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06/13/2021

Upcoming Podcasts: Discussion of the Recently Published Book, "The Hospital: Life, Death and Dollars in a Small American Town" and Harvard's Eric Reinhart Discusses How Mass Incarceration Makes Us All Sick

June 22nd: Brian Alexander will discuss his recently published book, The Hospital, Life, Death and Dollars in a Small American Town.  Information on the book is at: https://us.macmillan.com/books/9781250237361.

June 24th: Harvard's Eric Reinhart, a physician and anthropologist, will discuss the interaction between mass prison incarceration and public health.  For information on Dr. Heinhart's research go to: https://scholar.harvard.edu/reinhart/bio.  See too, the recent related piece in The Harvard Gazette: https://news.harvard.edu/gazette/story/2021/06/study-sheds-new-light-on-covid-19-and-mass-incarceration/.  

06/11/2021

Ms. Priti Krishtel Discusses the Biden Administration's Support for a Temporary WTO COVID-19 Vaccine Patent Waiver (June 10th)

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Last October India and South Africa appealed to the World Trade Organization to temporarily waive patent or intellectual property (IP) rights such that COVID-19 production and distribution worldwide could be accelerated.   As of a month ago 80% of COVID-19 vaccines had gone to those in in high or upper middle income countries while only 0.2% had gone to those in low income countries - meaning it was projected to take until 2024 to inoculate developing world populations.  The Trump administration opposed a waiver.  In early May, the Biden administration announced it would support a so called TRIPS (Trade-Related Aspects of Intellectual Property Rights) waiver over the opposition the European Union (EU) and the pharmaceutical industry - though Moderna announce last fall it would not enforce its COVID vaccine-related patents).   Along with recent administration announcements to purchase and distribute over 500 million vaccines worldwide, the administration has evidently recognized the moral imperative and the fact COVAX, the WTO's initiative to pool vaccine resources, remains profoundly underfunded.      

During this 26 minute conversation Ms. Krishtel moreover explains why the Biden administration was unprecedented, the definition of a waiver, its timing and the practical issue of tech transfer.  She goes on to address or refute the industry's objections to a temporary waiver and discusses more generally inherent problems with the market-driven US patent system.  Among other issues, it undermines the purpose of public investment, socializes risk while privatizing profits (or places profits over people) and slows the worldwide diffusion of pharmaceutical know how.         

Ms. Priti Krishtel is the co-founder of Initiatives for Medicines Access and Knowledge (I-MAK),  a non-profit building a more just and equitable medicines system.  She has spent Priti-Krishtel-Headshot nearly two decades exposing structural inequities affecting access to medicines and vaccines moreover across the Global South.  Of late this work includes advocating for equitable access to COVID-19 vaccines across the globe and helping to ensure the Biden administration prioritizes equity the US Patent and Trademark Office's work.  I-MAK's work on the patent system has been cited repeatedly in Congressional testimony on prescription drug costs, most recently in hearings by the House Committee on Oversight and Reform.   To improve equity in the patent system, I-MAK recently developed a new tool called Participatory Changemaking that will provide an assessment of the patent system and bring together stakeholders from across the stakeholder spectrum, from patients to investors and policymakers, to drive sustainable, long-term change into what has long been an exclusionary process.  Ms. Krishtel and I-MAK have also put out a 10 point plan for the Biden administration to bring equity into the patent system.  She is a recent TED speaker, Presidential Leadership Scholar, and an Ashoka Fellow.

For information on I-MAK go to: https://www.i-mak.org/.   

Ms. Krishtel's recent British Medical Journal article noted during this discussion is at: https://www.bmj.com/content/bmj/373/bmj.n1344.full.pdf

The Ink interview noted during this interview is at: https://the.ink/p/doses-are-charity-knowledge-is-justice.

 

06/09/2021

Dr. Robert Phillips Discusses the National Academy of Sciences, Engineering and Medicine's Recent Report, " Implementing High-Quality Primary Care" (June 8th)

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Podcast listeners are aware US healthcare significantly underperforms.   Among numerous other statistics, despite spending approximately twice what comparative countries spend on healthcare, the US has highest rates of preventable deaths.  Even wealthy Americans are more likely to, for example, die during childbirth, from cancer and from heart attacks than those in 12 comparative countries.  This is substantially due to the fact primary care in the US, as the National Academy of Medicine report states in its opening, is “slowly dying.”  The report further notes despite the fact primary care's value is beyond dispute, approximately 25% of Americans do not have a primary care physician and 80 million Americans live, per  HRSA, in primary care health professions shortage areas.  In turn, this is largely due to the fact only 5% of healthcare spending goes to primary care despite such visits accounting for 40% of all medical office visits.  Translation: primary care physicians are substantially undercompensated that contributes to a growing shortage of primary care clinicians.

During this 34 minute conversation, Dr. Phillips discusses several of the reports nearly 20 recommendations including recommending all Americans select a primary care provider or be assigned one and that there be created a HHS Secretary Council on Primary Care.  Among other subject covered in the report, Dr. Phillips discussed Primary Care Medical Homes (PCMHs), discusses measuring quality performance, value and risk adjusment particularly as it relates to adjusting for social risk or social need.      

Robert L. Phillips, Jr., MD, MSPH, is the founding Executive Director of the Center for Professionalism and Value in Health Care.  Dr. Phillips also currently practices part-time in a Smgray_PHILLIPS_Bob community-based residency program in Virginia and is Professor of Family Medicine at Georgetown University and Virginia Commonwealth University.  Prior to, or from 2012 to 2018, he was Vice President for Research and Policy where he led the launch of a national primary care clinical registry and a Measures that Matter research and development program for primary care.  Previously still, Dr. Phillips served as Director and Assistant Director of the Robert Graham Center in Washington DC.   He has also served on the American Medical Association’s Council on Medical Education and as President of the National Residency Matching Program.   Dr. Phillips was elected to the National Academy of Medicine (NAM) in 2010.  He currently serves NAM's Membership Committee and the Action Collaborative on Clinician Well-Being and Resilience.  He is a graduate of the Missouri University of Science and Technology and the University of Florida College of Medicine where he graduated with honors for special distinction.  He completed his family medicine training at the University of Missouri that was followed by a two-year fellowship in health services research and in public health. 

Information regarding the report is at: https://www.nationalacademies.org/news/2021/05/high-quality-primary-care-should-be-available-to-every-individual-in-the-u-s-says-new-report-payment-reform-telehealth-expansion-state-and-federal-policy-changes-recommended. 

The report is summarized in a May 4 JAMA Viewpoint essay, at: https://jamanetwork.com/journals/jama/fullarticle/2779749. 

Information on the report's webinar series, noted during the interview, is at: https://www.nationalacademies.org/our-work/implementing-high-quality-primary-care.

 

 

05/28/2021

John Kotcher Discusses His Recent Survey of International Health Professionals Regarding Climate Crisis Advocacy (May 27th)

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Despite a long history of engagement in various political and social and issues, for example, from the nuclear test ban treaty to the global AIDS epidemic, healthcare professionals have been largely absent in addressing the climate crisis.  This helps explain why the health care industry has been, in sum, absent from addressing what the World Health Organization has defined as the greatest threat to human health in the 21st century or what Nobel Price economist William Nordhaus (noted for his work on the carbon tax) has termed the "colossus that threatens our world."  As listeners of this podcast may recall the US healthcare industry’s own greenhouse gas (GHG) emissions account for 10% of total US GHG emissions, 25% of global healthcare GHG emissions and 4.5% of total global GHG emission.  Recently, however, a letter drafted by U. of Washington's Dr. Howard Frumkin and APHA’s Dr. Georges Benjamin addressed to DHHS Secretary Xavier Becerra, outlining in detail regulatory policy measures the Secretary should take to address the climate crisis, was co-signed by 65 medical professional associations including, for example, the Alliance for Nurses for Healthy Environments, Medical Students for a Sustainable Future and Mason's Center for Climate Change Communication.     

Professor Kotcher begins the 30 minute conversation by briefly describing his Center's work.  He moreover describes the survey's methodology and the survey's findings including respondents understanding of the climate crisis and more specifically health risks associated with the crisis, respondents understanding of their responsibility as healthcare professionals to address the crisis, what barriers prevent or inhibit them from addressing the crisis and what products or tools would help healthcare professionals more successfully or productively engage in advocating/lobbying for solutions. 

Dr. John Kotcher is a Research Assistant Professor at George Mason University’s Center for Climate Change Communication Kotcher_B_W_for_web where he conducts research on science, environmental, and risk communication.  His work focuses on how people respond to public engagement by scientists, how to effectively communicate about the public health implications of climate change and air pollution, and how civic organizations can most effectively recruit, organize, and mobilize citizens—especially political conservatives—to demand action on climate change.  Professor Kotcher also works on the Climate Change in the American Mind project, a series of national public opinion surveys carried out in partnership with the Yale Program on Climate Change Communication to investigate and track public attitudes toward climate change and support for climate policies in the United States.

Professor Kotcher and colleagues' article, "Views of Health Professionals on Climate Change and Health: a Multinational Survey Study," was published in the May issue of Lancet Planetary Health and is at: https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(21)00053-X/fulltext.  

05/21/2021

CUNY's Nick Freudenberg Discusses His Just-Published Work, "At What Cost, Modern Capitalism and the Future of Health" (May 20th)

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As the book's dust jacket notes, At What Cost, Modern Capitalism and the Future of Health [ recently published by Oxford University Press] confronts how globalization, financial speculation, monopolies, and control of science and technology have enhanced the ability of corporations and their allies to overwhelm influences of government, family, community, and faith.  As corporations manipulate demand through skillful marketing and veto the choices that undermine their bottom line, free consumer choice has all but disappeared, and with it, the personal protections guarding our collective health.  At What Cost argues that the world created by 21st-century capitalism is simply not fit to solve our most serious public health problems, from climate change to opioid addiction.  

This 32-minute interview opens with Professor Freudenberg commenting on the relationship between our economic model and public health in context of the current pandemic.   The discussion moves on Professor Freudenberg describing attributes associated with, or the problems related to, neoliberalism, the negative effects neoliberalism/American capitalism has had on what he terms the five pillars of well being, specifically food and healthcare, the health care industry's role and responsibility in addressing capitalism's negative effects and concludes with an overview of Part III of his work, or solutions he identifies to temper modern American capitalism.  

Nicholas Freudenberg is Distinguished Professor of Public Health at City University of New York School of Public Health and Freudenberg-1 Director of the CUNY Urban Food Policy Institute.  Professor Freudenberg is also founder and director of Healthy CUNY, a university-wide initiative to improve the health of CUNY’s 274,000 students in order to support their academic success.  Professor Freudenberg was also founder and first director of the CUNY School of Public Health’s Doctor of Public Health program.  For the past 35 years, he has worked in sum to plan, implement and evaluate health policies and programs to improve living conditions and reduce health inequalities in low income communities in New York City and elsewhere.  Among numerous other publications, he is also the author of Lethal But Legal Corporations, Consumption and Protecting Public Health (Oxford, 2014 and 2016).    Professor Freudenberger earned his BS from CUNY and his MPH and DPH from Columbia University.  

05/10/2021

Phase 3 Study of MDMA Proves Clinically Effective (May 10th)

Listeners may recall I interviewed Dr. Rick Doblin in October 2019 regarding the potential therapeutic benefits of LSD, psilocybin and other psychedelic agents.  (The interview is at: https://www.thehealthcarepolicypodcast.com/2019/11/dr-rick-doblin-discusses-the-therapeutic-potential-of-psychedelics-october-31st-.html.)   

Today's New York Times published a front page article titled, "Psychedelics Are Poised to Reshape Psychiatry," that picks up on last week's reporting noting Nature Medicine is soon to publish the results of a Phase 3 clinical trial that showed pairing MDMA, more commonly termed Ecstasy and Molly, with counseling demonstrated therapeutic benefits for those suffering from PTSD.   (A recently NEJM-published study showed the benefits of treating depression with psilocybin (found in certain mushrooms).   

Today's lengthy NYT piece is in part an account of Dr. Doblin's 40 year effort to reintroduce these chemical agents into the clinical setting. 

 

04/29/2021

The Arc's Nicole Jorwic Discusses President Biden's Care Economy Proposals (April 28th)

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Over the past several weeks the Biden administration has incrementally released proposed infrastructure policies under the title, "Build Back Better."  The White House defines infrastructure to include human capital that under grid the functioning of the economy.   (As Bryce Covert noted in yesterdays The New York Times, Lanham Act funds, initially used to fund infrastructure deemed critical to the war effort, eventually became used to build child care centers when it was learned children were being locked in cars because working mothers had no other options.  Infrastructure policies that address the "care economy" are outlined in the administration's April 21 American Jobs Plan and their April 28 American Families Plan.  The Jobs Plan includes proposals to expand Home and Community Based Services (HCBS) waivers, extend the Money Follows the Person program and policies to expand and improve elder care jobs.  Beyond paid family and medical leave and child related tax cuts, the American Families Plan proposes universal pre-school, free community college and related higher education supports expanded nutritional program policies.  Among other realities, the absence of universal day care, along with no long term care and paid leave policies, largely explains why compared to similar counties women are significantly under-represented in the US workforce at a significant cost to overall economic performance.   A recent AARP survey found one in five Americans, moreover women, served as a caregiver for an adult or child with health or functional needs in ’20.  Concerning elder care workforce, this labor market is expected to grow by approximately two million jobs over the next decade plus in caring for a significant percent of the 25% of Americans who will be 65 or older in 2040.   

This 30 minute interview begins with a brief explanation of The Arc's work.  Ms. Jorwic goes on to moreover outline/explain provisions of the American Families Plan and the American Jobs Plan, discuses how the cost of these policies will be offset and the chances for Congressional approval.   

Ms. Nicole Jorwic is the Senior Director of Public Policy at The Arc, a national community-based organization advocating for and serving people with intellectual and developmental Nicole-Jorwic_2 disabilities and their families.  Prior to joining The Arc Ms. Jorwic served as Senior Policy Advisor for the state of Illinois.   Prior to that appointment, she served as the CEO/President of the Institute on Public Policy for People with Disabilities where she continued the Institute’s mission to improve the lives of people with disabilities and assisted the leadership of the state of Illinois in developing public policy driven best practices in serving individuals with disabilities.  Ms. Jorwic i a special education attorney and an advocate for students with disabilities, with a focus on transition-aged youth.  Nicole received her JD and Child and Family Law Certificate, from Loyola University Chicago and received her BS from the University of Illinois.  Nicole's sibling, her brother Chris, has been diagnosed with autism.

For information on The Arc go to: https://thearc.org/

The administration's 15-page American Families Plan outline is at: https://mail.google.com/mail/u/0/#inbox/WhctKJWQntDXPWTSKGmSvRdkQDZZGdFbkBMKMblcGFztpZqKwNkjXHzTzrTdkqczLNTNGgq?projector=1&messagePartId=0.1.

The administration's five-page American Jobs Plan outline is at:  https://www.whitehouse.gov/briefing-room/statements-releases/2021/04/21/fact-sheet-the-american-jobs-plan-will-support-womens-employment/. 

04/25/2021

Mt Sinai's Professor Shanna Swan Discusses Her Recently Published Book, "Countdown" (April 22nd)

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In her recently published volume, co-authored with Stacey Colina, Countdown: How Our Modern World Is Threatening Sperm Counts, Altering Male and Female Reproductive Development and Imperiling the Future of the Human Race, discuss the relationship between our exposure to endocrine-disrupting chemicals (EDCs) and the dramatic decline in global fertility rates over roughly the past half century – a finding that was initially documented in the early 1990s and again in 2017 when Professor Swan and her colleagues published a meta-analysis that received considerable attention.  Over the past four decades, the book authors' note, sperm levels among men in Western countries has declined by nearly 60 percent.  With adverse reproductive changes in males increasing by 1% per year, in theory at least, by 2045 Western men will be infertile.       

During this 35 minute discussion Professor Swan explains what are Endocrine Disruptive Chemicals (EDCs) and their effects.  She explains how EDCs adversely effect male sperm count and women's ability to reproduce along with lifestyle factors that exacerbate difficulty in reproduction, e.g., obesity and sedentary lifestyle, and negative side effects of testosterone of replacement therapy.   She discusses related declining fertility rates worldwide, the extent to which exposure to EDCs create an inter-generational reproductive problem, the extent to which homo sapiens qualify under the definition of an endangered species and what, if any, relationship there is between EDC exposure and gender fluidity and dysphoria.  The discussion concludes with Professor Swan's assessment of the extent to which EDCs have been regulated to date and what regulatory efforts should be made, for example, the US should take a lesson from the European Union's REACH program.                         

Dr. Shanna Swan is Professor of Environmental Medicine and Public Health at the Ichan School of Medicine at Mt. Sinai in New York City where is also a member of the Transdisciplinary Center on Early Environmental Exposures and the Mindich Child Health and Development Institute.  Professor Swan has worked for over twenty-five years to understand the threats posed by 0000072500014267606611 chemicals to our environment and our health, and, when necessary, to develop new paradigms to assess their risks.   Professor Swan works with a wide range of collaborators, including epidemiologists, biostatisticians, toxicologists, geneticists and systems biologists, to conduct studies and develop methods to evaluate the risks from such chemicals.  She has published more than 200 scientific papers and myriad book chapters and has been featured in extensive media coverage around the world. Her appearances include ABC News, NBC Nightly News, 60 Minutes, CBS News, PBS, the BBC, PRI Radio, and NPR, as well as in leading magazines and newspapers, ranging from The Washington Post to Bloomberg News to New Scientist.  

For information on Countdown, go to: https://www.shannaswan.com/countdown or  https://www.simonandschuster.com/books/Count-Down/Shanna-H-Swan/9781982113667.

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/