CareTalk Podcast – What’s Inside Biden’s Health Plan?

President-elect Joe Biden has revealed his American Rescue Plan. In this episode, John and David take a deep dive into Biden’s plan, while weighing the potential impact its policies can have on the United States as a whole.

 

David Williams:

Well, John, Operation Warp Speed delivered the vaccine for approval, but where the heck is it in Boston? I can’t find it.

John Driscoll:

Can’t find it there. Can’t find it most places.

David Williams:

Welcome to CareTalk, your happy home for incisive debate about healthcare business and policy. I’m David Williams, President of Health Business Group.

John Driscoll:

And I’m John Driscoll, the CEO of CareCentrix.

David Williams:

Hey, John, talk about a slow roller, how about that vaccine? Not moving!

John Driscoll:

It borders on incompetence at a national level, not to have a plan, not to be able to track or find the vaccines. It’s scary. We need to fix this and we need to fix it ASAP. What do you think?

David Williams:

Well, John, maybe what happened was this Warp Speed, nobody really believed it. It was a great talking point. Hey, they’ll have the vaccine by November. And it’s like, “Oh yeah, right.” I mean, I could have planned for that to happen, okay?

John Driscoll:

Stop. I mean, we-

David Williams:

What?

John Driscoll:

We have a national system that successfully distributes 140 million flu doses a year. This should be rolling out of bed for a country that spends so much of its money on healthcare, has so much infrastructure. I mean, come on. This is something that we-

David Williams:

Well, fine, John. Let’s get into some lessons learned. First, some interesting anomalies, John. Whenever I see a list of 50 states according to this, that or the other, it could be about childhood literacy or clean air or economic development. And it’s always like, you have states like Massachusetts are at the top. And you always have like Mississippi and Alabama at the bottom. Am I right?

John Driscoll:

[inaudible 00:01:40].

David Williams:

Of course, I’m right.

John Driscoll:

You’re [inaudible 00:01:41].

David Williams:

But what’s the story here, John, with the vaccine rollout and say what percentage of people are vaccinated and what percentage of the vaccines are being used, you still have Mississippi and Alabama at the bottom. But you’ve also got Massachusetts down there. Meanwhile, the perennial laggards, like West Virginia, are at the top and also Connecticut, John. Probably because you’re there.

John Driscoll:

Stop! I mean, David, you’re such a northeastern snob when you come down to it. I mean, of course, there at the bottom. Let’s just look at this for what it is. It’s this entrepreneurial moment for health, public health and government leadership. I, honestly, am inspired by the fact that we’ve got red states and blue states that are near the top and with very different healthcare infrastructures. It’s a great example of leadership. In the case of South Dakota, the governor is working with two or three health systems there who are meeting twice a week to make sure that they are absolutely optimizing and getting as many people vaccinated as possible.

In the case of West Virginia, which is a beautiful state by the way, with incredible natural resources and by the way, one of the oldest populations in the country, the oldest population with most chronic conditions, is number one or number two in vaccine, leveraging vaccine distribution, leveraging independent pharmacies, regular pharmacies and the National Guard. Message to governor’s, you’ve all got a National Guard. National Guard is actually pretty good at logistics and dealing with emergency. This is an emergency. Light up the National Guard.

And finally, the State of Connecticut, a blue state which got organized in public, private partnerships, bringing institutions and public health institutions, leveraging the hospitals, forcing them to work together and then adding ambassadors to where there are healthcare deserts to underrepresented communities, which is also… And the other thing about those three states is they’re not only vaccinating a high number of people, they’re actually using most of the vaccines they’ve got, unlike Massachusetts. Something’s got to be breaking down in that ivory tower of yours, David.

David Williams:

John, I think they get excited by having a freeze… They got all these high-tech freezers that somebody let them order. And then it’s like, it’s a good thing if it’s like the freezer is stocked. Instead of like what they do in Seattle, is unplug it. Let everybody come and race and get the vaccine. So John, I’m trying to figure out, so South Dakota, it’s Mount Rushmore, West Virginia coal mines, Connecticut… I’m trying to think of something to say. Oh, the insurance industry. So there’s a lot of different things that they have in common.

John Driscoll:

They’re organized, David. The vaccine thing is like, look, we’re missing on therapeutics. I still think we’re behind there. We’re missing in terms of testing in a sensible way. I mean, in many states there’s only 110, 115 positive test results are actually getting sequenced. We have to be sequencing all positives so that we can track these new mutant variables, the new viral strains from South Africa or the U.K. or whatever, but-

David Williams:

Yeah, or your neighborhood, John.

John Driscoll:

This vaccine stuff is actually pretty straightforward. We do it every year. It’s embarrassing that we aren’t doing it better. And I don’t quite know how you federalize it, but there needs to be more federal and local leadership.

David Williams:

All right, John, you’re very defeatist here. So in Israel they’ve vaccinated about 10 times as many people on a per capita basis as the U.S. But on the other hand, they’re still in the pandemic. They’re still doing a lockdown. So what’s the story?

John Driscoll:

Well, let’s first answer the question of what did they get right?

David Williams:

All right. So what they got right, first of all, they saw this as an issue upfront. They went and negotiated with Pfizer, secured a supply of vaccines. Then they got, once they saw the Pfizer one was working, they went and they negotiated to make sure that they get a second dose. And they did that by becoming, essentially, a living laboratory, real-world evidence about how well the vaccine was working. Pfizer and others can use that information to basically see if the vaccine is working and to use it for rollout elsewhere. So that’s one thing they got right. And then the other thing is they treat it really as a civil defense exercise, something with urgency, a mission and deadline and getting stuff done. And so that’s also helped.

John Driscoll:

I think that the difficult history of Israel has prepared it for responding quickly to a national crisis. But to answer your question, just because you’ve got, let’s say 80 to 90% of the people over 70 and the vast majority of people over 60, vaccinated doesn’t mean you actually have the virus under control. And what the example of Israel has shown is even with 10 times as many people vaccinated on a per capita basis, the virus is still running around, because certain parts of that population in that country have chosen not to social distance, are not using their masks and they’re ignoring it. This is still a very deadly unpredictable virus. So that’s why they’re still in lockdown.

The other thing I think you’re missing, David, which I think we also are at a disadvantage in the U.S., they have a true digital wired infrastructure. Every Israeli citizen has a number. All of their activity is tracked in their electronic health records. There’s four HMOs with fully interoperable systems. That kind of digital illumination and connection allows you to really manage not just your health and the information about your health better, but the country to actually manage the population more effectively. We’d be in much better shape if we were faster down the track of getting that kind of interoperability and identification, which sometimes scares people in the U.S. But there’s a huge public health benefit of knowing who’s sick, who’s getting healthcare and who’s not?

David Williams:

John, I want to make sure we don’t inadvertently dis the vaccine, because while it’s true there’s plenty of infections that still occur, once there’s vaccination, first of all, there’ll be fewer once more people have the vaccination and once they’ve had it for a couple of weeks and have their second dose. But one thing the vaccines do very well is prevent severe illness and death and hospitalization. So even if people are getting COVID-19, they’re much less likely to die from it. So the vaccines, it really is a tremendous thing and everybody should go out and get one when they have the chance.

John Driscoll:

It’s a really important point, David, that-

David Williams:

Hey, you’re supposed to be disagreeing with me.

John Driscoll:

No, on this one I do think that the vaccine, there’s so much news pro and anti vaccine that is misleading. That one thing that is uniformly clear is that all of these vaccines are actually providing some element of protective immunity. And in the cases of where it’s partial, they appear to be extremely well designed to prevent people from getting very seriously ill, which is what everyone’s objective should be. But I also still think we need to put more money and time and investment so we have a Warp Speed on therapeutics. Therapeutics are those things that actually could help make this more manageable if you do get sick. We have to actually pay for getting all these positive samples sequenced so that we know where your friends, the mutants viruses, are actually lying.

David Williams:

Well, John, since we need to save some money on all that stuff and we’re running a big deficit, I think that we should actually use the Chinese and Russian vaccines, which actually have shown to be highly effective, even after we were first worried about the transparency of the data collection. I’m going to sign you up for the China and Russia vacs.

John Driscoll:

Not! I mean, come on, David, do you think at a time when there’s skepticism that people are going to want your friends, the Russians, who just have been attacking and breaking our systems and our friends, the Chinese, who are chasing our ships in the South China Sea? I mean, I don’t think now is the time when we should try to internationalize our access to vaccines. We need to go with the vaccines we’ve got. We’ve got to deal with the trust issues and the challenges that we’ve already got. Don’t add to them by showing more flexibility internationally than we need to. Those vaccines, if they work, and again, to your point, there’s not that much transparency about the clinical side of it, I think we give them a pass in the U.S.

David Williams:

Okay. All right. We’ll send them off to our friends elsewhere. There’ll also be vaccines from India. But John, I think it really is important to make sure that we realize that the vaccine is going to be very helpful, but it’s not going to end the pandemic. We still need therapeutics. We still need testing, as you were saying. We need to advance that. We need social distancing. And we need to realize that we’re going to be in this for some time now. We have to make some adjustments and plan accordingly. Not say, “Hey, you know what? I’m sick of this thing!” Oh, okay. You know what? I’ll tell you what. I’ll take the vaccine, but then I’m done with the pandemic. Throw it out.

John Driscoll:

Pandemic’s not done with us.

David Williams:

All right, John. Well, I’m done with this. I’m done with you, at least for this episode of CareTalk. I’m David Williams, President of Health Business Group.

John Driscoll:

And I’m John Driscoll, the CEO of CareCentrix. If you like what you heard, please subscribe. And always feel free to leave a review. We learn from those reviews. We appreciate them. And thanks for listening.

David Williams:

And John needs the attention.

John Driscoll:

So does David.