The Healthcare Policy Podcast ® Produced by David Introcaso

Under the Biden administration the US once again became the world’s largest producer of oil and gas. Because all fossil fuels projects are politically constituted via permitting, etc., it is no surprise that of the nearly $7 trillion of fossil fuel investments since the 2015 Paris Accord, almost $2 trillion has been provided by six US banks including Citi.

Cancer alley, the nickname for a stipe of largely Louisiana coastline, is home to over 200 petrochemical plants, refineries and ports. As the name implies, per the EPA, cancer alley residents are exposed to over ten times the level of health risks from resulting air pollution. A recent report by Hip Hop, Stand.earth and others, titled “Citi: Funding Fossil-Fueled Environmental Racism in the Gulf South,” documents Citi’s investment in moreover four liquified natural gas (LNG) export terminals, the GHG emissions they’ll emit and the resulting health harms they’ll inflict on moreover minoritized communities. As likely the frontline example of environmental racism should cause one to recall the prosecutor’s closing argument in the George Floyd case, “if you’re doing something that hurts somebody, and you know it, you’re doing it on purpose.”

The report is at: Citi-Funding-Fossil-Fueled-Environmental-Racism-in-the-Gulf-South.pdf.

Info on the Hip Hop Caucus is at: https://hiphopcaucus.org/.

Info on Stand.earth is at: https://stand.earth/resources/citi-enviro-racism/

Info on Rise St. James is at: https://risestjames.org/

As for our failure to make any progress in addressing health equity see, e.g., this JAMA-published research in 2019: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2736934

To begin my 14th year podcasting . . . , per the Sabin Center for Climate Change Law at Columbia Unversity, as of last September there were 1,850 climate crisis-related cases filed in the US challenging climate policy under constitutional, federal statutory including securities and financial regulations, state law claims and under several other categories. Law suits have been and will continued to be filed for the simple reason Congressional lawmaking and state legislating have failed to legitimately address the climate crisis, i.e., reduce CO2e emissions. Ms. Rodgers, Deputy Director, US Strategy at Our Children’s Trust, a public interest law firm dedicated to securing children’s legal rights to a healthy climate, discusses the current state of Juliana v the US initially filed in 2015, the 2023 Held v Montana decision in favor of 16 young people and a favorable 2024 settlement agreement resulting form Navahine F in which Hawaii’s DOT agreed to move aggressively to achieve a net zero ground transporation system. Ms. Rodgers also discusses OCT’s ongoing Genesis v the EPA case and the current International Court of Justice effort to reach an advisory opinion regarding climate-related legal obligations. Listeners may recall I interviewed Ms. Rodgers regarding Juliana in February 2020 and most recently, or last June, I spoke again with Michael Burger, CEO of Columbia’s Sabin Center, regarding climate litigation generally.

The Sabin Center’s litigation database is at: https://climatecasechart.com/.

Our Children’s Trust is at: https://www.ourchildrenstrust.org/.

Judge Josephine Staton’s January 2020 dissent in Juliana is at: https://cdn.ca9.uscourts.gov/datastore/opinions/2020/01/17/18-36082.pdf.

After heart disease cancer is the leading cause of death in the US. Forty percent of Americans will be diagnosed with cancer in their lifetime. Timely diagnosis and treatment of cancer has always been a concern made worse by the COVID pandemic and the ongoing problem of un- and under-insurance. Another reason for concern is the increasing use of networked-based social media sites used to advertise bogus cancer cures, particularly to Generation Z, or those 27 or under, who increasing use social media sites as de facto search engines. Dr. Baker’s recent research reveals health disinformation is rife on TikTok via its “For You” algorithm that directs users to fake cures and conspiratorial content via primarily five themes including personal anecdotes, conspiracy theories and spiritual messaging. (Devoted listeners may recall I interviewed Harvard’s Dr. Susan Linn two yrs ago next month re: her 2022 book, “Who’s Raising the Kids?” a critique of the “kid tech” world’s pernicious influence on children.)

Prof. Baker’s, article, “Link in Bio: Fake Cancer Cures, Radicalization and Disinformation on a Democratic Society,” is at: https://osf.io/preprints/socarxiv/pqs5e. Information regarding her most recent book, “Wellness Culture: How the Wellness Movement Has Been Use to Empower, Profit and Misinform,” is at: https://bookstore.emerald.com/wellness-culture.html.    

Prof. Baker serves as Deputy Head of the Department of Sociology and Criminology and a Reader in Sociology at City St. George's, University of London.

The human rights/public health crisis known as US border policy serves as further proof of what Richard Hofstadter termed in 1964 the “paranoid style in American politics.”  To his credit Mr. Washington’s work attempts explain the recent phenomenon of closed or militarized borders here and around the world.  Closed borders, Mr. Washington explains, are responsible for untold human suffering that cannot be legitimately explained as efforts to protect our economy, government budgets, our environment and our sense of sovereignty or nationalism.  They do not limit migration, protect communities from crime and violence or dystopian-level anarchy, are counterproductive in addressing racism/modern-day Jim Crowism and the climate crisis and fail to serve any ethical purpose. 

Information on “The Case for Open Borders” is at: https://www.haymarketbooks.org/books/2199-the-case-for-open-borders.

Beyond roughly 1,700 NFL players, five to six million children participate in tackle football.  As a collision sport, brain (or TBI) and other neurological, bone, joint, ligament, muscle, organ and tendon injuries are commonly occur and frequently develop into long-term chronic conditions, particularly chronic pain.  Not surprisingly, the avg life expectancy of an NFL lineman - who played as few as one game - is just 55 years of age.  Prof. Goldberg’s book examines how the NFL has for decades masterfully, successfully employed a set of strategies or scripts termed the “Manufacture of Doubt,” to avoid governmental regulation.  The NFL’s success constitutes a an ongoing serious public health problem in it circumvents the precautionary principle upon which the entire field of public health is based - that is precautionary measures should be taken in the presence of a high stakes human health hazard even if definitive proof is lacking.  

Information concerning Prof. Goldberg book is at: https://www.press.jhu.edu/books/authors/daniel-s-goldberg.

Harvard Chan School of Public Health’s Dr. Troy Brennan argues in sum that because government Medicare, Medicaid and ACA marketplaces have grown and evolved, meaning the feds have improved their ability to competently regulate the healthcare market, employer-sponsored commercial plan coverage has become both comparatively unaffordable and increasingly irrelevant. Primarily for these reasons Dr. Brennan argues the US is headed toward or on the path to federally-sponsored and regulated healthcare administered by private or commercial payers. That is it appears increasingly likely the US will finally realize universal, socialized, single payer healthcare insurance or what he defines as Medicare For All, or more specifically Medicare Advantage for All in which commercial insurance plans serve a strictly administrative role.  

Dr. Brennan’s book can be found at: https://www.press.jhu.edu/books/title/53759/transformation-american-health-insurance.

This century drug overdose deaths have equaled roughly 1.1 million largely due to overdose deaths among men that increased from 15,000 to 80,000.  As Dr. LeBaron notes drug overdose fatalities this century have exceeded the sum of all service member deaths in all wars in US history.  The vast majority of drug overdoses were opioid related that, e.g., increased from 50,000 to 82,000 between 2019 and 2022.  While opioid drugs have been available for decades, the opioid - or the opioid use disorder epidemic is strongly correlated with opioid prescribing.  As Dr. LeBaron notes between Purdue Pharma’s 1996 introduction of OxyContin and 2010, opioid prescriptions and overdose deaths increased fourfold, or in almost exact parallel.  The CDC, only agency charged with controlling epidemics, published in 2016 its “Guideline for Prescribing Opioids for Chronic Pain in the US.”  Tragically, the guideline was quickly weaponized, by payers and states.  This led to significant decreases in prescribing that in turn led to dramatic increases in undertreated pain and not surprisingly increased suicides.  In 2022 CDC updated its opioid guideline but as Dr. LeBaron notes in his conclusion reduced prescribing without improvements in prevention and treatment programming will backfire.  Though the CDC last month announced preliminary data showing drug overdose deaths may have dropped by 10% or to 70,000 over the 12-month period ending this past April, the epidemic continues largely unabated. 

Climate denial remains rife in the US. For example, in Washington, D.C., nearly 25% of the current members of Congress are, via their public statements, climate denialists. As for Health and Human Services (HHS), the department has steadfastly refused to promulgate any regulations to mitigate the healthcare industry’s massive carbon footprint that, for example, amounts to well over four times the annual cumulative greenhouse gas emissions of Exxon, Marathon Petroleum, Phillips 66, Chevron and BP.

In his just-published book Tad Delay provides an unsparing assessment of “the vast arsenal of denial that we rarely ever talk about,” i.e., “the scams, lies and misinformation that sustain the degradation of people and planet.” As I note during the discussion, Delay’s work can be read in context of Wainwright and Mann’s 2018 work, “Climate Leviathan” also published by Verso.

See: https://www.versobooks.com/products/2857-future-of-denial?srsltid=AfmBOoqF3FkLO1Aa5HBJhDrdFBE2ssKju6LOOjW0Og1x4l0YOE59Cup3

In the recent past, hunger, food insecurity and malnutrition have (re)gained policymakers’ interest largely due to the COVID pandemic and accelerating climate breakdown – that has among other things reduced the growth of global agricultural production by 30-35%.  As a result, last year 2.8 billion of the world’s population could not afford a healthy diet.  In the US, over 40 million Americans receive food assistance via the federal Supplemental Nutrition and Assistance Program (SNAP) in large part because grocery prices have increased by over 20% since 2021.  Poor diet has long been known to be responsible for innumerable causes of disability and death.  For example, the number of states with an obesity rate at or above 35% doubled over the past five years to 19.  One in 10 Americans have diabetes and one in three will be diagnosed with cancer, both of which are related to poor diet.  Diet-related diseases also help explain high US COVID morbidity and mortality rates.   

Information concerning West Side Campaign Against Hunger’s efforts is at: https://www.wscah.org/.

Recently published research regarding the association between food security, health and dietary factors discussed during this interview is at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10857290/.

In late 2020 the Congress passed the No Surprises Act largely intended to address patient “surprise,” or out of network bills, typically the result of ER visits. Should settlement between the healthcare provider, e.g., hospital, and insurance company fail, the bill created an arbitration, termed Independent Dispute Resolution (IDR), process. To date the number of disputes going to arbitration have vastly outnumber those expected, the vast majority of provider-initiated disputes have been curiously backed by private equity, arbitration settlements takes take more than twice as long than the statutory limit, providers have been winning 75% plus of arbitrated cases and the median arbitration reimbursement is nearly four times what the Medicare program pays. 

With me to discuss the topic is Nathan Martinez, an Arizona-based healthcare claims software developer.

During this interview we mention an April 2024 New York Times article that discussed efforts by insurers to reap, or game, greater out of network reimbursement. The article is at: https://www.nytimes.com/2024/04/07/us/health-insurance-medical-bills.html.