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03/31/2021

Drs. Braveman and Gottlieb Discuss Addressing Social Determinants of Health Policy (March 31st)

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(As explained on the podcast home page, this is the last of eight interviews concerning federal healthcare policy reform.  This discussion is with UCSF's Dr. Paula Braveman and Dr. Laura Gottlieb and was conducted in early January.   As you will hear this podcast like all others is introduced by ProMedica's CEO,  Randy Oostra.  This series was produced in an effort to interest or persuade federal healthcare officials to pursue substantive healthcare policy reform.)

The US ranks last or near last in healthcare access, affordability and outcomes and this holds true even for white, educated, insured and upper income Americans.  What largely explains this high spending - poor health paradox, or our health disadvantage, are the social determinants of health: generally defined as education, economic circumstances, food security, housing and social, environmental and related exposures.  Where people live, work and socialize determines approximately 60% of their health status whereas medical care accounts for approximately 10%.  Despite the essential role social determinants play, the US has the lowest ratio of health care spending to social services spending in the OECD.  For every dollar spent on HC, the US spends one dollar on social services.  Across the remaining 36 OECD countries, the ratio averages $1 on healthcare to $2.50 on social services.  As for the health care industry’s investment in social determinants, a study published in February 2020 found that among 57 health systems that include 957 hospitals, or one-sixth of total US hospitals, researchers found that they had collectively invested only $2.5 billion in social determinants programming over a two-year period, or just 4% of their overall community benefit spending.      

This interview begins by Dr. Braveman and Dr. Gottlieb providing general comments about social determinants.  The interview progresses to their commenting on the ill  health effects of economic inequality due in part to economic inequality, in turn, causing/creating a profound lack of social solidarity or social cohesion, exacerbating racism and undermining our ability to invest in the social determinants or social service spending, discuss related for-profit, industry silos and misaligned incentive problems, address the success of pay for performance programming to address social determinants moreover under the Medicaid program, the extent to which there is for providers a return on investment and the problem in expecting and/or calculating a return, how social determinant spending is prioritized, i.e., the importance of making higher level community level investments, not just spending on immediate, e.g., transportation problems, and identifying a percent of spending on social determinants and discuss recommendations on how to increase social spending in Medicaid and Medicare.          

Paula Braveman, MD, MPH is Professor of Family and Community Medicine and Director of the Center on Social Disparities in Health at the University of California, San Francisco PhotoHandler (UCSF).  For more than 25 years, Dr. Braveman has studied and published extensively on health equity and the social determinants of health, and has worked to bring attention to these issues in the U.S. and internationally.  Her research has focused on measuring, documenting, understanding, and addressing socioeconomic and racial/ethnic disparities, particularly in maternal and infant health.  During the 1990s she collaborated with World Health Organization staff in Geneva to develop a global initiative on equity in health and health care.  She has been the Research Director for a national commission on the social determinants of health in the U.S. supported by the Robert Wood Johnson Foundation.  Throughout her career, she has collaborated with local, state, federal, and international health agencies to see rigorous research translated into practice with the goal of achieving greater equity in health. Dr. Braveman was elected to the Institute of Medicine of the U.S. National Academy of Sciences in 2002 and has served on the Advisory Council of the National Institute for Minority Health and Health Disparities of NIH.

Laura Gottlieb, MD, MPH, is a Professor of Family and Community Medicine at the University of California, San Francisco.  A former National Health Services Scholar and safety-net PhotoHandler family physician with fellowship training in social determinants of health, Dr. Gottlieb now serves as Principal Investigator on multiple quantitative and qualitative projects examining the integration of social and medical care services.  These projects range from large randomized trials on specific interventions undertaken in clinical settings to projects that explore the scope of this rapidly evolving field, including by characterizing the payment, technology, and workforce foundation for care integration.  She is the founding director of the Social Interventions Research and Evaluation Network (SIREN), a national research acceleration and translation institute supported by Kaiser Permanente and the Robert Wood Johnson Foundation that brings together researchers across the U.S. to synthesize, disseminate, and catalyze research at the intersection of social and medical care.  Dr. Gottlieb also is Associate Director of the Robert Wood Johnson National Program Office Evidence for Action grants program based at UCSF.  She completed her MD at Harvard Medical School, and both her MPH and residency training at the University of Washington.  Dr. Gottlieb is affiliated with the UCSF Center for Health and Community and affiliate faculty in the Institute for Health Policy Studies.

The 2016 RAND study, "Are Better Health Outcomes Related To Social Expenditure?" referenced during this interview, is at: https://www.rand.org/pubs/research_reports/RR1252.html.

To read a transcript of this interview or to post a comment or question, please go to: https://commissiononhealthcare.org/

03/28/2021

Brookings' Dr. Matt Fiedler Discusses the Public Option (March 25th)

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Despite coverage gains obtained under the ACA, today, approximately 13% of Americans or over 30 million are uninsured and 43 percent or approximately 115 million Americans are under-insured.  Broadly defined, the public option is a government regulated if not managed health insurance plan that pays reimbursement rates comparable to Medicare or significantly lower than commercial insurers.  A public option plan was passed by the House during the ACA debate in 2009 but failed in committee the Senate.  Forwarding the policy has been pursued since ACA exchanges went into effect in 2013, was supported by candidate Hillary Clinton in 2016 and by the Biden campaign last year.   This past month Senators Bennet and Kaine proposed legislation titled” “the Medicare Exchange “or X” Choice Act” that would create a public option plan that promises to improve care quality and reduce healthcare costs for all Americans since lower public option plan premiums would require commercial plans, in turn, to lower their premium costs in order to compete.   

During this 30 minute interview Dr. Fiedler begins by defining further the public option, discusses advantages of a public option policy including the extent to which or how the policy expands coverage, potential downsides including reduced provider income, how a public option compares to an alternative price cap policy, where, if at all, the individual mandate fits into the public option debate, chances for a public option policy to pass the Congress this session and states moving public option policy via, for example, ACA 1332 Section waivers.     

Dr. Matthew Fiedler is a fellow with the USC-Brookings Schaeffer Initiative for Health Policy.  His research examines a range of topics in health care economics and health care Matthe-fiedler_1x1 policy.  Prior to joining the Brookings, Dr. Fiedler served as Chief Economist of the Council of Economic Advisers, where he oversaw the Council's work on health care policy, including implementation of the Affordable Care Act’s health insurance expansions and health care delivery system reforms.   Fiedler holds a Ph.D. in economics from Harvard University and a B.A. in mathematics and economics from Swarthmore College.  

Information on Senator Bennet (CO) and Senator Kaine's (VA) "Medicare-X Choice Act" is at: https://www.bennet.senate.gov/public/index.cfm/medicare-x.  

Information regarding the related Brooking's September 23, 2020 webinar program noted during this discussion is at: https://www.brookings.edu/events/health-care-price-regulation-and-public-options-assessing-approaches-to-increasing-the-public-role/

03/24/2021

Dr. Kate Goodrich Discusses Healthcare Quality Reform (March 24th)

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(As explained on the podcast home page, this is the seventh of eight interviews concerning federal healthcare policy reform.  This discussion is with Humana's Dr. Kate Goodrich and was conducted in late December.  As you will hear this podcast like all others is introduced by ProMedica's CEO,  Randy Oostra.  This series was produced in an effort to interest or persuade federal healthcare officials to pursue substantive healthcare policy reform.)

Healthcare quality has been a significant federal policy concern for decades.  Despite substantial federal efforts to develop quality measurement and benchmarking performance programming, poor health care outcomes persist, Americans also experience high rates of medical errors that include diagnostic errors, avoidable infections and the mis- or over-use of antipsychotics.  Also too, the relationship between healthcare quality and healthcare spending, or value achieved for the healthcare dollar spent, remains largely unknown.  The result thereof is that there is significant variation in healthcare spending across geographic regions.  For these reasons and related others, MedPAC, in a rare instance of candor stated in 2014, "Medicare's current quality measurement approach is gone off the track."  

During this 48 minute interview, Dr. Goodrich begins the discussion by providing an overall assessment of currently quality measurement performance.  She discusses the intent behind reforming the the Medicare Part B physician payment program's quality performance program, termed the Merit-based Incentive Payment System (MIPS), to CMS' proposed MIPS Value Pathway (MVP) program, including clinically-related episode based cost metrics, whether quality reporting remain mandatory, discusses how the industry can move to measuring for value or outcomes achieved relative to spending, the use or accounting for socio-economic factors in risk scoring quality measures/performance,  discusses patient reported outcome measures (PROMs) and concludes by briefly commenting on including climate crisis health effects in quality measurement and benchmarking.          

Dr. Kate Goodrich is Senior Vice President of for Trend and Analytics within the Clinical and Pharmacy Solutions division of Humana, Inc.  Prior to coming to Humana, Dr. Goodrich KateGoodrich served as the Director of the Center for Clinical Standards and Quality and Chief Medical Officers at the Centers for Medicare and Medicaid Services where she was responsible for 18 quality and value-based purchasing programs, quality improvement programs in all 50 states, development and enforcement of health and safety standards of all facility-based providers across the nation, and coverage decisions for treatments and services for Medicare.  Prior to CMS, Dr. Goodrich was on the faculty at the George Washington University Medical Center (GWUMC) and served as Division Director for Hospital Medicine.  She continues to practice clinical medicine as a hospitalist and professor of medicine at the GWUMC.  Dr. Goodrich earned her undergraduate degree at Rhodes College in Memphis, her MD at Louisiana State University Medical Center in Shreveport, LA and completed her residency training in internal medicine residency training at GWU. 

To read a transcript of this interview or to post a comment or question, please go to: https://commissiononhealthcare.org/

 

03/21/2021

230th Interview: Professor Judy Feder Discusses Long Term Care Policy Reform (March 21st)

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(As explained on the podcast home page, this is the sixth of eight interviews concerning federal healthcare policy reform.  This discussion is with Georgetown University Professor Judy Feder and was conducted in late November.  As you will hear this podcast like all other eight is introduced by ProMedica's CEO,  Randy Oostra.  This series was produced in an effort to interest or persuade federal healthcare officials to pursue substantive healthcare policy reform.)

Unlike other rich countries, the US has no non-catastrophic long-term care (LTC) policy despite the following: the country is rapidly aging, by 2030 one in five Americans will be 65 or older; and, two-thirds of those 65 or older need or will need some form of LTC for an average of three years, 12% for five or more years.  While typically associated with aging, approximately 40% of those in LTC are under 65.  Among other realities: LTC is unaffordable to many since monthly nursing home fees can cost upwards of $10,000 per month; care quality on balance is poor as demonstrated by the COVID pandemic; beyond the long-standing problem of anti-psychotic misuse, a recent GAO study found 82% of nursing homes were cited for having infection prevention and control deficiencies; less than 10% of the middle income population age 45 or older own a commercial LTC insurance policy, in part, because insurers have substantially increased premiums over the past two decades; and, family care givers, or 30% of the adult population, moreover women, suffer related emotional, financial and physical hardship. 

During this 30 minute interview, Profess Feder discusses moreover recent efforts by the Congress to fashion a LTC policy in context of a 2018 proposal authored by Professor Feder and her colleagues, explains her more recent 2020 proposal outlined in the Journal of Aging and Social Policy and evaluates the Biden campaign policies to improve long term care.  

Judy Feder is a Professor of Public Policy at the McCourt School of Public Policy at Georgetown University.  From 1999 to 2008 she served as it  Dean.  Professor began  her health Download policy research career at the Brookings Institution, continued at the Urban Institute and since 1984 has been at Georgetown.  In the late 1980s, she served as Staff Director of the Congressional Pepper Commission (chaired by Sen. John D. Rockefeller); from 1989-90 she served as Principal Deputy Assistant Secretary for Planning and Evaluation at the Department of Health and Human Services in former President Bill Clinton’s first term administration; as a Senior Fellow at the Center for American Progress (2008-2011); and, today, as an Institute Fellow at the Urban Institute.  Judy is an elected member of the National Academy of Medicine, the National Academy of Public Administration, and the National Academy of Social Insurance; a former chair and board member of AcademyHealth; a former board member of the National Academy of Social Insurance; a member of the Center for American Progress Action Fund Board and as a member of the Hamilton Project’s Advisory Council.  In 2006 and 2008, Judy was the Democratic nominee for Congress in Virginia’s 10th congressional district.  Professor Feder received her BA from Brandeis and her a MA and PhD from Harvard.

The 2018 LTC policy proposal noted, titled, "A New Public-Private Partnership: Catastrophic Public and Front-End Private LTC Insurance" is at: https://www.umb.edu/mccormack.umb.edu/uploads/gerontology/Public_Catastrophic_Insurance_Paper_for_Bipartisan_Policy_Center_1-25-2018.pdf

The 2020 LTC policy proposal noted, titled, "COVID-19 and the Future of Long-Term Care: The Urgency of Enhanced Federal Financing," is at: https://www.tandfonline.com/doi/full/10.1080/08959420.2020.1771238

To read a transcript of this interview or to post a comment or question, please go to: https://commissiononhealthcare.org/

03/16/2021

Dr. Mark Miller Discusses Drug Pricing Policy Reform (March 16th)

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(As explained on the podcast home page, this is the fifth of eight interviews concerning federal healthcare policy reform.  This discussion is with Arnold Ventures' Dr. Mark Miller and conducted in late November.  As you will hear this podcast like all other eight is introduced by ProMedica's CEO,  Randy Oostra.  This series was produced in an effort to interest or persuade federal healthcare officials to pursue substantive healthcare policy reform.)

As has been widely reported and debated the US spends substantially more than comparative countries on prescription medicines.  For example, Medicare Part B and D drugs cost approximately two to four times what comparable countries pay and spending is projected to continue to rise rapidly.  High prices are explained largely by economic rent seeking and anti-competitive practices including so called patent evergreening and pay-for-delay tactics.  As a result, medication nonadherence is epidemic, responsible for an estimated 10% of all hospitalizations.   Among Medicare beneficiaries, upwards of of 60% are nonadherent due in part to cost.  Among those that do adhere, a recent study published in the American Journal of Medicine an estimated 42% of cancer patients depleted their entire net worth within the first two years of treatment.   

The interview begins with Dr. Miller providing a general overview of drug pricing, or what explains the failure of current drug pricing policy.  The discussion moves on to his discussing practices commonly exploited by comparative countries, i.e., negotiating drug prices or how such a policy could be formulated, exploiting an inflation rebate, basing prices on value or comparative effectiveness research, using international drug prices, or some percent thereof, to set US drug prices and questions whether the US is willing to take a drug of formulary due to excessive price.  He discusses the extent to which, like comparable countries, US drug pricing policy could or should apply to all patients.   Dr. Miller concludes his comments by identifying Arnold Ventures policy recommendations regarding FDA and patent reforms and whether price regulation can drive greater competition in pharmaceuticals.

Dr. Mark E. Miller is currently the Executive Vice President of Health Care at Arnold Ventures, a philanthropy.   Previously, he served as Executive Director of Medicare Payment Download Advisory Commission (MedPAC), as Assistant Director of Health and Human Resources at the Congressional Budget Office, as Deputy Director of health plans at the Centers for Medicare and Medicaid Services, as health financing Branch Chief at the Office of Management and Budget and as Senior Research Associate at the Urban Institute.  Dr. Miller has extensive experience identifying emerging health care issues, developing policy solutions, working with policymakers, and engaging diverse stakeholders. Over the course of his career, he has been directly involved in the development of major health legislation such as the Balanced Budget Act; the Medicare Prescription Drug, Improvement, and Modernization Act; and the Affordable Care Act.  Dr. Miller earned his Ph.D. in public policy analysis at the State University of New York at Binghamton and his MA and BA in political science from Old Dominion University. 

To read a transcript of this interview or to post a comment or question, please go to: https://commissiononhealthcare.org/

03/15/2021

Professor Michael Ruse Discusses the Gaia Hypothesis (March 11th)

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(Please note: Because of poor sound quality, this interview was rerecorded on March 22nd.)  

Discussing the climate crisis sooner or later begs the Gaia Hypothesis.  Simply explained, the Gaia Hypothesis, proposed in the early 1970s by James Lovelock and Lynn Margulis, argues all of planetary life works autonomously to maintain environmental conditions within a narrow range of habitability, or in a dynamic state of constancy, via a long list of biological self-regulating mechanisms.  In sum, Gaia Hypothesis argues the planet is self-regulating.  Gaia has been of particular interest relative to the what the climate crisis poses for our survival since it has been interpreted in two radically different ways.  One in which we have accountability or a moral duty to defend Gaia and another whereby the planet is resilient or immune from human-caused global warming.

During this 38 minute discussion, Professor Ruse defines Gaia, discusses criticism thereof and comments on interpretations of the hypothesis.   

Michael Ruse is the former, now retired, Lucyle T. Werkmeister Professor of Philosophy and Director of the Program in the History and Philosophy of Science at Florida State Scruffy mcgruff and pet human University.  Previously, he was Professor Emeritus at the University of Guelph, in Ontario, Canada.  He is the author of over 60 books.  He is currently the co-editor of the Cambridge Elements series in the Philosophy of Biology and co-editor of the Cambridge Handbook of Evolutionary Ethics (forthcoming).  He was the founding editor of the journal Biology and Philosophy and edited the Cambridge Series in the Philosophy of Biology.  He also co-edited two volumes with Oxford University Press on the philosophy of biology; co-edited the Cambridge Companion to the Origin of Species; co-edited the Oxford Handbook of Atheism; recently edited The Cambridge Encyclopedia of Charles Darwin and Evolutionary Thought; co-edited a volume on evolutionary theory with Harvard University Press; a volume on paleobiology with the University of Chicago Press; and, another on twentieth-century evolutionary biology with the American Philosophical Society.  He has appeared as an expert witness in a case in Arkansas against the teaching of biblical literalism (Creationism) in state-supported science classes.   He writes frequently on pseudo-science, as in The Gaia Hypothesis: Science on a Pagan Planet.   Most recently he has authored, Darwinism as Religion, a history of evolutionary theory as seen through creative writing, particularly as seen through fiction and poetry.  He is now writing a book on hatred.  Professor Ruse earned his undergraduate degree at the University of Bristol, his master's degree at McMaster University and his Ph.D. at the University of Bristol. 

Information on Professor Ruse's The Gaia Hypothesis, Science on a Pagan Planet, is at: https://press.uchicago.edu/ucp/books/book/chicago/G/bo10665496.html.

Leah Aronowsky's just-published Critical Inquiry essay, "Gas Guzzling Gaia, or: A Prehistory of Climate Change Denialism," noted during this interview, is at: https://www.journals.uchicago.edu/doi/10.1086/712129.

 

03/08/2021

Professor Mike Chernew Discusses Medicare Advantage Policy Reforms (March 8th)

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(As explained on the podcast home page, this is the fourth of eight interviews concerning federal healthcare policy reform.  This discussion is with Harvard economics Professor Michael Chernew and was conducted in late November.  As you will hear this podcast like all others is introduced by ProMedica's CEO, Randy Oostra.  This series was produced in an effort to interest or persuade federal healthcare officials to pursue substantive healthcare policy reform.)

On background, the rapidly growing Medicare Advantage (MA) program currently provides care to 24 million or 36% of all Medicare beneficiaries at a cost of approximately  $275 billion annually.  Despite approaching its 4oth year, MA still does not, as initially intended, reduce Medicare spending.  Per MedPAC, this year overall MA benchmarks will average 107% of Medicare Fee For Service (FFS) spending.  This is due in part to MA’s quality performance program that pays bonuses to plans with a high Star rating and risk adjustment upcoding not fully offset by the program’s coding intensity adjustment factor.   More problematic is the fact that a September 2020 CBO budget outlook concluded Medicare’s hospital insurance trust fund will be insolvent as soon as 2024.   As MedPAC candidly recognized in its most recent report to the Congress, “unless changes are made . . . the cost of the Medicare program will become unsustainable” necessitating “dramatic changes to the Medicare program.”

During this interview begins with Professor Chernew providing a general overview of the MA  program or how generally it can be improved.  He moves on to discussing  how MA financial benchmarking can be improved, e.g., reform benchmark quartiles, move MA into a value incentive program and reform the MA Stars program, comments on MA coding intensity reform, discusses reforms to MA's Quality Bonus Program (QBP), again, Stars, or via MedPAC's recommended Value  Incentive Program (VIP) program, comments on patient reported outcome measures, factoring social economic status in adjusting beneficiary risk and MA performance pay, equalizing MA and Medicare Fee For Service quality performance payments, how, if at all, MA and Fee for Service can compete on a level playing field, MA plans  participating in the MACRA Advanced Payment Model (APM) pathway, the MA Value Based Insurance Program (VBID) demonstration and comments on the pending insolvency of Medicare's hospital trust fund. 

Michael Chernew is the Leonard D. Schaeffer Professor of Health Care Policy and the Director of the Healthcare Markets and Regulation (HMR) Lab in the Department of Health Care Chernew Policy at Harvard Medical School.   Profess Chernew is also currently the Chair of the Medicare Payment Advisory Commission (MedPAC) while previously serving as the Vice Chair from 2012-2014 and a Member from 2008-2012.  In 2000, 2004 and 2010, he served on technical advisory panels for the Center for Medicare and Medicaid Services (CMS) that reviewed the assumptions used by Medicare actuaries to assess the financial status of Medicare trust funds.  He is a member of the Congressional Budget Office’s Panel of Health Advisors and Vice Chair of the Massachusetts Health Connector Board.  Dr. Chernew is also a member of the National Academy of Sciences, a research associate at the National Bureau of Economic Research and a senior Visiting Fellow at MITRE.  He is currently a co-editor of the American Journal of Managed Care.  Dr. Chernew earned his undergraduate degree from the University of Pennsylvania and his PhD in economics from Stanford University.  In 1998, he was awarded the John D. Thompson Prize for Young Investigators by the Association of University Programs in Public Health.  In 1999, he received the Alice S. Hersh Young Investigator Award from the Association of Health Services Research.

To read this interview's transcript or to post a comment or question, please go to: https://commissiononhealthcare.org/

03/04/2021

Dr. Amol Navathe Discusses Medicare Fee for Service Policy Reforms (March 4th)

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(As explained on the podcast home page, this is the third of eight interviews concerning federal healthcare policy reform.  This discussion with Dr. Amol Navathe was conducted in late December.  As you will hear this podcast like all others is introduced by ProMedica's CEO, Randy Oostra.  This series was produced in an effort to interest or persuade federal healthcare officials to pursue substantive healthcare policy reform.)    

Medicare is projected to grow from 62 to 80 million Americans by 2030.   Largely because of the so called age wave, Medicare spending in sum is projected to double to $1.28 trillion by 2029.  Among other current policy problems, the Part A hospital trust fund is projected to be insolvent in three years.  Part B , or physician payments, intended under 2015 MACRA legislation to move eligible Fee for Service (FFS) clinicians into financial at-risk models, remains unproven, largely due to the fact only less than one in five clinicians participate.  Part B and Part D drug spending growth continues to plague Medicare program largely because Medicare, unlike the VA, is prohibited from exercising its purchasing power.   Medicare FFS is plagued by numerous other coverage problems including, for example, no long term care policy, no hearing, oral, vision and non-medical social support coverage.  In addition, CMS' Innovation Center's (CMMI) demonstrations have proven to be at best marginally successful and post-acute FFS care suffers numerous quality and reimbursement problems, for example, SNFs continue to over-prescribe anti-psychotics while 2018 marked the 19th consecutive year freestanding skilled nursing facility profit margins were in the double digits. 

During this interview Dr. Navathe begins by commenting on the Medicare program in context of the ongoing COVID-19 pandemic.  The discussion moves on to discussing policies to expand Medicare coverage, provides comment on the FFS Medicare Shared Savings Program, discusses the inherent problems with FFS payments and policy recommendations he and his colleagues outline in their December Medicare's "next decade" paper (cited below).   He concludes by commenting on post acute, particularly related to skilled nursing, under FFS Medicare.    

Dr. Amol Navathe is an Assistant Professor of Medical Ethics and Health Policy, Co-Director of the Healthcare Transformation Institute and Associate Director of the Center for Health Incentives and Behavioral Economics, all at the University of Pennsylvania.  He is also presently a Commissioner of the Medicare Payment Advisory Amol-Navathe-expert-2020 Commission (MedPAC).  He founded the academic journal, Health Care: The Journal of Delivery Science and Innovation, serving as its Co-Editor-in-Chief, as well as Founding Director of the Foundation for Healthcare Innovation.  His work on health care cost and quality improvement has been published in numerous leading journals, including ScienceNew England Journal of Medicine (NEJM)Journal of the American Medical Association (JAMA)Health AffairsHealth Services ResearchHealthcare, and other leading academic journals.  Dr. Navathe completed his medical training at the Perelman School of Medicine and his post-graduate medical training at the Brigham and Women’s Hospital at Harvard Medical School.  He obtained his PhD in Health Care Management and Economics from The Wharton School at the University of Pennsylvania.

Dr. Navathe's writings can be found at: https://ldi.upenn.edu/expert/amol-s-navathe-md-phd.

His recent article December noted during this essay, "Medicare Payment Reform's Next Decade: A Strategic Plan for the Center for Medicare and  Medicaid Innovation," is at: https://www.healthaffairs.org/do/10.1377/hblog20201216.672904/full/

To read this interview's transcript or to post a comment or question, please go to: https://commissiononhealthcare.org/

03/03/2021

Recommended Reading: Lancet's "Public Policy and Health in the Trump Era" (March 3rd)

If  you're unaware this past February 20, the Lancet Commission of Public Policy and Health in the Trump Era released its 49-page report by the same title. 

It's at: https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2932545-9.  

The report, authored by over 30 scholars, opens with "President Trump's time in office brought misfortune to the USA and the planet.  In 2020 alone he expedited the spread of COVID-19 in the USA, deserted the WHO when the world needed it most, and responded to largely peaceful protests against racist policing by largely peaceful protests against racist policing by inflaming hatred and unleashing military force and vigilante violence that he subsequently mobilized for insurrection.  The report, over nine sections, discusses life expectancy declines, the history of racism in the US, the assault on immigrants, the opioid epidemic, universal health care, the environment, workplace and global climate, reproductive rights, and globalizing harm.  

02/26/2021

Stanford's Mark Jacobson's Discusses How the Healthcare Industry Can Eliminate Its Carbon Footprint (February 25th)

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Per the essay I posted last week concerning federal policy makers' indifference toward the health harm imposed on Medicare and Medicaid beneficiaries via the healthcare industry's carbon emissions, I thought it useful to discuss however limitedly why and how the US healthcare industry  can rapidly transition to the use of clean or renewable energy resources, i.e., wind, water and solar (WWS).  Possibly, if not likely, the leading US researcher on transitioning to 100% clean energy is Stanford's Professor Mark Jacobson.   For example, as early as 2009, in an article published in Scientific American, he and a colleague argued the barriers to a 100% conversion to WWS worldwide are primarily social and political, not technological nor even economic.  In a 2017 article published in Joule he and 27 colleagues summarized the development of what they termed “roadmaps” to transform energy infrastructures for 139 countries to 80% WWS by 2030.  In 2020 Professor Jacobson published a text titled, “100% Clean, Renewable Energy and Storage for Everything."  In it he explains in detail how the world can rapidly and entirely transition the world’s current combustion-based energy to 100% clean renewables and storage.  

During this 34 minute conversation Professor Jacobson begins by briefly explaining clean energy's numerous advantages.  Beyond avoided human and environmental harm, substantial economic savings are accrued from costs associated with continuing fossil fuel combustion, land use savings (e.g., clean energy does not require an extraction industry), permanent job growth, substantially cheaper energy costs, reductions in large scale energy disruption, increased access to energy by up to four billion people currently in energy poverty, and a decentralized world power supply.  He then discusses generally how the US healthcare industry can convert to 100% clean energy in part by offering lessons learned from building his own 100% energy clean home and Stanford University's substantial transition to clean energy.  Professor Jacobson concludes by making comment on carbon tax policies.

Mark Z. Jacobson is Professor of Civil and Environmental Engineering, Director of the Atmosphere/Energy Program, Senior Fellow at the Woods Institute for the Environment and the Precourt Institute for Energy and Co-Founder of The Solutions 2018-08-05 11.24.12.LAH Project, 100.0rg and 100% Clean, Renewable Energy Movement.  His work provided the primary scientific justifications behind the Green New Deal and House bills H.R. 3314, 3671, and 330 and Senate bill S.987, all of which called for the U.S. to go to 100% clean, renewable energy.  In addition, his 100% roadmaps were the scientific basis behind the platforms of three presidential candidates and a major political party in 2016.  To date, he has published three textbooks and over 165 peer-reviewed journal articles.  He has testified four times before the Congress.   In 2005, he received the American Meteorological Society Henry G. Houghton Award.  In 2013, he received an American Geophysical Union Ascent Award and the Global Green Policy Design Award.  In 2016, the Cozzarelli Prize from the Proceedings of the National Academy of Sciences.  In 2018, he received the Judi Friedman Lifetime Achievement Award and in 2019 he was selected as "one of the world’s 100 most influential people in climate policy" by Apolitical.  He has also served on the Energy Efficiency and Renewables advisory committee to the U.S. Secretary of Energy.  He earned undergrad degrees in civil engineering in economics and a masters in environmental engineering from Stanford and was graduated from UCLA with a Ph.D. in Atmospheric Science.

(The sound quality of some portions of this discussion are poor, my apologies.) 

Information on Prof Jacobson's 2020 text, "100% Clean, Renewable Energy and Storage" is at: https://www.cambridge.org/highereducation/books/100-clean-renewable-energy-and-storage-for-everything/26E962411A4A4E1402479C5AEE680B08.

His 2009 Scientific American article is at: https://www.evwind.es/2009/11/16/a-plan-to-power-100-percent-of-the-planet-with-renewables-by-mark-z-jacobson-and-mark-a-delucchi/2259

His 2017 Joule  article is at: https://www.sciencedirect.com/science/article/pii/S2542435117300120.

Prof. Jacobson's 2015 Energy and Commerce testimony is at: https://web.stanford.edu/group/efmh/jacobson/Articles/I/15-11-19-HouseEEC-MZJTestimony.pdf

His Stanford webpage, that contains a significant amount of information, is at:  http://web.stanford.edu/group/efmh/jacobson/Articles/I/15-11-19-HouseEEC-MZJTestimony.pdf.