The Healthcare Policy Podcast ® Produced by David Introcaso

During this podcast I read part two of a draft, yet-to-be-published essay titled, “Institutional Betrayal: HHS and the National Academy of Medicine’s Failure to Decarbonize the US healthcare Industry.” That the window formally closed in January 2025 means healthcare will not approach reducing its greenhouse gas emissions by 50% in 2030. HHS will continue to intentionally fund the industry’s harm-treat-harm business model meaning healthcare is by design traumatic. Iatrogenesis is built-in. Americans will become increasingly consumed by, not consumers of, healthcare.

Comments are of course welcomed.

During this podcast I read part one of a draft, yet-to-be-published essay titled, “Institutional Betrayal: HHS and the National Academy of Medicine’s Failure to Decarbonize the US healthcare Industry.” That the window formally closed in January 2025 means healthcare will not approach reducing its greenhouse gas emissions by 50% in 2030. HHS will continue to intentionally fund the industry’s harm-treat-harm business model meaning healthcare is by design traumatic. Iatrogenesis is built-in. Americans will become increasingly consumed by, not consumers of, healthcare.

Comments are of course welcomed.

This is the first of a two-part reading of a yet-to-be-published essay presently titled, “Institutional Failure: HHS and the National Academy of Medicine’s Failure to Decarbonize Healthcare.”

Comments are of course welcomed.

Thank you.

Unlike most rich countries or advanced economies the US does not define healthcare, including long term care, as a universal social risk – despite the fact we all get sick, no one knows their health status tomorrow, approximately 85% of Medicare beneficiaries have at least one chronic condition and life expectancy at birth is approximately 79 years. Medicare does not provide long term care, Social Security replaces just 43% of the average workers’ wages and only approximately 40% of retirees receive income from some form of employer or personal retirement plan.

With me to discuss Prof. Ghilarducci’s book is her colleague Ms. Je...

To state the obvious nutrition is considered the cornerstone of public health, a, if not the, primary preventative measure against chronic disease. Nevertheless, the OBBBA cut SNAP funding by an estimated $187 billion; since the start of the pandemic food prices have increased by roughly 30%; and, going forward are at risk due to uncertain trade policy, global shocks including the ongoing war in Iran, water supply/access and widespread drought and other climate-related issues include the looming super El Nino event that is expected to disrupt planting cycles worldwide and breach thermal safety margins - causing most major crops to...

Not surprisingly healthcare affordability has risen to the top or #1 mid-term election campaign issue.

Largely due to pricing failure, that costs Americans about $250 billion annually, pricing power is the consequence of an increasingly concentrated healthcare market. Think: Herfindahl-Hirschman Index scores. Hospital pricing/prices are particularly noteworthy or moreover surgical procedures and patented drugs that have risen at multiples of the annual inflation. This means those insured pay increasingly higher coverage (premiums, deductibles, copays) and are forced into medical debt or bankruptcy, forced to avoid necessary care and/or make financial trade offs. Insurance plans, here we’re di...

Per my May 2025 interview with Stanford’s Chris Callahan regarding his April 2025 “Nature” article titled, “Carbon Majors and the Scientific Case for Climate Liability,” we know that among the 90 companies responsible for 63% of industrial GHG emissions over the past 200 years, 83 are fossil fuel companies.

Two weeks ago Senator Cruz (R-TX) and four other Republican senators dropped their “Stop Climate Shakedown’s Act.” In part the legislation would prohibit retroactive liability, mandate dismissal of pending climate liability lawsuits in several states and preempt state authority, e.g., outlaw state climate superfund laws (think: NY and VT).

The bill was lar...

Listeners are all well aware US healthcare is increasingly unaffordable. Among other stats nearly 50% of Americas are either uninsured, at 8% or 27 million, or underinsured, at 41% or 120 million. Upwards of 4.8 million Americans are expected to drop their ACA coverage; the average commercial family plan comes w/a $6,800 annual premium and 42% of Americans are now enrolled in high-deductible commercial health plans. As a result 36% of all adults now skip or postpone medical care. Though I’ve likely previously cited, the Noble Prize-winning Princeton economist Angus Deaton concluded in 2020, the US healthcare industry,

“is a cancer at the heart of the...

Over the past 12 years the Affordable Care Act (ACA) has reduced the total number of uninsured Americans and low-income individuals more specifically by over 50% and by over 66% for young adults. In 2025 the ACA insured a record breaking 45 million Americans: 24 million through the federal and state exchanges; and, 21 million via the ACA’s expansion of the Medicaid program. Having been under nearly continual attack by Republicans, the proposed 2027 ACA rule, announced February 9th (with comments due March 13), was highly anticipated. Within a week after it was announced, Professor Keith and her colleague Matthew Fielder authored three lengthy essays unpacking numerous pr...

Podcast listeners are aware US healthcare, the largest industry in the world’s largest economy, consumes- and wastes a massive amount of carbon-based energy made painfully evident by the fact annual greenhouse gas emissions account for over 600 million metric tons of carbon dioxide equivalents. Healthcare’s extraordinary or excessive energy consumption means it is a high entropy producer, one that is s responsible for a great deal of (literally) unaccounted for waste, termed more formally negative externalities. What this means in sum is the US healthcare industry works directly against itself. For example, the annual social costs of just thre...

Listeners may recall I interviewed Ms. Smith early last March because the Trump administration immediately abandoned a decades old policy that forbade immigration enforcement at “protected [or sensitive] areas” that include healthcare facilities. Now a year later, ICE contingents have been sent to over 15 cities including of course Minneapolis. Beyond ICE arrest operations resulting in gunshot wounds, blunt force and psychological trauma and a constellation of subsequent health harms via arrest and detention, ICE agents have been appearing moreover in community health center and hospital ED waiting rooms, accessing facility medical examination rooms and pursuing Medicaid and other patient reco...

Over the past few weeks the Trump administration has significantly upped its game to eliminate greenhouse gas regulations that protect human and global health. The Sabin Center on Climate Change Law’s “Climate Backtracker” database presently identifies over 320-related administrative and regulatory actions that in sum undermine the EPA’s mission to protect human health and the environment. Most recently, the US has withdrawn from the United Nations Framework Convention on Climate Change (UNFCCC) and 65 other related international organizations, rescinded National Environmental Protection Act’s (NEPA) implementing regulations and moved to roll back automotive fuel efficiency standards by nearly 33%. Concerning...

To begin my 14th year of podcasting, my 335th interview is with John Abraham, Professor of Thermal Science and Fluid Mechanics at the University of St. Thomas. Prof. Abraham joins me for a fifth time or for a fifth consecutive year to discuss ocean warming in 2025 and the increasingly frightening consequences thereof.

Last Friday, Prof Abraham along with 54 research colleagues published in “Advances in Atmospheric Sciences” the article, “Ocean Heat Content Sets Another Record in 2025.” Their research found that in 2025 oceans absorbed 23 zetajoules (n followed by 21 zeros) of heat (30% more than in ’2024), a finding consistent with the fact that...

At least one in four girls suffers childhood sexual abuse. For example, the Department of Justice (DoJ) concluded Jeffery Epstein trafficked over 1,000 girls, some as young as 14. Nevertheless, six years after Epstein’s reported suicide, the Trump Administration’s 2026 budget proposes to entirely delete a subsection of federal law that requires DoJ’s Office of Violence Against Women to be “a separate and distinct office” and proposes to cut the Office of Violence Against Women’s budget by nearly 30%. Per the CDC’s Adverse Childhood Experiences (ACEs) study, launched over 25 yrs ago, at least 1 in 4 girls and 1 in 20 boys are sexually a...

The US has effectively always suffered a physician shortage. Last year the AMA estimated a shortage of 86,000 by 2035. US policymakers have since 1965 addressed this problem by recruiting foreign born physicians (termed Foreign Medical Graduates or FMGs), mostly from Southeast Asia, largely India. Today FMEs, that account for 25-30% of the physician workforce, are disproportionately employed in Health Professional Shortage Areas or HPSAs in which there remains or persists a strong demand, e.g., HRSA recognizes over 7,500 primary care HPSAs. Nevertheless, Prof. Alam concludes stratifying our medical system can be interpreted in part as a cover up to a problem...

Over roughly the past year Prof. Blumberg and her Georgetown Center for Health Insurance Reform (CHIR) colleagues have been researching healthcare providers and payers increasing use of third-party entities they collectively termed “middlemen” with whom providers and payers contract to provide various supportive administrative or financial services. For example, payers frequently use of Third Party Administrators/TPAs and providers of Revenue Cycle Managers/RCMs. The use of middlemen is a problem because these entities are “rent seeking,” meaning they profit without creating new or additional value, thereby reducing economic efficiency and competition and driving prices up. In CHIR’s October re...

Even though PC is the only component of healthcare shown to increase life expectancy and is crucial to achieving healthcare equity, outcomes, quality and value PC remains on life support. For example, an August National Academy of Medicine report concluded, “despite PC’s essential value for the health of the nation, more than 100 million people across rural and urban communities in the US are experiencing a calamitous lack of access to primary care.” Among numerous problems: PC accounts for less than 5% of total healthcare spending; there are too few primary care clinicians and too many, at 7,501, HRSA PC shortage areas...

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 n...

This past summer CMS, more specifically CMMI, announced a six-year Medicare Part A demonstration that would require hospitals in six states to submit claims for prior authorization (PA) approval by non-medical, CMS-contracted, 3rd party entities using enhanced technologies, i.e., AI, for 17 medical items and services. Private/commercial Medicare or Part C Medicare Advantage plans have for years extensively used PAs though data suggests Medicare Advantage PA use has been excessive, e.g., a very high percentage of PA denials are reversed upon appeal) and widely viewed as a tool to enhance profit taking. CMMI-contracted tech/AI companies will...

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 foun...

Recently published research by Prof. Wrigley-Field and her colleagues found that between 1980 and 2023 the total number of US excess deaths equaled 14.7 million. Between 2010 and 2023 excess deaths ranged between 120% and 130% higher compared to other HIC (High Income Countries). Possibly more disturbing the authors found US excess deaths were moreover among working-age adults, for example, in 2023 excess deaths among US adults aged 25-44 were 2.6 times higher than in other HIC. That same year excess deaths remarkably made up almost 23% of all deaths and 46% of excess deaths were among people younger than 65 years. The causes of excess deaths since 1980 have on balance...

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...

On July 23rd the United Nations’ International Court of Justice (ICJ) announced its highly-anticipated climate advisory opinion. The opinion represents a watershed moment because the court ruled states or countries are accountable for contributing to anthropogenic warming or for their GHG emissions. Consequently, the ICJ concluded countries are legally obligated to ensure the climate is protected from GHG emission, if not, countries - and private actors such as healthcare - can be held culpable for failing to do so. Though an advisory opinion the ICJ ruling has significant implications for US healthcare largely because US healthcare annually accounts for a...

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 dec...

Last week’s signing of the OBBBA serves as federal policymakers’ latest reverse Robin Hood effort, or to redistribute wealth from the poor to the rich. Per a February RAND report, over the past 50 years $79 trillion in wealth has been redistributed from the bottom 90% of Americans to the top 1%. The 2017 Trump tax cult left billionaires $6 trillion richer and the OBBBA, otherwise termed the Bill for Billionaires Act, is expected to achieve similar of not greater results largely because the number of billionaires has dramatically increased to nearly 2,000 over the past decade. The legislation is (partially) offset moreover by cutting Medi...

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...

Frequent listeners of this podcast are well aware healthcare emits an immense amount of carbon pollution at over 600 million metric tons annually. This is substantially due to energy waste or inefficiency. For example, hospitals, that account roughly 35% of the industry’s GHG emissions, loses or forgoes tens billions in annual revenue or explicit and implicit lost opportunity costs. Healthcare pays in several ways for its energy inefficiency. Among other reasons, though one of the world’s most high tech sectors, healthcare still largely consumes electricity produced by burning fossil fuels. Heat-generated electricity is significantly less efficient than use of rene...

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 b...

Despite the fact US healthcare has $7.6 trillion market cap and is beyond capital intensive, industry executives have been loathe to divest in fossil fuels. For example, per “The Lancet’s” 2023 and 2024 annual “Countdown on Health and Climate” reports, between 2008 and 2023 of the 1,613 institutions committed to divesting in fossil fuels, only 28 were healthcare institutions and since 2018 only one has committed to doing so. Among numerous other reasons why this is, to be polite, disturbing, if not evil, is because: fossil fuel investments substantially explain healthcare’s massive carbon footprint at over 600 MMT of CO2e annually; anthropocentric warming poses the greatest thr...

US healthcare costs and spending are extreme made evident by the fact healthcare at a $5 trillion annually accounts for roughly half the global healthcare market. This reality led Princeton’s Nobel Prize Economist Angus Deaton to conclude in 2020, “the industry is a cancer at the heart of the economy.” Though healthcare costs are projected to rise 7 to 8%, this year, cost growth over the past 15 plus years plus has not on average exceeded GDP growth - made evident by the fact that while the 2020 Medicare Trustee report concluded the Medicare hospital trust fund would be bankrupt by 2026, the most recent report...

At present, measles, one of the most contagious communicable diseases for which there is no treatment, disproportionately sickens - and kills - preschoolers. The outbreak is present today in 21 states ranging from Alaska to Vermont. As of last Friday, this year has already seen 607 confirmed cases, 72% of cases were among those age 5 to 19 and 97% of those infected were either unvaccinated or their vaccination status is unknown. For comparison, for five-year period ending in 2024 the average number of annual measles cases equaled 105.

The measles, mumps, and rubella (MMR) vaccine is exceptionally effective and when immunization is greater than 95...

The Trump administration has made no secret it intends to aggressively enforce immigration laws, made evident by the recent arrest of a Columbia University grad student and green card holder on Columbia’s campus. Since the White House has repeatedly stated it intends to deport roughly all 12 million undocumented immigrants, this presents an immediate problem for healthcare providers who, in part, have legal and ethical obligations to all their patients. This is particularly true ironically for HHS-regulated Federal Qualified Health Centers (FQHCs) who serve 32 million largely racial/ethnic minorities who, because they are largely poor and medically disenfranchised, are di...

Two weeks after being sworn in, last Friday HHS Secretary Robert Kennedy announced, “effectively immediately, the [1971] Richardson Waiver is rescinded and is no longer policy of the Department.” He explained his decision by stating “the extra-statutory obligations of the Richardson Waiver impose costs on the Department and the public, are contrary to the efficient operation of the Department, and impede the Department’s flexibility to adapt quickly to legal and policy mandates. “ The waiver, issued by President Nixon’s HEW Secretary, Elliot Richardson, effectively meant HHS would use the 1946 Administrative Procedure Act’s “notice of proposed rule making” (NPRM) process broadly an...

Last year was the first calendar year with a global mean temperature of more than 1.5°C above the 1850-1900 average. Since 90% of global warming is occurring in the ocean, due to the earth’s rising energy imbalance resulting from continuing and increasing GHG emissions, not surprisingly research published in “Environmental Research Letters” in late January concluded ocean temperatures for the 450 day period between April ’23 and July ’24 were the warmest ever. Ocean surface temperatures are now warming 40 times faster than 40 years ago. As I’ve noted in previous discussions with Prof. Abraham, because warming oceans/ocean heat content plays a fundamental r...

Under the Biden administration the US once again became the world’s largest producer of oil and gas. Because all fossil fuels projects are politically constituted via permitting, etc., it is no surprise that of the nearly $7 trillion of fossil fuel investments since the 2015 Paris Accord, almost $2 trillion has been provided by six US banks including Citi.

Cancer alley, the nickname for a stipe of largely Louisiana coastline, is home to over 200 petrochemical plants, refineries and ports. As the name implies, per the EPA, cancer alley residents are exposed to over ten times the level of health ri...

To begin my 14th year podcasting . . . , per the Sabin Center for Climate Change Law at Columbia Unversity, as of last September there were 1,850 climate crisis-related cases filed in the US challenging climate policy under constitutional, federal statutory including securities and financial regulations, state law claims and under several other categories. Law suits have been and will continued to be filed for the simple reason Congressional lawmaking and state legislating have failed to legitimately address the climate crisis, i.e., reduce CO2e emissions. Ms. Rodgers, Deputy Director, US Strategy at Our Children’s Trust, a public interest law firm de...

After heart disease cancer is the leading cause of death in the US. Forty percent of Americans will be diagnosed with cancer in their lifetime. Timely diagnosis and treatment of cancer has always been a concern made worse by the COVID pandemic and the ongoing problem of un- and under-insurance. Another reason for concern is the increasing use of networked-based social media sites used to advertise bogus cancer cures, particularly to Generation Z, or those 27 or under, who increasing use social media sites as de facto search engines. Dr. Baker’s recent research reveals health disinformation is rife on Ti...

The human rights/public health crisis known as US border policy serves as further proof of what Richard Hofstadter termed in 1964 the “paranoid style in American politics.”  To his credit Mr. Washington’s work attempts explain the recent phenomenon of closed or militarized borders here and around the world.  Closed borders, Mr. Washington explains, are responsible for untold human suffering that cannot be legitimately explained as efforts to protect our economy, government budgets, our environment and our sense of sovereignty or nationalism.  They do not limit migration, protect communities from crime and violence or dystopian-level anarchy, are counterproductive in addressin...

Beyond roughly 1,700 NFL players, five to six million children participate in tackle football.  As a collision sport, brain (or TBI) and other neurological, bone, joint, ligament, muscle, organ and tendon injuries are commonly occur and frequently develop into long-term chronic conditions, particularly chronic pain.  Not surprisingly, the avg life expectancy of an NFL lineman - who played as few as one game - is just 55 years of age.  Prof. Goldberg’s book examines how the NFL has for decades masterfully, successfully employed a set of strategies or scripts termed the “Manufacture of Doubt,” to avoid governmental regulation.  The NFL’s success co...

Harvard Chan School of Public Health’s Dr. Troy Brennan argues in sum that because government Medicare, Medicaid and ACA marketplaces have grown and evolved, meaning the feds have improved their ability to competently regulate the healthcare market, employer-sponsored commercial plan coverage has become both comparatively unaffordable and increasingly irrelevant. Primarily for these reasons Dr. Brennan argues the US is headed toward or on the path to federally-sponsored and regulated healthcare administered by private or commercial payers. That is it appears increasingly likely the US will finally realize universal, socialized, single payer healthcare insurance or what he defines as Me...