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