undertreated pain and not surprisingly increased suicides. In 2022 CDC updated its opioid guideline but as Dr. LeBaron notes in his conclusion reduced prescribing without improvements in prevention and treatment programming will backfire. Though the CDC last month announced preliminary data showing drug overdose deaths may have dropped by 10% or to 70,000 over the 12-month period ending this past April, the epidemic continues largely unabated.

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

Prof. Tad Delay Discusses His Recent Work, "Future of Denial, The Ideologies of Climate Change" Aug 09, 2024

Climate denial remains rife in the US. For example, in Washington, D.C., nearly 25% of the current members of Congress are, via their public statements, climate denialists. As for Health and Human Services (HHS), the department has steadfastly refused to promulgate any regulations to mitigate the healthcare industry’s massive carbon footprint that, for example, amounts to well over four times the annual cumulative greenhouse gas emissions of Exxon, Marathon Petroleum, Phillips 66, Chevron and BP.

In his just-published book Tad Delay provides an unsparing assessment of “the vast arsenal of denial that we rarely ever talk about,” i.e., “the scams, lies and misinformation that sustain the degradation of people and planet.” As I note during the discussion, Delay’s work can be read in context of Wainwright and Mann’s 2018 work, “Climate Leviathan” also published by Verso.

See: https://www.versobooks.com/products/2857-future-of-denial?srsltid=AfmBOoqF3FkLO1Aa5HBJhDrdFBE2ssKju6LOOjW0Og1x4l0YOE59Cup3

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

Ms. Alyson Rosenthal Discusses Food As Medicine Aug 01, 2024

In the recent past, hunger, food insecurity and malnutrition have (re)gained policymakers’ interest largely due to the COVID pandemic and accelerating climate breakdown – that has among other things reduced the growth of global agricultural production by 30-35%. As a result, last year 2.8 billion of the world’s population could not afford a healthy diet. In the US, over 40 million Americans receive food assistance via the federal Supplemental Nutrition and Assistance Program (SNAP) in large part because grocery prices have increased by over 20% since 2021. Poor diet has long been known to be responsible for innumerable causes of disability and death. For example, the number of states with an obesity rate at or above 35% doubled over the past five years to 19. One in 10 Americans have diabetes and one in three will be diagnosed with cancer, both of which are related to poor diet. Diet-related diseases also help explain high US COVID morbidity and mortality rates.

Information concerning West Side Campaign Against Hunger’s efforts is at: https://www.wscah.org/.

Recently published research regarding the association between food security, health and dietary factors discussed during this interview is at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10857290/.

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

Nathan Martinez Discusses the Government’s Attempt to Address Out of Network Healthcare Billing Jul 05, 2024

In late 2020 the Congress passed the No Surprises Act largely intended to address patient “surprise,” or out of network bills, typically the result of ER visits. Should settlement between the healthcare provider, e.g., hospital, and insurance company fail, the bill created an arbitration, termed Independent Dispute Resolution (IDR), process. To date the number of disputes going to arbitration have vastly outnumber those expected, the vast majority of provider-initiated disputes have been curiously backed by private equity, arbitration settlements takes take more than twice as long than the statutory limit, providers have been winning 75% plus of arbitrated cases and the median arbitration reimbursement is nearly four times what the Medicare program pays.

With me to discuss the topic is Nathan Martinez, an Arizona-based healthcare claims software developer.

During this interview we mention an April 2024 New York Times article that discussed efforts by insurers to reap, or game, greater out of network reimbursement. The article is at: https://www.nytimes.com/2024/04/07/us/health-insurance-medical-bills.html.

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

Stephanie Wang Discusses the Health Disparities Think Tank Jun 22, 2024

Over the past four decades the US has, per a 2019 JAMA-published study, made a “clear lack of progress on health equity.” Health equity or disparities have almost certainly worsened over the past five years due to COVID and accelerating climate breakdown. For example, air pollution in 2021 killed over 8 million globally including 2,000 children under age five daily. Foul air, nearly entirely the result of fossil fuel combustion, is 2nd only to malnutrition and hypertension as a risk factor for death among children and adults, respectively. In late May, HHS’s Centers for Medicare and Medicaid Services (CMS) hosted only its second annual health equity conference. Conference planners however ignored air pollution - as does CMS’ “Framework for Health Equity, 2022–2032” report. (Despite the fact I’ve produced this podcast for 12 years conducting over 300 interviews this, sadly, is my first interview with a student-led research group. I welcome learning of related efforts.)

Students interested in participating in the Health Disparities Think Tank are encouraged to review their website at: https://www.hdtt.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

Columbia's Sabin Center's Executive Director, Michael Burger, Discusses State of Play Re: Climate Crisis-Related Litigation Jun 13, 2024

Mr. Burger joins me to discuss climate crisis-related litigation here and abroad and its effectiveness in curbing greenhouse gas emissions. Dedicated listeners may recall I interviewed Mr. Burger in May 2020 regarding the Trump administration’s unwinding of numerous environmental regulations.

Michael Burger is the Executive Director of the Sabin Center for Climate Change Law at Columbia University. Prior to, he was an associate professor at Roger Williams University School of Law and served as an attorney in the Environmental Law Division of New York City’s Office of the Corporation Counsel. He is a co-founder and member of the Environmental Law Collaborative, the incoming chair of the New York City Bar Association International Environmental Law Committee and is a widely-published scholar, a frequent speaker at conferences and symposiums and a regular source for media outlets. Mr. Burger graduated from Columbia Law School, Brown University and holds a MFA from NYU.

Per my noting Sabin provides a monthly climate litigation update, their June report is at: https://climate.law.columbia.edu/news/june-2024-updates-climate-case-charts.

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

Clayton Page Aldern Discusses His Recently Published, "The Weight of Nature, How a Changing Climate Changes Our Brains" May 08, 2024

Climate-related health effects are typically defined or limited to those resulting from extreme weather events, exacerbations of chronic disease and increases in vector borne diseases. Unfortunately, very little attention or even recognition is afforded the effects the climate crisis has on brain health largely via climate-fueled neurotoxin exposure. Mr. Aldern’s valuable if not indispensable work attempts to explain how the climate crisis infuses our air and water with neurotoxins that increase the range of brain disease vectors and spur PTSD and other psychiatric conditions that can spread intergenerationally.

Clayton Page Aldern is a senior data reporter at Grist. A neuroscientist turned environmental journalist, he holds a master’s in neuroscience and a master’s in public policy from the University of Oxford, where he studied as a Rhodes Scholar. He is also a research affiliate at the Center for Studies in Demography and Ecology at the University of Washington. Information on “The Weight of Nature,” is at: https://www.penguinrandomhouse.com/books/717097/the-weight-of-nature-by-clayton-page-aldern/.

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

300th Podcast Interview: Merle Hoffman Discusses Her Just-Published, "CHOICES, A Post-Roe Abortion Rights Manifesto" Mar 22, 2024

In Dobbs v. Jackson Women’s Health Organization, the Supreme Court in June 2022 reversed the court’s previous 1973 Roe v Wade decision, and 20 related cases, wiping out a half century of constitutional protections for women’s reproductive rights. In Dobbs, the court found the Constitution now excludes a woman’s control over her body as well as the possible continuation of her life. Compelled pregnancy, involuntary childbirth and forced parenthood is not, the court ruled, an essential part of the “liberty” protected under the 14th amendment - or presumably even the freedom of “involuntary servitude” protected under the 13th amendment. Dobbs effectively demotes women to the status of an involuntary vessel entitled to no more respect than other forms of collectively-owned property. Since some have termed the Dobbs decision a “break the glass” moment, Ms. Hoffman has published her “post-Roe abortion rights manifesto,” that leverages her five decades of reproductive rights work to shed light on the repercussions of overturning Roe and work she believes now needs to be done, or redone, to ensure the safety and legality of reproductive rights.

Ms. Merle Hoffman is an American author, activist, feminist health care innovator who established one the first abortion clinics in the US, CHOICES Women’s Medical Center in Queens, New York. CHOICES also provides prenatal care, all-options counseling, GYN visits, mental health services, and trans health services. Ms. Hoffman was the publisher and editor-in-chief ofOn the Issuesmagazine (1983–99) and is also the author of Intimate Wars (Feminist Press, 2012). She is the cofounder of the National Abortion Federation.

Information on Ms. Hoffman’s book is at: https://www.skyhorsepublishing.com/9781510776951/choices/.

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. Mitchell Li Discusses Reforming Corporate Practice of Medicine Legislation Feb 21, 2024

Over the past 12 years this podcast has discussed increasing corporate dominance of healthcare delivery, made evident in part by the fact the healthcare market is highly concentrated and highly leveraged, e.g., over the past decade private equity has spent roughly $1 trillion to acquire physician practices. The corporate practice of medicine (CPOM) is problematic because allowing for corporate medicine can compromise a physicians’ independence and/or creates a conflict between physicians’ ethical duty to their patients and corporate interests in maximizing profits. While states have historically prohibited corporate medicine, enforcement has both been limited and every state has created CPOM exceptions. In part because the Biden administration has given priority implementing regulatory policies to promote market competition, there is renewed interest in revising corporate medicine statutes. This past fall the AMA considered a resolution seeking a federal ban on CPOM informed in part by a 70-page report published last October by Take Medicine Back. AMA delegates voted to refer the resolution to the AMA Bd of Trustees for further study.

Dr. Mitchell Louis Judge Li is a practicing board certified emergency physician in North Carolina and founder of Take Medicine Back. Dr. Li has been an invited speaker to represent physicians to the FTC on the effects of mergers and acquisitions on healthcare, has spoken as a panelist at the Capitol Forum’s Conference on Healthcare Competition, and currently serves as the only physician-advisor to the Robert Wood Johnson Foundation’s committee on healthcare financialization. Dr. Li earned his MD at the University of Massachusetts and completed his emergency medicine residency at St. John Hospital in Detroit.

Information on Take Medicine Back is at: https://takemedicineback.net/. Their 70-page working paper discussed during this interview is at: https://qrco.de/beUEJm.

Sen. Warren’s Take Medicine Back video noted during the discussion is here.

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 John Abraham Discusses Rising Ocean Heat Content Feb 15, 2024

Research published last month in Advances in Atmospheric Sciences by Prof. Abraham and his colleagues once again show ocean temperatures, more specifically ocean heat content (OHC), once again dramatically increased in 2023. (As I noted last year, many believe OHC is the best way of measuring anthropocentric warming because it is comparatively less variable on a year-to-year basis.) Oceans, that cover over 70% of the earth’s surface, absorb roughly 90% of the sun’s heat trapped by an increasing Earth Energy Imbalance (EEI) due to our continuing inability to meaningfully curb our greenhouse gas emissions. Oceans also serve as immense carbon sinks. Oceans determine the Earth’s energy, water and carbon cycles and increasingly warming oceans have an increasingly deleterious effect on the Earth’s climate and weather. Think: human survival, i.e., warming ocean water (and rising ocean acidification) disrupts marine life that in turn substantially threatens the availability of food we eat and the oxygen we breathe.

John Abraham, Ph.D., is a Professor and Program Director in the Mechanical Engineering Department at the University of St. Thomas in Minnesota. His studies largely concern geophysical science related to the climate crisis that includes the rate at which the planet is warming, particularly oceans. His team’s warming measurements provide insights on future climate crisis effects over the coming decades. Professor Abraham also studies the impact of increasing heat on the human body - information that has important health consequences particularly for at risk and minority populations. Professor has conducted approximately 400 published scientific studies. He is a frequent television and radio guest having participated in over 100 TV and radio interviews. Professor Abraham earned his BS, MS and Ph.D. in mechanical engineering at the University of Minnesota.

Prof. Abraham and his colleagues’ January Advances in Atmospheric Sciences article, titled “Another Year of Record Heat for the Oceans” is at: https://link.springer.com/article/10.1007/s00376-023-2385-2.

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. Ajay Chaudhary Discusses "The Exhausted of the Earth, Politics in a Burning World" Feb 03, 2024

In his soon-to-be-published book, Dr. Chaudhary argues the climate crisis or the Anthropocene era is the political product of rightwing climate realism - what he terms the “Rex Tillerson Position.” Listeners should be aware politics, not technology or economics, explains why the US continues to emit an enormous amount of CO2e pollution. (The US healthcare industry contributes approximately 550 MT CO2e annually or roughly 9% of the nation’s total.) The politics of functional climate denialism, or the belief business-as-usual can mitigate global warming, has resulted in economic, ecological and social despair, disenchantment or in sum socioecological exhaustion. What capitalism has built, Dr. Chaudhary argues, is an exhausted world. Any workable solution or any effort to create a sustainable environmental niche requires a new climate realism. Real ecomodernism he argues must be in sum grounded in decolonization - that essentially means the Global North no longer exploits the Global South.

Ajay Singh Chaudhary is the Executive Director of the Brooklyn Institute for Social Research and a core faculty member specializing in social and political theory. He holds a PhD from Columbia University and an MSc from the London School of Economics. His research focuses on social and political theory and economy, political ecology, media, religion, and post-colonial studies. He has written for The Guardian, The Nation, The Baffler, n+1, Los Angeles Review of Books, Quartz, Social Text, Dialectical Anthropology, The Hedgehog Review, Filmmaker Magazine, and 3quarksdaily, among others.

Information on the book is at: https://www.penguinrandomhouse.com/books/736324/the-exhausted-of-the-earth-by-ajay-singh-chaudhary/.

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. Robert Scoggins Discusses Medicare's Recent Regulatory Reform to Improve Sepsis Care Dec 19, 2023

Sepsis presents an enormous public health threat. There are for approximately 1.7 million hospital cases and 270,000 deaths per year. Sepsis is consistently in the top five for hospital case volumes and is the most expensive and resource intensive medical inpatient condition, representing approximately 15% of total hospital costs despite accounting for less than 4% of hospital stays. Various studies estimate sepsis is present in 30% to 50% of hospitalizations that culminate in death. Because two-thirds of sepsis cases are paid for by Medicare, beginning this January 1, HHS will add sepsis care Medicare’s Value-Based Purchasing/VBP program. Meaning, Medicare hospital reimbursement will be determined in part on adherence in meeting a multi-step sepsis treatment protocol focused on timely diagnosis and treatment. Dedicated listeners of this podcast may recall ten years ago this week I interviewed Dr. Jim Palmer regarding the use of heart rate variability to identify the onset of infection.

During this 23-minute interview Dr. Scoggins begins by explaining why timely diagnosis of sepsis has remained challenging and why the Medicare program will now tie reimbursement to meeting a sepsis quality measure or protocol. He explains the SEP-1 measure, addresses concerns regarding the sepsis measure driving antibiotic overuse and administrative burden, whether paying for sepsis performance will unduly penalize hospitals serving poorer communities, how the Medicare rule will impact his program, comments on emerging technology improving sepsis diagnosis, the extent to which commercial payers will adopt a similar sepsis pay for value payment rule and finally why we are seeing more sepsis infections and mortality.

Robert Scoggins, MD, PhD, has been a practicing medicine for over twenty years as a pulmonary and critical care physician. He currently is Chief of Staff and ICU Medical Director at Kootenai Health in Northern Idaho. He earned his undergraduate degree in Molecular Biology from Vanderbilt University and his MD and a Ph.D. in Microbiology at the University of Virginia. Dr. Scoggins completed his residency in Internal Medicine and a fellowship in Pulmonary and Critical Care at Vanderbilt University.

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

David Ropeik Discusses His Just-Published Book, "Curing Cancer-Phobia, How Risk, Fear and Worry Mislead Us" Dec 01, 2023

In part because there are over 10,000 known human diseases and symptoms thereof may have numerous possible explanations, frequently diagnostic tests can be in-determinative or less informative than observing (termed: watchful waiting) a suspected disease’s clinical course over time. Because of diagnostic complexities population level diagnostic errors represent a significant public health problem. Nevertheless, despite the progress made in treating cancer - as Ropeik writes in his introduction two-thirds of nearly 200 types of cancer are either treatable as chronic diseases or entirely curable - cancer today remains the emperor of nosophobias that in turn leads to over-screening, over diagnosis and false positives, over treatment, potentially harmful side effects, death and excessive healthcare budgeting and wasteful spending. As one reviewer of the book wrote, “Ropeik details how the gravity force of cancerphobia warps risk perception, leading to personal and societal harms and legislative misdirection.”

During this interview Mr. Ropeik begins by clarifying the book’s discussion is at the population level, disputes the belief cancer always needs be diagnosed as soon as possible and describes the US Preventive Services Taskforce’s (USPSFT’s) work upon which his book is based. He next discusses USPSTF’s (evolving) mammography screening recommendations for breast cancer, the prevalence of associated false positive diagnoses particularly related to DCIS (ductal carcinoma in situ). He discusses his chapter regarding environmental agents as cancer agents or contributing to the fear of cancer, the lack of a relationship between federal funding and the burden of disease, e.g., breast v pancreatic cancer funding. He concludes by discussing policy solutions that can simultaneously reduce cancer phobia and improve the effectiveness and cost cancer care.

Mr. David P. Ropeik is a retired Harvard University Instructor, author, and international consultant on risk perception, risk communication, and risk management. He worked as a television reporter for WCVB-TV in Boston from 1978 – 2000 specializing on environment and science issues, wrote a science column for The Boston Globe, taught journalism at Boston University, Tufts University, and MIT, was a Knight Science Journalism Fellow at MIT and a member of the Board of Directors of the Society of Environmental Journalists. Mr. Ropeik previously published “How Risky Is It, Really? Why Our Fears Don’t Always Match the Facts,” (2010, McGraw Hill), and co-author of “RISK, A Practical Guide for Deciding What’s Really Safe and What’s Really Dangerous in the World Around You,” (2002, Houghton Mifflin). Mr. Ropeik has also authored more than 50 articles, book chapters, and other essays on risk perception and risk communication published in The New York Times, The Washington Post, The Los Angeles Times, USA Today, Scientific American, The Atlantic Monthly, Health Affairs, Issues in Science and Technology and elsewhere. He writes a blog for Psychology Today and blogged at Big Think and The Huffington Post. Among numerous awards Mr. Ropeik is a two time winner of the DuPont-Columbia Award and seven regional EMMY awards.

Information on “Curing Cancer-Phobia” is at: https://www.press.jhu.edu/books/title/12956/curing-cancerphobia.

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

UCLA Law Professor Joanna Schwartz Discusses Her Just-Published, "Shielded: How the Police Became Untouchable" Oct 26, 2023

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

Columbia University's Ms. Cynthia Hanawalt Discusses Public Reporting of Greenhouse Gas Emissions Oct 22, 2023

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

Dr. Robert Moffit Discusses "Modernizing Medicare: Harnessing the Power of Consumer Choice and Market Competition" Oct 18, 2023

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

Prof. Nancy Tomes Discusses Patients as Consumers and to What Extent Defining Medicine as a Commodity Has Proven Useful Sep 27, 2023

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/.

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Professors Fredrik Albritton Jonsson and Carl Wennerlind Discuss They're Recently Published Book, "Scarcity: A History From the Origins of Capitalism to the Climate Crisis" Aug 25, 2023

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.

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Dr. Richard Young Discusses His Dystopian Healthcare Novel, "2060" (August 1st) Aug 02, 2023

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

Sonia Roschnik Discusses the International Hospital Federation's Environmental Sustainability Programming Jul 07, 2023

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/.

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Professor Larry Churchill Discusses "Bioethics Reenvisioned, A Path Toward Health Justice" Jun 14, 2023

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

285th Podcast: Wendell Potter Discusses the Recently Released Documentary, "American Hospitals: Healing a Broken System" (May 26th) May 27, 2023

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

CBPP's Ms. Katie Bergh Discusses SNAP Policy (May 22nd) May 24, 2023

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

East Boston Neighborhood Health Center’s Dr. Trede and Ms. Shapiro, a Mental Health Nurse Practitioner, Discuss the CDC's Youth Risk Behavior Survey Findings in Light of Their Clinical Care (May 17th) May 18, 2023

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

Ms. Kelly Willis Discusses the IPCC's "Last Warning" Report and the Upcoming COP 28 Meeting (April 18th) Apr 19, 2023

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.

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280th Interview: Mr. Clark Reed, the EPA's Energy Star National Program Manager, Explains the Energy Star Program (March 24th) Mar 25, 2023

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/.

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Oxford Professor Neta Crawford Discusses Her Just-Published, "The Pentagon, Climate Change and War" (March 22nd) Mar 23, 2023

The US government is frequently defined generally as an army with an insurance company. Regarding the latter, podcast listeners are well aware federal healthcare policymakers have essentially done nothing to address the healthcare industry's annual 500 million ton carbon footprint, 9% of total annual US GHG emissions, despite the fact that at $1.5 trillion the federal government is far and away the largest purchaser of healthcare services. What about the army? The army, or the Department of Defense (DOD), is the single largest institutional fossil fuel user and consequently the single largest GHG emitter in the world. The DOD along with the military-industrial complex annually emit over 110 million tons of greenhouse gas emissions that represents 80% of the federal governments total annual GHG emissions. This reality is particularly disturbing and paradoxical because the DOD’s contribution to the climate crisis compromises its mission to ensure our nation’s security. Despite the fact climate crisis-caused geopolitical instability is increasing, absent proactively working toward building climate security, or climate crisis-related conflict prevention the Pentagon is, Prof. Crawford concludes, inadvertently or deliberately militarizing climate change, that is preparing to fight climate-related battles. (Listeners are also encouraged to read MIT Press's related 2021 work by Gus Speth titled, They Knew, The US Fed Govt’s 50 Year Role in Causing the Climate Crisis.)

This 35-minute interview begins by Prof. Crawford describing what largely accounts for the DOD GHG emissions and problems associated with calculating total DOD emissions. She explains the 1997 Kyoto agreement that permitted countries to exempt military emissions from nations' reduction goals. She explains the DOD's use of fossil fuels since Vietnam to present and reductions in DOD emissions over the past few years, discusses US continuing the emission costs of continuing to defend the Persian Gulf, the debate between DOD building resilience versus mitigating GHG emissions and the interview concludes with Prof. Crawford's comments concerning whether increasing climate disruption will necessarily lead to conflict or war.

Neta Crawford is Montague Burton Chair in International Relations and also holds a Professorial Fellowship at Balliol College, Oxford. She previously taught Boston University and the University of Massachusetts, Amherst. Prof. Crawford is a co-founder and co-director of the Costs of War Project, based at Brown University and since 2017 has served on the board of the nuclear non-proliferation advocacy organization, Council for a Livable World. She also serves on the editorial boards of The Journal of Political Philosophy and Global Perspectives. Prof. Crawford received the Distinguished Scholar award from the International Ethics section of the International Studies Association in 2018. She was a co-winner of the 2003 American Political Science Association Jervis and Schroeder Award for best book in International History and Politics for her work, Argument and Change in World Politics: Ethics, Decolonization, Humanitarian Intervention. Professor Crawford’s most recent publication is The Pentagon, Climate Change, and War (MIT Press, 2022). She is also working on To Make Heaven Weep: Civilians and the American Way of War. She has authored several other books including, Accountability for Killing: Moral Responsibility for Collateral Damage in America’s Post‑9/11 Wars (2013). Her opinion pieces have appeared in The Washington Post. Prof. Crawford earned her undergraduate degree at Brown and her doctorate in political science at MIT.

Information on Prof. Crawford's book is at: https://mitpress.mit.edu/9780262047487/the-pentagon-climate-change-and-war/.

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Dr. Eric Reinhart Remembers Paul Farmer (March 13th) Mar 14, 2023

Dr. Paul Farmer unexpectedly passed away on February 21, 2022. He was 62. Trained as physician and medical anthropologist, Dr. Farmer was known moreover for his healthcare work in Haiti that he more formally forwarded via Partners in Health (PIH), an organization he cofounded in 1987. Over the subsequent years Dr. Farmer and PIH expanded their work around the world in Africa, Russia, South America and in the US. Dr. Farmer and his colleagues were also widely known for their international efforts to address multi-drug resistant tuberculosis (MDR TB). Among other notable achievements, Dr. Farmer served as a University Professor and a department chair at Harvard, served in United Nations’ positions, on numerous boards and as editor in chief of Health and Human Rights. He authored over 100 articles and a dozen books. His most recent was the 2020 work, “Fevers, Feuds and Diamonds: Ebola and the Ravages of History.” Among numerous awards Dr. Farmer received a MacArthur fellowship, was elected to the National Academy of Sciences was the recipient of numerous honorary doctorate degrees and prizes. (Listeners may recall I interviewed Dr. Reinhart on June 24, 2021 regarding mass incarceration, public health and structural racism during the COVID era.)

During this 38-minute conversation, Dr. Reinhart begins by noting his relationship with Dr. Farmer. He goes on to discuss or attempt to interpret Dr. Farmer's work, what informed his work or motivated him, how he pursued his work and what might his legacy be or should be.

Dr. Eric Reinhart is a political anthropologist, psychoanalyst, and physician. His teaching and research addresses the anthropology of law, inequality, and public health; psychoanalysis, ethnography, and aesthetic politics; and medicine, policing, and logics of apartheid and abolition. In addition, he conducts conduct policy-oriented public health research to address carceral-community epidemiology, or how the health and welfare of incarcerated people are always intertwined with that of broader communities. The work examines systemic prejudice in healthcare and legal systems, the uses of confinement and punishment in the US and internationally, and large-scale decarceration policies in relation to public health and safety, pandemic preparedness, and biosecurity. His research has been published in medical and legal journals including The New England Journal of Medicine, The Lancet, Proceedings of the National Academy of Sciences, Health Affairs, and Journal of Legal Studies – and in popular media venues, such as The New York Times, The Atlantic, TIME, Slate, The Nation, Boston Review, The New Republic, and USA TODAY.

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

Stanford's Mark Jacobson Discusses His Latest, "No Miracles Needed, How Today's Technology Can Save Our Climate and Clean Our Air" (March 6th) Mar 06, 2023

Listeners may recall two years ago this past month I interviewed Professor Jacobson regarding his text “100% Clean Renewable Energy and Storage for Everything.” I noted in my introduction to that 2021 interview Prof. Jacobson argued since 2009 100% of the world’s energy supply could be produced via solar, wind and water power within 20 to 30 years. The barriers to a 100% conversion to renewables are not, he continues to argue, technological or even economic but social and political. In “No Miracles Needed,” Prof Jacobson argues we can transition to 80% wind, water and solar (WWS) power by 2030 and to 100% by 2050, ideally 2035.

During this 33-minute interview, Prof. Jacobson begins by explaining what three problems converting to 100% clean energy simultaneously solve, identifies the technologies that allow for 100% conversion to WWS, what few remaining technologies are still in development and massive efficiencies associated with WWS versus fossil fuel combustion. He discusses the numerous reasons why subsidizing carbon capture technology is, as he states, a scam, how hospitals can readily decarbonize and concludes with a critique of Inflation Reduction subsidies.

Prof. Mark Z. Jacobson’s career has focused on better understanding air pollution and global warming problems and developing large-scale clean, renewable energy solutions to them. Toward that end, he has developed and applied three-dimensional atmosphere-biosphere-ocean computer models and solvers to simulate air pollution, weather, climate, and renewable energy. He has also developed roadmaps to transition states and countries to 100% clean, renewable energy for all purposes and computer models to examine grid stability in the presence of high penetrations of renewable energy. He has numerous awards including being recognized as the #1 impactful world scientist in Meteorology & Atmospheric Sciences among those first publishing past 1985, the World Visionary Clean Tech Influencer of the Year, Clean Tech Business Club (2022) and one of the World’s 100 most influential people in climate policy, Apolitical (2019, 2022). Prof. Jacobson earned a BA in economics, a BA in civil engineering and a MS in civil engineering from Stanford and a MS and PhD in atmospheric sciences from UCLA.

Information on "No Miracles Needed" is at: https://www.cambridge.org/core/books/no-miracles-needed/8D183E65462B8DC43397C19D7B6518E3.

Mark's recent Samuel Lawrence Foundation interview noted during this interview is at:

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Prof. Julianne Holt-Lunstad Discusses Social Isolation and Loneliness (February 15th) Feb 23, 2023

Since suicides serve as a proxy measure for social isolation and loneliness (SIL), last week the CDC reported after declines in 2019 and 2020, suicides increased 7% in ‘21, particularly among those 25-44, to 48,343 returning their peak in 2018. Over the past 2 decades suicides have increased 30%, they are now is the 12th leading cause of death. Also in 2021, the CDC’s most recent bi-annual Youth Risk Beh Survey, published this past November, found among other things teenage girls experienced persistent sadness at twice the rate of teen boys and three in five teenage girls reported being persistently sad or hopeless, a 60% increase compared to a decade earlier. The survey also found 30% of teenage girls had also seriously considered attempting suicide, up nearly 60% from 2011. Frequent listeners are aware in June 2021 I had related conversations with Brian Alexander regarding his book “The Hospital,” discussed deaths or despair in November 2021 with U of Maryland’s Prof. Carol Graham, published a related piece in December 2021 subtitled “the unrecognized tragedy of working class immiseration,” discussed with psychiatrist, Dr. Lise van Susteren, related climate crisis health effects last March and in December with Susan Linn related issues she raises in her book "Who’s Raising the Kids.”

The 33-minute interview begins by Prof Holt-Lunstad defining social isolation and loneliness, the magnitude of the problem, i.e., and the causes thereof. To what extent SIL is recognized and addressed in the clinical practice setting, discusses the need for core objectives and for SIL measuring and benchmarking SIL, SIL among clinicians and other medical professionals, discusses related efforts by the Administration for Community Living and the World Health Organizations, what the healthcare insurance industry is doing to address SIL, and offers comments for family caregivers regarding SIL.

Julianne Holt-Lunstad, Ph.D., is a professor of psychology and neuroscience at Brigham Young University, where she was recently named the Martin B Hickman Outstanding Scholar and is also the director of the social neuroscience lab. She also has an adjunct professorship at Iverson Health Innovation Research Institute Swinburne University of Technology; Melbourne, Australia; and the founding Scientific Chair for the US Coalition to End Social Isolation and Loneliness and the Foundation for Social Connection. Prof Holt-Lunstad has provided expert testimony in a US Congressional Hearing, expert recommendations for the US Surgeon General Emotional Well-Being in America Initiative, served as a member of the scientific advisory committee for the UK Cross Departmental Loneliness Team, and a member of a National Academy of Sciences Engineering & Medicine consensus committee, and the US Administration for Community Living. She has been awarded the George A. Miller Award from the American Psychological Association, Karl G. Maeser Distinguished Faculty Research Award, Mary Lou Fulton Young Scholar Award, Marjorie Pay Hinkley Endowed Chair Research Award from BYU, and is a Fellow for the Association of Psychological Science and American Psychological Association.

Prof. Holt-Lunstad's SIL review published last year in the Annual Review of Public Health, discussed during this interview, is at: https://www.annualreviews.org/doi/abs/10.1146/annurev-publhealth-052020-110732.

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

Prof. Toshihiro Higuchi Discusses His Work, "Political Fallout, Nuclear Weapons Testing and the Making of a Global Environmental Crisis" (February 8th) Feb 23, 2023

The word Anthropocene has been used over the past 20 years to define the modern era during which time man has come to shape the environment. This reality became significantly more pronounced with the advent of the nuclear Anthropocene. As Prof. Higuchi explains in the introduction of "Political Fallout," from 1945 to 1963, when the Partial Test Ban Treaty (PTBT) was signed by the US, the Soviet Union and Britain, these three nations conducted approximately 450 nuclear weapons tests, in sum equal to 26,000 Hiroshima-sized bombs, that caused worldwide radioactive contamination. Though in small concentrations, radioactive particles from this period of atmospheric nuclear weapons tests are still present around the world. How and why the 1963 Partial Test Ban Treaty, signed by the US, the Soviet Union and Britain, came into effect remains important. Among other reasons, this past August the UN Secretary General, Antonio Guterres, concluded the world has entered “a time of nuclear danger not seen since the height of the Cold War.” Two weeks ago the Science and Security Board of the Bulletin of the Atomic Scientists forwarded its Doomsday Clock to 90 seconds to midnight. The clock has move forward 4:30 since 2010. This history is also important because it potentially offers lessons regarding how we address the climate crisis.

During this 46 minute discussion, Prof. Higuchi begins by defining the Japanese word hibakusha and defines what is radioactive fallout. He next discusses how concerns regarding nuclear fallout became publicly known, how the US's understanding of radioactive contamination evolved through the 1950s, discusses his "politics of risk" framework used to discuss fallout's biological effects, social acceptability and policy implications, how ultimately a PTBT was achieved, and discusses what lessons can be learned from the nuclear Anthropocene relative to the climate crisis.

Prof. Toshihiro Higuchi is an Assistant Professor of History at Georgetown University and field chair of Regional and Comparative Studies (RCST) in the School of Foreign Service (SFS), Georgetown University. Prof. Higuchi is also an official historian for the International Commission on Radiological Protection, serves on the editorial board of Kagakusi kenkyu, the executive board of Peace History Society, and a committee of the Japan Society for the Promotion of Science. A native Japanese, Prof. Higuchi received his PhD at Georgetown University in 2011. Before he returned to Georgetown in 2016, he was a postdoctoral fellow at the Center for International Security and Cooperation, Stanford University (2011-12); an American Council of Learned Societies New Faculty Fellow at the University of Wisconsin - Madison (2012-14); and, a Hakubi Project assistant professor at Kyoto University (2014-15). His Political Fallout: Nuclear Weapons Testing and the Making of a Global Environmental Crisis (Stanford University Press, 2020) won the 2021 Michael H. Hunt Prize for International History from the Society for Historians of American Foreign Relations. His academic works have also appeared in Peace & Change, Journal of Strategic Studies, Historia Scientiarum, and International Relations of the Asia-Pacific. His opinion pieces have also appeared in a number of news outlets, including the Bulletin of the Atomic Scientists and Asahi Shimbun. Prof. Higuchi is a member of several professional societies including the Society for Historians of American Foreign Relations, History of Science Society, Association for Asian Studies, American Society for Environmental History, Peace History Society, and Japan Association of International Relations.

Information on "Political Fallout" is at: https://www.sup.org/books/title/?id=23212.

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

275th Interview: John Abraham Discusses the Continued Rapid Increase in Ocean Heat Content (January 23rd) Jan 24, 2023

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