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 (00:00):
Hey, John, what would it look like if the federal government put its full weight against the pandemic?

John Driscoll (00:05):
It’d look a lot like what president-elect Biden proposed just last week.

David Williams (00:09):
Do tell.

David Williams (00:10):
Welcome to Care Talk the incomparable home for incisive debate about healthcare business and policy.  I’m David Williams, president of Health Business Group.

John Driscoll (00:28):
And I’m John Driscoll, the CEO of CareCentrix.

David Williams (00:31):
Well, John, President Biden put forward a $1.9 trillion plan. They call it the American Rescue Plan. What are we talking about here, John?

John Driscoll (00:42):
Well, I think this is the rescue from the virus, rescue from the economic pain. And there may be some cyber stuff salted in the whole thing. But it’s really about how are we going to beat back the coronavirus with all of the tools of the federal government? I mean, I know you’re going to miss your buddy Donald Trump, but what’s exciting is that President Biden has a plan. And a plan that leads with federal money, federal ideas. And I think an All-American solution,

David Williams (01:18):
John there’ll be time for nostalgia later. But what I like about this plan, it is really kind of a comprehensive and internally consistent approach. And it is a unifying plan. It’s really focused on beating back the virus and reducing disparities at the same time. And it really is non-ideological. Of course, it takes some of the longstanding Democratic priorities, but it’s in the context of a broader crisis. And really says there’s no conflict between getting the economy going and tackling COVID. In fact, you need to do one in order for the other to work.

John Driscoll (01:50):
I knew that you’d come up with some thin political shiv that you’d put in there. This is not about a Democratic solution or a Republican solution. Look, we have a deep of lack of leadership around vaccinations. I mean, David, that’s not a political thing. And it establishes a clear and expanded plan with more money, more resources, the National Guard. And one of my favorite things, 100,000 new people trained to be public health workers who can expand, triple the size of our public health infrastructure. It calls for an actual plan to make certain that for those people who are going to get sick, because a lot of them are going to continue to get sick from the coronavirus while we’re getting vaccinated, that we have treatments that work. And it also calls out another one of my favorite areas, which is testing, which we have the ability to do. So, we can monitor, identify and sequester those who are sick. I don’t think this is about politics. I think it’s about healthcare.

David Williams (02:57):
Well, John, I think it’s a very good plan. And maybe it should take a cue from the new senator, Warnock and do a little ad with maybe a puppy, and say all the things that people are going to say because there will be opposition to it based on, “Oh my goodness, we’re spending almost $2 trillion. We’re going to add to the deficit,” all the sudden religion that some opponents will get. We’re aiding the cities in the states. We’re raising the minimum wage. We’re bringing in socialism with sick leave and childcare. And speaking of shivs, John, they actually are going to be making sure that prisoners get the vaccine and are safe from COVID. And then, they’re also going to make sure that the undocumented people are going to get the vaccine too John.

John Driscoll (03:39):
David, you shouldn’t be intimidated by the fact that a plan actually captures all of the components of what we need to do, starting with vaccines testing and treatment. And the reason why it’s expensive is this pandemic has done more damage to the US, from a suffering and economic dislocation than most wars. I mean, we need a solution that’s equal to the problem. And, certainly, people will focus on the size of it. But the size of the economic hole from COVID is pretty sizable. I think if you look at the dollars invested, they are investment dollars, whether it’s around rental subsidy and support. I mean, millions of Americans are well behind in their rent.

John Driscoll (04:29):
It includes an integration of the restaurant industry and to getting people food. There’s like 15 million people who are going hungry this week, who are food insecure. That number’s growing every week. We have the resources to fill these gaps in the economy while we turn around the war against COVID. And I actually think it’s a pretty sensible if, at times, blindingly comprehensive plan that focuses first on healthcare. Second on the economic dislocation. And, finally, on the genuine human suffering, whether it’s around childcare or the lack of healthcare in tribal territories. I was pretty impressed.

David Williams (05:17):
John let’s tick through some of the specifics. So, vaccine distribution, that’s a big one. We need to give credit to the prior administration for operation Warp Speed and getting two amazingly effective vaccines out there. And, well, let’s just be clear, you want this vaccine because it really seems to have almost 100% effectiveness against severe illness. It prevents deaths. But distribution had been left to the states. Now, we’re going to see a muscular federal response in coordination with the states and local officials. And we’re going to see vaccine distribution revved up, as it must be. So, that’s one item.

David Williams (05:52):
John, school reopening. I know you never went to school, but there’s a plan for school reopening. What do you think about that?

John Driscoll (05:58):
I think what’s exciting about the school reopening plan the kind of K through 12 plan is through a combination of access to medical help, access to testing and support for the schools will start to return a lot of areas that are hard hit by COVID that have had schools sort of in hybrid states or, frankly, all remote back to a normal classroom setting. And I think that has a knock on effect on a lot of essential workers and lower income workers ability to actually show up at work. It also starts to help a lot of the areas, which were not initially set up well for remote work, poor and lower middle income communities where, honestly, I think we’ve taken a real dent to educational progress for kids who just can’t get
access to the resources they’ve got at school. So, I think this is a comprehensive plan for a comprehensive problem. I mean, I’m intrigued by this. It’s massive, but I think it’s necessary,

David Williams (07:05):
John, we’re going on getting into now the second year. So, kids will have been home from school for a year. So, this idea of trying to get everybody, or most people back to school in the first 100 days, I think, is great. And, in fact, much sharper message politically than saying, “I want everybody to wear a mask for 100 days,” or the idea of a new lockdown, or something like that. So, that is a great goal.

David Williams (07:24):
You mentioned that testing is going to be part of getting the schools reopened, and there’s also a broader approach toward testing and contact tracing that’s also contemplated in this bill. And it also includes making sure that there’s not a bottleneck for the testing materials. And that they’ve got contact tracers that are trained to make it happen. I know you’ve been pushing for that because we need everything. We need the vaccines and we need the testing and the tracing.

John Driscoll (07:50):
Well, there’s a three-legged stool to solving this problem, purely from a healthcare perspective. And one of them is this phenomenal development of protective vaccines. And I agree with you, in fact, I actually got my first dose last week, David. And we all have to be believers. And it’s remarkable technology, but it does the country no good with a 50 state sort of, kind of, maybe distribution plan where each of them is interpreting these differently.

John Driscoll (08:21):
I was intrigued, David, that after Biden recommended it the current administration or, I guess by the time this comes out, the last administration flipped their position and is now going to use all of the vaccines that are available. But that the slow twitch way in which they’ve stumbled here is what happens when you have the medical experts centrally and you don’t provide them a plan.

John Driscoll (08:47):
The second piece is to make sure the therapeutics that we’ve developed to care for people who are sick are used, they’re available, and people understand how to deploy them. That’s going to save a lot of lives. And the third is just this to create more capacity, to make sure the materials are available, and to make sure people understand how to use, whether it’s a rapid test or the PCR test that, again, there are protocols and approaches. We have some of the best public health experts in the world. We’ve developed a lot of these tests. Let’s provide that information at a state and local level, so that we can contain it, we can care for it, and we can kill the coronavirus.

David Williams (09:27):
So, John, the idea of the treatments, I agree, they’ve got some of these new monoclonal antibody treatments, for example, those becoming more available. There’s also a need for development of more treatments. And some of that may be repurposing drugs that already exist, but that’s been an area that’s been lagging. And even with the vaccine, they’re still going to need to treat people with the disease. So, I’m glad that that’s happening.

David Williams (09:49):
Now, there’s a couple of things in here that don’t look at first blush as though they are related to the pandemic, but they are. So, one thing, John, is to take the minimum wage and take it from, I think it’s $7.25 cents an hour, the federal minimum wage, to $15 an hour. And I think it’s something like you’ve got these essential workers, they’re told to all day long they’re a essential worker until they look at their paycheck, and they realize that they’re not. So, what’s with that, John?

John Driscoll (10:16):
Well, I’ve been a big advocate for moving up to the $15 minimum wage. We had froze executive salaries CareCentrix and moved to 15, six years ago. And it’s been a game changer for the culture and, much more importantly, for the people who were making minimum wage and couldn’t afford a bill, a surprise bill without risking food insecurity, or where they lived. I mean, it’s a crime that many essential workers are working full time on front lines, putting their lives at risk and can’t even be paid a living wage. So, I think that’s really exciting.

John Driscoll (10:54):
But even more exciting, David, is it calls for the end of the tipped minimum wage, which is really a legacy of Jim Crow and has survived as a way to kind of manage the margin and the cost of restaurants. But it has put restaurant workers really in a very, very vulnerable position. So, I think that’s really powerful.

David Williams (11:17):
Say more about that, John, because I think this tipped minimum wage is something you don’t see in other countries. So, what’s the language [inaudible 00:11:22]?

John Driscoll (11:23):
Tipped minimum wage, if memory serves, it’s closer to $2 an hour. And it was a legacy of the Jim Crow era, where a lot of people of color, not all, were in service positions. And the notion was that you would compensate people who were, whether it’s restaurant workers, or cleaning folks, or boot blacks, shoeshine folks, on a tip. So, there was no base pay. And it was a way to indirectly hold down compensation for folks who were frequently of color.

John Driscoll (12:02):
And if you look at frontline workers who were in the tip minimum wage, a disproportionate number of people are still of color. But regardless it’s a ridiculously unfair way to pay restaurant workers. And I think it’s the legacy… I mean, the time for that is gone. And I think what will emerge from fair wages for hard work is an economy that is fair. And that allows more of the hardworking employed folks, who are particularly on those front lines to kind of care for their families and participate in the economy, which should serve as a pretty big boost as we launch from COVID time to post COVID time. And we try to recover our economy.

David Williams (12:50):
John, way back toward the beginning of the pandemic, when there’s massive dislocation and huge layoffs you and Toby Cosgrove were advocates for kind of a public health service corps. And I see echoes of that here in the Public Health Jobs program to hire 100,000 people. What’s the story of that?

John Driscoll (13:09):
I think it’s really super exciting. I mean, we’ve got this enormous number of service workers who are dislocated by the coronavirus. We’ve got a huge need for public health workers. Healthcare jobs are going to be one of the fastest growing categories in job growth over the next decade with so many people becoming… As the boomers become Medicare eligible, we have an ability to train them right now for a need right now around contact tracing, and care for folks with COVID. But then, we’re also creating a skilled workforce with a purpose of caring for others that then, we’ll have jobs as the economy comes back. And so, I think it’s a terrific program, combine service, need, competence, and it
fills a gap that we’ve got in, not just in our public health infrastructure, but in terms of caring for our increasingly old and fragile population, as people live longer and need more support.

John Driscoll (14:10):
And I think it’s a great way to invest in much of the human capital that’s been dislocated. At 100,000 new public health workers, I think it would roughly triple the number of public health workers we currently have, and they can then transition into long-term jobs. It’s super exciting.

David Williams (14:31):
John, most of this package, 1.9 trillion, is focused on the COVID-19, the current coronavirus. But there’s another virus lurking in there. And that has to do with the cybersecurity type of virus. And while we’ve been doing whatever we’ve been doing here in the United States over the past couple years, the other China virus and Russia virus have been coming in and, basically, infiltrating the federal government’s IT systems, and those of private industry. And so, there’s a belated but, I think, important investment now being made on the IT infrastructure, including on the cybersecurity side to bring us up to speed on the 21st century. And it’s interesting, decided to include that here on this bill, but I think it does go together.

John Driscoll (15:16):
Yeah, no, I don’t think it necessarily goes together, but it’s certainly necessary. I mean and there’s been a devastating loss of intellectual capital in the last four years. I think that, if memory serves, about 26% of the federal workforce was under the age of 40 when Obama left office. And now that Trump is leaving office it’s less than 6%. So, all of that brain drain of digital natives, and cyber experts, who are up to speed with new technology has put us more vulnerable. So, you’ve got $200 million just to hire hundreds of new experts to support the digital and cyber defense experts work across the federal government. And you’re looking at a $9 billion investment, so that we could build a new IT and
cybersecurity shared services force within the federal government. And we’re also looking to invest another 300 million in the general services administration.

John Driscoll (16:22):
The numbers sort of are a little bit mind-boggling, but what’s interesting is they’re investing in infrastructure, in people, and in a comprehensive, again, [plan-ful 00:16:34] way to build up the defenses we need to protect ourselves from an increasingly dangerous cyber world, handling, investing almost $700 million in monitoring and incident response, which will not just be for the federal government, but will also protect the private sectors.

John Driscoll (16:55):
No, I think this is about investing in America, defending America and getting America back in a strong sense, whether that’s in terms of human capital, economics, healthcare, or cyber. So, it does make sense, David, even though it’s a bit of a bewildering long list of investments.

David Williams (17:14):
John, one of the things I’m grateful to the new administration for is that we’re now putting policy back on the table. And I think you and I are going to enjoy ourselves in Care Talk, doing what we do best, which is talking about the wonky stuff. So, with that, I’m going to say, that’s it for this edition of Care Talk. We’ve been talking about the American Rescue Plan. I’m David Williams, president of Health Business Group.

John Driscoll (17:37):
And I’m John Driscoll the CEO of CareCentrix. Thanks for listening.