The Healthcare Policy Podcast ® Produced by David Introcaso

Listen Now After the food industry health care is considered this country's second largest emitter of green house gas (GHG) pollution.  With emissions equal to approximately 655m metric tons of CO2 equivalents annually, if the health care industry was its own country it would rank 13th worldwide in GHG emissions.  Yale researchers have estimated the industry's GHG emissions alone are “commensurate...

Listen Now The e-cigarette market, or what the FDA formally terms Electronic Nicotine Delivery Systems or ENDS, has grown since 2004 to approximately 11 million American consumers.  Recent survey data published in February in JAMA has shown use of e-cigarettes (or vaping) among underage youths or middle and high school students has increased significantly since 2011.   Beyond potentially serving a...

Listen Now In 2017 more than 47,000 Americans committed suicide.  While suicide rates decreased during the 1980s and 1990s, they have increased by 33% over the past two decades.  Today they are one of the top ten causes of death.  Suicide or suicide-homicides, where the spouse or partner kills their loved one and frequently and immediately themselves, are unsurprising for several reasons.  Among o...

Listen Now Medicare's Fee for Service Alternative Payment Models (APMs), a creation of 2015 MACRA legislation, currently 12 in number with participation largely voluntary, requires Medicare providers to assume financial risk, based on historical spending and quality measurement performance, beyond a "nominal amount."  The flagship APM is the ACA's Medicare Shared Savings Program, more commonly ter...

Listen Now Despite gains made under the ACA, health insurance coverage in the US remains fraught with problems.  Over 28 million non-elderly remain uninsured.  Health care spending is extreme.  Health care coverage is the most expensive worldwide in absolute terms and relative to average incomes – despite the fact Americans consume no more or fewer health care resources than our comparative peers....

Listen Now For this, my 168th interview, David Wallace Wells discusses his just-published book, "The Uninhabitable Earth, Life After Warming."  Listeners may recall I interviewed Mr. Wallace Wells on August 2, 2017 shortly after his published his July 2017 New York Magazine article by the same title, "The Uninhabitable Earth."  (At: http://nymag.com/intelligencer/2017/07/climate-change-earth-too-h...

Listen Now The administration and the Congress are currently discussing various proposals to reform drug pricing policy.  Drug prices, as listeners are likely well aware, have risen substantially over the past two decades.  For example, between 1997 and 2007 they tripled and currently year-over-year Medicare Part D drug spending is expected to grow through 2026 at twice the 2007 through 2013 growt...

Listen Now Over 40 million Americans live in poverty or upwards of 14% of the population.  Those living in extreme poverty number 18 million and over 5 million live in absolute poverty.  The US also has the highest youth poverty rate among OECD countries.  This reality is made worse by the fact the US is the only highly developed country in the world that lacks universal health care coverage.   De...

Listen Now This past summer the the Democratic Republic of the Congo (DRC) began experiencing its 10th Ebola outbreak.  (The virus, with a mean mortality rate of 50 percent, is endemic in that country.)  To date, the current outbreak has claimed approximately 400 lives.  The World Health Organization (WHO) expects the outbreak to persist for another six months, in part, because current political t...

Listen Now In late November, Lancet published its 2018 "Countdown: Tracking Progress on Health and Climate Change."  The 36-page report (link below), authored by nearly 70 scientists, including Dr. Jeremy Hess, provides an assessment of health and economic effects of climate change and global warming as well as provides an assessment of the world's green house gas emissions and current global effo...

Listen Now During this 31 minute discussion Rosemary Gibson unpacks her latest work, co-authored with Janardan Prasad Singh, titled, China, Rx, "Exposing the Risks of America's Dependence on China For Medicine.  As the title suggests the authors discuss the problems with relying on China for the production of essential ingredients for thousands of medicines, or the implications of relying on China...

Listen Now Listeners may recall, I have previously discussed the opioid epidemic this past February 2 with Dr. Steve Passik concerning abuse deterrent formulations and on November 16, 2016 with Dr. Ann Lembke regarding her work, "Drug Deal MD."  Tragically, the opioid epidemic continues unabated.  In 2017 there were 72,000 drug overdose deaths, among these 29,000 were from synthetic opioids, predo...

Listen Now   The below November 7th podcast post provides a link to an essay that, in part, provides an overview of the United Nation's International Panel on Climate Change's (IPCC's) recent report titled, "Global Warming of 1.5°C."  As noted in the essay, what is particularly noteworthy about the IPCC's report is its conclusion that keeping or holding temperature increases to below 2°C, the goal...

Listen Now Soon after the 9/11 attacks the Congress created the Victim Compensation Fund (VCF).  Initially, the VCF was created to award moneys to 9/11 victims or their families.   Awards were made through 2004.  In 201o1 the Congress passed the James Zadroga 9/11 Health and Compensation Act, named after a 34-year old NYC policeman who died in 2006 of 9/11 related illness, was created to compensat...

Listen Now Earlier this month the United Nation's Inter-governmental Panel on Climate Change (IPPC), the world's definitive body on the subject, concluded we have just 12 years, or until 2030, to avoid global temperatures rising above 1.5 degrees Celsius (or 2.7F).  We've already warmed by 1C.   Among other consequences, if we warm to 2.0C (or 3.6F) we will lose 99 percent of our coral reefs.  We...

Listen Now Currently, CMS is accepting public comment on a proposed Medicare Shared Savings Program (MSSP), known more commonly as the Accountable Care Organization (ACO) program, rule.  The MSSP, created under the 2010 Affordable Care Act, is Medicare's flagship pay or performance program currently providing care to over 10 million Medicare beneficiaries.  MSSP or ACO performance, or to the exten...

Listen Now Despite the fact social circumstances and environmental factors account for approximately 20% of an individual's health status, twice that of medical care at approximately 10%, social circumstances or social determinants of health are frequently unaddressed by health or medical care providers.  This is largely because medical care providers are neither trained to provide social service...

Listen Now In the recent past the federal government has made several efforts to expand the use of telehealth and Remote Patient Monitoring (RPM) services.  Related provisions can be found, for example, in the 2017 CONNECT Act, the Bipartisan Budget Act of 2018 and in federal regulatory rule making, for example, the current 2019 proposed Medicare Physician Fee Schedule (PFS) rule, and in payment w...

Listen Now According to a recent Kaiser/Washington Post survey 59 percent of Americans support Medicare for All (M4A).  Per a March New England Journal of Medicine poll 61 percent of physicians said single payer would make it easier for them to deliver cost-effective, quality health care.   Currently, before the House is legislation titled the "Expanded and Improved Medicare for All Act" with over...

Listen Now Over the past several years the Congress and Medicare regulators have discussed reforming the 1989 Ethics in Patient Referral Act.  Otherwise known as the physician self-referral or more commonly termed Stark law (named after the former California House member, Pete Stark, the initial sponsor of the bill).  Stark law is today widely viewed as an impediment to care coordination or paymen...

Listen Now While coverage under the Affordable Care Act (ACA), Medicare and Medicaid enjoy, deservedly, a great deal of discussion and debate, employer-sponsored insurance (ESI) insures approximately 55% of the non-Medicare eligible population, or approximately 152 million Americans.  (Medicaid insures 19.5% of the population and Medicare 16%).  Larger employers, or those with over 500 employees,...

Listen Now As listeners may be aware well over 50 million Americans suffer from a mental or behavioral health disorder.  Less than half of these individuals actually receive treatment.  This reality is substantially worse for minorities.  For example, African Americans and Hispanic whites are half as likely as non-Hispanic whites to receive treatment.  Primary care practices, more than any other s...

Listen Now Research published by the Association of American Medical Colleges (AAMC) this past April estimated the US could see a shortage of up to 120,000 physicians by 2030.  AAMC estimates the shortage would be particularly acute in primary care, i.e., upwards of 50,000 primary care physicians would be needed.   The primary care shortage is already acute.  The federal Health Research and Servic...

Listen Now Recently, Oral Health America (OAH), published the fourth volume in its series, "State of Decay."  The current volume,  is subtitled, "Are Older Americans Coming of Age Without Oral Healthcare?"  (The series dates back to 2003.)  Among other findings, the current report again concludes the state of oral health in this country is, in a word, poor.  For example, one-third of older adults...

Listen Now This past week public comments were due in response to a CMS Request for Proposal (RFI) that would potentially lead to the agency fielding a Medicare a direct primary care (DPC) demonstration.  The demo would pay Medicare physicians directly a predetermined fixed per-beneficiary-per-month fee to provide primary care services to participating beneficiaries.  The demo would try to replica...