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Reflections of a Privileged White Male

This title is redundant. I am privileged because I am white and male.

I usually write about healthcare, employee benefits and insurance issues, but given the racial unrest in our country, I feel compelled to write about a much more complicated and emotional topic.

The senseless killing of George Floyd, another black man while in police custody, has rightfully brought shock and outrage to our country. But with our history of racism, prejudice and social injustice, shock and outrage has never been enough to overcome the inequalities that consistently plague racial minorities.

It is time to be honest with myself, and I implore you to do the same. I am a white male who is protected by our status-quo society, given unwarranted power and prestige at the expense of others. This privilege buffers me from the naked truth of what is happening to non-white citizens. I don’t know what life would be like without having that privilege. Consequently, how can I possibly understand the perspectives and struggles experienced by those without privilege? I simply can’t.  But it is imperative that I begin to try harder.

In 1984, while unknowingly taking a wrong turn on a one-way street in downtown Minneapolis, I was stopped by a police car, sternly directed to step out of my vehicle and place my hands on top of the car. I quickly complied. The officer then forcefully kicked my feet apart and told me that I was driving the wrong way – the interaction felt unnecessarily aggressive.

Despite my privilege – power through wealth, health and opportunity that others are not afforded because of the color of their skin – this simple traffic stop made me feel demeaned. I was humiliated, frightened and incensed about how I was treated. But, unlike George Floyd and too many other people of color, my life was never at risk.

Watching George Floyd’s brazen killing changed everything for me – in a very fundamental way.

Upon reflection, that experience of feeling demeaned 36 years ago makes me realize that privilege is the ability to get angry and see that moment as an isolated incident. That experience lasted 10 minutes…not a lifetime. My societal privileges have shielded me from the reality that people of color are at risk of experiencing much worse every day. I have been complicit by not speaking up about such social injustices.

Dr. Martin Luther King Jr. described this complicity: “A man dies when he refuses to stand up for that which is right. A man dies when he refuses to stand up for justice. A man dies when he refuses to take a stand for that which is true.”

I have not stood up as I should have.

It is said that any society, any nation, is judged on the basis of how it treats its vulnerable members. Dignity should not be discretionary and should be afforded to all people.

So how can we as Americans move forward from this history of systemic racism? I don’t have the answer. However, I do know for real change to happen, it must begin with a confession from me, and from each white American who comfortably accepts the privileges enjoyed. Merely believing you are ‘not racist’ is not enough. We must learn how to be anti-racist in our core beliefs and practices.

I am responsible for educating myself and can no longer remain silent. I must not tolerate ignorant or intentionally harmful actions or words aimed at people of color. Listening and learning are the first steps in the very long and critically important journey ahead. Voting is a necessity – insisting on policy and political reform to eradicate social injustices. We, as a society, must step up.

I do not write this because I am more enlightened than others. But change must start with me – and each of us, individually.  I must recognize that my societal privileges have been at the expense of those who are without. I can certainly do better. Our country can do much better – and together, we must.

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New Trend or Passing Fad?
Reliance on Foreign Drugs

This blog is the THIRD in a new series regarding the ‘unintentional consequences’ of the COVID-19 pandemic. As our lives have been abruptly altered due to social distancing requirements – both at home and in the workplace – unplanned ‘disruption’ of previous normal activities could permanently replace sacred elements once believed to be unyielding to any change. But COVID-19 just may have dictated new approaches to how we live and work.

NOTE: Running the risk of writing a xenophobia-like piece about foreign countries, this particular blog is intended to address a serious national security issue that has been neglected for at least two decades.

To borrow a phrase from the ‘Apollo 13’ movie, “Houston, we have a problem.” No, wait, we have a BIG problem!

If the COVID-19 pandemic has taught us anything, it’s that we must not become too dependent on outside countries for drugs and certain medical supplies – such as masks, gloves, ventilators and other personal protective equipment (PPEs). These dependencies can seriously undermine our health security, which is critical to our national security. But, over the past two decades, our country HAS increasingly become more reliant on foreign countries, especially China.

Interestingly, the pandemic just may serve as the catalyst to help remedy this problem.

The China Situation

A major event occurred in the year 2000 that triggered the U.S. to rely more on China for the supply of medications. Congress and the White House agreed to grant China access to the U.S. market, and permitted China to join the World Trade Organization. Shortly after, China developed the penicillin and Vitamin C ‘cartels,’ by basically replacing American manufacturers through the dumping of low-cost product into our country. As a result, American manufacturers could no longer compete against China’s government-financed manufacturers. China’s monopolizing behavior is also commonly found in many other manufacturing products from various industries. Pharmaceutical dependence on China can be found in an earlier blog that I wrote in 2019, “Dependence on China – The ‘Weaponization’ of our Medicine.

In 2019, The U.S. Food and Drug Administration (FDA) estimated that 80 percent of active pharmaceutical ingredients (APIs) and 40 percent of finished medications were manufactured overseas, primarily in China and India. Most generic drugs, including antibiotics, accounting for more than 90 percent of all U.S. prescriptions, are imported from India, but India imports 70 percent of their active ingredients from China.

Having a high concentration of our medicine coming from just one country, no matter the country, can become a major strategic risk to the health and security of our population. To function, the U.S. (and other countries) rely on having appropriately-manufactured medicine of high-quality with safe ingredients, reasonably-priced, and readily available. In fact, by ceding the manufacturing of medicine elsewhere, any country could be held hostage by a new warfare that has never been waged in the past – the weaponization of medicine.

During a congressional testimony in October of last year, Janet Woodcock, the FDA’s director of the Center for Drug Evaluation and Research, pointed out that drug production has moved out of the U.S. into other countries.  According to Woodcock, “The FDA doesn’t know whether Chinese facilities are actually producing APIs, how much they are producing, or where the APIs they are producing are being distributed worldwide, including in the U.S.” In short, the FDA does not know how dependent the U.S. is on China for its drugs!

National Emergency Order – Stafford Act

Addressing the pandemic on March 13, President Trump declared a national emergency under the Stafford Act, a 1988 law that presidents can use to declare disaster areas after storms and other natural disasters. This declaration granted that certain medical products and supplies, such as disposable gowns and drapes, be excluded from the 25 percent tariff imposed by the U.S. since September 24, 2018, on $200 billion goods imported from China.

These tariffs have increased concern about relying heavily on a single market (e.g. China) for critical medical and pharmaceutical products, forcing many U.S. organizations to rethink their China-based supply chains. It’s additionally anticipated that the Administration is preparing an executive order that would require certain essential drugs be made in the U.S. This executive order is believed to streamline regulatory approvals for “American-made” products and encourage the U.S. government, including the Departments of Defense, Health and Human Services and Veterans Affairs, to buy only American-made medical products.

To maintain independence from foreign control, streamlining regulatory approvals for American-made products and more detailed labeling of the origin of drug products could help facilitate American production at home.

Conclusion

Whether the novel coronavirus will be the tipping point for drug makers to adopt new technologies and resist the offshoring trend is yet to be determined. Preventing an interruption in the supply of vital medications and other medical products that save lives and treat diseases – whether during pandemics or in routine care – is a matter of national security. As our population ages, Americans will become even more dependent on medications indispensable for treating heart disease, cancer, stroke – and viruses. Mobilizing resources to mitigate the supply shortages is a strategy that must be paramount to our government and all policymakers.

The COVID-19 pandemic serves as a wake-up call for our government and the pharmaceutical industry to take notice – and act. If this particular opportunity is somehow tragically missed, then policy malpractice has been undeniably committed. Regardless of the political leanings one may have, we can all agree this should not be a red or blue issue – but an American one.

Next Week’s Discussion:  Fear of virus will propel smokers to quit.

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New Trend or Passing Fad?
Telehealth Services

This blog is the SECOND in a new series regarding the ‘unintentional consequences’ of the COVID-19 pandemic. As our lives have been abruptly altered due to social distancing requirements – both at home and in the workplace – unplanned ‘disruption’ of previous normal activities could permanently replace sacred elements once believed to be unyielding to any change. But COVID-19 just may have dictated new approaches to how we live and work.

Thanks to the COVID-19 pandemic, social distancing and stay-at-home orders during the past two months have made it difficult to have a face-to-face meeting with our doctor(s).

But necessity is indeed the mother of invention, and thankfully, telehealth – using email, video conferencing, online patient portals and other technologies – was already being used by some providers to aid in the delivery of patient care, typically to the benefit of rural patients.

Telehealth has been around for quite some time – at least a few decades. But its relatively steady growth trajectory has been refueled by the COVID-19 virus, prompting enhanced usage that we have not seen before. Patients, both young and old, have found a new method to safely seek care. Cleveland Clinic, as one example, has reported that demand for virtual visits is up more than 1,000 percent since the start of the pandemic.

For the sake of simplicity, I will be using the term telehealth interchangeably with telemedicine. According to HealthIT.gov, telehealth is different from the term, telemedicine, “because it refers to a broader scope of remote healthcare services than telemedicine.” Telemedicine refers to remote clinical services, while telehealth goes beyond clinical services to also include non-clinical services, such as provider training, administrative meetings and continuing medical education. Any reference to telehealth, therefore, also includes telemedicine.

Prior to the pandemic, telehealth usage wasn’t widely adopted in healthcare for many reasons. To understand the push-pull of telehealth, we must first understand the perspectives from patients and their healthcare providers.

Patient Perspective

For patients, telehealth can provide value and benefits for many key reasons, including:

  1. Less time in the doctor’s waiting room.
  2. No need to take time off of work.
  3. No transportation time or parking hassles.
  4. Reduced risk of obtaining infection while at doctor’s office.
  5. Eliminate child or elder care issues.
  6. More affordable.
  7. Access to specialists.

Telehealth, it must be noted, is not the panacea for every health-related scenario. A medical emergency or a difficult case to diagnose will still require a visit to the doctor or hospital. Telehealth can include physical exams, but depending on procedures performed (e.g. blood drawing, biopsy, X-ray, strep test) the process is more limited. But for wellness-related interactions, such as common office visits and mental health consultations, telehealth can be an efficient interaction process. A sample telehealth consent form offered up by the Agency for Healthcare Research and Quality provides easy-to-understand insight for patients who pursue telehealth services.

Physician Perspective

Physicians and hospitals, on the other hand, are a different story – at least prior to the pandemic. Generally, in the pre-COVID past, providers did not receive higher pay when using telehealth care, and most of the time, they received less pay for telehealth care when compared to in-office care.

With telehealth services, doctors would have to do essentially the same amount of work regarding time spent with the patient and documentation requirements, all while learning a new workflow to interact and treat patients. For this, the doctor is paid less for their time – something that few of us would want to experience in our own jobs.

Telehealth usage prior to the pandemic, therefore, struggled to quickly trend upward largely due to lack of payment parity with face-to-face office meetings. Without payment parity, telehealth did not see the growth gains that it currently has found under the current pandemic environment.

The value equation must also work for the health provider as it does for the patient.

Telehealth and the COVID-19 ‘Experiment’

With the advent of the virus epidemic, telehealth became an overnight ‘sensation’ for a few key reasons. To help providers experience telehealth as a value equation, Medicare is now paying for most visits and many private payers* waive virtual visit copayments, including Wellmark in Iowa. As of March 6, Medicare and some commercial insurers have said they will pay the same rate for video calls as for office visits.

*Some insurers have subsequently found, due to software problems, they are unable to immediately eliminate telehealth copays and cost sharing for millions of members. Additionally, carriers need consent from their self-insured clients to implement these policies.

Many states have relaxed, or deregulated, more stringent requirements for telehealth usage, including Iowa.  The Federation of State Medical Boards provides an updated listing of all states and their telehealth practices regarding COVID-19.

Stay-at-home orders offered legal risks if doctor offices and clinics stayed open and did not adopt telehealth services. Avoidance of legal risks and in-office infection, coupled with payment parity has made telehealth a tool for many health providers to finally embrace.

Going Forward

The value equation for both patients and doctors will be interesting to watch. When the virus finally simmers down and social distancing requirements are greatly relaxed, how will doctors react when their patients can safely return to visiting the doctor? Will the value equation for the doctor shrink from the heightened COVID period or will doctors look more long term on valuing physical distance for their own health, including staff members, and accept telehealth in the future?

Now that the genie is out of the bottle, will patients demand more telehealth services? Perhaps the patient experience during the COVID period will push patients to seek telehealth services elsewhere should their doctor reduce or eliminate the telehealth options in place during the pandemic.

How telehealth services are reimbursed from payers will certainly predict the future for telehealth. Will telehealth reimbursement to providers become more marginalized whereby payment parity is no longer being practiced by key payers? Perhaps payment parity becomes more prominent and, as a result, unleashes additional sophisticated telehealth services than what is provided today? Clearly, the opportunities are just as great as the barriers. The barriers can be difficult to accessing telehealth, such as absence of technology, digital literacy and reliable internet coverage.

The future of telehealth services looks extremely bright, but it will largely be dependent on how physicians view the value proposition of delivering this service to their patients. The COVID-19 pandemic may have provided the fortuitous nudge for telehealth to become a mainstream model of delivering healthcare to Americans. This will be a trend worth following!

Next Week’s Discussion:  Reliance on Drugs from Foreign Countries

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