CareTalk Podcast – Biden’s Healthcare Rescue Plan

John and David debate whether or not the American Healthcare Rescue Plan can fix America’s healthcare problems.

David Williams:

John, they used to say, “A billion here, a billion there” And pretty soon you’re talking about real money. Now what do we say?

John Driscoll:

Well, with $2 trillion, it’s kind of hard to tell, but let’s figure out what’s in the American Rescue Plan.

David Williams:

Welcome to CareTalk your American 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. So David, what is in this multi trillion dollar mountain of cash that’s embedded in this recovery act? Are we building back better or are we just spending a lot of bucks?

David Williams:

Well we’re spending a lot of bucks, John and it’s American Rescue Plan, and you could call it the American Healthcare Rescue plan. That might be, too much for it, but let me tell you…

John Driscoll:

Wasn’t that what the Republicans were saying? Oh, just give us a little trivial 77 to $800 million. They probably wouldn’t have even voted for it anyways. They were sort of arguing that healthcare doesn’t need trillions. It just needs billions.

David Williams:

Well, John I’ll actually what they were saying. That the reason that it could be smaller is because you don’t need all these fancy doctors in Washington. You just need Dr. Seuss, but of what is actually passed here at 1.9 trillion, let’s just call it, two trillion John, about one trillion of it, just over as for three things. One is this $1,400 direct payments that people have heard about there’s 350 billion to state and local governments, which Republicans are completely against and then there is the expansion of unemployment insurance. So all those together add up to about a trillion and then there’s everything else on top of it and John it’s pretty fundamental stuff.

John Driscoll:

Well, wait a sec. You just got to about a trillion. I mean, I’m just simple math here and you didn’t mention anything about healthcare. I mean, isn’t this a healthcare bill.

David Williams:

So, healthcare is in the tens of billions. So the biggest thing for healthcare is for testing. So there’s about $50 billion for a national…

John Driscoll:

Finally, at the end of the pandemic, the government has decided to invest in testing, which we’ve been asking for, for a while. Why is testing important, David? I mean, gee whiz, what could go wrong if we don’t know how much virus we have?

David Williams:

Well, John has a certain logic to it, right? Maybe it’s a final exam. That’s why the testing is so big at the end.

John Driscoll:

No, you’re missing it. No, no, no, no. We are seeing new variants that require sequencing, which currently there is no consistent standard for sampling the positive tests that come through that you want to sample and you sample them and sequence them to understand how much of those dangerous new variants are populating the virus. They kind of missed the opportunity to explain. We need to invest in testing as an early warning network and as a learning network about what kind of virus we have, because COVID-19 is likely to be an endemic virus. So I think, no, I think that’s a really important point. So I’m glad you hit that one, but no, this is an important investment that was not terribly well explained.

David Williams:

So that is the biggest part of it. Now the immediate issue relates to vaccines. There was already money allocated for the development of vaccines, and now there’s more for distribution. There’s about $8 billion going to health and human services and the centers for disease control for promotion and distribution and monitoring of the vaccines and then at least a billion dollars for awareness and engagement. That’s really important because first we were talking about just getting the vaccine out to the communities, but now it’s really a matter of encouraging people that they should use the vaccine.

John Driscoll:

But a billion? Like just, to throw away a billion cause it’s like we had to communicate. The thing that I think it’s hard for folks to understand and may justify why we’re putting so much money out there is the scale of the human tragedy that’s happened to, working class folks and poor folks as part of this devastating virus.

Which is really it’s sort of unfairly and disproportionately harmed communities of color and poor communities and also how spare and incomplete the healthcare infrastructure is in many of these communities and I saw support for rural health in this bill. I saw support for public health departments. I mean, we have $7 billion associated with really a new training and new public health workforce, tracers, vaccine givers, basically more new arms and legs to make sure the vaccines get into people’s arms, but also to support hopefully a revitalization of our public health infrastructure.

Without that, poor communities, whenever something like this happens, will be super vulnerable and there’ll be disproportionately disadvantaged by illness on an everyday… this is really an investment in public health that David, I think it’s as big, as those that, on a proportionate basis that Lyndon Johnson did in the era of the great society, with all the investment he made in hospitals and federally qualified health clinics.

David Williams:

John, we see that there is the funds for the community health centers and also some things that are kind of focused. So there’s this quarter of a billion dollars, not much for nursing home strike teams. We saw major issues in nursing homes that should never happen again, another a hundred million for the Medical Reserve Corps, which is something that you’ve touted in 800 million for the National Health Service Corps and that actually helps pay for people to go to medical school who then serve in underserved communities.

So there’s a bunch of stuff that’s directly related to treatment, but I think more fundamentally, some of the things, that first trillion dollars that I glossed over upfront is also pretty important because you’re actually providing these $1,400 payments can be thought of as in a way, this universal, basic income and unemployment insurance that allows people to continue to exist and feed their families, even when they don’t have a job and then John, I know you have been a longterm proponent of child tax credits and the ability to…

John Driscoll:

Before you go there, Dave, I do think there’s a tectonic shift where the Republican leaders don’t really understand what the Republican and Independent voters are thinking. We’ve been in this era of, shame, blame, and shrink government since Reagan and it’s really undermined… Since the Republicans led by Reagan, the ability for government to actually get support and perform. But if you look at the polls, I mean, shocking. Everyone knows that the majority of voters are in favor of this bill for, the reasons that, that first trillion dollar. It’s hard for me to get a trillion out of my… But if you, ask people, what they, care about in this bill. 59% of Independent and Third party voters want to see continued investments in job growth and the economic recovery. 77%, not surprisingly of Democrats, but 61% of Republicans, the Anti-government party, those voters by a, significant majority are in favor of leveraging the government to invest in with government dollars, taxpayer dollars to turn around the economy and, really build back better through the government.

I think it’s remarkable and I think it’s going to be, it’s a very interesting disconnect with no Republicans voting for this in the Senate almost. I think, with no, or almost none in the house to have 61% of Republican voters saying the government has to invest. I think that at the long cost of Republican incompetence in the last administration, maybe a reset of expectations about what government’s role is. I think it’s remarkable, David

David Williams:

Sean, there were the Reagan Democrats and these may very well be the Biden Republicans that you’re talking about. You know, one thing that should be noted is, is obviously during the democratic primary, there was a big focus on Medicare for all and Biden was very clear that he wanted to build on Obamacare. No surprise, since it was part of this administration and this bill does it actually, in a way that was, doable at the time we had Dan Mendelson on last week talking about it, but, this expansion of subsidies to make it more affordable, to have people to enter, into the marketplace, Obamacare, marketplace premiums, and then also an increasing federal match. So that the states that haven’t yet expanded Medicaid. There’s still time, for them to do it and then adding on a few other things, like making it so that that States have the option to cover low income women who just gave birth. They can cover them with Medicaid for a year.

So they’re all moving toward universal coverage, which is something that, you know, before in the previous thinking before the pandemic, some people might say, well, gee, I don’t want someone to get free stuff. We heard that from previous candidate Romney, but now it’s more like I want my neighbor to have health insurance, because I don’t want people running around with a virus unchecked.

John Driscoll:

Well, I think it’s also, I mean, there’s a lot in here. Given how hard it is to get legislation passed, it feels like they stuck everything they possibly could into this legislation. But the tax credit that you’re referring to now, which is pretty remarkable, it is a significant increase. Americans will now have a higher tax benefit up to 3,600 bucks a year for kids under six and 3000 for older kids, that credit is fully refundable. So low-income, and even no income families can fully benefit.

What, this is tied to is we have a shockingly high level of child poverty in America, 15 million kids last week, and that when you’ve got kids locked in a cycle of poverty early on in life, the research is quite clear that there are significant cognitive and healthcare disadvantages that follow this tax credit literally cuts child poverty in half in America and just to put that in context, I think David it’s, either one out of three or one in every two babies born in America is born on Medicaid.

So we have a ton of children who are born poor. If we can make sure that we can cut that poverty in half, we’re going to cut our healthcare costs. So by rethinking sort of whole patient or whole person, or what’s called the social determinants of health, by giving, babies and young children, adolescents, a ladder out of poverty, we may actually bend or break the curve of healthcare costs going forward and really returned to sort of America as a place of opportunity, not just for those upper middle class and rich people who’ve got fair benefits and don’t have to worry about a meal, but for everyone. It’s significant it literally, that tax benefit alone cuts child poverty that kids under 18 in half.

David Williams:

So John, the president got on TV to tout this plan and also he said that he wants people to be able to be approaching normalcy for the 4th of July, otherwise known as independence day. What are your plans, John?

John Driscoll:

Well, I got lucky. I get pulled off a backup list and get vaccinated. So, I’ll be socializing, but I’ll be socializing outdoors. I’m, a little nervous David that the virus has plateaued and historically where it’s plateaued, it has sometimes, bounced up. If you look at Europe, which is typically led us by, 20 to 30 days, they plateaued and they are seeing a pop-up in, COVID growth. But I’m cautiously optimistic that with 30% of the, country vaccinated, we’ve got more momentum behind it and an administration that kind of knows how to get vaccines out. So, I think the president’s probably right. What about you?

David Williams:

Well, John, before the pandemic hit, there was a rating that showed you how well different countries were prepared for the pandemic and it showed the U.S. At the top, we had all the things in place, compared to other places and you see that, of course, that we didn’t go there. But we have all those still have those advantages now and I think what you see is government now doing the right set of things so that we can try to get the pandemic behind us. I thought the president was right in his caution about saying, here’s something to look forward to because I think we don’t want to be negative, excessively negative. Pandemics do eventually end, but also, setting the right goal and saying, have a low key party on the fourth.

I like to do that. John. I planned to be outside on the 4th of July, and I hope I don’t get Lyme disease or something, by getting bit by a tick when the virus, passes me by and I’m hoping I will be vaccinated by then and I, think I will be. All right, John, we’ll end up with some fireworks next time, but that’s it for the latest edition of CareTalk. I’m David Williams, president of Health Business Group.

John Driscoll:

… and I’m John Driscoll, the CEO of CareCentrix if you liked what you heard, please subscribe. If you didn’t like it, or you did, please leave us your comments. Thanks for listening.