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06/03/2017

Extraordinary Altruism in Voluntarily Donating a Kidney to a Stranger: A Conversation with Professor Abigail Marsh (June 2nd)

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Approximately 8,700 Americans die annually awaiting a kidney donation or become too ill to receive one.  This is half the number of those who annually receive a kidney, or 17,000.   Over 100,000 at any time are awaiting a kidney.  The median wait time is over three and a half years.  One-third of kidney donations are live donations typically from a child, parent, sibling, spouse or other relative.  However, an increasing number of live donations are made by strangers voluntarily choosing to donate. The number of these donations while small, at less than 400 annually, has doubled in recent years.  The benefits of receiving a donated kidney are pronounced, the expected benefits to the recipient are estimated at 100xs the expected costs to the donor. 

During this 26 minute conversation Professor Marsh explains why she became interested in altruism particularly extraordinary altruism, what her and her colleagues' research has found that explains donor reasoning in providing a kidney, how "social discounting" and other factors play into their decision making, how brain development, or the size of a donor's amygdala (the part of the brain responsible for decision making and emotional reactions including compassion), plays a factor and to what extent normalizing voluntary kidney donations may over time reduce or eliminate the shortage of kidney donations.

Professor Abigail Marsh is an Associate Professor in the Department of Psychology and the Interdisciplinary Program in MarshNeuroscience at Georgetown.  Prior to Georgetown, Dr. Marsh conducted post-doctoral work at the National Institute of Mental Health at the National Institutes of Health from 2004 to 2008.   Her areas of expertise include social and affective neuroscience, particularly understanding emotional processes like empathy and how they related to altruism, aggression and psychopathy.   Her work has appeared in the Proceedings of the National Academy of Sciences, Psychological Science, the American Journal of Psychiatry, JAMA Psychiatry and Nature Human Behavior.  Dr. Marsh was graduated with a BA in Psychology from Dartmouth and a Ph.D. in Social Psychology from Harvard.   

Professor Marsh's June 2016 TED talk, "Why Some People Are More Altruistic Than Others," is at: https://www.ted.com/talks/abigail_marsh_why_some_people_are_more_altruistic_than_others.

A 10-page, footnoted discussion weighing the pros and cons of voluntary donating a kidney can be found on the Effective Altruism Forum website, at: http://effective-altruism.com/ea/ay/kidney_donation_is_a_reasonable_choice_for/

06/02/2017

AHCA In Context of Social Justice: A Conversation with Jason Silverstein (June 1st)

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This past May 4, US House or Representative Republicans passed the American Health Care Act (AHCA).  The bill, defined by Republicans as a repeal of the Affordable Care Act (ACA), is now under debate among Senate Republicans. (Neither any House Democrat voted for the AHCA nor are there any Senate Democrats expected to vote for related Senate bill should it make the Senate floor.)  Per the Congressional Budget Office's (CBO) estimate of the AHCA's spending and revenue effects, published May 24, the AHCA would cause 14 million Americans to lose their health insurance in 2018 and 23 million by 2026, 14  million of this latter total would be Medicaid recipients.  This is because the AHCA would cut $834 billion from the Medicaid program over the ten year budget window, or by 2026.  The cuts in Medicaid spending, along with substantial reductions in tax credits, would allow for ACA taxes, approximately $600 billion, to be rescinded.  For example, the ACA's 3.8% tax applied to capital gains for family incomes over $250,000 and a 0.9% Medicare surtax on wage income in excess of $250,000 per year, i.e., tax cuts that would benefit the comparatively wealthy.           

During this 25 minute conversation Dr. Silverstein provides, among other things, his assessment of the AHCA, i.e., legislation moreover as tax relief for the wealthy, the likely effect it would have one women's health and on disparities in care and alternatively how the ACA could be improved. 

Dr. Jason Silverstein is a Lecturer and Writer-in-Residence at Harvard Medical School in the Department of Global Health Silversteinand Social Medicine. He is also currently an Instructor at the Harvard T. H. Chan School of Public Health.  He is also a faculty affiliate of the Science, Religion and Culture Program at the Harvard Divinity School.  He is a regular contributor to VICE's health channel, Tonic.   He has written for The New York Times, the Atlantic, The Guardian, Slate, The Nation and others and has provided commentary for, among others, MSNBC, NPR, HuffPost Live and BET.   His previous experience includes conducting research at Children's Hospital Boston, the Dana-Farber Cancer Institute, Harvard Law School's Program on Disability, and Stony Brook's HIV Treatment Development Center. Dr. Silverstein holds a Ph.D. and Master's in Anthropology from Harvard, a Master's in Religion, Ethics and Politics from Harvard Divinity and an undergraduate degree in philosophy from Penn. State. 

Dr. Silverstein's Tonic writings are at: https://tonic.vice.com/en_us/contributor/jason-silverstein

05/04/2017

"Would Repealing the ACA Violate International Law?" (May 3rd )

 

The Health Care Blog (http://thehealthcareblog.com/) posted an essay under this title on April 28th by myself and Jason Chung. The blog post summarizes Washington Post opinion writer, Dana Milbank's, April 25th essay noting the UN forwarded to the Trump administration on February 2nd a letter arguing repeal of the ACA would likely violate several US-agreed to international treaties and other international agreements concerning the rights of everyone to enjoy the highest attainable standards of physical and mental health. As Milbank noted, and as repeated in the blog post, the Trump administration, despite the UN's request to make known the letter to Congressional leaders, buried the correspondence.  The letter was leaked by a DHHS employee who had obtained a copy from the State Department.   

Milbank's article and the UN letter are at: https://www.washingtonpost.com/opinions/apparently-repealing-obamacare-could-violate-international-law/2017/04/25/2794a77c-29f4-11e7-b605-33413c691853_story.html?utm_term=.3d3cbd497026 and  https://www.washingtonpost.com/r/2010-2019/WashingtonPost/2017/04/25/Editorial-Opinion/Graphics/103_17_ACA_Repeal_Request_for_Information.pdf?tid=a_inl

04/28/2017

The Current Status of Employer-Based Insurance: A Conversation with James Gelfand (May 3rd)

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Considering the debate over the past five months about repealing the ACA (and more generally reforming the Medicare program via premium support),  it is worth remembering that approximately 55% of non-elderly Americans, or 155 million, still receive their health care coverage via their employer.   In addition, as of 2016 the ACA requires employers with over 50 employees to either offer health benefits or face a financial penalty.   The question remains what is the future of employer based insurance coverage, both for employees and retirees) if, for example, the ACA's "employer shared responsibility" provision and/or the employer tax exclusion (addressed in the ACA by the so called "cadillac tax") is repealed. 

During this 25 minute discussion Mr. Gelband briefly describes ERIC's mission/work, identifies what methods large employers are using to continue to offer employee coverage, how retiree coverage is being addressed, how employers are incenting providers to deliver quality care, ERIC's view of much debated HRAs (Health Risk Assessments) and wellness programs and his organization's position on the employer tax exclusion.  (Listeners may recall I interviewed Dr. Joe Antos last August 5th on the tax exclusion.)

Mr. James Gelfand is Senior Vice President of Health Policy at ERIC where he works to develop and advance public policies to James Gelfand's Headshot support the ability of employers to design and administer health plans.   Previously, Mr. Gelfand was the Director of Federal Affairs at the March of Dimes Foundation.   Prior to, he served as Associate Director for Luntz Global Partners.  He served on Capital Hill as Counsel to Senator Olympia Snowe, on the Senate Small Business Committee and to Senator Tom Coburn.   Mr. Gelfland also was for four years a lobbyist for the US Chamber of Commerce.   Mr. Gelfand received his JD from the George Washington University Law School and his undergraduate degree from Northwestern. 

For more information on ERIC go to: http://www.eric.org/.

04/18/2017

CMS' "Market Stabilization" Rule Goes Final: My Comments (April 17th)

For those carefully following the ACA state marketplaces, i.e., the viability thereof, here's an update to my March 22 THCB essay (four posts down).  This one is titled, "The Strange Making of the 'Marketplace Stabilization' Rule," at: http://thehealthcareblog.com/blog/2017/04/17/the-strange-making-of-the-marketplace-stabilization-rule/.   The CMS rule is at: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2017-Press-releases-items/2017-04-13-2.html.

 

04/12/2017

"Teeth: The Story of Beauty, Inequality & the Struggle for Oral Health In America," A Conversation with the Author, Mary Otto (April 12th)

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 As former DHHS Secretary Louis Sullivan wrote in support of this work, "Mary Otto brings history, policy and painful personal realities together in this compelling and engaging book about our nation's highly preventable epidemic of oral disease.  Teeth should be read by every policy maker and health professional who believes we can and must ace to reduce the current barriers to dental care."  (Listeners of this podcast may be also interested in related interviews with Burton Edelstein, DDS, from April 2013 and my interview with the American Dental Association's Dr. Marko Jujicic from January 2016.) 

During this 22 minute conversation, Ms. Otto discusses the impetus for her work, i.e., the 2007 death of a 12-year old Maryland resident, Deamonte Driver, from an abscessed tooth, she discusses efforts to integrate oral health with overall physicial health, the problems of substantial racial/ethnic disparities in oral health in light of the industry's increasing financial interests in provided cosmetic dentistry, the battle between dentists and mid-level providers, e.g., dental hygienists, over the latter's efforts to improve oral health primary and secondary prevention and the possibilities for improved oral health coverage moreover for adults under both Medicare and Medicaid.   

Ms. Mary Otto is the oral health topic leader for the Association of Health Care Journalists.  She began writing about oral health Ottoat The Washington Post, where she worked for eight years covering social issues, including health care and poverty.  Ms. Otto is a resident of Washington, DC.  

Ms. Otto's volume is available via Amazon at: https://www.amazon.com/Teeth-Beauty-Inequality-Struggle-America/dp/1620971445.   A review of her work appeared in the March 23rd issue of The New York Times, at: https://www.nytimes.com/2017/03/23/books/review/teeth-oral-health-mary-otto.html?_r=0.   An executive summary of Surgeon General David Satcher's 2000 report, "Oral Health In America," noted during this conversation, is at: https://www.nidcr.nih.gov/datastatistics/surgeongeneral/report/executivesummary.htm

04/04/2017

Essay: "The Child Sexual Abuse Conspiracy" (March 31st)

Listeners may recall The Healthcare Blog (http://thehealthcareblog.com/) posted last June 4th my essay, "About Hastert's 'Known Acts': The Indifference is As Disturbing as the Crime" (at: http://thehealthcareblog.com/blog/2016/06/04/about-hasterts-known-acts-the-indifference-is-as-disturbing-as-the-crime/).  

Last Friday, THCB posted, "The Child Sexual Abuse Conspiracy."  Using the recent Larry Nassar/USA Gymnastics case I argue organizations that employ predators, political leaders in DC, the professional medical community and others continue to, de facto, conspire in ignoring the problem.  Again, per the CDC's ACEs study, one in four girls and one in six boys are raped/molested.  The essay is at: http://thehealthcareblog.com/blog/2017/03/31/the-child-sexual-abuse-conspiracy/

 

04/03/2017

What Was Discussed at February's "Climate and Health" Meeting: A Conversation with Dr. Jonathan Patz (March 31st)

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In mid-January the CDC abruptly canceled a three-day "Climate and Health Summit" the Center had been planning for months.  The meeting was intended to discuss public health risks caused by the climate crisis and steps being taken to reduce the emissions of carbon dioxide and other greenhouse gases or its adverse consequences on human health.   (It was speculated the meeting was canceled because the CDC did not want to run afoul of the incoming president who has repeatedly called climate change a “hoax” perpetrated by the Chinese.)   The American Public Health Association (APHA) and others however went ahead and held a one-day meeting on February 16 titled,"Climate and Health" at the Carter Center in Atlanta.  The meeting was keynoted by former Vice President Al Gore.   Dr. Jonathan Patz, the Director of the Global Health Institute at the University of Wisconsin-Madison, was one of the meeting's organizers and participants.    

During this 24 minute conversation Dr. Patz discusses how the meeting came about and what was accomplished, e.g., he summarizes the afternoon's panels that discussed what's being done to reduce green house gas emissions.  He also discussed how to better involve the professional medical community  and how to effectively communicate the reality of the climate crisis. 

Dr. Jonathan Patz is the Director of the Global Health Institute at the University of Wisconsin-Madison.  He is a professor and the John P. Holton Chair in Health and the Environment with appointments in the Nelson Institute for Environmental Studies and the Department of Population Health Sciences.  For 15 years, Dr. Patz served as a lead author for the United Nations Intergovernmental Panel on Climate Change (or IPCC)—the organization that shared the 2007 Nobel Peace Prize with Al PatzGore.  He also co-­chaired the health expert panel of the U.S. National Assessment on Climate Change, a report mandated by the Congress.  Dr. Patz has written over 90 peer-reviewed articles, a textbook addressing the health  the health effects of global environmental change and co-edited the five volume Encyclopedia of Environmental Health (2011).  He has been invited to brief both houses of Congress and has served on several scientific committees of the National Academy of Sciences.  Dr. Patz served as Founding President of the International Association for Ecology and Health.  He is double board-­certified, earning medical boards in both Occupational/Environmental Medicine and Family Medicine.  He received his medical degree from Case Western Reserve University (1987) and his Master of Public Health degree (1992) from Johns Hopkins University.

A webcast of the February 16 meeting is at: https://www.climaterealityproject.org/health.  Listeners are particularly encouraged to listen to Vice President Gore's 30 minute keynote address.  

For more information concerning the Medical Society Consortium on Climate and Health go to: https://medsocietiesforclimatehealth.org/.

Since I mention during the discussion the Obama administration's 2016 "The Impacts of Climate Change on Human Health in the US: A Scientific Assessment," a review of the paper is, again, at: http://altarum.org/health-policy-blog/nature-bats-last-a-warming-earth-will-exact-adverse-health-effects-but-our-responsibilities-are.   

 

03/27/2017

Playing Dice with the State Marketplaces: CMS' Proposed Market Stabilization Rule (March 22nd)

In mid-February CMS published a proposed rule intended to "stabilize" the state insurance marketplaces.  This essay, posted on The Health Care Blog last Wednesday, is my critique of the proposed.   What's actually amazing about the proposed is CMS admits the proposed changes have a 50-50 chance of succeeding, i.e., CMS summarizes the proposed changes by stating "on the one hand" the proposed changes may work, "on the other hand" they may not.  Imagine if this was the standard for drug approvals?

The essay was originally titled, "Playing Dice with the State Marketplaces: The Administration's Admittedly Ambiguous Market Stabilization Proposed Rule."  The editor changed the titled.  

http://thehealthcareblog.com/blog/2017/03/22/the-incredible-self-destructing-healthcare-marketplace/

03/13/2017

Does Pay for Performance Improve Care and Lower Spending? A Conversation with Stephen Soumerai (March 15th)

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Over approximately the past decade the health care industry has become increasingly committed to financially incenting physicians and other clinicians, or tying performance to reimbursement.  Commonly termed "pay for performance"(P4P), these arrangements are increasingly employed in the Medicare (i.e., under the Medicare Access and CHIP Reauthorization Act, or MACRA) and Medicaid programs and by commercial insurers, most notable accountable care models and bundled payment arrangements.   One might assume because P4P models are now common there is research evidence that demonstrates they are effective in, again, improving care quality, patient outcomes and lowering spending growth.  That is not the case.  For example, a systematic review published by Cochrane in 2011 found "there is insufficient evidence to support or not support the use of financial incentives to improve the quality of primary health care."  Among other examples, for all the attention the Massachusetts' Alternative Quality Contracts (AQCs) have received since they were launched in 2009, it remains unclear if they have reduced spending or spending growth.   Because P4P models have not proved out, payers and providers, for example, England's National Health Service and in the US the integrated, 12 hospital system, Geisinger Health, have substantially reduced incentive payments or are returning to paying providers straight salaries.            

During this 27 minute conversation, Professor Soumerai discusses his interest in the P4P topic, describes P4p arrangements, summarizes his and others' review of the research evidence relative to the effectiveness of P4P arrangements and suggests model designs that may be more effective.  

Stephen B. Soumerai is Professor of Population Medicine at Harvard Medical School and Harvard Pilgrim Health Care SsoumeraiInstitute.  He also co-chairs the Statistics and Evaluative Sciences concentration within Harvard University’s health policy Ph.D. program.  Dr. Soumerai recently served as International Trustee for the Canadian Health Services Research Foundation.  Dr. Soumerai has published more than 250 original scientific articles in leading scientific journal, such as the New England Journal of Medicine and the Journal of the American Medical Association.  He is well known nationally and internationally for his work on the impacts of health policies and methods to improve the quality of medical practice.  He frequently advises Congress, state legislatures and federal and international agencies on the design of drug cost containment, coverage and quality-of-care policies, evidence-based health policy and his research has been used extensively to support expanded economic access to medications in Medicaid and Medicare. He is the recipient of numerous honors including numerous article of the year awards from national and international scientific societies, named lectureships, and is the recipient of the Everett Mendelsohn Excellence in Mentoring Award from the Harvard University Graduate School of Arts and Sciences.

Professor Soumerai's 2015 and 2016 CDC articles noting in this discussion are at: https://www.cdc.gov/pcd/issues/2015/15_0187.htm and https://www.cdc.gov/pcd/issues/2016/16_0133.htm