On facebook, youtube, twitter and from axios. Com. With theollow along axios on twitter. We will unpack how the pandemic has changed the trajectory of healthcare and what is expected over the next four years. Is dr. Robertt blendon, professor of Health Policy at the school of Public Health. He is joining us from boca raton. Welcome. Thank you for having me. Theets Start Talking about Number One Health topic right now, the coronavirus. Lets talk about equities and disparities. Can you outline what are the best things we can do from a policy perspective to help reduce the pain of the pandemic and to reduce the inequities associated over the next few months . Dr. Blendon first i want to be very cautious. A number of things are done under an emergency basis over the next six months. A lot of like and hispanic americans could die. There are a lot of things we can do about race inequity that are really important. I am really worried about the next six months. Americansent black and latino americans are dying from this virus at a much higher rate. As you just said, weve got to get people through the next six months. I would focus on four things. One of the reasons why they are dying at such high rates is they have existing chronic illnesses, diabetes, Heart Disease, asthma in particular. If they are infected, they are at much higher risk of dying from infection. We need an adequate connection that if they have symptoms, and secondly they can be referred and seen when the coughing starts or some other symptom and they dont have to wait long times for that. The connections are there. Direct medical ly in thens particular short time period that if you are at risk that you can get seen and get referred. Lot. Ng helps a that is not the only answer for people who are high risk. The communities are underinsured. If they do need care or advanced testing, there can be no question that their bill is going to be paid. And so emergency covered in the next 90 days or something would help enormously. Worried as we enter the winter season, the caseloads are going up quite dramatically in all the states. I just want to be sure that these populations make it through the next six months. Issue has to do with a survey with National Public radio. Andhis economic downturn black andssentially latino hispanic americans are having problems today. What we found is 72 of latinos said i have serious financial problems in the household now. 60 of black americans. Almost double of white americans. What does this mean . It tells us they dont have any savings left. One quarter cannot pay their rent. Ge, utilities, that was when the federal aid was going on. We have people who are hanging on by a fingernail when there was federal aid and there is no federally and we are about to stop the protection that you cannot be evicted if you cannot pay your rent or utilities. We are going to increase the number of homeless black and latino americans in six months unless there is emergency financial aid. Problem for your audience to understand, something that has happened with this outbreak. Natural disasters in this politicalve not been this year. When a level five storm hits the gulf. Ang, hits the whether or not we help people in this emergency period, it has to be a political issue where otherwise we are saying they are grounded. People, get, feed the tent set up so they dont die. The last is this promise of a vaccine is so exciting because at the moment Public Health we are say we think going to shut the economy down. A lot of americans living from paychecktopaycheck, that is not an ideal answer to them. But a vaccine is. The problem we are going to face his people have to understand the history. Less forricans and latino americans. The issue for them is for more than a century a number of thoughtful books have been published about this, black americans have been experimented among by scientists. At tuskegee there is a whole list of drugs that have been tested for this. In the black community there is a history that these experts out been inngton have not our public interest. Many latino communities have a different history of coming from countries where they use untested drugs. We have something that can actually when it is announced that we actually have something i can save your life, youre going to be resistance. There has to be a very sensitive effort in the next five or six months to convince groups that are suspicious of medical scientists and pharmaceutical companies that this is a way for them to stop dying disproportionately, but it will not be easy. These are the things that i would move forward for, but my focus is the next six months. Caitlin lets start with the next six months and then we can go beyond that into the next four years. Joe biden is about to be president in a few months. He will inherit the coronavirus pandemic between now and in that six month timeframe. How do you see the quest for equities playing out politically and once the pandemic is over, extending into the next four years . Dr. Blendon all of the political divisions in this country did not disappear in this election. Those of us who were more nonpartisan wish they did. And for to understand viewers, this is not been settled. Will be settled in georgia with two seats in a special election in the first week in january. There are some estimates that republicans may win one of those seats. If they do, you have to understand that republican s were elected by voters who did not start the show with equity. Equity was not a priority. What was a priority for them, growth, open the schools, get the religious Services Back economic growth. Make sure we do not burrow ourselves into oblivion. Achieving equity is not it for them. , there could be very substantial barriers. I want to move to the other side. The president has enormous authority to move administratively in many areas. For those of you who are not familiar with election year, will notelect biden provide voters in the primary. The week before the democratic primary major news sources talked about how joe bidens time had come and gone and it did not come and go because unbelievable black numbers of voters came out in South Carolina on super tuesday and even though they were black, they voted for him because they thought he would do something about their deep structural problem. He will use every level administratively lever administratively to help the group out. If the republican holds the senate where you have to pay attention, if what he proposes is billions of dollars in spending, they are going to be very weary to do that. This is not their top priority, absolutely that. Absolutely not. Any administrative that he would make overseeing agencies, priorities, public advertising, reaching out, emergency help to the uninsured that he can do himself will be done because he has an obligation. But we will have not ended the politicalization of healthcare. This election did not resolve the fundamental differences about what governments should and should be doing in the next four years. Thank you so much. I love hearing your perspective on these issues. We are almost out of time. Unfortunately we will move on to one funding. 20 seconds, how are you celebrating this very unusual thanksgiving . Dr. Blendon so, i take watching crowds very literally. We have agreed that we found a restaurant that has opened in a field essentially. Open air. In florida you can get away without wearing a winter coat. So we decided we will go out wearing a mask in an open field for that. Everything else we are in fact watching very carefully crowds, travel because we are nervous about this. But we thought we could have one meal if it was out in the air and everybody was wearing masks. Thanksgiving that everybody muck must take. Caitlin well, i hope you enjoy it. Dr. Blendon thank you for having me. Caitlin thank you for joining. Up next we have a view from the from founder of axios. It is my honor to give you a steve ballmer. Th good to have you in this conversation about facts and things that really matter. Thanks for having me back. As we think about healthcare, it is a huge part of the u. S. Economy and a huge part of her lives. Lets egg down the facts as we think about how do you fix the system. When you look at it, talk broadly about spending. How much do we spend and where do we spend that money when it comes to our healthcare . About 3. 1 trillion which is hard for people to think about. 15 of our gdp. You can think of that has one do or every six things we spend is healthcare related. Or you can think of it as 9,400 per year on average per capita. That is less for some, much more for others. The thing that is crazy about it is that same number is about 3030 100 inflationadjusted in 1980. 3,310. People also focus on prescription drugs which is only 10 of healthcare costs. We are driving it across the board. For most of us we get our insurance through our provider. Talk about that landscape. How many people have insurance . And for those that do, where do they get it . Is it enough for the average person to be able to cover those exploding costs . 8 of people are uninsured. It is down from 1990 at 14 . It kicked back up some over the last couple of years probably the policy changes and the trump administration. If you look at who is uninsured, certainly a piece of that is going to be undocumented immigrants who are not eligible for government plans. That is something that largely is omitted from the discussion about who is insured and who was not. That is a government policy that does ensure some uninsured folks. Most people are under a private plan whether they bought it themselves or got it for their employer, about 68 . 34 of people are insured under some government plan, medicare, medicaid, veterans plan, it all adds up to more than 100 because in number of people are under multiple plans, particularly medicare patients. ,f you look at what people pay it really ones the gamut runs the gamut both in terms of premium and copay and coinsurance that he will need to put up. It is quite clear that for people who are in the bottom 40 of income, maybe even bottom 50 , an Unexpected Health problem could easily put people into deep debt or even a bankruptcy position. You are a businessman. You on the clippers, you ran microsoft, you are big on return on investment. Are we getting a good return on our investment through spending so much on healthcare and what is the end result . Is my healthcare in general as an average citizen that much better than it would have been years ago . Steve you have to decide how you want to measure your healthcare. I dont think for me the relative issue is how is my healthcare. I think the relevant issue is how is my health. Is my Health Better . Am i living longer . I dont like what i see there. The average age, it moves people by. Maybe because i am close to 65 thousand number i look at. That number is about 73. 2 years. Wasears ago, that number 72. 4. You can say, that is great. It is up. 8 years. Oot, for thaty sh kind of investment in healthcare, all we are buying is. 8 years . That is distressing. Look at Heart Disease. Heart disease continues to rise pretty dramatically. It is up 11 , almost 12 in the last five years. And 30 million americans have Heart Disease issues. Obesity is the key driver of that hear it child obesity is up 26 of hispanic children are obese. 14 of white children are obese. That only leads to bad health, lower life expectancy. The question we got to ask is at the end of the day can our healthcare give us health or is it our lifestyle and our habits . It really is accommodation of both. Probably more of the latter. I probably obsess more about my health that they might parents and my parents. I assume a lot of people are doing the same. There is a lot of buying in terms of why think i can see. Is there not enough attention on that side of the equation in your mind, the self ownership of our health . Steve i think so. There are some things in which the medical system does a good job. They say, we are not going to give you a new need, and artificial knee unless you get your weight down. If you want to be entitled to insurance, you should also be required to put in some exercise, something that is going to keep you healthy. Obviously that would be a thing that citizens through the democratic process would have to agree on. I used to write Health Insurance plans. Microsoft was health insured. We decided what our Healthcare Plan was and be paid people to go through diet programs if they were technically obese. It was a saver of money for our company. Up, how worried are you about this latest surge and the strain it is going to put on us as individuals, but the Healthcare System as a whole . Steve the explosion has been nothing short of stunning. Just stunning. We are running about 180,000 new covid cases. We have a map that shows how the covid cases per capita keeps moving and we started in the east and the south. It moves to the west. Now there are counties in north dakota where one out of five people in the county have had covid. So i am very worried about it. Im not an expert. I cannot tell you when the vaccines are really coming. I personally am very conservative when it comes to protecting my health and my familys health. Be hospital situation will bad. If you can save people, that is great. But if all you are doing is buying people lack of stress by being able to put people on ventilators, i think we are in a messy situation for the next two or three months anyway. Jim thank you for this conversation. To makingto usa facts this conversation possible. Happy and stay safe. Caitlin. Ou, caitlin joining me now from new york city is everett cunningham, the president and ceo of Ge Healthcare in United States and canada. Hello and thanks for having me. Caitlin thanks for being here. One big storyline has been technology and how technology has been enhanced and excellent rated accelerated. Can you talk about these how the can you talk about how the Available Technology has changed from march until now . That geology is one Way Healthcare has really partnered with our customers throughout the pandemic and even actually before the pandemic. We knew that digital and technology and Artificial Intelligence and things like that would be a way of making Healthcare Systems more efficient and effective. In a weird way, covid19 has accelerated the acceptance of technology around healthcare. A couple of great examples from Ge Healthcare and how we are partnering differently with Health Systems is around making the Health System much more thelligent and efficient in way in which they take care of their patients. We have a tool called command center. And nasa and Mission Control and how they are looking at their business all in one room and they can see everything. Command center is the exact same thing for hospitals and Health Systems. They are able to see a lot of the vitals in the hospitals in one room. Around covid19 Health Systems have been embracing this technology. One good example is tampa general in florida. I worked with their ceo, he wanted to make sure that they took care of patients more efficiently, he wanted to make sure he cared for his clinicians so he did not have to go from bedside to bedside and so they adopted our command center and rebranded it and called it care comm. But they have seen is not just the inefficiency improving, efficiency improvement, or bringing but bringing the cost down as well. Thing i am reading about all across the country, two things, hospitals are facing Staff Shortages and they are also facing a huge number of burnout among Healthcare Providers. How can Technology Help address those two issues . Everett i am glad you mentioned the word burnout. When people hear the word burnout, they sometimes think of physical burnout. What we are seeing and hearing across the country and canada is we are hearing mental burnout. We have been in this for 10 months. They are concerned about their wellbeing physically and mentally and how can digital and Technology Help. I think about a tool that we have called neral. It takes a lot of intensive care unit vitals and instead of going from bedside to bedside as a clinician looking at the vitals of patients, it moves it more toward a central located room to where they can see the vitals of those patients, whether they are at that hospital or a satellite hospital, in one room. I think about the caring of clinicians around this burnout. They dont have to move bedside to bedside. That can be physically and mentally exhausting in terms of am i increasing my chances to get infected. Not just from a clinician standpoint, but from a patient standpoint. We are doing is around the country. We are doing it with ohsu in portland, florida, in the province of saskatchewan and we are getting feedback that it is really increasing the productivity of clinicians but then also caring for them in terms of decreasing exposure, lowering ppe use and things like that. Really happy to partner in that space. Caitlin hopefully sooner rather than later but one day this pandemic will be over. What do you see as being a lasting effect in the healthcare sector of some of these trends we are seeing now . Changed healthcare has and i think that covid19 has done a couple of things. First of all, it has really brought the importance of making sure that people are safe whether they are our own employees when they go into a hospital like field engineers, we need to make sure they have the latest and greatest in terms protocol, the consistency of that, really caring for patient safety. And patients, clinicians, our own workers, i think it is important to your one other thing i think it is important. One of the things covid19 as don has increased the access. Im going to go into the hospital and have that exchange facetoface. Telemedicine has been widely accepted through covid19. My wife is a physician in the bronx and she told me before of her patient visits were facetoface. And now during covid and after covid, it is the opposite. 90 of her visits are now telemedicine. It has increased the access. Now where patients might not have had the ability to go into the hospital because of the transportation difficulties or whatever, telemedicine increases the reach of caring for patients and that is exciting and plays very well giving access to medicine for all patients. Caitlin that is a great segue into my next question. One of the topics has been in equity. Healthcare technology is really exciting with all kinds of breakthroughs and the as incredible as we have seen especially during covid. The science is incredible. That raises the question will everyone be able to access the technology. As a leader in the corporate sector, how do you think about this question of equity and how do we address it . Everett it a passion of mine. Ever since i got into healthcare, i really focused on healthcare disparities. Someone who uses the term your healthcare depends on what zip code you are in. I think everyone in healthcare should be passionate to take that away. My thing is irrespective of which zip code you are in, you should get the highest quality of care. What i love about schools that make healthcare more digital like our command center, not just makes healthcare available for those people that are in zip codes with really good Health Systems, but it allows us to reach out to the rural nature of patients where they are and give them that same quality of care. I think of people that are maybe patients that were not able to have access to transportation to get to the hospital. Telemedicine and other Digital Technology will give them the access to healthcare in their homes. Gehink of ge, i think of leaning into making more of our products more mobile like our mobile xray and things attached to our mobile xray, mobile ultrasounds or pointofcare ultrasounds allows patients to get care in a more mobile setting and not necessarily getting into a car, going into a Healthcare System in urban america and that is why i am exciting about excited about where covid19 accelerated innovation. Caitlin it is pretty tough to find a Silver Lining in a Global Pandemic like covid. When you think about technology that would not have existed at all had the pandemic not taken place, is there anything ge is developing or has developed that that wek four can thank covid for . Everett it has increased the acceptance of innovation. I think at ge, something we Just Launched recently. Covid19 has actually increased people that are getting intubated. I look at the 50 million patient that have either had covid for half covid now or will have covid, about 2 million to 7 million of those patients will have to be intubated. And the criticalcare 2. 0 that we have lost has automated the process of how patients get innovated intubated. And that is really important when you think of the productivity increases that we have had in this space, giving of making importance sure that intubation is done for the right patient at the right time to meet is where ge is at the forefront. It is exciting. Wayte to use pandemics as a of increasing innovation but criticalcare 2. 0 is a great example. Caitlin we have to find some silverlining. We have just about one minute left. We would like to end our interview with one fun thing. I am told you are the father of some older children. I would love to hear your take on how your family is celebrity thanksgiving this year. Everett it is great. I have three adult daughters. One is 24 who lives in the bay area. A daughter who was 23 and lives in brooklyn. And my youngest daughter is 20 who lives in seattle. She is an athlete at the university of washington, go huskies. She cannot travel back. Night center last a nice care package of ice cream and cookies and poundcake and just letting her know that we love her and we are with her and our other two daughters will be joining us. We are excited. We are going to have a socially thanksgiving stuffing ourselves with turkey. We are excited to see our girls because we do not get a chance to see them that much. Caitlin mom, if you are listening, i take care packages. Everett send us your address. We will send you something nice. Caitlin thanks. Do you hear that, mom . Anyway, thank you so much for joining us. Everett thanks for having me join. Everybody be safe and take care of themselves especially during the holidays. Caitlin joining us now from virginia is deborah addo, the president of Inova Loudoun hospital. Welcome. Thanks for having me. Caitlin thanks for joining us. One of the most prominent features of the pandemic has been the racial inequities that have been exposed through it. As a hospital president , can you talk through little bit what those inequities and disparities have looked like . Deborah absolutely. We were surprised a little bit when we saw a disproportionate share of people of color that were impacted by covid19, especially the death rate. We have always heard about disparities of care, but to see it up front and center really did allow us to step back and take a look at some of the things that we do and ways that we can better reach all of our communities equally. I think that was a good lesson for us. Unfortunately covid is not something we can discuss in the past tense. It is very much ongoing right now and the next few weeks and months could be very dark. What have you learned over the last few months that you think we can apply to the weeks and months Going Forward to help address and reduce inequities . Deborah sure. As we look at this and i am sure many other industries have seen the same thing, the people who peopleblic facing, the who were First Responders and first out of the gate, those were the ones who also were not allowed or did not have time really to take off. When i think about one of the things that we could do and that would be just take leave, here is the reality. If you know that if you come to work ill, you will be paid. But if you stay home and you are ill, you will not be paid. That is the difference between making a rent payment and keeping the lights on. It is unlikely that you are going to let your employer know you are not feeling well. So we really need to help to remove that barrier. Here is another reality for us and i heard a phrase that said if you take care of the least of them, you take care of all of us. If this person who has to come to work ill actually is the person who is taking care of your children the person who is caring for your long, working in the Grocery Store or the cleaners, that person comes to that alongd passes to all of us as consumers. That is going to be really important for us. The other thing that we also learned and this is about new information for us, this is not new information, there are still communities that are on trusting of the Healthcare System. When we get a pandemic and you say, wait a minute im a i have been treated equally wait a minute, i have been treated equally. Should i use a home remedy . When people are thinking of that, they are also saying should i actually asked as the health service. Create to make sure we trusting relationships and what do those look like, we need to be in the community. We need to push it to get you in. We need to have people here who look like you. We need to make sure that we have people who speak the native language. All of these are things that engender trust and those of the things we have learned that we need to continue to do. We need to be in your community. Caitlin that is a good set up for my next question which is one day this pandemic will be over but what we have seen about the systemic inequities in our Healthcare System, those are not going away overnight. What can we do at your hospital at a microlevel to start removing these inequities from the system . Deborah i think we need to focus on the oppressed and vulnerable among us. When we think about profiling and many times we use the phrase profiling in a negative way. Nothing positive can come out of that. If we know the pockets of our community and the demographics of our community and we know where we need to write the resources. That is information that is important. We should learn from other places. While we talk about inequities, the reality is inequities are not equitable. That are some communities have pockets of inequities that they are better than other communities. Fare better. A good example of something that we did was we learned there was a period of time where many providers were not taking uninsured or underinsured women who were either pregnant or getting ready to deliver. Ova stepped in and we positioned those clinics in communities most needed and this allowed us to ensure that these women had the services they needed. We do believe if you get a good start, you have a more like the to have a good ending. And so we played those resources and services there with people who spoke the language and with care providers who looked like the Patient Population we were caring for. That was important and we started to see much improvement in that Patient Population and that community. I think there are number of things you can do in your own community to help remedy this. Caitlin if we could move onto another topic that is really effectnd a very sad side of the pandemic, the explosion of Mental Health issues across the country. Can you talk about what that looks like in a hospital setting . Deborah sure. It is unfortunate. I think that this whole timeframe that we are living in has brought to the surface so many things. If you think about 2020 and all that we have experienced, we have had a pandemic, we have had an economic crisis, we have had social injustice, we are looking at democracy in its core. There are so many things that even the most stable of us would be at least rocked by this, distracted by this. You take someone who already has a Mental Health issue or Mental Health condition, coupled with Everything Else going on. What has happened with us unfortunately and it is across beenation it has difficult to access. Even for an outpatient, it is difficult to access. Trying to get to a psychiatrist, a counselor, the time is much longer than it should be and that we would like. When people are in crisis and suffering at home and in communities, the child who has not been able to go to school, the parent who is dealing with Everything Else that is going on within the family. Weve got the person who was lost their job, lost their home. This is something that is farreaching and that will last far beyond the pandemic itself. There are a number of ways that this is surfacing in our communities and we are looking at ways to really address it. Caitlin that is something that scares me is the pandemic is going to go away but Mental Health issues probably are not. If you are someone who has developed a Substance Abuse disorder during this time period, that does not go away just because the pandemic has. My question for you is knowing that we are going to have this wave of potentially longterm Mental Health issues facing us, what can providers do to change their ways and perhaps change their processes to help address that . Deborah that is a great question. So much is promising that think about a vaccine. We are hearing that at least three manufacturers are almost ready to go. The success rate should be very good. At some point we will address the physical component of the pandemic. The mental component will still linger. Think about this. Think about the person who has lost a loved one and was not able to be there with them. Think about the person that has lost that loved one and they were not able to really honor them in the way they would have honored them in their passing. There are so many things that will be farreaching. The person who started a business from scratch and now they have lost that business, we need to address that. One of the things we do is an initial assessment when they come in. Put in a question that says how has 20 20 impacted spiritually,y, mentally, emotionally, psychologically, financially because that first 15 or 20 minutes you spend with a Healthcare Provider will allow us to address what you need to address. One of the questions many of our writers ask is what matters most to you. We want to make sure we get to what matters most to you. Many times a patient waits until the last second with the doctor is getting ready to walk out to really express why they came in. We want to start the conversation with how has 2020 impacted you and what can we do to address it. And on a lighter note, we do like to end these interviews with one fun thing. Something i learned about you just from our conversation prior to the event is you have a really fun hobby that has worked very well with social distancing. Can you tell us about it . Deborah it depends, i have several. Some have not worked as well as others. I do like fast cars and i also like to drop the top. That gives me the opportunity to really go out and escape even though i am safe and even though i am isolated. But it gives me the opportunity to really open up. I use that as my zen time. Because people are working from home, i can drive really fast in places where before i was not able to. It has been great. Caitlin one Silver Lining of this years open roads. Deborah youve got it. I have not been stopped yet so that is a plus. Caitlin good luck with that. Thank you so much for joining us. Deborah thank you. It has been a pleasure. Caitlin thank you again to our audience, all of you who have joined us for todays event. We hope it made you smarter faster. Thank you to our sponsor, usafacts. Isyou enjoyed this, axios hosting another event on december 18. This will look at immigration policy in the context of the Public Health crisis. You can always find the latest news at axios. Com. You can download the axios app. If you would like to sign up for our newsletter including mine, you can do that at signup axios. Com. Axios is launching newsletters in cities across the u. S. To help you become smarter faster about the areas you live in. It is called axios local and you can find out more at axios. Com local. Again, thank you for joining us and i hope you have a safe rest of your week. Announcer here is a look at what we have coming up today here on cspan. The futureis morning of the Transatlantic Alliance and natos role in ukraine and georgia hosted by the german marshall fund. This afternoon at 2 00 joe biden gives his thanksgiving address from delaware. Coming up tonight at 8 00 Washington Post columnist george will discusses the impact of the trump presidency. United forews democracy is hosting this event. Orch live coverage online listen live with the free cspan radio app. Georgia senator Kelly Loeffler and democratic challenger will debate on sunday, decembers experience the race is one of two georgia runoff elections. It will be held on january 5. We have live coverage at seven 5 p. M. Eastern, online at cspan. Org or listen with the free cspan radio app. Wall street journal readers know Scott Mccarty for his column. He has been on the airline for nearly two decades. He joins us via zoom tuesday before thanksgiving