Latest / CareTalk: Healthcare. Unfiltered. / Healthcare in a Divided Congress

Transcript

Healthcare in a Divided Congress · CareTalk: Healthcare. Unfiltered.

• 0:01
  David: Well after that runoff in Georgia, the election is finally over.
• 0:05
  David: It's a divided Congress, but will it be gridlock or will our legislators find a way to work across lines for the good of the public?
• 0:13
  David: Welcome to Care Talk a top five healthcare podcast featuring incisive debate about healthcare, business, and policy.
• 0:19
  David: I'm David Williams, president of Health Business.
• 0:22
  John: And I'm John Driscoll, the president of Walgreens, south David, only top five.
• 0:26
  John: What are we doing wrong, John?
• 0:27
  John: I don't
• 0:28
  David: wanna make those other guys feel, uh, bad or, you know, nip at our, our, our heels too much.
• 0:32
  David: But I wanna talk about America, John and I wanna talk about the federal government, America.
• 0:36
  David: So, but before we look ahead, Oh yeah.
• 0:39
  David: Before we look ahead, what, in the last couple years, I mean, we're talking about what's gonna happen in a divided Congress, but what happened in a Congress that was, you know, narrow majorities for, uh, the Democrats, but what did they actually accomplish in healthcare the last two years?
• 0:52
  John: Well, I, you know, the, the, I mean, I, I think you're kind of missing the point here, David.
• 0:58
  John: They don't do much in Congress.
• 1:00
  John: You know, divided government is from gerrymandered district, but there's a lot going on with the states.
• 1:05
  John: But even with divided government in an allegedly weak.
• 1:09
  John: Or, uh, tepid president, uh, Biden, I mean, he actually made some amazing progress.
• 1:15
  John: We've, for the first time in American history, we've made a political breakthrough in terms of a move, an incremental move to regulate drug pricing, a significant move to, to, for complex.
• 1:28
  John: Patients with diabetes, with chronic, complex chronic conditions with, uh, capping the price of insulin.
• 1:33
  John: We expanded, uh, some of the ACA subsidies.
• 1:36
  John: We were actually cleaning up and making government access to, to healthcare simpler.
• 1:42
  John: I mean, I actually think that, uh, You know, it may be divided government, but it's, it's, it's, it's progressing in the right direction.
• 1:49
  John: Um, what do you think?
• 1:50
  David: Yeah, I think the last couple years, uh, Biden achieved a lot, you know, and they're saying he is a, a, a heman, he's gotten a whole lot done, uh, especially, you know, the 50 50 Senate and a very narrow, uh, majority in the house.
• 2:01
  David: So that's kind of what has happened.
• 2:02
  David: Now, it's gonna happen is the, uh, other party is control.
• 2:06
  David: the house, or at least they have the majority, whether they can control anything remains to be seen.
• 2:11
  David: And there's a question of, you know, are we gonna see anything happen, uh, when a divided Congress in terms of new legislation moving forward, or the things that they can, can and will agree on?
• 2:22
  David: John, there's some things that are floated out there, you know, expansion of telehealth.
• 2:26
  David: . Yeah.
• 2:26
  David: Easy.
• 2:27
  David: Yeah.
• 2:28
  David: Should be an easy one, right?
• 2:29
  David: Maybe it means people aren't thinking if everyone's for it, maybe you know, someone should be against it.
• 2:33
  David: But no, don't be, don't be such
• 2:34
  John: a skeptic.
• 2:35
  John: David Telehealth is a step in the right direction.
• 2:39
  John: There actually are is a fair amount of bipartisan agreement that drugs are too there.
• 2:45
  John: Drugs cost too much.
• 2:47
  John: and pharma gets to kind of jam price increases through at any given moment?
• 2:52
  John: No, I think there's actually a, a, uh, an increasing awareness that the ACA is not going away.
• 2:59
  John: I mean, the interesting challenge is the, the Republicans are highly focused on.
• 3:04
  John: Entitlement programs, and I don't see any move in the, on the public to support any changes in those entitlement programs.
• 3:11
  John: You know, things like covid 19 extensions and some other things that you'd like to see happen.
• 3:18
  John: Um, but I actually think that the, uh, the, the, the progress as, as, uh, as well as some of the, the, the, the sort of, uh, cranky acceptance of some of these policies shows that, that, uh, that, that, that, that, that biden's.
• 3:33
  John: There's a couple
• 3:33
  David: places, uh, other places besides telehealth, which I poo-pooed or was, uh, too skeptical on for you.
• 3:39
  David: One is about mental healthcare access.
• 3:42
  David: Now that's one where I think, uh, two sides are interested in for different reasons.
• 3:47
  David: I think Democrats interested in expanding mental healthcare access just to sort of a, a broader, uh, approach consistent with universal care.
• 3:55
  David: Republicans may be more interested in it because it helps, uh, to say this is instead.
• 4:01
  David: Instead of gun control, let's actually have more access to, uh, to mental health care.
• 4:06
  David: So they may be able to agree on it for different
• 4:09
  John: reasons.
• 4:09
  John: David, why do you Everything skepticism, skeptic, skeptics happen.
• 4:13
  John: Come on.
• 4:14
  John: This is a massive investment in community mental health.
• 4:18
  John: The biggest since 1962.
• 4:20
  John: It gives a tremendous, I mean, it's billions of dollars per state, David, to do, to support, um, local community health centers.
• 4:29
  John: Me mental health workers, state-based programs.
• 4:32
  John: We're a 50.
• 4:33
  John: We, we there.
• 4:33
  John: There's no simple solution for healthcare.
• 4:36
  John: Healthcare's very local.
• 4:38
  John: Uh, it's the biggest investment we've made in more than 30 years in, in, in rebalancing.
• 4:44
  John: Uh, bringing behavioral health in, I mean, just because it's a, uh, it's a kick say for Republicans who don't wanna deal with true gun safety issues, doesn't mean, doesn't, should not detract from the significant investment they're making, which allows the different governors to set up a mental health agenda to meet.
• 5:03
  John: What's one of the biggest challenges, uh, in.
• 5:06
  John: , which is the fact that we've underinvested in mental health for, for 30, 40
• 5:10
  David: years.
• 5:11
  David: Well, good, John, I . I think that's right.
• 5:13
  David: I also think you're kind of softening in your, uh, I won't say you're, you know, in your old age, but, uh, I'm allowed to be skeptical.
• 5:20
  David: It's fair enough to be cynical even John, about some of these motivations.
• 5:24
  David: I think I, but da David, I mean, this is the
• 5:25
  John: challenge of Yeah.
• 5:26
  John: Of, of, of people like you who watch Fox News and MSNBC and, and treat the ping pong back and forth of who's up and who's down, and you miss.
• 5:35
  John: The substance of what's happening, which is big important legislation, whether it's around drug pricing or around, um, or a sig material investment in mental health.
• 5:47
  John: Uh, the, the cap on insulin prices, the 35 bucks.
• 5:51
  John: I mean, it's, it's pretty, it's actually pretty interesting.
• 5:53
  John: And if you go then one layer below that, and again, we are a 50 state.
• 5:58
  John: Uh, a country and you look at what's going on in the, on the ballots, I mean, you've gotta see this as progress.
• 6:05
  John: I mean, have you been just following cable news, David, or have you been actually checking out what's going on in healthcare locally?
• 6:12
  John: John,
• 6:12
  David: it may surprise you, but actually most of my viewing habits have to do with watching Old Care Talk episodes.
• 6:17
  David: So I, I have missed out on my MSNBC and Fox News recently.
• 6:21
  David: I got one more.
• 6:22
  David: Federal level before we go down to the states, which I know you, you want to do, and that is another thing that's been floated out there a little more controversial, is about at the national level, do we re relax the scope of practice rules?
• 6:34
  David: In other words, uh, do we have people that are not physicians?
• 6:38
  David: Uh, uh, allowed to do things that physicians typically do, like writing prescriptions, uh, or, um, practicing without supervision.
• 6:46
  David: That's typically for nurse practitioners, physician assistants, even pharmacists.
• 6:50
  David: Um, also talking about, uh, expanding what they, what they can do.
• 6:53
  David: Now, the reason for doing that is because there's a shortage of healthcare workers.
• 6:57
  David: People don't have access.
• 6:58
  David: The reason not to do it is there's different levels of.
• 7:01
  John: Oh, so that's a, and so I, this is another one of those things where your stick in the mud tendencies are making you a skeptic.
• 7:09
  John: I mean, how can you be against expanding care and allowing skilled healthcare professionals?
• 7:16
  John: To meet a, a, a, a, a mismatch of children who need access to healthcare and no providers available.
• 7:24
  John: I mean, come on, take the other side of that one.
• 7:26
  John: You went Mr.
• 7:27
  John: Scope of practice
• 7:28
  David: idea log.
• 7:29
  David: You went right down to the children.
• 7:30
  David: You know, you got it.
• 7:31
  David: That, that shows you desperate.
• 7:32
  David: You know, think of the children.
• 7:33
  David: I am thinking of the children.
• 7:34
  David: John, how about.
• 7:35
  David: My
• 7:35
  John: 88 year old mother who can't, can't get a pharmacist to talk to her.
• 7:39
  John: Or, or, or, or ELD your elderly relatives who may be coming down with the flu.
• 7:45
  John: Yeah.
• 7:45
  John: Who can't get a doctor to show up.
• 7:46
  John: I mean, come on.
• 7:47
  John: So you
• 7:47
  David: talk about, you know, you sit up a little bit here, dude.
• 7:50
  David: You want people to be, I think it's, it's a worthwhile discussion, but it shouldn't be a blanket answer.
• 7:54
  David: And I think it actually should vary more by geographic area.
• 7:58
  David: There's some places that have a real shortage.
• 8:00
  David: Of healthcare workers that's hard to, to deal with.
• 8:03
  David: Like rural, some rural areas, for example.
• 8:06
  David: Um, but you know, people have training for, for a reason and you don't want the patient to be going to somebody that's not qualified for what the issue is.
• 8:12
  David: Now, if people are working more toward the top of their license, which has more to do with management, John like.
• 8:18
  David: , big top level management people like yourself, uh, you know, allowing people to practice at the top of the lesson is less of an issue.
• 8:24
  David: You're, you're,
• 8:25
  John: you're standing behind complexity when this is, this is a really simple problem.
• 8:30
  John: We are, we are tens of thousands of doctors and nurses short in this country, and one of the reasons is we narrowly define the scope of service that people who don't have.
• 8:41
  John: Va a doctor degree can do.
• 8:43
  John: I mean, whether it's, uh, uh, doing testing and, and, and treating for basic things like flu viruses and cough and cold, or whether it's ba being able to just evaluate and support and prescribe when, when, with, particularly when you've got telehealth oversight.
• 9:01
  John: We have overly strict rules that are much more related to a regulatory.
• 9:08
  John: In a hierarchical world, uh, 50 years ago, we've got 10,000 people becoming Medicare eligible every day.
• 9:14
  John: I mean, I'll give you an example.
• 9:15
  John: There is an Indian health Service, um, has a very hard time.
• 9:19
  John: Putting dentists, getting dentists, yeah.
• 9:23
  John: To, to serve in the northern territories of Alaska.
• 9:26
  John: I know you've been following this carefully.
• 9:28
  John: The, the, the, the, so the, the, the, the social workers who have been trying, and doctors have been trying to recruit dentists and people get, you know, real dental issues in the, in the, in the Northern territories.
• 9:40
  John: They actually trained a group of people to do basic dental maintenance and work.
• 9:45
  John: Not anything like surgery.
• 9:47
  John: And the American Dental Association took them to court and went after them because they weren't following this scope of practice thing.
• 9:54
  John: I think we need to be open about how best to take care of people and make sure that people are practicing at the top of their license, but also where it's sensible, expanding that license.
• 10:04
  John: To meet the need.
• 10:05
  John: And I just think that's, that's just, that's just logical, David.
• 10:09
  David: Fair enough, John.
• 10:09
  David: Well, at least we need, you know, some, some, uh, contrast on the show.
• 10:13
  David: Uh, you can be the open-minded guy and I'll be the close-minded guy.
• 10:16
  David: Now, let's go to the States for a minute now, there's a whole lot of interesting stuff happening at the States, so talk about the states being the laboratory.
• 10:22
  David: For policy changes, especially in healthcare.
• 10:25
  David: If we remember Obamacare really came from Romneycare, uh, in Massachusetts that there's other experiments like that.
• 10:30
  David: There's a whole bunch of things that occurred on ballot initiatives.
• 10:33
  David: John, related to abortion, marijuana, Medicaid, expansion, expansion, medical debt, tobacco, and even dental.
• 10:40
  David: John, going back to the dentist as, uh, as you were, a lot of interesting stuff.
• 10:43
  David: I mean, I think on abortion, the theme.
• 10:45
  David: Is that, you know, when places where, when states were putting ballot initiatives to have further restrictions, those are rejected.
• 10:51
  David: And when there are new protections, uh, those one and that happened, you know, red, blue, purple states, uh, whatever, it was pretty interesting.
• 10:59
  David: Marijuana, more of a mixed bag.
• 11:01
  David: John.
• 11:01
  David: There's a couple places that approved and, you know, I don't say bag in the wrong way.
• 11:05
  David: I'm, I'm not talking about the bag that you're carrying, but the, uh, you know, in, in Maryland and Missouri, they approved, uh, loosening of marijuana laws, but in some other places, including both Dakota, , they rejected the relaxation.
• 11:16
  David: But South Dakota meanwhile became the 39th state to enact, uh, Medicaid expansion.
• 11:23
  David: Well, I think,
• 11:23
  John: I think what you're seeing is a transition of some of the harder issues, uh, rather than being resolved at the federal level, are being resolved at the state level.
• 11:31
  John: I think that reflects the best of America.
• 11:34
  John: People like you who just watched cable news might miss that, but I'm really glad that you've, you've caught.
• 11:39
  John: To the fact that honestly, the Med Medicaid expansion has been going on now for years, where the people are bringing basic access to medical care, to the ballot and, and they're winning.
• 11:51
  John: I know that you're really irritated about that.
• 11:54
  John: The fact that the dentist have found a, a, a way to, a more effective way to bill people like you, uh, in the state of, in the, in the, in the People's Republic of Massachusetts.
• 12:03
  John: Maybe you could talk about.
• 12:05
  John: , sort of a ballot initiative gets hijacked and goes the wrong way at a state level.
• 12:09
  John: You
• 12:10
  David: know, I, I, I think there's.
• 12:12
  David: The question about whether technical sort of things should really be done with ballot initiatives versus more in the, in the legislature.
• 12:17
  David: So in Massachusetts, as you're, as you're mentioned, there is something where, um, dentists pushed for a kind of the equivalent of the medical loss ratio for dental, which means that the insurance companies have to pay out a certain percentage of premium.
• 12:31
  David: uh, it's payments to the dentists and it, the, uh, the amount is 83% of premiums.
• 12:37
  David: That's what they set for Massachusetts, and uh, it was just started as like a crusade by one orthodontist who's also a real estate.
• 12:44
  David: Guy and he brought in the American Dental Association and actually 72% of people voted in favor of this cap.
• 12:50
  David: It's not obvious that it's actually, it's, it's, it is obvious.
• 12:53
  David: It's good for dentists, right?
• 12:54
  David: They're gonna get paid more.
• 12:55
  David: I don't think it was
• 12:56
  John: obvious to that 73% that they're gonna be paying more.
• 12:59
  David: Yeah.
• 12:59
  David: They're gonna get screwed.
• 13:00
  David: You know?
• 13:01
  David: It's where, you know, no one likes going to the dentist, so I don't know why they're all in favor of it.
• 13:04
  David: So I think that's some, I think we don't have enough time to really discuss
• 13:06
  John: that one.
• 13:07
  John: Well, that's one, that's one thing that went wrong.
• 13:09
  John: But in general, , I think we're making progress at, at, at, at, at a state and a federal level, actually creating a better healthcare system.
• 13:16
  David: John, I love it.
• 13:17
  David: You know, I got, I gotta, uh, drop off this episode here so I can, oh, I have a tissue right here, John, cuz you bring, you bring a tear to my eye when I hear about all the wonderful things that are happening, and I realize I need to repent in my ways of being such a skeptic in any case.
• 13:29
  David: That's it for yet another edition of Care Talk.
• 13:31
  David: I'm David Williams, president of Health Business Group,
• 13:34
  John: and I'm John Driscoll, the president of Walgreens Health.
• 13:36
  John: If you like what you heard or you didn't, please subscribe on your favorite service.