Health Policy Moves in ’22 Set the Stage for New Year

hosts Mark Masselli and Margaret Flinter – Year In Review Part 2

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Marianne O’Hare: Welcome to Conversations on Health Care. This week, part
two of our look back at 2022 with COVID sti ll surging, the
dumps decision, and Anthony Fauci ’s farewell. Now, here are
your hosts Mark Mas s elli and Margaret Flinter.

Mark Mas selli: Welcome back to Conversations on Health Care. We've been
taking a look back at some of the memorable guests from this
last year .

Margaret Flinter: An incredibly challenging and fascinating year marked by the
ongoing pandemic and the shifting landsca pe as variants of
COVID - 19 fueled more surges across the country.

Mark Masselli: Margaret, you're so right, it was a year of more turbulence and
unrest, the war in Ukraine, the burgeoning opioid and mental
health crisis, more mass shootings and gun violenc e, and the
emergence of a new threat from an old pathogen monkey pox.

Margaret Flinter: P erhaps one of the most seismic events of the year , Mark, was
the Supreme Court's controversial Dobbs decision in June . It
overturned 50 years of women's reproductive r ights under Roe
vs. Wade, essentially ending protections for American women
seeking abortion access, depending on which state they live in.

Mark Masselli: Margaret, as you know we welcome d two guests who brought
clarity into just how seismic an even t that Supreme Court
ruling was . Robin Marty, Director of the West Alabama
Women's Center, the last facility in that state to perform
abortions.

Margaret Flinter: S he was joined by Amanda Allen of The Lawyering Project.
That's a legal nonprofit that’s seeking to help states navigate
the restrictive laws governing women's reproductive
freedoms .

Robin Marty: Because we know that no matter how much money and how
many resources you give pregnant people there are some who
are not going to be able to leave the state . It just cannot
happen. T hose people are going to turn to medication
hopefully, hopefully safe medication to terminate their own
pregnancy. T hey are going to be afraid that they're going to be
arrested for it. W e have to be there because we will be a safe
pla ce for them to come to in order to get that follow up care
that in a hospital they or someone they love might e nd up
investigated and in jail.

Amanda Allen: Well, it is terrifying what is happening and we all said this
would happen, right. This was never j ust about abortion

hosts Mark Masselli and Margaret Flinter – Year In Review Part 2

because when you try to regulate these things then you're
putting doctors and other health care providers . Y ou're
essentially tying their hands.

I just read right before this interview a story about a woman in
Louisiana who was 16 weeks pregnant and was forced to labor
her dead fetus because the hospital doctor ’ s lawyers said that
it would be an abortion under Louisiana law and they could be
charged with a crime. That should never happen here. This is
not the America that any of us want o r deserve and yet story
after story after story it ’ s just painting this picture of this really
horrifying reality that we're in where ectopic pregnancies as
you said Margaret which are never ever viable are not being
treated right away w here obstetric emer gencies are getting
drawn out to the point of near death . D octors b ecause of the
way these laws are written, doctors don't know how much
does a patient has to bleed out before I can provide her care.

Mark Masselli: The ruling has already had a dramatic imp act on women's
health in multiple red states across the country. We'll continue
to examine the impact of this decision in the coming year.

Margaret Flinter: W hile all of that was going on, it was also a time to explore
some interesting sources of innovatio n in the delivery of
health care. Dr. Ryan Vega is Director of the VA ’s Innovation
Ecosystem . H e shared with us some of the really
groundbreaking work they're doing at Veteran's Health
Administration.

Dr. Ryan Vega: Really, the idea is how do you create a culture where
individuals on the front lines now have access to this national
opportunity, this national network where the work that
they're doing at one VA has t he opportunity to spread across.
There ’s two things that are really important about the Shark
Tank competition. One, and we get hundreds of applications a
year . W e really focus and get those down to the ten that have
some level of evidence s o there's pretty in depth reviews on
the practice or the solution and, t w o , those that really seem to
have th e most potential for impact for veterans. This doesn 't
have to just be technologies . It can be processing changes . It
can be even potential policy changes.

But the other piece of this is that our medical center directors
and even our network directors, the y're bidding on these
practices, whic h means they're going to invest. They are going
to appoint either human capital or even working capital ,
money to get these projects replicated at their site because
they see a need . I t's that replication and that willi ngness and
that buy in that enables us to really test solutions in multiple

hosts Mark Masselli and Margaret Flinter – Year In Review Part 2

different markets. Instead of saying w e see something at one
place plus it must be everywhere, we really get to test and get
these solutions out.

What you know about any innovation process or lifecycle is it's
a very narrow funnel when you get to the end . Not
everything's going to make it. You need markets , a nd so you
have to sort of create those quasi markets as we call them. But
this allows us to really energize the frontline to t ap into that
entrepreneurial spirit . T hose individuals on the frontline
they're the best position ed to understand what's needed,
what's potentially going to work, because they're the ones
actually doing the work.

Shark Tank has really sort of fostered that both
entrepreneurial spirit . S ome of the practices we have seen
come out of that are not just changing and saving lives in the
VA, but they're actually spreading across American hospitals
and saving lives there as well.

Mark Masselli: T he pandemic also ga lvanized interest in how we make our
buildings safer . A fascinating conversation we had with Joseph
Allen, who runs the healthy buildings project at Harvard,
where they're seeking to foster more widespread use of
technologies that will limit the spread of pathogens. It's a
discipline whose time has surely arrived.

Joseph Allen: In the 1970s we started tightening up our building envelopes
in response to the energy crisis . We stopped designing
buildings for people. Public health lost its seat at the table in
the architectural design and engineering community. I t wasn't
a surprise that we had this sick building era. W e were
confronted with all of our buildings that many of them that
underperform in this era, and this is why that revolution, the
healthy building revolution has to change because it shouldn't
be obvious that we need to design buildings in a way that
promote human health.

I think what's become obvious because of COVID, the virus
that spread nearly entirely indoors, that the indoor
environment is rea lly impacting all of us all the time and has
been under appreciated. T hat's the short g enesis why we need
this revolution to happen.

Margaret Flinter: W e welcomed a true giant in the field of epidemiology to the
show, Dr. Larry Brilliant . He's credited wit h helping to end the
10,000 year old smallpox epidemic, huge accomplishment .

Dr. Larry Brilliant: In the immediate period, before it was eradicated , s mallpox

hosts Mark Masselli and Margaret Flinter – Year In Review Part 2

th
killed half a billion people 300 million to 500 million in the 20
century alone . One out of thre e people who contracted it died
from it. T he way that we were able to eradicate it was by
following a unique strategy conceived of by Bill Foege , who
then was working on the smallpox program became the head
of CDC. T hat was to find every case of smallpox i n the world at
the same time and to draw a ring of immunity around each
case. T hat ring was not just geographic, it was soci o - metrics,
by investigating the index case, by doing forward and
backward tracing, words that we've come to learn about from
COVID b ut in reality they have a much deeper meaning than
the simple way of thinking about just contact tracing . We were
able to immunize all those people who might next get
smallpox until there were no more susceptible host around.
T hat's how we eradicated small pox.

Mark Masselli: S peaking of another great thought leader that we had on Dr.
Atul Gawande on how to improve primary care and health
care in general. He's the author of The Checklist Manifesto,
and now is leading administrator at USAID , the world's large st
global aid agency.

Dr. Atul Gawande: We have discovered in the last century how to make it so that
the average person can live 80 plus years of life, that is
included 6000 drugs, 4000 medical and surgical procedures
and a couple of 1000 public health in terventions. O ur job has
been to deploy that capability town by town to everyone alive .
Even within the United States, we have large parts of the
population that don't get the benefit of that capability.

B eing able to have -- this is a generation of work o n our hands.
Part of the reason I took this job is COVID made it clear how
interconnected we are. T here are two billion people in low
income parts of the world who simply don't have access to the
basic medicines . It’s the public health interventions that m ake
it possible to have that lifespan and that kind of productive
contribution to society. W hen we don't support and enable
that capability to grow, we end up paying the price for it in
many, many ways from direct infection to our own political
loss of sup port. I n politics it matters, and then it matters
economically to o.

Margaret Flinter: F ormer CDC Director Tom Frieden joined us on the show
again . He now has resolved to save lives. It's an organization
that's dedicated to address ing the global causes of e arly death
or premature mortality, as we call it, such as heart disease and
diabetes, and really doing some incredible and groundbreaking
work.

hosts Mark Masselli and Margaret Flinter – Year In Review Part 2

Dr. Tom Frieden: I think it's very important . There needs to be a clear look .
More than a million Americans are dead. I f the US had a death
rate of Canada's, for example, most of those people will still be
alive. What went wrong? But more importantly, what do we
need to change so that preventable deaths like this in
response to a health threat never occur at this le vel . You know
that the US is an outlier. If you look at death rates for 100,000
people in high income countries, the US has a much higher
rate than most other countries. T hat's not something where
the US should be number one. That's something where we
shou ldn't be a leader. T his kind of review is very important.

I became CDC director after 9 / 11. W e look really carefully at
the 9 / 11 c ommission recommendations and those
recommendations change d the way government does
business. Did they fix everything? No. Did they make it better?
Absolutely. T here's also kind of a reckoning that’s important
that that get done so that people who want to know the truth
can know what really happened, what went right, what went
wrong .

Mark Masselli: Well, as you said, Tom was a fo rmer CDC director, Margaret,
we've had so many CDC directors on but we were blessed to
have Dr. Rochelle Walensky , the current CDC Director ,
rejoined us talking about the rollout of the new bivalent COVID
b ooster . S he expressed grave concerns about the low uptake
of the booster shots across the population and how the CDC
will likely be revamped moving forward.

Dr. Rochelle Walensky: People who we are seeing most at risk of severe disease and
death continue to be those who are unvaccinated or under
vaccinate d. I've always said there is no bad time to become
up - to - date on your COVID chats. If you haven't gotten a
booster in the calendar year of 2022 and you're eligible for a
booster , there's no bad time to get one. We are going to be
reviewing data on these up dated boosters, as I mentioned ,
coming soon. But if you are in a place where you feel like
you're at high risk of severe disease, if you're over the age of
50, if you're especially over the age of 65, and there's a lot of
infection in your community, you m ay want to go ahead and
not wait for that booster the information from that booster .
G et the one that is available to you now and then we'll have
further recommendations about when you can get an updated
booster in the fall.

Margaret Flinter: What we didn' t factor into this ongoing crisis was the spread
of a pathogen that was doing previously only to a small section
of Africa. But suddenly, monkey pox began spreading quickly.

hosts Mark Masselli and Margaret Flinter – Year In Review Part 2

I t was largely within the gay community, first across Europe
and then across the U nited States. Dr. D emetre Daskalakis is a
longtime HIV and public health activist who was tapped by the
White House to help address the crisis. H e shared his insights
with us into how this threat could be contained.

Dr. Demetre Daskalakis: We have two diff erent equity pilots that are happening at the
same time . The first equity pilot, I like to call the macro pilot,
which is large events that come up on jurisdictions that focus
on LGBTQ A I + individuals . The micro version is what if you
don't have an event wi th 50,000 p eople? What if you have
smaller ideas or big ideas for smaller groups of people that
may benefit on equity ?

T he second equity innovation pilot really focuses on providing
a supply of vaccine to jurisdictions to really be a little bit of a
lab to see what works best to get the vaccine in people's arms.
W e're going to allocate for both of those 10,000 vials, it's a
pilot. I f it goes well we'll obviously extend it. But that's really
what the strategy is to try to do a real equity intervention,
which is what can we do to augment what's happening in a
jurisdiction so that we can reach people in a way that they're
not being reached by the sort of industrial strain strategies for
vaccine distributions.

Mark Masselli: W e also welcomed House Majority Whip James Clyburn back
to the show . Representative Clyburn is from South Carolina
a nd , of course, we have our roots as an organization in South
Carolina with one of our founding board members, Reba
Moses born there in the 1920s. I t was great to talk with him.
One of the nation's early leaders, Representative Clyburn is in
the Civil Rights Movement , longtime champion of community
health centers.

James Clyburn: Well, I started this battle. I shouldn't call it battle let's just say
this that’s you’re with communit y health centers more than 50
years ago. I recall back when Senator Fritz Hollings wrote his
book The Case Against Hunger, and we took that book as a
fou ndation upon which to develop the Beaufort - Jasper
C omprehensive Health Care Program, the Franklin Cente r sent
a health care program there in Charleston Rural Missions.

I've been on a community health center let’s just say journey
ever since. I've always had it as my goal to try to get a
community health center that’s located within commuting
distance of eve ry American. E very time a legislation comes
forward on health care, I'm always trying to figure out how we
can get community health centers to benefit from this
legislation. It was in the R escue Act , the Inflation Reduction

hosts Mark Masselli and Margaret Flinter – Year In Review Part 2

Act, the Infrastructure Bill . Y o u go through all those bills, and
you will see some attention being given to community health
centers in order to make them more efficient, more effective,
and more equitable in carrying out their duties and
responsibilities.

Margaret Flinter: W e welcome d to Dr. Jennifer Nuzzo. Dr. Nuzzo is one of a
growing group of very promising young public health and
epidemiology specialists. She's leading Brown University's new
pandemic c enter. This is a discipline we ar e likely to see
growth in the coming years as we train our next generation to
prepare for what we hope will never come, which is the next
pandemic.

Dr. Jennifer Nuzzo: First of all, when I first began the thought and conversations
with Ashish about coming up to Brown to work on pandemics
it was actually in between where we saw a rise in cases and
then the subsequent really meteoric rise of the Omicron
variant. T hat just tells you that even when the case numbers
are low, even when perhaps there's a glimmer of hope in the
future, it's worth still working on these issues and digging into
them b ecause even if the virus were no longer part of our daily
thinking, there's going to be more pandemic threats in the
future. W e need to make sure that we're never again caught
so vulnerable in the ways that we were for this one. But in
terms of this one, I mean, look, it's still clearly a significant
health threat, the fact that we have more than 400 Americans
dying each day, 1000s of Americans each week, is really
something quite serious and something that we have to
co ntinue to do work on.

Mark Masselli: Well, Margaret, what a year 2022 was, and it was in part made
by the fact that there was a national midterm elections and
there was much speculation that there would be a so called
red wave as the ballot in November was being counted. We
launched a series of shows health care on the ballot
welcoming health policy experts like Victoria Knight of Axios
and Sheryl Gay Stolberg of The New York Times to share their
insights on what was at stake in the November election.

Victo ria Knight: Well, I think it will certainly be an abortion election, a Roe v.
Wade election . I think that we've seen that the Supreme
Court's decision in the Dobbs case has really up ended what a
lot of people thought was going to be a Republican, if not a
route, certainly Republican victories in both the House and the
Senate. N ow that's looking less so. Democrats are really
energized to go to the polls, and they are angry and mad about
this ruling , and they want Congress to do something about it.

hosts Mark Masselli and Margaret Flinter – Year In Review Part 2

W e're goi ng to see President Biden in fact talk about it. Just
today, h e's emphasizing this as a factor in the midterms. I do
think abortion will play a role and to a lesser extent healthcare
writ large, because health care is always an issue. It's so
important to so many Americans. E ven when inflation is top of
mind, health care is going to be on the ballot as well.

Sheryl Gay Stolberg : I think Republicans know that it's really embedded in the
system, and its popular people like Medicare. I think they're
more focus ed on maybe like general Medicare, like expanding
Medicare Advantage options, or that's something they really
liked, which are private plans within Medicare. I don't see that
as too much of a reality but you never know. We'll see what
happens depending on the midterm outcomes.

Victoria Knight: It's long been said that Medicare is the third rail of American
politics and that's for a reason that nobody wants to touch it .

Margaret Flinter: After the election w ith all the results finally in we welcomed
opposing views on how the election results would impact
health policy moving forward with former Obama CMS
Administrator Dr. Don Berwick and Jim Capretta former Office
of Management and Budget Director under President Bush to
discuss where there might be room for bipartisanship a nd we
heard some of that Mark .

Dr. Don Berwick: There should be bipartisan interest in a strong public health
infrastructure. It doesn't matter how you vote, you're going to
pay the price if we don't have one , a nd that's got to be
governmen t. You can't -- there's no private sector public
health defense . We did talk about drugs . I think we're all
worried about it. We have different solutions. My solutions are
certainly different from Jim’s, but we're concerned enough, we
ought to find our way to some answers.

The mental health and s ubstance misuse arena is desperate
killing 10s of 1000s of Americans and w e have not yet
formulated strong public policy on that. I think we probably
could find a bipartisan route there . On markets and the ACA,
we w ill continue to disagree . I don't have much faith that
market solutions are going to be the ones that work. But then
again, I haven't studied Jim's book yet so maybe I’ll change my
mind.

Jim Capretta : Well, I think on this question of mental health and sub stance
abuse, it's reall y bordering on really a crisis in the United
States at this point. It really needs to be attended to by both
parties, because it's affecting so many aspects of our society. I
think there is great interest in both parties and being j ust

hosts Mark Masselli and Margaret Flinter – Year In Review Part 2

much more aggressive, and putting together a national
strategy to really get the problems that are out there a little
bit better under control and directed and treated. I'm hopeful
that that could be one big area where there could be a lot of
bipartisa n agreement and movement. T hen on these other
things, some of them are by necessity, they're going to have to
do Medicare probably on a bipartisan basis, because neither
party probably has enough kind of political capital to do it on
its own.

Mark Masselli : T hat's so important, we really want to find the seam of
opportunity where people from opposing views can come
together. Margaret, when we started the show in 2009, we
were really interested in highlighting innovators seeking to
disrupt the status quo . Am erican healthcare billionaire and
entrepreneur Mark Cuban joined us on the show this past year
talking about his plans to shake up the prescription drug
market with his cost plus drugs .

Mark Cuban: Significantly , I mean, there's very much a vertically inte grated
environment right now where health insurance companies
own PBMs and own retail pharmacies and are expanding into
other areas of health care. T hey keep on creating these
fortresses where they control the left pocket and the right
pocket. B y having so much control, they they're able to create
an environment where pricing is opaque. It's confusing, and
they have a lot of control.

I mean, and on top of that, because they're able to contract
with insurers and major corporations and consultants t hey're
abl e to play these games where they ’ll say, o kay, if you want
access to all these lives then you have to do business
manufacturers the way we want to do business . T hat is
unfortunate and creates a lot of pricing distortion for patients.

Margaret Flinger: W e w ere able to welcome Dr. Fauci back on the show after his
announcement that he was stepping down after more than 50
years at the National Institute of Allergy and Infectious Disease
at the NIH. He hopes to keep finding ways to inspire young
people to enter the world of research and s cience and I think
he's probably going to be pretty effective.

Dr. Anthony Fauci: I want to utilize the 54 years of experience I have at the NIH ,
38 of which is as d irector and my experience with seven
p residents to use that by w riting , by lecturing , by getting
involved in advisory capacity to inspire particularly the
younger generation to get involved in science and medicine,
public health, and particularly to seriously consider public
service. I will do that, perhaps writing a m emoir. I can't say for

hosts Mark Masselli and Margaret Flinter – Year In Review Part 2

sure but that's one thing that I might do, because people
might be interested, particularly the younger people of w hat
the different milestones in a person's career.

Mark Masselli: Dr. Fauci joined us on the show many times over the years
talking about the dramatic work he did on HIV, his work in the
Ebola outbreak . F rom the very beginning of the COVID
pandemic he’s been a steadfast practitioner of science driven
medicine and research and will be missed in the public arena.

Margaret F linter: I will say that I have followed him and his work closely since
the early 1980s. I t is impossible to calculate the dramatic
contributions that he's made to help in science, Mark . Even
beset by the personal attacks in this most current round and a
li ttle bit in some of his earlier work , he has always maintained
his integrity, his grace, his willingness to listen, kept his focus
on helping us navigate, including through this, we hope once
in a lifetime pandemic.

Mark Masselli: Yeah, such an influential voice in the American health care
landscape. Also a little personal plug for us , if you know
anyone interested in the quest to end health inequity and
injustice in the world and how a small band of dedicated folks
can make a huge impact , p ick up the new b ook about our
community health organization . I should note that all proceeds
are going to our domestic violence shelter an d learn about
how it began. Wesleyan based writer and author Charlie
Barbers wrote a fascinating b ook entitled Peace & Health . It's
av ailable at Amazon or your favorite independent bookstore.

Margaret Flinter: I f you're a 20 something , the parents of a 20 something or
once we're a 20 something who set out to change the world ,
it’s a great book to pick up and read. Y ou can learn more abou t
us access all of our shows by going to www.chcradio.com .
T hanks for listening. Thanks for watching us on the podcast
however you choose to join us, most of all for being part of
our show this year at Conversations on Health Care . Happy
New Year .

Mark Masselli: Happy New Year and more to come in 2023 Peace and Health .

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Mark Masselli: I'm Mark Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Peace and H ealth .

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hosts Mark Masselli and Margaret Flinter – Year In Review Part 2

Marianne O’Hare: Convers ations on Health Care is recorded in the Knowledge
and Technology Center Studios in Middletown, Connecticut,
and is brought to you by the Community Health Center , now
celebrating 50 years of providing quality care to the
underserved where healthcare is a r ight not a privilege ,
www.chc1.com and www.chcradio.com .

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