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07/05/2020

Upcoming Podcast: Professor Ruqaiijah Yearby Will Discuss Structural Racism in Health Care (July 8th)

Saint Louis University of School of Law, Member, Center for Health Law Studies and Co-Founder and Executive Director of the Institute for Healing Justice and Equity, Professor Ruqaijah Yearby, will discuss structural racism in health care and its effects on racial and ethnic minorities during the COVID-19 pandemic. 

06/29/2020

The Sixth Mass Extinction: National Academy of Sciences Publication (June 29th)

Related to my June 20th post, "The World Has Sixth Months . . ." the current COVID-19 pandemic has renewed interest in climate-induced changes in the proximity of so-called reservoir species, for example bats, and human interaction.  Similarly, climate change or the climate crisis, caused by anthropocentric warming, is also a significant contributor to the ongoing sixth mass extinction.  (There have previously been five mass extinctions over the past 450 million years caused moreover by volcanic activity.  Each of which destroyed between 70% and 95% of all life on earth.)   In research published earlier this month in PNAS (Proceedings of the National Academy of Sciences) and titled, "Vertebrates On the Brink as Indicators of Biological Annihilation and the Sixth Mass Extinction," Gerardo Ceballos and his colleagues concluded ongoing biological annihilation "is likely accelerating for several reasons" including "human pressures on the biosphere are growing rapidly."   The authors conclude "the window of opportunity," to stop extinction, "is almost closed."  "It is, therefore, a scientific and moral imperative for scientists," they argue, "to take whatever actions they can to stop extinction."  

The June article is at: https://www.pnas.org/content/117/24/13596.

In May 2017 Ceballos and colleagues published in PNAS related research under the title, "Biological Annihilation via the Ongoing Sixth Mass Extinction Signaled by Vertebrate Population Losses and Declines," at: https://www.pnas.org/content/114/30/E6089.    

06/24/2020

ProMedica's CEO, Randy Oostra, Discusses the Need for a Congressionally Created National Health Care Reform Commission (June 23rd)

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The current public health emergency brings into stark relief US health care’s ineffectiveness.  As previously noted, with 4.25% of the world’s population, the US currently accounts for 26% of worldwide COVID-19 infections and deaths.  Concerning our response to date, Harvard's Ashish Jha recently stated, "we may end up being the worst of any country in the world in terms of our response."  Despite outspending all other OECD countries 2 to 1, or currently $4 trillion annually (and expected to grow to $6 trillion by 2027) , the effect the pandemic is having should not be unexpected.   In the first major attempt to rank health care performance globally, the World Health Organization (WHO), in 2000, ranked the US health care 37th in the world.  More recently, a 2017 Commonwealth Fund study ranked US health care’s performance last among 11 rich countries.  With a current projected COVID-19 death toll of over 200,000 by October 1st, per the University of Washington's Institute for Health Metrics and Evaluation, the question begged is what will federal policy makers learn from the pandemic, or more specifically what will they do to substantially reform how health care is currently defined, delivered and funded.  

During this 28-minute conversation Mr. Oostra begins by providing a a brief overview of ProMedica, he then discusses moreover several structural problems or flaws confronting US health care delivery and financing, including failure to address social determinants and the failure to deliver adequate long term care, he explains the need for a national health care reform commission, it's scope and membership, Congressional member and staffs response to date to the proposal and industry support thereof.    

Randy Oostra is President and Chief Executive Officer of ProMedica, an integrated health care provider headquartered in Toledo, Ohio.   He presently serves on the board of trustees of the Local Initiatives Support Corporation, the Health Research and Educational Trust and The Root Cause Coalition which ProMedica founded.  He also serves on the board of RandyOostraUpdatedPicture-lgtrustees for his alma mater, Northwestern College in Orange City, Iowa and organizations in northwest Ohio including the Regional Growth Partnership, Toledo Museum of Art and the Toledo Symphony.  Randy is also a member of the Ohio and Michigan Hospital associations and is a fellow of the American College of Healthcare Executives.  Among other awards he is the recipient of the Jefferson Award for Public Service and the Ohio Hospital Association’s Donald R. Newkirk Award.  Randy holds a doctorate in management from Case Western Reserve, a master’s degree in Health Care Administration from the University of Minnesota, a master’s degree in Management from the University of Wisconsin, and a Bachelor of Science degree in Biology from Northwestern College.

Concerning a national commission, see, Randy Oostra, "Achieving Healthcare Reform Requires a Congressionally Mandated Commission," Modern Healthcare (January 25, 2020) at: https://www.modernhealthcare.com/opinion-editorial/achieving-healthcare-reform-requires-congressionally-mandated-commission

For more on ProMedica go to:  https://www.promedica.org/pages/home.aspx.

06/21/2020

"World Has Six Months to Avert Climate Crisis" (June 20th)

This past Thursday, June 18, The Guardian reported (at: https://www.theguardian.com/environment/2020/jun/18/world-has-six-months-to-avert-climate-crisis-says-energy-expert) on the just-published International Energy Agency's special report, "Sustainable Recovery" (at: https://www.iea.org/) in which the Paris-based sustainable energy research organization concluded world leaders have through the remainder of this year to design a COVID-19-related economic recovery that, from an energy perspective, is sustainable.  "As they design economic recovery plans," Dr. Fatih Birol, the IEA's Executive Director, states in the report's forward, "policy makers are having to make enormously consequential decisions in a very short time of space.  These decisions will shape economic and energy infrastructure for decades to come and will almost certainly determine whether the world has a chance of meeting its long-term energy and climate goals."  Dr. Birol told The Guardian, "if we do not [take action] we will surely see a rebound in [carbon] emissions.  If emissions rebound, it is very difficult to see how they will be brought down in the future."  Per Bloomberg New Energy Finance, to date $509 billion in economic recovery moneys worldwide have been given to high-carbon industries while only $12 billion to low-carbon industries.     

06/17/2020

Interviewer as Interviewee: David Introcaso Answers Listeners' Questions (June 17th) (Part II)

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Since I've received and answered questions via email concerning podcast interviews and related health care policy questions over the past eight years, I thought it might be it might be useful to attempt answering listeners via a podcast program.  This podcast addresses questions I received via my solicitation a few months ago.  Joe DiLauro, the gentleman whom introduces the podcast and thanks listeners after each interview, and moreover my audio engineer, poses the questions.

During Part II of this discussion, 24 minutes length , I address questions concerning differences between the two presidential candidates, expectations for the next Congress, the relationship  between economic inequality and health, additional comments regarding the climate crisis, what I've learned over the course of 200 plus podcast interviews and advice I'd give those interested in pursuing a health care policy career.   Part I of this conversation was posted May 27th.   

As for my bio . . . , over approximately the past 25 years I have done health care delivery, financing, policy research and evaluation in Washington DC.  My bio includes having served as Health Policy Adviser to the U.S. House of Representatives Majority Leader, Rep. Steny Hoyer.  I also spent eight years working in the US Department of Health and Human Services serving as the Evaluation Officer for the Agency for Healthcare Research and Quality (AHRQ) and as a Public Health Analyst in the Office of Assistant  Secretary for Planning and Evaluation (ASPE).  I have acute care experience having worked at DC General and post-acute experience having worked with the National Hospice and Palliative Care Organization.   My consulting clients have ranged from the American Heart Association and the American Public Health Association to UnitedHealth Group.  Among other awards I received a three-year W. K. Kellogg National Leadership Fellowship.  I have taught as a adjunct at Georgetown and at George Washington universities and over the past eight years, beyond producing over 200 interviews via this podcast, have authored over 50 health policy-related essays.  My BS, MA and Ph.D. degrees were earned at Rutgers and Arizona State.  

06/07/2020

Mary Paier Powers Discusses What Family Caregivers Should Consider During the Pandemic When a Relative Is Resident in a Long Term Care Facility (June 5th)

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The COVID-19 pandemic has had particularly fatal effect on seniors or the frail elderly residing in Long Term Care (LTC) facilities, e.g., in a Skilled Nursing Facility (SNF_ or in assisted living.  As of last week approximately four in ten COVID-related deaths had occurred in these residences.  For example, in Virginia, as of mid-May approx. 60% of all COVID 19 related deaths have occurred in a SNF, among other states, in Minnesota , 80% of deaths have occurred in SNF and residential care homes.  Beyond LTC residents being immuno compromised, federal regulations concerning SNFs have, again, proven to be inadequate.  The question begged here is what can family caregivers, or those who have Power of Attorney or serve as Medical Proxy, do to protect their family members living in LTC - particularly if the facility is locked down or preventing family visits.

During this 30-minute conversation, Ms. Powers discusses among other related questions: what family members should know about the LTC facility in which their relative resides; beyond LTC facility’s precautions, what added/additional safety steps can the family caregiver take, e.g., if they've not should they pursue obtaining legal Power of Attorney (POA) and health care proxy authority; considering the extent to which the pandemic has adversely affected their family member's LTC facility, should, or how should, family caregivers evaluate proactively relocating their family member; can family members refuse to have their relative tested for COVID-19; if the relative tests positive for COVID 19 is the family caregiver, POA, medial proxy required to tacitly accept their relative being transferred to a hospital; and, if not, what are appropriate, proactive options can they take or what de facto dvanced care plans/planning should family caregivers make? 

Ms. Mary Paier Powers has been practicing law since 1984. Her practice focuses primarily on Estate Planning, Probate matters and Elder Law. She is a native of the Pioneer Valley where 9379 she was born and raised,  Ms. Powers began her career as a trust officer for Bank of New England West.  She next worked at Monarch Life Insurance Company, where she provided legal support and documentation on various life and disability income plans.  In 1993, she opened her own estate planning, probate and elder Law practice.  In 2019, Ms Powers formed Powers Law Group with her husband and son in West Springfield and Springfield, Massachusetts.  Ms. Powers graduated from Trinity College in Vermont and received her Juris Doctorate from Western New England University School of Law. 

Per my mention, the CDC guidance, "COVID-19 Guidance for Shared or Congregate Housing," is at: https://www.cdc.gov/coronavirus/2019-ncov/community/shared-congregate-house/guidance-shared-congregate-housing.html

06/03/2020

Jennifer Kent, Former Director of the California Dept. of Health Care Services, Discusses California's Response to the COVID-19 Pandemic (June 2nd)

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Since the federal government's response to the COVID-19 pandemic remains, as the The New England Journal of Medicine termed last week, laconic, the US response continues to be best understood at the state level.  California immediately comes to mind for obvious reasons.  Among others, it has a population of 40 million or 12% of the nation’s total (and if it was its own nation, would constitute the world’s fifth largest economy).  To date, California has limited COVID-19 related deaths to 4,250 or 4% of total COVID-19 related US deaths - notwithstanding having a substantial homeless population (approximately 20% of the nation's total). 

During this 28 minute podcast Ms. Kent discusses moreover the state's actions in response to the pandemic, especially concerning those most vulnerable including seniors, the poor or the states Medicaid, termed Medi-Cal, population and the homeless.  She also discusses the state's efforts at addressing related mental health and those with substance use disorders as well as whether the COVID-19 infection rate has peaked in the state and the state's predicament in funding its Medi-Cal program going forward. 

Ms. Jennifer Kent is currently CEO of the Sacramento-based Kent Group.  Previously she served as Director of the California Department of Health Care Services.  As Director, she Jkentoversaw the second largest public healthcare system in the nation with an annual budget of over $100 billion and serving approximately 13 million Californians.  She oversaw the administration of twenty-four managed care plans as well as 56 county behavioral health plans.  Ms. Kent has also held leadership roles in the state's Health & Human Services Agency and Governor’s office.  Her previous experience also includes working in the private sector as a lobbyist, consultant and association executive.  Ms. Kent earned her undergrad degree at Saint Mary's College of California and her MPA from the University of Southern California. 

Per my mention of California Governor Newsom's response to the pandemic see, for example, https://www.gov.ca.gov/california-takes-action-to-combat-covid-19/.  

05/31/2020

The Sabin Center's Michael Burger Discusses the Administration's Dismantling of Environmental Protections (May 29th)

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It should go without saying that we interact with the environment constantly.   It should also go without saying a degraded environment compromises our health and leaves us less resilient.  This explains why Black Americans, disproportionately suffering from chronic conditions resulting from, e.g., poor air quality, are suffering COVID-19 mortality rates upwards of three time that of White Americans.  According to the National Academies of Science, the environment is responsible for 30% of premature mortality while health care is only responsible for, or prevents, 10%.  Despite formally admitting via, e.g., Environmental Impact Statements, the Trump administration has gutted the nation’s environmental protections.  According to the Sabin Center, the administration has unwound, or intends to unwind, approximately 100 environmental regulations ranging from power plant and car and truck CO2 emissions, mercury and hydroflurocarbons emissions, rules protecting wetlands from oil and gas leasing, rules regarding pesticide use, drilling, fracking and coal leasing rules, off shore oil and gas drilling rules, Arctic exploration rules, rules governing natural gas pipeline construction and logging rules and the US’s commitment to the Paris climate accord.  Concerning the climate crisis, as I've noted previously research published in 2016 concluded that the adverse health affects resulting from health care industry’s greenhouse gas emissions is commensurate with upwards of 98,000 deaths annually in the US alone. 

During this 30 minute discussion, Professor Burger explains the Sabin Center's mission, provides an overview of the administration's efforts to moreover unwind air quality standards, discusses related procedural rules the EPA has/is unwinding, e.g., restrict the use of scientific research, and discusses the Juliana decision in light of related climate crisis-related court decisions world wise.  

Profess or Michael Burger is the Executive Director of the Sabin Center for Climate Change Law.  He frequently collaborates with researchers across Columbia's Earth Institute, and with local and national environmental groups, government representatives, and international organizations.   Previously,  he was an associate professor at Roger Williams University BurgerSchool of Law.  Previously still he taught in the Lawyering Program at New York University School of Law, served as an attorney in the Environmental Law Division of New York City’s Office of the Corporation Counsel.  He has also lead short courses on climate change and human rights in the Hague.  He is also a co-founder and member of the Environmental Law Collaborative, and is the incoming chair of the New York City Bar Association International Environmental Law Committee.  Professor Burger is a widely published scholar, a frequent speaker at conferences and symposiums, and a regular source for media outlets, including The Washington Post, Newsweek, Time, Forbes, The Guardian, Bloomberg, and Vox.com.  Michael is a graduate of Columbia Law School and of Brown University and also holds a Master of Fine Arts degree from the Creative Writing program at NYU.

Though not noted during the interview, listeners are encouraged to read, Climate Change, Public Health and the Law (Cambridge University Press), edited by Michael Burger and Justin Gundlach.  At: https://www.cambridge.org/core/books/climate-change-public-health-and-the-law/D2DED4C703EBD2F8CBD5B302E0B7AA3B.

Concerning the administration's attack on air quality, see, e.g., S. William Becker and Mary D. Becker, "The Devastating Impacts on the Trump Proposal to Roll Back Greenhouse Gas Vehicle Emissions Standards, "The Untold Story," at http://blogs.edf.org/climate411/files/2019/05/FINALGHGREPORT.pdf.   

05/27/2020

Interviewer as Interviewee: David Introcaso Answers Listeners' Questions (May 27th) (Part I)

Listen Now

Since I've received and answered questions via email concerning podcast interviews and related health care policy questions over the past eight years, I thought it might be it might be useful to attempt answering listeners via a podcast program.  This podcast addresses questions I received via my solicitation a few months ago.  Joe DiLauro, the gentleman whom introduces the podcast and thanks listeners after each interview, and moreover my audio engineer, poses the questions.

During Part I of this discussion, approximately 22 minutes, I address questions concerning the current COVID-19 pandemic and questions concerning health care policy specifics related to Republican and Democratic party approaches to health care reform, Congressional functioning and policy management by Medicare program regulators.    

As for my bio . . . , over approximately the past 25 years I have done health care delivery, financing, policy research and evaluation in Washington DC.  My bio includes having served as Health Policy Adviser to the U.S. House of Representatives Majority Leader, Rep. Steny Hoyer.  I also spent eight years working in the US Department of Health and Human Services serving as the Evaluation Officer for the Agency for Healthcare Research and Quality (AHRQ) and as a Public Health Analyst in the Office of Assistant  Secretary for Planning and Evaluation (ASPE).  I have acute care experience having worked at DC General and post-acute experience having worked with the National Hospice and Palliative Care Organization.   My consulting clients have ranged from the American Heart Association and the American Public Health Association to UnitedHealth Group.  Among other awards I received a three-year W. K. Kellogg National Leadership Fellowship.  I have taught as a adjunct at Georgetown and at George Washington universities and over the past eight years, beyond producing over 200 interviews via this podcast, have authored over 50 health policy-related essays.  My BS, MA and Ph.D. degrees were earned at Rutgers and Arizona State.  

05/05/2020

Howard Friedman Discusses His Recently Published Book, "Ultimate Price, The Value We Place on Life" (May 12th)

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Considering how the COVID-19 pandemic has been addressed by federal policy makers, e.g., the US, with 4.25% of the world's population, accounts for approximately 30% of worldwide deaths, the question arises to what extent do we value life - literally.  As Professor Friedman notes in his work, lives undervalued are lives unprotected since they are exposed to greater health and safety risks and enjoy far fewer legal protections. 

During this 33-minute conversation, Prof Friedman discusses his motivation or intent in writing the book, what in theory is intended in calculating a monetary value for a life, how value is calculated or the "Value of a Statistical Life," why valuations vary widely, examples of why and when they're employed, for example, the 9/11 Victims Compensation Fund (VCF), the infamous Ford Pinto example and others including employer insurance policies on employees (commonly termed "dead peasants" insurance") and lives threatened by the climate crisis and relevance today in context of the COVID-19 pandemic.

Professor Howard Friedman teaches at the Columbia University Mailman School of Public Health and Columbia's Data Science Institute. He also provides statistical analysis for the United Nations Populations Fund.  Previously, Dr. Friedman served as a Director at Capital One where he led teams of statisticians, analysts and Howard Friedman photoprogrammers in various areas of operations.  He has authored and co-authored over 70 scientific articles and book chapters in areas of applied statistics, health economics and politics.  His recent publications have appeared in the American Journal of Gastroenterology, Current Medical Research & Opinion, Clinical Therapeutics, Inflammatory Bowel Disease, Journal of Managed Care Pharmacy, Clinical Drug Investigation, American Journal of Cardiovascular Drugs and Value in Health. Professor Friedman is also the author of the 2012 work, Measure of a Nation and the 2013 work, A Modest Proposal for AmericaProfessor Friedman Friedman received his Bachelor’s degree from Binghamton University in Applied Physics, earned a Masters in Statistics and Ph.D. in Biomedical Engineering from Johns Hopkins. 

Information on Ultimate Price is at: https://www.ucpress.edu/book/9780520343221/ultimate-price