Conversations on Health: How We Get There - with Stephani Shelton

Early in the new year – January 7th to be exact – Robert F. Kennedy Jr., the head of Health and Human Services, quietly posted a new set of food guidelines on the USDA website and an upside-down (or inverted as he called it) Food Pyramid. Replacing the “My Plate” pictograph of the Biden years. The guidelines themselves are updated every 5 years - and at a quickly organized White House news conference, RFK Jr. promoted the changes. Which push lots of red meat, whole milk and butter. He said, “We are endng the war on saturated fats.” The guidelines also include beef tallow as an alternate to olive oil or butter for cooking. And feature the MAHA mantra of ignoring highly processed foods. That part medical associations applauded, even as the American Heart Association warned again about the risks of eating a lot of high fat animal products. Very healthy whole grains are at the very bottom of the upside-down Pyramid; they had been featured, along with fruit and vegetables, on the previous “My Plate” guidelines. The Food Guidelines are important to a number of government food programs – and to dietitians. Many of us remember learning about the older Food Pyramids in grammar school.  My Boston school served a hot lunch but most of us brought our own sandwiches and washed them down with the free cartons of milk delivered daily to all city schools and - yes, it was 8 ounces of whole milk.   So. I went looking for a Registered Dietitian who could explain what’s good or bad or just different about RFK Jr.’s 2026 Inverted Pyramid. And I found one of the best. Stephanie Hodges has MS, MPH and RDN degrees. She’s a Registered Dietitian and food policy expert who has spent more than a decade improving access to healthy food through public health nutrition programs and policy. She’s the founder of “The Nourished Principles” which supports clients in strengthening public health nutrition programs and policies, writing and implementing grants, and translating complex nutrition topics for diverse audiences. Here’s a link to her website . She’s really good at this! YouTube Episode Link: https://youtu.be/BwDozyX5ffI YouTube Channel Link: @conversationsonhealthhowwe4827

2/17/26 • 43:35

Donald Trump has changed America in many ways since his second term began a year ago.  But perhaps in none so personally important as our overall health and health care. On February 25th 2025 the Senate confirmed Robert F. Kennedy Jr. as Secretary of Health and Human Services. Nearly a year later he has managed to dismantle or re-direct much of it. Among the multitude of public health agencies administered by H-H-S, the one where we’ve seen perhaps the biggest changes is the Centers for Disease Control and Prevention – or as we usually call it – the CDC. Many experienced scientists and other employees have resigned or been let go. Many research grants to universities or non-profits - cancelled or cut back. And many long-term health policies have been changed. RFK Jr. has tried to promote a long debunked link between childhood vaccines and autism, and between Tylenol during pregnancy and autism. This last was definitively shot down this month by a retrospective study in the prestigious women’s health journal - Lancet. A meta-analysis of 60 studies found no association between Tylenol when taken as recommended and autism - as well as with intellectual disability or ADHD. The other big area attacked by RFK Jr. and his appointees has been vaccines. For both adults and children. Routine recommendations have been removed from the CDC website and the members of the Advisory Committee on Immunization fired and replaced with RFK Jr’s choices. Including a number of vaccine skeptics. Perhaps the most controversial change, posted in early January, is the Childhood Vaccine Schedule – reducing the number of routine vaccines from 17 diseases to 11. After much discussion - measles remained on the list – as a measles outbreak raged in South Carolina, doubling in just a week and spreading to at least 3 other states. The outbreak mostly among unvaccinated kids. In late August a  group of CDC senior officials and scientists resigned - after CDC Director Dr. Susan Monarez was fired. She refused to implement RFK Jr’s vaccine policy changes. And among those who walked away from their long-term CDC careers is my guest on this episode – Daniel Jernigan MD, MPH. Dr. Jernigan is a nationally recognized public health leader with more than 30 years at the CDC. Most recently he directed the National Center for Emerging and Zoonotic Infectious Diseases and the Influenza Division. He has led responses to major health crises including anthrax, SARS, H1N1, Ebola, MERS, and COVID-19. He’s authored over 160 scientific publications and is a recipient of the Service to America Medal. Dr. Jernigan is a graduate of Duke University, Baylor College of Medicine, and the University of Texas School of Public Health and has completed residencies in Internal Medicine and Preventive Medicine. Our conversation clarified a lot of now “murky” health issues. YouTube Episode Link: https://youtu.be/3RtVJOq7K7I YouTube Channel Link:  @conversationsonhealthhowwe4827

1/20/26 • 51:51

What will happen in the US if cases of a now contained virus – or a totally new one -  suddenly start multiplying by the millions? The CDC has drastically cut back on vaccine research as well as childhood vaccine recommendations. What diseases may come roaring back? Episode 40 drops on Tuesday January 20th with some answers from Daniel Jernigan, MD, MPH - one of the former top officials at the CDC. Links to the major podcast platforms and show notes on https://stephanishelton.com/conversations Video link https://youtube.com/shorts/lHunlffqTRg  

1/13/26 • 02:02

It’s not exactly an episode – thus the A-40 label. It’s just me talking to you for a few minutes.  We had some last minute cancellations – which of course can happen as the holidays as well as the end of the business and financial year approach.  The historically long US government shut down also took its toll. On virtually everything. So -- we will resume the usual episodes on the third Tuesday of January – the 20th to be precise - with Episode 40. Please check the podcast page on my website for guest and subject info; it will be there as soon as I know it – stephanishelton.com/conversations.  And while you’re there you may want to review the notes on Episode 37 and then the podcast itself  - the Emergency Update on Autism. You’ll get the actual scientific facts about autism – which Trump appointee and vaccine skeptic Robert F. Kennedy Jr. Is now trying irresponsibly to link to the one drug pregnant women can take to reduce dangerously high fevers – Tylenol. There’s an earlier and more detailed podcast on autism as well – Episode 34 – both with autism expert Amy Wetherby of Florida State University. One of the subjects I hope to discuss during the coming year is what’s happened to the CDC and the FDA under RFK Jr. And the whole, once highly respected, scientifically factual, federal public health data base. And the government grant money which would normally be going to areas like cancer research and the virtually miracle-like mRNA base for everything from individualized cancer treatments to new vaccines for potential pandemics. Remember – smallpox was eradicated globally thanks to vaccines. And in the US the routine vaccination of children had virtually wiped out measles, polio and many other diseases. Now measles is coming back big time here. It’s a dangerous disease which can and is killing babies, children and even unvaccinated adults. And don’t forget Covid. It still makes a lot of people really sick and still kills a surprising number of them – and not just the very old and ill. Lots of people live their whole life in what we might call fragile health. Vulnerable to many diseases because their immune systems are suppressed by their diseases or by the drugs they take to control those diseases. I could go on a total rant about what RFK Jr. has done to the credibility of any US government report on any disease and what he and the unscientific people he’s appointed to key positions at the CDC and FDA are doing to the overall health and potential health outcomes of the American people. But I’ll leave that for the guests I hope to have in 2026 discussing this situation and where it’s taking us. I don’t think a lot of people actually understand science. It’s not immutable, not unchangeable. It is called science precisely because as researchers and scientists keep testing what they know, they often learn something new which modifies specifics about a disease or a treatment or a procedure. And so what health professionals use as their guidelines often get rewritten by new discoveries. Which, i think, lots of us find confusing. And when you’re confused you tend to stop believing. In anything. Of course none of us knows what 2026 will bring. Sadly it’s a pretty sure bet that many people on Obamacare health insurance now won’t be able to afford it after January first – unless there’s a small miracle in the few days left before Congress goes home for its holiday break. On the podcast – I hope to discuss that along with subjects like how venture capital contributes to drug, device and treatment breakthroughs. The extension of the 9-11 Fund for First Responders. And likely some personal stories which a lot of us can identify with. And in small, understandable chunks – i want to discuss more about how all health systems – hybrid like ours or totally government controlled like the rest of the world – will have to change in order to pay for expensive new treatments and the social care that virtually every health system seems to put on the back burner. I want to thank all of you who have subscribed to this podcast and especially those who have stayed with me over these 3 years. Please tell your friends and colleagues about us. And if you have suggestions for episodes – please let me know. May 2026 bring you and yours health and happiness and the courage to follow your dreams. YouTube video link:  https://youtu.be/UlTpOZzAMfw    

12/16/25 • 05:53

Our neighbor and long-time friend Canada has been the subject of President Trump’s ire -and his tariffs - since he became President again in January. He’s even claimed Canadians would have “much better” health coverage if Canada were somehow to become the 51st US state. Actually, Canada - like almost all other industrialized countries - has a publicly funded, government run health care system. Which is somewhat similar to the UK’s venerable NHS. Which of course this podcast has looked at several times. Every Canadian in the country legally is covered. Although some fringe coverage can vary from province to province. Since there’s so much inaccurate information about the Canadian system floating around – I thought I’d try to set it all straight in a conversation with the extremely well-qualified Gregory P. Marchildon, CM, PhD, FCAH. He’s Professor Emeritus at the University of Toronto’s Institute of Health Policy, Management and Evaluation. And the Founding Director of the North American Observatory on Health Systems and Policies. Gregory Marchildon has worked as a lawyer, senior public servant, and consultant for numerous governments and international organizations. In recognition of his impact on both scholarship and public policy in Canada, he was made a member of the Order of Canada. He has written extensively on Canadian history and public policy. His most recent book is Tommy Douglas and the Quest for Medicare in Canada  published by the University of Toronto Press in 2025. I’m embarrassed at how much I didn’t know about the Canadian system – even with research – until I talked to Greg. I think you’ll learn a lot also.. YouTube Episode    https://youtu.be/_DxK-GUviPY

11/18/25 • 65:06

UPDATE -2/26 SEE END OF SHOW NOTES As I record this – at the end of the second week in October 2025 – the US government is officially shut down. Senate and House Democrats are demanding negotiations with Republicans and President Trump to restore  major health care cuts to Medicaid and the Affordable Care Act marketplace subsidies for 2026. It’s expected that if these cuts aren’t restored – and restored quickly - insurance premiums will double or even triple. And millions of Americans who now have at least some basic health insurance will be unable to afford any. Many small, rural hospitals may have to close as well. Which brings me to the overall state of the US healthcare “system” – such as it is. And my guest. Dr. Erica Rowe Urquhart. She’s a leading orthopedic surgeon who runs a private practice in New Jersey with her husband – who’s also a highly credentialed orthopedist. Dr. Urquhart has a PhD in molecular and cellular neuroscience and served her orthopedic surgery residency at New York’s renowned Hospital for Special Services. After 15 years in private practice Dr. Urquhart also got an MBA from Oxford’s Said Business School, so she could deal with the ever more complicated insurance issues we’ll be talking about – issues which often prevent even patients with “good” insurance from getting the medical procedures they need. Her book - The Invisible Hand Wielding the Scalpel - is just out. We cover a huge amount of ground in our conversation and I think you’ll identify with many of the issues we raise. As usual on this informal podcast, we use first names. YouTube Episode link: https://youtu.be/YFuhwDcJxKU https://drurquhart.com/ https://www.urquhartortho.com/ Channel link: @conversationsonhealthhowwe4827          

10/21/25 • 51:40

UPDATE 1/16/26: Today, January 16th, the Lancet – a prestigious women’s health medical journal – published a review and meta-analysis of 60 studies about Tylenol (acetaminophen)and its potential effect when taken as recommended by pregnant women. The research found no association with autism, intellectual disability or ADHD UPDATE 9/22/25; There was no real study released in late September, as expected, on a potential causal relationship between autism and Tylenol. Instead we got, basically, a rambling statement from President Trump (with HHS Secretary Robert F. Kennedy Jr.at his side) warning that pregnant women should ask their doctors before taking Tylenol. (Already a protocol). The President  – citing no evidence - told pregnant women  just “tough it out”. I’m calling this an emergency update on autism – as we wait for the new causal studies authorized by Robert F. Kennedy Jr. – the Secretary of Health and Human Services. So far, according to a recent Reuters report,  researchers have submitted more than 100 proposals for RFK Jr’s 50 million dollar study of autism’s causes – essentially mining the CDC’s large data base. There’s a separate review in progress on vaccine safety as well as the relationship if any to autism. Secretary Kennedy originally made the unlikely  promise to have definitive findings by September – that’s this month  - but has now stretched that much further out. Earlier this month Kennedy appeared before the Senate Finance Committee for what evolved into a highly contentious hearing. Mostly on vaccines, changes at the CDC  – and autism. There’s an excerpt in the podcast. So I’m bringing back Dr. Amy Wetherby - one of the top US autism experts - for this emergency update. To set you straight on the facts. The science. What we know now about autism’s causes – which is quite a lot. And how early intervention can change an autistic child’s life. Dr. Wetherby was my guest last June on Episode 34. Here’s the link to that much longer and more detailed podcast. https://youtu.be/5EMedABGCrU Amy Wetherby is a Distinguished Research Professor in the Department of Clinical Sciences and Director of the Autism Institute in the College of Medicine at Florida State University. She’s also a Fellow of the American Speech-Language-Hearing Association with over 45 years of clinical experience and the Executive Director of the FSU Center for Autism and Related Disabilities. Amy is also co-developer of the websites Autism Navigator and Baby Navigator - which can provide a huge amount of help to the parents and teachers of autistic children. This update was recorded September 12, 2025. I’ll add to these notes if something coming out of HHS or the CDC substantially  changes anything we discussed.   Autism Navigator now has a new menu of diagnostic services: https://autismnavigator.com/diagnosis-get-started-now/ The Society for Developmental and Behavioral Pediatrics (statement) YouTube video link:  https://youtu.be/0RTTN5Yh4lc Channel link: @conversationsonhealthhowwe4827  

9/16/25 • 33:51

The cornerstone of any healthcare system is the general practitioner or GP. In the US we’ve renamed the GP to the rather cold sounding “primary care doctor”. Perhaps because so few of us still have that old multi-year connection with our doctor or perhaps because of the way our huge health insurance companies function. In the last podcast – Episode 35 - we talked about the UK’s still ailing health system – the NHS – a year after the Labor Government took over. Not much change yet but a recently released 10 year plan envisions most standard health care centralized in neighborhoods at the GP level. Including the mushrooming varieties of medical imaging. This doesn’t sound particularly revolutionary – especially if you live in the Czech Republic. Health care there still revolves around the general practitioner. So we’re going to meet a long time GP in this episode – who also teaches and is involved in many international health care projects. In addition to his MD, Dr. Bohumil Seifert also holds a PhD and is an Associate Professor at the Institute of General Practice, First Faculty of Medicine at Charles University.  He headed that department for 14 years - until 2023. Dr. Seifert now spends half his time practicing in central Prague – the Czech Republic’s capital. The rest of his time is spent in international activities and research, much of it for the World Health Organization and WONCA - the World Organization of Family Doctors. We used first names in this interview – as is my custom on this podcast.       YouTube Episode Link:     Dr. David Marx Episode #1  https://youtu.be/io3rVfvYgj4

8/19/25 • 56:08

The United Kingdom’s National Health Service was founded in 1948 and is considered the mother of all government run health care systems - with Sweden’s slightly later plan for universal coverage just behind. We’ve profiled both systems on this podcast series. But we’re going back to take another look at the NHS --almost exactly one year after labor won a huge parliamentary victory. And the new Prime Minister Sir Keir Starmer and his new Secretary for Health and Social Care Wes Streeting declared the NHS was “broken” and promised to fix it. All health systems are having trouble adjusting to rising costs and demographic changes but perhaps the faltering NHS has gotten the most notoriety. Health care waiting lists as long as 2 years, doctor shortages and strikes, no hospital beds available for emergency patients – it’s a very long list. Under the government’s recent “Spending Review” – somewhat like the annual US budget outline – the NHS got the lion’s share of the available money – along with the military. And a 10 year plan emphasizes moving to neighborhood health centers for most healthcare instead of it being hospital-based. But what about immediate help for people?  Are there any improvements in this first year? For the answers – I went back to the UK’s David Hunter - who explained how the UK system works in Episode11. He’s Emeritus Professor of Health Policy and Management at the Population Health Sciences Institute, Newcastle University and also Emeritus Professor at Durham University. His long list of endeavors also includes the recent addition of board member at “Ways to Wellness”.  Which tries to reduce health inequalities. As you watch or listen - you’ll notice a lot of similarities to the US right now. Think Elon Musk’s DOGE and its abrupt firing of so many health policy related government workers. And of course our unending debate about taxation. This episode was shot, recorded and edited in Prague, Czech Republic before Labor released its 10 year plan to “fundamentally rewire” the NHS. https://www.bbc.co.uk/programmes/l00578wn https://www.waystowellness.org.uk/ Episode 11: David Hunter on the NHS: https://youtu.be/jqrNfpxSayA Episode 18 – Catharina Barkman – Sweden #1:  https://youtu.be/Y4pTu_XcSqA Episode 19 – Catharina Barkman – Sweden #2:  https://youtu.be/2vdA41ckoVA

7/15/25 • 31:12

What do we actually know about autism? Not enough according to Robert F. Kennedy Jr. – the Health and Human Services Secretary.  He’s promised an initial 50 million dollars for his plan to find out what exactly causes autism. With an unusually short turnaround for research proposals . Remember Kennedy first promised he’d have all the answers by September but then extended that to March and now it appears by the funding guidelines it will be a year or more. Still much faster than research norms. Many health experts fear HHS will just cherry pick the answers RFK Jr. has pushed for years - including the long-debunked idea vaccines cause autism. The reality is there is already a solid base of data about autism’s cause. And some very successful methods to greatly improve a child’s ability to overcome it. When I decided to do this episode on autism – i didn’t have to look far to find  one of the top experts in the country – Amy Wetherby, PhD. She just happens to be my cousin. Amy is a Distinguished Research Professor in the Department of Clinical Sciences and Director of the Autism Institute in the College of Medicine at Florida State University. She’s also a Fellow of the American Speech-Language-Hearing Association with over 45 years of clinical experience and the Executive Director of the FSU Center for Autism and Related Disabilities. Amy has served on the National Academy of Sciences Committee for Educational Interventions for Children with Autism and her list of credits and activities goes on and on. She is also co-developer of the websites Autism Navigator  and Baby Navigator for parents and teachers which we discuss extensively on the podcast. This interview was recorded in early June of 2025; if there are major updates from RFK Jr. – I’ll add them to the show notes also. I learned so much from my conversation with Amy Wetherby – I hope you will also. The podcast is also available on YouTube: https://youtu.be/5EMedABGCrU  

6/17/25 • 58:41

It’s no secret our population is aging fast. According to the US  Census Bureau, 10,000 Baby Boomers hit that 65 landmark year each day. In fact 2025 is predicted to be “peak 65” demographically – with more than 11,000 Boomers crossing the daily line. Unfortunately as we age – more of us develop dementia and Alzheimer’s – with most of the associated costs paid by Medicare. It’s estimated that for Alzheimer’s care alone – costs are as much as 2.8 times higher than for other seniors. So Medicare has begun an experimental program called Guide. Partnering with some private, digitally oriented companies to create better dementia outcomes -  both personally for older people and their caretakers and financially for Medicare. One of those companies is Tembo Health – founded and run by Dr. Anurag Gupta. He’s a practicing emergency physician with both an MBA and an additional degree and board certification in Clinical Infomatics. And lots and lots of real world experience at top rated hospitals. The concept of public-private partnering in healthcare isn’t new; but it’s certainly not every venture capitalist- financed start-up which hopes to make its mark with dementia care. So here’s my really useful conversation with Dr. Anurag Gupta: https://www.tembo.health/ https://www.cms.gov/priorities/innovation/innovation-models/guide YouTube Episode link: https://youtu.be/3Dw1rnp8Rc0

5/20/25 • 45:37

Most of you know something about the opioid crisis. It’s considered one of the most devastating public health catastrophes of our time. Just to summarize briefly – the first wave of deaths began in the mid 1990s when Purdue Pharma’s newly approved pain drug OxyContin was pushed to doctors. Purdue had lied to the FDA, saying OxyContin was less addictive than other opioids. It was, actually, even more addictive. Then came the wave of deaths from many of those addicts switching to “street” heroin. And then, as we all know, came the synthetic opioid fentanyl. 2024 figures aren’t yet finalized but even though there has been a decline in deaths - the US continues to have the highest rate in the world. With that as the background – I just had a very illuminating discussion with Dr. Arun Gupta. He started as an internist.  But ultimately, he got so upset about the plight of his addicted patients in his mostly rural Michigan practice that he became a specialized addiction doctor. Then he wrote a book laying out the history of opioids and what needs to be done to help patients recover.  This is a conversation I don’t think you want to miss. Note: all episodes are also available in video form on YouTube https://thepreventableepidemicbook.com/ (website is being updated) https://entrepreneursecho.com/usas-most-compassionate-medical-leader-advocating-access-to-addiction-treatment-nationwide/ https://www.samhsa.gov/substance-use/treatment/overdose-prevention/opioid-overdose-reversal   (NARCAN etc.)      

4/15/25 • 50:45

Have you ever been hit by a huge medical bill when you thought your health insurance would be covering most of it? Do you know that unpaid medical bills are one of the top reasons Americans declare personal bankruptcy? Well, meet Frank Lobb. He’s a retired navy pilot whose later managerial background in law and compliance had nothing to do with health care. But some years ago Lobb had a very frustrating and ultimately tragic fight with his wife’s insurance company. And he began researching health insurers, personal medical bills and your rights under the law. He’s now written four books on what he’s learned – the latest  - just recently published – is called “The Big Lie in My Healthcare Bill”.  Here’s our conversation -- and I think you’ll learn a lot from Frank Lobb about how you can protect yourself and your family. I certainly did! Note: all episodes are also available in video form on YouTube

3/18/25 • 44:34

UPDATE: The Trump administration has decided Medicare will NOT pay for the popular GLP-1 drugs just for weight loss. It would have cost the government nearly $40 Billion over 10 years. Perhaps the hottest, most divisive topic in health care is obesity. Which in the US appears to have stabilized in 2024 at about 40% of adults. Is obesity a disease or a lifestyle result? How does it affect overall health and what diseases can it cause? Who should take the expensive new GLP-1 weight loss drugs like Wegovy? And perhaps the most divisive issue - who should pay for those drugs – and how.  Get ready for a great conversation with tons of useful information from my guest Dr. Naser Gharaibeh, MD, CPE, DABOM, NCMP – who heads the Valley Health System Center for Weight and Wellness in New Jersey. Dr. Gharaibeh is board certified in obesity medicine as well as endocrinology, diabetes, metabolism and internal medicine. Note: all episodes are also available in video form on YouTube

2/18/25 • 46:24

Is women’s health moving backward?   The Supreme Court’s Dobbs Decision in 2022 overturned what most women believed was settled law – the landmark 1973 Roe v. Wade decision - establishing a constitutional right to abortion. Since Dobbs, many states - especially in the South and Midwest - have banned abortions for any reason or tightly restricted them.  Leaving many women in medically dangerous conditions. Even before Dobbs – the United States had a maternal death rate more than double and sometimes triple most other high income countries. More women are obese than men. Causing multiple health issues. These all suggest that after major gains – women’s health in general may be moving backwards. So i asked Dr. Michelle P. Warren to come on the podcast. She’s a distinguished New York City physician who specializes in both endocrinology and gynecology and has spent her lifetime focused on women’s health issues. In 1997, Dr. Warren founded and remains the Medical Director of the Center for Menopause, Hormonal Disorders and Women’s Health at Columbia University Medical Center.  Where she is the Wyeth Professor Emeritus of Obstetrics, Gynecology and Medicine. Full disclosure - I have been her patient for many years. UPDATE 2/2025: Currently – the main source of women’s health information – the CDC website – carries an advisory that it’s “being modified to comply with President Trump’s Executive Orders”. Some unavailable original pages - including many on HIV – have been archived by doctors and health writers at CDCguidelines.com and other websites. But the CDC’s scrubbed website still has much on menopause - complementing the useful women’s health information in Episode 29. Note: all episodes are also available in video form on YouTube http://www.center-for-menopause.com/ https://menopause.org/  

1/21/25 • 45:04

Late word from CMS – Medicare will keep covering telehealth use through March. Congress must OK a further extension. Lots of us became well-acquainted with telemedicine during the pandemic. And while many of us have gone back to office appointments with our doctors – telemedicine remains useful. Especially for mental health issues. How useful? Well – recently I logged onto a fascinating Health Affairs Journal webinar on telemedicine. And with winter upon us – I thought it would make a timely episode. Joining me is one of the presenters – Ateev Mehrotra, MD, MPH. He’s a practicing physician as well as the Walter H. Annenberg Distinguished Professor and Chair of the Department of Health Services, Policy, and Practice at the Brown University School of Public Health. His research focuses on delivery innovations and their impact on access, quality, and spending. These include innovations such as telemedicine, remote patient monitoring, retail clinics and e-visits.  Our interview was recorded earlier this month  – before the Trump Administration takes office. Note: all episodes are also available in video form on YouTube The Impact of Telemedicine on Medicare Utilization, Spending and Quality  2019-2022. Ateev Mehrotra MD, MPH and colleagues; published 4/27/2024 in Health Affairs Journal    

12/17/24 • 47:20

 Open enrollment for Medicare supplement plans, which continues until December 7, runs somewhat concurrently with the annual sign up period for the Affordable Care Act plans - commonly called Obamacare. The plans became available on state marketplaces on November 1 and the window closes on December 15 for coverage beginning January 1. We explained the major Medicare changes for 2025 in Episode 26 - check it out if you or someone in your family still needs the podcast’s actionable information. But right now let’s talk about the other actionable information – the 2025 Obamacare plans and who’s eligible for them. Back again is Dr. Steven D. Culler - our expert from Episode 26 and last year’s more extensive Episodes 14 and 15. He’s an Associate Professor at the Rollins School of Public Health, and Affiliated Associate Professor at the Goizueta Business School at Emory University in Atlanta. Note: all episodes are also available in video form on YouTube  

11/19/24 • 20:50

Once again it’s open enrollment time for Medicare plans - which runs for just 6 weeks each year - from October 15 until December 7th. Millions more Americans who don’t get health insurance through their jobs or Medicaid can find or change so-called Obamacare insurance plans from November 1st through January 15th of next year.  In this episode we’re concentrating on the biggest changes to Medicare for 2025, including qualifications for weight loss drug Wegovy coverage and the Medicare Advantage plans used by about 50 percent of Medicare recipients. Episode 27 – dropping on November 19th – will catch you up on the Affordable Care Act changes and their relationship to the state-run Medicaid coverage. This is hard information you can – and should use right now. We’re also taking a look at the effect of the top Medicare changes on private, work–related insurance plans, which are likely to make adjustments for 2025. If you need a primer on how these programs actually function – check out Episodes 14 and 15. Dr. Steven D. Culler - our expert from those earlier episodes – was kind enough to come back again for this update.  He’s an Associate Professor at the Rollins School of Public Health, and affiliated Associate Professor at the Goizueta Business School – at Emory University in Atlanta. Note: all episodes are also available in video form on YouTube https://www.kiplinger.com/retirement/medicare/three-medicare-changes-on-the-horizon-for-2025 https://www.kff.org/medicare/issue-brief/what-to-know-about-medicare-part-d-premiums/ https://www.cms.gov/  

10/15/24 • 28:19

Health experts in many countries – including the United States – are looking beyond standard health care and medical treatments to some kind of community-based care.  Both as a way to improve people’s general health - and as a way to cut the spiraling costs of medical procedures and new drugs. The Netherlands appears to be well ahead of most countries with its varied efforts to re-invent what is generally called “social care” - starting right at the neighborhood level. With the huge Boomer population aging quickly - the Netherlands also has a particular focus on integrated care for people with multiple health issues. Which includes giving them access to adequate health care before those issues become serious. My guest is one of the Netherlands’ top experts in these areas - Professor Dr. Mirella M. N. Minkman of Tilburg University, Tias Business School and CEO of Vilans, National Center of Expertise for Care and Support. We cover a lot of territory – including what is a growing problem virtually everywhere – more and more young people with mental health needs. You’ll be surprised to find out how varied – and sometimes how simple social care can be. Note: all episodes are also available in video form on YouTube    

9/17/24 • 56:22

Do you know someone – perhaps in your own family – who has spent time in a rehabilitation facility? Maybe after an illness or operation? Lots of people – and particularly older people who live alone – find themselves in rehab or long term care facilities. These are somewhat different from the assisted living or independent care communities we talked about in Episode 10 - when we explored one family’s exhaustive effort to find a place for their Mom in North Carolina. Rehab facilities are often affiliated with hospital groups and deal with everything from recovering from knee replacements to stroke and even dementia care.  The residents may be there for just a few weeks – or much longer. My husband and I discovered that two good friends each have someone they care about in residential care at the same, independently owned, northern New Jersey facility. One day they started talking about the issues they’re encountering – like staffing, adequate physical therapy, mental stimulation and the overall differences between this independently owned facility and the more common and usually larger, company-owned facilities. My husband – the video editor and producer for this podcast series said – “you know -– this would make an interesting episode”. And I thought it may also be very helpful. We decided not to use the actual name of the place – or the names of our friends. So – cozy up with a cup of tea or coffee – and join “Maggie”, “Suzanne” and me for the conversation. Note: all episodes are also available in video form on YouTube

8/20/24 • 32:57

We’re spending some time this summer revisiting the UK’s National Health Service. It’s celebrating its 76th birthday this month – although I doubt anyone would use that exact word. Actually, right after the Labor Party swept the UK parliamentary elections on July 4th – both the new Prime Minister Sir Keir Starmer and his new Health and Social Care Secretary Wes Streeting said flat out that the NHS is broken. Both promised to save it. And - both stressed it couldn‘t be done overnight. Small comfort to the nearly 10 million people the BBC says may be on NHS waiting lists for doctor visits, operations or tests. That’s somewhat more than the official NHS count of 7 million. But the lists do seem to depend on who’s counting. There’s a crisis in available hospital beds. In doctors to care for patients in those beds. And - at the point of first patient contact – a shortage of GPs or general practitioners. People in some parts of the UK can wait weeks or months to see their doctor, as overworked GPs retire without being replaced. So - as the new UK government settles in – how do GPs feel about their own future? Do they think the Labor government – the first in 14 years – can make meaningful changes in the NHS? And make them quickly enough to save it - as the party has promised? My guest on this episode is Dr. Jihad Malasi. He’s been a practicing physician in the UK for over 20 years and is trained in family medicine and psychiatry. His practice is in Kent and the borough of Medway - an area south of London. Dr. Malasi is a member of the Royal College of General Practitioners and a Senior Fellow of the Faculty of Medical Leadership and Management. His interests are in primary care, health economics and policy. He holds a Master of Science degree in Health Economics from the London School of Economics & Political Science (LSE) and works for the National Institute for Clinical Excellence (NICE) and Kent & Medway Integrated Care Board as Mental Health clinical lead. Full profile on LinkedIn. The interview was recorded AFTER the July 4th UK Parliamentary elections. Note: all episodes are also available in video form on YouTube  

7/16/24 • 53:05

As the US Surgeon General calls for a social media warning label similar to the one on cigarettes and alcohol, we focus on child and teenage mental health in this somewhat longer than usual episode. And about halfway through – we get into a really good discussion on that really big issue: the role of social media in the growing problems of Gen Z and the youngest children – Gen Alpha. We’re talking about all this with a child psychiatrist from the United Kingdom’s storied but now struggling National Health System. And she has some ideas you probably haven’t heard before. This is one of several episodes revisiting the NHS and it’s ongoing shortages and waiting lists from the standpoint of the doctors who keep it functioning. Often with great difficulty. If you haven’t heard or watched Episode 11 – perhaps you might want to for the overall story of the NHS and its current woes. A quick refresher: the NHS began in 1948 – more than 75 years ago – and along with the slightly younger Swedish system – is the basic model for taxpayer financed, government controlled, universal health care. Free at the point of use for all. Many of the NHS doctors that patients see are also its caretakers. Helping their local systems function while they also work in their specialties. Like my guest in this episode - who lives and works in Wales, one of the UK’s four devolved nations. Dr. Amani Hassan is an experienced practicing child and adolescent psychiatrist  – a consultant, as many doctors are called in the NHS. She also chairs the Faculty of Child and Adolescent Psychiatry at the Royal College of Psychiatrists in Wales and works as well in learning disability psychiatry. Additionally, Dr. Hassan researches neuro-developmental disorders. She was the Training Program Director (2015 to 2018) of Child and Adolescent Psychiatry at Wales Deanery. There is some discussion about mentally disturbed young people. So I’ve included information below on how to get help if you or someone you know needs it – in both the UK and the US. Note: all episodes are also available in video form on YouTube IN THE UK: NHS National Suicide Prevention Line 0800 689 5652. 6pm to midnight. Backup: 0800 689 0880 999 for life threatening emergencies. Or go to nearest A and E. https://www.spuk.org.uk/national-suicide-prevention-helpline-uk/ IN THE US: 988  Suicide and Crisis Lifeline 24/7 Reaches local crisis centers similar to the way  911 functions for all other emergencies. https://988lifeline.org/  

6/18/24 • 59:59

How many times have we all asked – when will they find a cure for cancer? Of course there is no one cure any more than there is just one type of cancer. Each one requires its own research pathway. But there have been great strides in recent years. Some cancers which used to be a death sentence can now be basically cured or turned into treatable, chronic illnesses. My guest for this episode is Theodore Lawrence, MD, PhD. He’s a Professor of Radiation Oncology at the University of Michigan and has an active oncology medical practice. He’s also researching better treatment outcomes for gastrointestinal and central nervous system cancer.  His research continues to be supported by the National Cancer Institute. I’ve known Ted for many years – since he was still a medical student, recently married to my second cousin. He’s always been really excited about his work. And he has that rare ability to explain really complicated concepts in a way we can all clearly understand.   Note: all episodes are also available in video form on YouTube  

5/21/24 • 47:32

This may surprise you with all the medical advances we’ve made in the last decade --but heart disease remains the leading cause of death in the US. As it has been since 1921. A recent poll conducted for the American Heart Association found 51 percent of respondents had no idea! According to the Centers for Disease Control and Prevention  – one person dies every 33 seconds in the US from cardiovascular disease. And this may also surprise you. The CDC says in 2019 - the last year it lists - heart disease cost the US about 2 hundred and 40 billion dollars. Think about the inflation you’ve experienced in the last few years and you can imagine how big that number will be for all of 2024. One reason for the growing cost of heart disease is that much of what causes it is treatable now. And as the huge boomer cohort moves into the senior class – older people with heart disease are living longer. So I thought it would be interesting to talk to a heart specialist I know - who would likely have been doing something else just 30 or 40 years ago. Dr. Mohammadali Habibi is an electrophysiologist with the highly rated Valley Health System and Valley Hospital in New Jersey. Valley’s state of the art, new hospital just opened. Valley is also partnered with the country’s top ranked heart hospital – The  Cleveland Clinic. Note: all episodes are also available in video form on YouTube  

4/16/24 • 27:53

Part 2:  I think we all learned a lot in Episode 18 about Sweden's pioneering universal health care system. Most countries except for the U-S have some version of this – health care that’s paid for by taxes, controlled by the government and essentially free at the point of use. But health care costs are skyrocketing everywhere. So now we're going to talk about how AI and other data-driven innovations may help Sweden - and health care systems in general - cope with the demographic changes and expensive medical breakthroughs already straining budgets. This is the second half of my discussion with Catharina Barkman of Sweden’s Forum for Health Policy It's a non-profit, independent think tank aiming to boost innovation and development in the health care system. Catharina has also held several top positions within the system itself in the region of Stockholm – Sweden’s capital. Note: all episodes are also available in video form on YouTube

3/19/24 • 35:36

Part 1:  Most of us are familiar with the idea of universal health care. Ideally – tax-paid, “free” health care for all. We know that in the US we don’t have it – while almost all other countries do – in some form. One of the first countries to adopt universal health care was Sweden – in the early 1950s. But how - exactly - does such a system work? And can it keep afloat as health costs keep rising?  I ask Catharina Barkman who heads Sweden's  Forum for Health Policy - a non-profit, independent think tank aiming to boost innovation and development in the health care system. Catharina has also held several top positions within the system itself in the region of Stockholm – Sweden’s capital. I think you’ll learn a lot about how universal health care works from our conversation – not only in Sweden but also in other countries. And you may be surprised – as I was – to see that even here in the US – we have some aspects of health care for all.  Note: all episodes are also available in video form on YouTube.

2/20/24 • 35:11

We start the 2024 season by celebrating the podcast's first year and a half. A fast review of some of the widely varied subjects and guests. Some are experts on health care systems. Others just people trying to navigate the way the privately-driven US system works. Or for many – doesn’t work.  Maybe you’ll find one or two conversations you missed?

1/18/24 • 15:02

I’m sure you’ve heard or read that Americans have better access to the newer, often life-saving drugs than people in other countries. But access and being able to pay for the drugs are two different matters. As anyone knows who has been to a pharmacist window lately – these great new drugs are really expensive. And in the United States – unlike other countries - they're often not covered or poorly covered by insurance. Sadly in this rich country - some people actually have to chose between the drugs which control their disease – and feeding their kids. Or even themselves. Like so much else in health care – it’s complicated. Joining me is Alan Weil, Editor-in-Chief of Health Affairs since 2014 and the podcast host of “A Health Podyssey” – where he talks with leading researchers shaping the big ideas in health policy. Note: all episodes are also available in video form on YouTube.

12/19/23 • 39:49

Part 2: Open enrollment for 2024 Medicare supplementary plans continues into December - while those under 65 who don’t have employer health insurance can look for Obamacare plans on state marketplaces until mid January. In Episode 14 we talked mainly about how those Obamacare plans work. Now we’re focusing more on Medicare. More on the difference between Medicare Advantage and purely supplementary plans. And toward the end – we do some “blue skying” about the future of Medicare and health care in general. And how to pay for it. Lots of useful info in the rest of my discussion with Dr. Steven D. Culler, Associate Professor at the Rollins School of Public Health, and Affiliated Associate Professor at the Goizueta School of Business – at Emory University in Atlanta. Read his just published, collaborative paper on Medicare spending here. Note: all episodes are also available in video form on YouTube.

11/21/23 • 31:06

Starting in mid October and ending January 15th, millions of eligible Americans who don’t get health insurance through their jobs or Medicaid can use what is known as the Open Enrollment Period to sign up for or change various insurance plans.  Medicare recipients – mostly 65 or older - have 6 weeks ending on December 7th this year to choose supplemental insurance or Advantage plans.  And those who have or want what most of us call “Obamacare” – health insurance created under the Affordable Care Act – can change or enroll from November 1st.  That’s the easy part. The rest – like virtually everything about health care in the US – is really complicated. So I’m asking an expert from Atlanta’s Emory University – Dr. Steve D. Culler - to explain it all. You may not believe all the hidden pitfalls he points out. Read his just published, collaborative paper on Medicare spending here. Note: all episodes are also available in video form on YouTube.  

10/17/23 • 31:58