The Healthcare Policy Podcast ® Produced by David Introcaso

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

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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/. 

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

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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/.

 

Dr. Eric Reinhart Remembers Paul Farmer (March 13th)

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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.  

 

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

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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: https://www.youtube.com/watch?app=desktop&v=VUb2T1EPcoQ&feature=youtu.be.    

My Latest Publication, "HHS's Environmental Justice Index Institutionalizes Climate Apartheid" (March 5th)

This past Wednesday, STAT published my latest article, "HHS's Environmental Justice Index Institutionalizes Climate Apartheid"  At: https://www.statnews.com/2023/03/01/hhs-environmental-justice-index-institutionalizes-climate-apartheid/.  While well-intended the index will in practice likely constitute environmental redlining and become, literally, the definition of structural racism.  

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

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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 12^th 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.

 

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

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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. 

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

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(Listeners may recall Professor Abraham discussed 2021 ocean warming last year on January 18.)

As a possible reminder, oceans, that cover 71 percent of Earth’s surface, absorb 93% of the heat energy trapped by greenhouse gases, termed ocean heat content (OHC).   Increased OHC in 2022 is not surprisingly when you consider global CO2 emissions increased by over two billion tons or rose by 6% to a total of 36.3 billion tons in 2021,  their highest ever level.  In 2022 the planet’s seas absorbed about 11 Zetta joules of heat—equivalent to the energy of seven nuclear bombs exploding every single second of the year or 19 times as much as the total energy produced by all human activities in 2020.  The consequences of warming ocean water to human health and survival are innumerable and incalculable.   For example, warning ocean water cause huge disruptions to marine life from phytoplankton and zooplankton that substantially threatens the availability of food we consume and of oxygen we breathe. 

This 34 minute interview begins with an overview of Prof Abraham's and his colleagues' publication in Advances In Atmospheric Sciences, discusses why ocean warming will continue or ocean heat content will continue to increase long after we stop emitting GHG gasses, the ability of oceans to continue to absorb GHG gasses and heat, uneven ocean warming, the continued amplification of the global hydrological cycle, explains El Niño and La Niña and what it means that 2023 is anticipated to be an El Niño year, increasing ocean acidity and what it means, the lack of interest or recognition of OHC in healthcare policy conversations but why they matter to human health.          

John Abraham, Ph.D., is a Professor and Program Director in the Mechanical Engineering Department at the University of St. Thomas in Minnesota.  He studies largely concerning the 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 scientific studies that have been published widely.  He is a frequent television and radio guest having participated in over 100 television and radio interviews.   Professor Abraham earned his BS, MS and Ph.D. in  mechanical engineering at the University of Minnesota.

Professor Abraham and colleagues' January 11 article, "Another Year of Record Heat for Oceans," is at: https://link.springer.com/article/10.1007/s00376-023-2385-2.   

Attorney Ms. Jayne Conroy Discusses Prosecuting Healthcare Fraud in Part Via Use of Criminal Statutes (January 19th)

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US healthcare fraud remains pervasive.  For example, this past November Pro Publica and The New Yorker published, “How the Visionary Hospice Movement Became a For-Profit Hustle."  (The article may remind readers of Eric Hoffer’s comment, “every great cause begins as a movement, becomes a business, and eventually degenerates into a racket.")  The National Health Care Anti-Fraud Association estimates healthcare fraud across the entire industry can be as high as 10% of total annual healthcare spending, or approximately $400 billion.     

During this 37 minute conversation, Ms. Conroy begins by describing decisions her firm recently achieved in civil court against Walgreens, CVS and Walmart related to opioid prescribing and discusses criminal convictions against Purdue Pharma related to Oxycontin that, however, did not include prison sentences.  She discusses the use of criminal codes, for example the Racketeer Influenced and Corrupt Organizations (RICO), or how they can come into play in cases of alleged healthcare fraud, and RICO's utility for civil litigation attorneys.  Ms. Conroy next discusses fraudulent healthcare billing largely in context of civil litigators' ability to publicly expose related corporate information, she discusses prosecution of fraudulent pharmaceutical marketing, and concludes with comments regarding healthcare fraud can be, or is being, better policed.            

Ms. Jayne Conroy is a named shareholder at Simmons Hanly and Conroy overseeing practice areas in the firm's Complex Litigation Department that addresses addresses mass torts, class actions, product liability, pharmaceutical and sexual abuse litigation.  She serves or has served on dozens of court appointed leadership committees in complex legal actions of national scope.  In 2022, Law360 named her a Titan of the Plaintiffs’ Bar.  Previous honors include induction into the National Trial Lawyers Association’s Trial Lawyer Hall of Fame, election as a member of the exclusive American Law Institute, recognition as an Elite Women of the Plaintiffs Bar Winner by The National Law Journal, and the American Association for Justice’s Lifetime Achievement Award.  Ms. Conroy was graduated from Dartmouth College and the New England School of Law. 

The ProPublic hospice article is at: https://www.propublica.org/article/hospice-healthcare-aseracare-medicare.

The Lown Institute 's 2023 Shkreli awards noted in the introduction is at: https://lowninstitute.org/projects/shkreli-awards/.

 

Kaiser Health News' "The System Feds Rely on to Stop Repeat Health Fraud Is Broken," is at:

https://khn.org/news/article/khn-investigation-health-fraud-hhs-exclusions-list/.

 

 

My Latest Publication, "FYI: The Health Care Industry Is Not Decarbonizing" (January 6th, 2023)

Last night The Hill published my latest climate-crisis related writing titled, "FYI: The Health Care Industry Is Not Decarbonizing."  

It's at: https://thehill.com/opinion/healthcare/3801506-fyi-the-health-care-industry-is-not-decarbonizing/.

Though the title is self-explanatory, please read why I've drawn this conclusion. 

Comments are welcomed.  Again: dmintr@gmail.com.