The Healthcare Policy Podcast ® Produced by David Introcaso

Because healthcare today can be increasingly defined as commodified, expedient, financialized, myopic, reductionist and failing to transcend politics, the question of healthcare’s ethics or the roll ethics plays should play is increasingly begged. For example, last October Health Affairs launched an “Ethics and Health Systems Change” series that to date has simply complained about private equity and corporate medicine, federal immigration and gender care policies and de-professionalization. What fidelity does healthcare have to normative ethics when, for example, 27 million Americans and counting are uninsured, over 100 million lack a primary care provider and over 90 million cannot afford care if they needed today. Dr. Jain, President and CEO of the SCAN Group and SCAN Health Plan, discusses the causes of healthcare’s ethical erosion and how begged ethical issues or questions can be addressed. The two Forbes articles authored by Dr Jain and discussed during this interview are at: https://www.forbes.com/sites/sachinjain/2025/09/22/ethical-erosion-how-good-people-lose-their-way-in-healthcare/ and https://www.forbes.com/sites/sachinjain/2025/01/21/who-me-ethical-erosion-and-the-deafening-silence-of-americas-healthcare-leaders/. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

The World Health Organization (WHO) defines patient safety as “a framework of organized activities to reduce risks, lower the occurrence of avoidable harm, make errors less likely, and minimize their impact when they occur.” Over this past summer the HHS Office of the Inspector General (OIG) published three patient-safety reports. (Since 2008 the OIG has published at least 24 related studies.) One published in July found hospitals failed to capture half of harm events that occurred among hospitalized Medicare patients, few were investigated and even fewer led to hospitals making PS improvements. These findings were sadly unsurprising since the OIG previously found in 2008 that 27% of Medicare patients experienced harm during hospital stays, a decade later, or in 2018, still 25% experienced harm. In an July 24 OIG letter to CMS Administrator, Dr. Mehmet Oz, the OIG noted in part that while CMS and states require hospitals to publicly report just 15 of 94 harm events, hospitals reported only 5 of 15, or 5% of all 94 harm events. HHS has yet to publicly respond to the OIG’s recent reports much less recognize them. Dedicated podcast listeners may recall I’ve previously discussed patient safety in 2015, 2017 and in 2020.A summary of the HHS OIG’s adverse events/patient safety work with a list of its publications can be found at: https://oig.hhs.gov/reports/featured/adverse-events/. Information regarding Mr. Millenson is at: https://millenson.com/.Mr. Millenson’s recent medical errors essay in Forbes is at: https://www.forbes.com/sites/michaelmillenson/2025/09/12/lessons-from-the-medical-error-that-orphaned-a-cabinet-secretary/. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

The greatest threat to human health is us. Humans are the only species capable of self-annihilation. For at least the past 30 years it has been acknowledged that the earth is presently experiencing its sixth mass extinction entirely caused by anthropogenic GHG emissions. Per research published in 2023, current generic extinction rates are 35 times higher than expected background rates prevailing in the last million years under the absence of human impacts. Research published in Proceedings, the National Academy of Sciences (PNAS) in 2022 concluded, “There is ample evidence that climate change could be catastrophic. We could enter such “endgames” at even modest levels of warming.” “Facing a future of accelerating climate change while blind to worst-case scenarios is naïve risk management at best and fatally foolish at worst.”Mr. Kellis’s August article (and related podcast), “Why Should Extinction Medicine Be a Specialty?” appears in the recent AMA Journal of Ethics special issue on extinction medicine, at: https://journalofethics.ama-assn.org/issue/existential-health-care-ethicsThe recent SSRN pre-print on extinction medicine is at: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=5109482The recent IPPNW-AMA Journal of Ethics webinar on the ethics of human extinctions: To sign up for the Extinction Medicine Reading Group, a new IPPNW Medical Student Movement initiative that will promote international, intergenerational, and interdisciplinary discussion on writings on the science, ethics, and medicalization of human extinction, go to: https://forms.gle/pLspc5URhu9VcuS37Mr. Kellis can be reached via : www.devinkellis.com This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

The climate crisis is not a tragedy. It’s a crime. The July 4 signing of HR1, is the latest if not the greatest climate crime considering the current state of the earth’s energy imbalance or the ever-increasing amount of atmospheric GHG emissions that trap infrared radiation (heat) causing planetary warming. It’s estimated the OBBBA will over just the next five years add an extra seven billion tons of GHG emissions into the atmosphere - equal to more than one-years’ worth of total annual US carbon emissions. While it had been projected the US would reduce GHG emissions this decade by upwards of 43%, or get close us to a 50-52% reduction to align with the 2015 Paris Accord, the OBBBA will now reduce carbon emissions this decade by just 17%. The legislation rescinds virtually all IRA renewable energy tax credits while further subsidizing fossil fuels. Prof. Jacobson’s considerable contribution to understanding and addressing climate breakdown can be found at: https://web.stanford.edu/group/efmh/jacobson/. Information regarding his most recent book, “No Miracles Needed” (U. of Cambridge Press, 2023), is at: https://web.stanford.edu/group/efmh/jacobson/WWSNoMN/NoMiracles.html. Prof. Jacobson’s LinkeIn page is at: https://www.linkedin.com/in/mark-jacobson-1b58b38/. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Anthropocentric warming, the greatest threat to human health and survival, disproportionately threatens children. Children pay the greatest climate penalty. Per the World Health Organization, children suffer more than 80% of climate crisis-related injuries, illnesses & deaths being more vulnerable to carbon-polluted air, extreme heat, drought and innumerable other climate-charged disasters and diseases. Nevertheless, the US healthcare accounts for an ever-increasing amount of carbon pollution and refuses to divest in fossil fuels. As for federal policymakers, the White House and Congressional Republicans remain intent on committing ecocide. To the surprise of no one, in late May Our Children’s Trust, on behalf of 22 plaintiffs age 7 to 25, sued President Trump and five administrative offices and departments arguing in part several White House Executive Orders will increase fossil fuel use and dismantle climate research, warnings and response infrastructure. The lead plaintiff in Lighthiser v Trump stated White House policy amounts to a “death sentence for my generation.” The WCC handbook available at: https://www.oikoumene.org/news/wcc-publishes-resource-on-legal-tools-for-climate-justice. The Lighthiser v Trump complaint is at: https://climatecasechart.com/case/lighthiser-v-trump/.Among related discussions, I interviewed the Michael Burger at Columbia University’s Sabin Center for Climate Change Law in May 2020 and again in June 2024 and Andrea Rodgers with Our Children’s Trust this past January. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Due to the federal government’s ongoing failure to effectively address the climate crisis, over 50 subnational entities have been taking increasingly aggressive steps to mitigate carbon pollution. Recently, Vermont (VT) and New York (NY) passed legislation to hold the oil and gas industry financial responsible for extreme weather events supercharged by their greenhouse gas (GHG) emissions. (Eleven other states are presently working to do the same.) The VT law tallies up the financial damage and then determines proportional responsibility; NY identifies in advance a damage amount and then proportionally bills responsible fossil fuel companies. VT and NY’s legislation is based attribution science. Simply explained, the methodology attempts to measure to what extent anthropocentric warming caused by fossil fuel use of specific entities supercharges extreme weather events. Last month, Stanford’s Dr. Christopher Callahan and Dartmouth’s Dr. Justin Makin published, “Carbon Majors and the Scientific Case for Climate Liability in the journal “Nature.” The authors calculated the trillions of dollars in economic losses attributable to the extreme heat caused by emissions from individual companies or carbon majors. For example, emissions attributable to Chevron caused between $791 billion and $3.6 trillion in heat-related losses between 1991 and 2020. Drs. Callahan and Mankin’s April 24 “Nature” article is at: https://www.nature.com/articles/s41586-025-08751-3 (subscription is required).A summary of the article is freely available via “The Guardian,” at: https://www.theguardian.com/environment/2025/may/05/cost-of-emissions-from-five-major-australian-resource-companies-more-than-900bn-study-finds. Info on Dr. Callahan is at: https://profiles.stanford.edu/326897 and for Dr. Mankin, at: https://geography.dartmouth.edu/people/justin-s-mankin. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com