APHA Executive Director: $10B in New COVID Funding Needed, Being Spent Responsibly

Dr. Georges Benjamin

[Music]
Marianne O’Hare: Welcome to Conversations on Health Care . This week, we
welcome Dr. Georges Benjamin, President of the American
Public Health Association, on the pandemic, disparities, and the
crisis in public health.

Dr. Georges Benjamin: Public h ealth has been so undervalued and underfinanced for
many years that the money that did go out built one - time
capacity and not long - time capacity.

Marianne O’Hare: Lori Robertson joins us from FactCheck.org . And we end with a
bright idea, improving health a nd wellbeing in everyday lives.
Now , here are your hosts Mark Masselli and Margaret Flinter .

Mark Masselli: Our guest represents over 25,000 members , whos e organization
states it’s the only one that has the ability to influence Federal
policy to improve th e public’s health. He’s a physician who’s
been leading the American Public Health Association for 20
years.

Margaret Flinter: Dr. Georges Benjamin oversees the push by APHA to make
America the healthiest nation in one generation. But there are
many challen ges, COVID of course being one of the most
devastating.

Mark Masselli: Dr. Benjamin, w elcome back to Conversations on Health Care.
th
And congratulations to you and your service and APHA’s 150
anniversary.

Dr. Georges Benjamin: Yeah, it’s a great birthday, a 150 years of age.

Mark Masselli: Oh my God! Well, I am feeling like a relative pop. We just turned
50, so I am feeling very youthful. But again, congratulations to
you, and the entire membership. But let’s start with the news
that the Center for Disease Control and Prevention Director Dr.
Rochelle Walensky says they are going to develop new systems
and processes to deliver their science and programs to American
people, along with the plan for how CDC should be structured to
facilitate public health work. We know this is in the early stages,
but share with us the advice that you have offered to CDC on the
direction they should head.

Dr. Georges Benjamin: Well, you know, look, the CDC is an amazing organization,
scientific organization, and they do extraordi narily good work .
But if you think about it, they in many ways perform like
academic institution, lots of thought, lots of science, and then it
takes forever to get the information out. And what we really
want them to function at, because they now need to do that in
this modern world much more like a n emergency preparedness

Dr. Georges Benjamin

entity . They have got to do fast science that’s accurate and
timely. They have got to make rapid operational decisions, and
they need to give good guidance to the public as they go
forwa rd. And so that means they have to think differently, and
they have to maybe in many ways be organized differently. And
so they are looking at whether or not they can do that as one
way of trying to improve their performance overall.

Margaret Flinter: Well , Dr. Benjamin , another piece of big news is there is a deal in
the Senate for an additional $10 billion for the COVID - 19
response. But, you know, there is still pushback that public
health departments need to be more accountable and maybe
more transparent for how they have spent the money so far. Do
you think this is a legitimate complaint, and is this something
that health departments and health directors around the
country are working to improve upon?

Dr. Georges Benjamin: Well, look, we always want to b e transparent and responsible
for taxpayer funds, and remind people that governmental public
health has enormous accountability and enormous oversight.
Every elected official, they meet legislative committees. They
have mayors and governors and boards of h ealth they have to
be responsible to. So, it’s not about accountability. Health
departments are accountable. But, we have to recognize that a
lot of money went out. But a lot of money went out in ways that
are difficult to not account for, but the timing i s everything.

And so people know where the money is, but public health has
been so undervalued and under - supported, underfinanced for
many years that the money that did go out built one - time
capacity and not long - time capacity. And this new $10 billion
ag reement is going to help a little bit more , b ut in many ways,
it’s really a drop in the bucket on what’s needed to give every
community the capacity and supports that we need anytime a
new health threat enters the community.

Mark Masselli: Well, I think yo u hit the right point there , t he woeful
underfunding that public health has had for decades . But I also
want to talk about something else in that bill, or not in that bill,
talking about underfunding, is that more money for
international vaccine support al so continues to be underfunded ,
and it is not in this compromise bill. Is n’t it shocking that we are
still arguing over the fact that COVID transcends national
borders, and that it’s in our country’s best interest to make sure
that people all over the glob e are vaccinated?

Dr. Georges Benjamin: Yeah , you know, that’s the real challenge we have here, is that
we are going to take this $10 billion because we need it, and we
need it urgently. But, we have to get the funding for the

Dr. Georges Benjamin

international component of th is because there is going to be
another variant, and that variant is going to come from
somewhere. It may come from out of the country, or it may
come from somewhere in this country. But this pandemic is not
over yet . It is transitioning, and we are going to need to make
sure that we have the adequate resources to do this.

Margaret Flinter: And Dr. Benjamin, one of the things that we saw throughout this
whole period of COVID, and that was so difficult to see , were
some of the attacks and the confrontations, everybody from
school board officials, to school teachers, to public officials. But I
saw a study recently that as many as one - third of local and state
public health officials who left their positions during that first
and very tumultuous year of the pand emic, reported having
been harassed. We haven’t been suffering from an
overabundan ce of talent out there in the field already, this has
got to make recruiting for open public health positions even
tougher. What are you hearing from the field from your
memb ership and from your people out in the field about how
much this has affected being able to bring people into public
health?

Dr. Georges Benjamin: It’s going to be a challenge. You know, there’s a lot of people
that hung on just because they had a need to help the public;
they felt it was important to do this work. But, nobody wants to
work in a hostile work environment. And quite frankly, many
people now have found themselves in a hostile work
environment, and the real tragedy in so many situations is thei r
bosses didn’t have their back. And so we have got to do several
things. Number one, we absolutely have to reestablish the rule
of law . No judge would tolerate the kind of behavior that
occurred in some of these town halls in their courtroom. And
security officials, police officials need to stand behind those
public officials in those meetings.

The public needs to treat them with respect, and of course, we
always have to treat the public with respect. So, we need to
reestablish thoughtful debates. That do esn’t mean people won’t
get mad. That doesn’t mean people won’t raise their voices , b ut,
it still has to be done in a way that nobody feels threatened. And
we have to do that very, very quickly, because if we don’t do
that the next time we have something r eally bad happen, the
people that are best equipped, the smartest people in the room,
they are not going to be there to help us. And I want to make
sure that there is a good public health system for my grandkids.

Mark Masselli: Well, I want to pull the thr ead on the thought that we are a
divided country, and yet the data suggests that there is a higher

Dr. Georges Benjamin

mortality rate in counties that voted Republican in the 2020
Presidential election where the pandemic guidelines were less
likely to be in place, compared to the counties that voted
Democratic. Is this the case where only some parts of the United
States have an issue of trusting public health? Perhaps we don’t
have a nationwide crisis, but we have one that’s a little more
segmented.

Dr. Georges Benjamin: Well, we have different views politically in this country, there is
no doubt about that. But nobody wants to have the water not
safe to drink, the air not safe to breathe, and the food not safe
to eat. Nobody wants to get infected from an infectious disease.
An d we have to continue to speak truth to power, and the
outcomes that you just talked about are the results that in some
communities we had elected officials, as well as [inaudible
00:08:18] and other influencers who quite frankly gave a lot of
misinformati on and disinformation.

It certainly politically has, you know, tracked along red and blue
lines, but I just have to say there are certainly some conservative
communities, some Republican communities where those
governors and elected officials did the righ t thing. My g overnor
Hogan in Maryland, did the right thing. Governor Deval [PH] did
the right thing. But, there are communities where people did
not do the right thing, they did not follow the science, and we
need to call them out when they do something t hat’s wrong like
that , and then we need to support people that are strongly in
support of the evidence and science.

That doesn’t mean we don’t have to listen to the public. And I
think far too often, people were saying, “I want to do the right
thing, but I don’t want the government to demand that I do the
right thing.” And so we just got to figure out how we incentivize
people differently. But at the end of the day, sometimes we
have to put in mandates, because if you don’t do that people get
sick and peop le die. And, you know, we have just got to come to
some consensus about how to do that, and we just have to
continue to push until we can get our nation back together on a
reasonable pathway to improve the public’s health.

Margaret Flinter: Well, I think D r. Benjamin, we are all in agreement that we yearn
for the country having kind of a unified voice. Doesn’t all have to
have the same opinions, but have , as an op - ed writer with the
New York Times said recently , a healthy distance maybe
between a group like the CDC and our political leaders that
would give the agency a chance to very quickly and
transparently communicate informati o n so that public -- even
when it may not be politically convenient. I wonder what your

Dr. Georges Benjamin

thoughts are on that . Do you think there n eeds to be a sort of
separating out of the CDC messaging from the rest of the
administration?

Dr. Georges Benjamin: You know, the challenge we have is that CDC needs to continue
to do the good science - based evidence that they do. But we
have got to come to the grips with the fact that public health
does most of what it does through change in policy. If you are
going to change policy, you are going to be in a political arena.
That doesn’t mean that we need to be politicians per se, but I do
think we need to understand political science, and I think we
need to improve our risk communication. We need to build
those trust relationships before we need the trusting
relationships.

That means going in the community, with people that disagree
with you, and talking w ith them and building that trust. You
can’t do that behind the desk. You can only do that by getting
out and going in the communities, whether they are progressive
or conservative, and getting trusted messengers, and we need
to build a communicat i on s syste m so that when we see people
saying really crazy stuff that has no evidence - base, we can push
back. And quite frankly, the people that have the time to give
the wrong information, are out there doing it each and every
day for nefarious purposes. And we, as the public health
community, need to have a better communication s system. It
needs to be funded and supported so that we can compete in
that environment.

Mark Masselli: It’s very interesting. I am thinking you have got many challenges
in your role leading the APHA. The theme of the National Public
Health Week this year is Public Health is Where You Are. But it
seems that too many Americans don’t see the connection or
trust in public health, and I am wondering this is a little like I
don’t like Congress but I like my Congressmen and women,
right?

Dr. Georges Benjamin: Yeah.

Mark Masselli: As you think about the challenge you have, is there somewhere
else in the globe , another country that you think you could look
to as an example of what they are doing right ? Is there anything
that as you think about your strategy that you blend in from
other parts of the world?

Dr. Georges Benjamin: Well look, you know, Taiwan did this pandemic fairly well . They
have got a very comprehensive public health system. South
Korea has one. Canada and Britain, although they have done
some things to undermine their system in the last several years ,

Dr. Georges Benjamin

w e want American model system. We love our own stuff, you
know. But, in the United States, we have a Federal - state - local
partnership, and we need to invest in that partnership in a way
that is going to improve the public’s health. So that means we
need to modernize the resources that we have. We need to
bring our technology systems into the modern age.

Look, there’s something called the fa x machine. I know that
many of your listeners don’t know what a fax machine is, but
that’s how the old folks used to move paper over the wires from
one point to another. And that’s how public health was moving
our data, using something called pens and penc ils to write with.
Now my children don’t know what that stuff is, you know. My
point is , you know, everybody is able to move data around the
world much faster than the public health and health care system
works, and we need to modernize that data system so that we
can make decisions in real time rapidly, so we can make data -
driven decisions.

We need to have the technology that is available now so that
when we get a new microorganism that enters the community,
we can look at its genetic structure very quick ly to decide
whether it’s new and something we need to be worried about.
Right now the technology is there, but it just takes us far too
long to do it. Other nations like Britain were able to track their
strains very, very quickly. Now we have built up tha t capacity in
United States, but it’s still not where it needs to be. And quite
frankly, while this was happening, Congress was still debating
over dollars for public health, which quite frankly the amount of
money they want to put on the table is a roundi ng error in the
Federal budget. So I just think that we need to -- if we are
serious about this , we need to act like we are serious.

Margaret Flinter: Well, Dr. Benjamin, I know we can’t say that COVID is in the
rearview mirror yet. People have been tellin g us for the last
couple of years that there will be other pandemics in the future
that we will have to deal with. So we are all in learning mode
about how we do things better. But we had scientist William
Haseltine on the show in the past, and he argued f or a much
more aggressive top - down public health initiative that worked
elsewhere to control COVID , would have worked better here,
maybe would be better in the future. I am not sure if all of our
listeners even have a good sense of how public health is
org anized around the country, but what’s your thought about
that focus on top - down approaches versus more state by state?

Dr. Georges Benjamin: Well, health care as you know in this country is very
decentralized, whether it’s public health or medical care. An d

Dr. Georges Benjamin

you know, we certainly would benefit from a more structured
approach . Until we change this issue called Federalization, our
system , where public health is actually governed at the local
level, and the laws that allow you to do stuff at the local level,
w ould have to be changed, and we would have to go through a
national discussion to change that. Bill is right, that you can get a
lot more guidance if you get a lot more consistency in what we
do. But I got to tell you it’s going to be a governance challeng e.

Right now you saw the governors were really excited about
support until it became politically untenable for some of the
recommendations that came from the Federal level, and then
they went off on their own. So I think that’s the challenge we
have to ha ve, getting that consensus, keeping that consensus,
and providing that support long term. But until we build, and
everyone has agreement on what the public health system in
United States of the future ought to look like, we are going to
continue to be vuln erable to new health threats as they enter
the community.

Mark Masselli: Well, you are down in Washington . At your Washington office ,
big day today in Washington , President Biden is going to host
former President Barack Obama as they talk about the
Afforda ble Care Act. Tell us, maybe underscore the benefit of
the Affordable Care Act, its impact that’s been on the health,
and really focusing also on the equity lens of how it’s helped
transform, still work to be done, the lives of so many people
throughout Am erica.

Dr. Georges Benjamin: Well, you know, we are the only nation, industrialized nation , in
the world that does not have a system for health care with
everyone in and nobody out. The Affordable Care Act has gone a
long way to making sure that everyone h as quality affordable
health care coverage. Having said that, it also has gone a long
way in improving the health and wellbeing of Americans overall.
In fact, in states which have not expanded the Medicaid
coverage in their states, they are not doing as we ll from a health
perspective as those states that have expanded Medicaid
coverage.

President Biden has invited back Pre sident Obama to both
celebrate the Affordable Care Act, but to also try to do some
things to fix some of the glitches. So there is somet hing called
the family glitch, where people who’ re not eligible because of
income. As an individual they are eligible, but their family isn’t.
And so they are going to try to fix that with tax credits, with a
proposal on tax credits. And then they are goin g to go from one
of the lessons that we learned during the COVID pandemic

Dr. Georges Benjamin

where we enhanced the premium support for people in the
health exchanges. We gave them more money and we reduced
the cost of health care for those individuals. And they are going
to be proposing that they expand that. So I am excited about
that.

Mark Masselli: That’s great.

Margaret Flinter: I don’t want to miss this opportunity when we have you with us,
to give you a chance to maybe just speak about health equity a
bit more. Certainl y right along with COVID over the last couple
of years there has been a renewed focus on health equity, on
what it means, and what we can do to assure that everybody in
the country has access to health equity. What are you doing at
the APHA to keep that fr ont and center even as we are dealing
with all of the other issues around COVID and various other
threats?

Dr. Georges Benjamin: We ll, we have certainly recognized the fact that health
disparities exist, and tragically COVID has shown to the whole
world th e impact of not having a system with everyone in and
nobody out, where people are treated differently based on race
and ethnicity, socioeconomic status, based on gender, based on
sexual orientation in many situations. Those tragic inequities in
our system result in preventable illness and death, and COVID
showed us very clearly how that happens. So the people that
had to go to work, were much more likely to be exposed to
COVID, and people with chronic diseases , disproportionately
based on race and ethnicity , were much more likely to get really
sick and die if they had COVID.

And Reverend Barber in the Poor People’s Campaign just put out
a report just the other day which shows that people who were
uninsured, were much more likely to get sicker and die sooner if
they had COVD. So, we know that socioeconomic status and
these “social determinants of health” are important, and
American Public Health Association is pushing on all of those.
We are trying to adjust things like housing that impact health,
education t hat impact health, economics that impact health,
and now by the way voting is now becoming a social
determinant of health.

So, we are encouraging people to get up and vote and be part of
the process, because being part of the process determines who
contro ls the purse strings in our country, and who controls your
access to health care. So we are strongly pushing on that. We
have declared racism as a public health problem. We particularly
structure d racism and try to do things to create systems and
programs for people to address those policies that we know that

Dr. Georges Benjamin

either help us become health y , or impede our health.

Mark Masselli: That’s great. You know, the APHA, as you know, does so many
things, and one of the things it’s very focused in on is tracking
legisla tion at the state and Federal level . There are a number of
bills that APHA has stated would directly harm transgender
people, particularly transgender youth. Are all public health
departments onboard with your position around that?

Dr. Georges Benjamin: We ll, I don’t know if all the departments are onboard, but I think
from a moral perspective we have to treat everybody equally.
We have to recognize that access to medical services and
surgical services for all people is important, including people
who are t ransgender, and that these efforts to , you know, really
stigmatize people and take away their supports , is really
foolhardy. And we need to leave medicine to the health
providers .

I am very happy to be attorney general if you want me to be
attorney genera l, but I don’t think that I am the right person to
be attorney general. And I absolutely am clear these lawyers
don’t need to be trying to practice medicine. They haven’t gone
to medical school, they don’t understand the science, and while
they are pretty smart people , they need to, as they say, stay in
their lane.

Margaret Flinter: Well, thank you Dr. Benjamin for your time today, for your
decades - long commitment to health and to public health. We
are proud to be part of the public health sector as well. W e are
all trying to do what we can to improve health in this country.
And thanks to our audience for joining us. You can learn more
about Conversations on Health Care and sign up for our email
updates at www.chcradio. com . Thank you so much Dr.
Benjamin.

Dr. Georges Benjamin: Thank you.

[Music]

Mark Masselli: At Conversations on Health Care , we want our audience to be
truly in the know when it comes to the facts about health care
reform and policy. Lori Robertson is an award - winning journalist
and Managing Editor of FactCheck.org, a nonpartisan, nonprofit
consumer advocate for voters that aim to reduce the level of
deception in U.S. Politics. Lori, what have you got for us this
week?

Lori Robertson : Senator Rick Scott w ent too far in claiming that Medicare will go
bankrupt in four years, and Social Security in 12 years.
Government trustees project that certain Medicare and Social

Dr. Georges Benjamin

Security trust funds would become depleted by then, but
payments would continue albeit at a reduced rate. Scott made
his remarks on Fox News Sunday when host John Roberts asked
the Florida Republican about his 11 - point plan to rescue
America. That’s Scott’s blueprint for a Republican - controlled
Congress after the 2022 elections. Scott’s plan call s for
sunsetting all Federal legislation in five years, forcing Congress
to act if it wants to keep Federal programs.

It also calls on Congress to “issue a report every year telling the
public what they plan to do when Social Security and Medicare
go bank rupt.” Scott told Roberts, “No one that I know of wants
to sunset Medicare or Social Security, but what we are doing is
we don’t even talk about it.” He continued, “Medicare goes
bankrupt in four years; Social Security goes bankrupt in 12
years.” The long - term financing of Social Security and Medicare
has been and remains a problem, but such bankruptcy claims
could leave the wrong impression. Neither program is going out
of business.

The two Social Security trust funds, the Old - Age and Survivors
Insurance Trust Fund and the Disability Insurance Trust Fund
combined , would be depleted by 2034 according to the most
recent report by the Social Security Board of Trustees. But even
if the trust funds are depleted, the program would still collect
enough in annual tax revenues and interest payments to pay
about three quarters of the benefits now promised. As for
Medicare, the Hospital Insurance Trust Fund, which helps pay
for inpatient hospital care under Medicare Part A, is expected to
be depleted in four years, by 2026 according to the Medicare
Board of Trustees. But the continuing income for Part A would
be enough to pay 91% of total benefits, the trustees said.

The Hospital Insurance Trust Fund is financed largely through a
payroll tax, which is currently 1.45% for the employer, and
1.45% for the employee on earnings up to $200,000. There is an
additional Medicare payroll tax of 0.9% that individual
employees must pay on earnings above $200,000. The trustees
have been warning about the depletion of the Part A Tru st Fund
since 1970, but the trust fund has never been depleted.

And t hat's my fact check for this week. I'm Lori Robertson ,
M anaging Editor of FactCheck.org.

Margaret Flinter: FactCheck .org is committed to factual accuracy from the
country’s major politic al players , and is a project of the
Annenberg Public Policy Center at the University of
Pennsylvania. If you have a fact that you woul d like check ed ,
email us at www.chcradio.com . We’ll have FactCheck .org’s Lori

Dr. Georges Benjamin

Rob ertson check it out for you here on Conversations on Health
Care.

[Music]

Margaret Flinter : Each week Conversations highlights a bright idea about how to
make wellness a part of our communities and everyday lives.
Baltimore, Maryland has one of the highest emergency medical
call volumes in the country, and it results in a significant number
of patients being taken to the ER for conditions that could have
been treated outside of the ER. The University of Maryland
Medical Center and the Baltimore City Fire De partment teamed
up in the hopes of reducing unnecessary ambulance trips and
hospitalizations.

Dr. David Marcozzi : How do we all start to address health issues more
comprehensively than simply calling 911, being transported to
an emergency department when t hat is not optimal care for
patients?

Margaret Flinter : They created a new pilot program which pairs doctors and
nurses at the hospital level with paramedics in the field, bringing
medicine right into the patients’ homes.

Dr. David Marcozzi : So th en we co - dispatch a paramedic and either nurse
practitioner or doctor to the scene of low acuity calls, ask the
patient whether or not they would like to be treated at scene,
and we then enroll them into our program, register them there
just like a mobile urgent ca re center. We then treat them at
scene, discharge them with the same exact paperwork we
discharge them from the hospital.

Margaret Flinter : Dr. David Marcozzi of the University of Maryland Medical Center
says that this mobile integrated health care communi ty
paramedicine program has a two - pronged goal , reducing
unnecessary trips to the ER by delivering right care at the scene.
The pilot also seeks another goal, to keep vulnerable patients
being released from the hospital healthier with paramedics
doing freq uent follow ups over a 30 - day period to ensure that
patients are compliant with their medicines, are getting enough
to eat, greatly reducing the risk of rehospitalization.

Dr. David Marcozzi : Once you understand the challenges when we discharge a
patient, or when patients are seen for low acuity issues , people
face just at home to navigate the insurance industry, the
multiple providers they are supposed to follow up with, the
challenges that individuals face certainly here in Baltimore, and
we are exploring could we do this for longer, or is there a better
way once we hopefully empower folks to transition to maybe a

Dr. Georges Benjamin

lower resource intensive setting for THS Transitional Health
Support, the 30 - day follow - up program. Our data demonstrates
that the patients who are followed in our program , utilize and
are admitted to the hospital significantly less and utilize the
health care primary care services significantly more. That
translates into lower cost to the system from a physician billing
construct , from a hospital construct, and oh by the way from an
EMS construct. Because you know what happens, those patients
typically call 911 to get to the hospital.

Margaret Flinter : But most importantly he says the patient outcomes are
markedly improved. The mobile integrated h ealth care
community paramedicine program, rethinking how
paramedicine is deployed in the field, reducing unnecessary
emergency room trips, and by the way making sure that the
emergency responders can respond that much more quickly to
the true emergencies, now that’s a bright idea.

[Music]

Mark Masselli: You've been listening to Conversations on Health Care. I'm Mark
Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Peace and health.

Marianne O’Hare: Conversations on Health Care is record ed at WESU at Wesleyan
University, streaming live at www.chcradio.com , iTunes, or
wherever you listen to podcasts. If you have comments, please e - mail us at [email protected] , or find us on Facebook or

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