U.S. Surgeon General Says Working Together Is Key To Combating Opioid Crisis
U.S. Surgeon General Jerome Adams, shown here testifying before a Senate committee in 2017, says President Trump’s top health priority is addressing opioid addiction.
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About a month ago, President Trump declared the opioid epidemic a public health emergency. He’s spent a lot of time talking about the severity of the drug crisis. But he’s spent less time outlining the specific steps he’ll take to fight it. Today, a White House analysis declared that the true cost of the opioid epidemic in 2015 was more than half a trillion dollars.
As Trump formulates his plan, All Things Considered’s Elise Hu spoke with Dr. Jerome Adams, the president’s surgeon general, about what’s next. Excerpts of the interview follow, edited for length and clarity.
What actions should we expect to see from the president and when?
One of the things that I should mention that folks may not realize, that administration has already spent more than $800 million on prevention treatment and for naloxone for first responders. I think getting that funding out to communities is one very important thing the administration is working on … As Surgeon General of the United States, the nation’s top public health advocate, I’m focused on prevention and helping folks understand how we can prevent the start of addiction in our citizens.
Patrick Kennedy, the former Congressman who served on the White House Opioid Commission, suggested that it would take at least $10 billion to fight this epidemic. Do you expect the president to ask for that money from Congress?
Well, the president has already asked for a significant amount of money in his pleas to Congress. Ultimately it’s going to be up to them to decide how much they give us and how. But what we know is Congress isn’t going to give us enough money to tackle this epidemic alone. It’s going to take federal, state, and local efforts. It’s why I’m trying to partner with the business community, with the law enforcement community, and bring all partners to the table. This is a national problem that has taken decades to come to pass. It’s going to take all of us on deck if we’re going to tackle it.
Do you think this epidemic can be brought under control without additional money from Congress?
To answer your questions directly, no. But I’m also confident that with Congress and the president working together, we will get additional funding. My part is making sure … we’re bringing other resources to bear, to help tackle this epidemic.
You mentioned that you support more funding in general, but can you give us an example of a bill that the president has supported that did have some sort of appropriation tied to it?
Well, the Affordable Care Act repeal that the president put forward had funding attached to it for attacking the opioid epidemic.
But then that would have gutted Medicaid?
That’s some folks’ contention. Again, that’s going to be up to Congress to sort out. I know that one of the ways that folks have talked about reforming health care is through Medicaid block grants. And there are different folks with different opinions about what would happen in different scenarios. At the end of the day, what I’m focused on is making sure we maintain funding to respond to the opioid epidemic, and I believe the president has expressed that he’s behind that, also.
I want to ask you a little bit more about what’s shaped your personal view on opioids. You were a practicing anesthesiologist during the early years of the epidemic. You’ve talked about being in the position of writing prescriptions for fentanyl and morphine. How did that on the ground experience shape your understanding of this crisis?
Well, as a public health advocate again I was at the helm during the Scott County (in Indiana) HIV outbreak and saw firsthand the progression from overprescribing to heroin use and ultimately to HIV. So I’ve seen it play out in real life and had to deal with it a very real sense. As a physician, I’ve prescribed narcotics, I’ve prescribed naloxone to people. I know how these medications work and I feel that I’m in a key role in terms of being able to educate the public about what these drugs are and what they aren’t….
Personally, I’ve dealt with it. I’ve visited my brother in state prison just recently. He’s still trying to get treatment for his addiction so I want folks to understand, I share that story, because I want folks to understand that addiction is a chronic disease and that if we don’t treat it as such, we will be doomed to continue in this vicious cycle.
A lot of people whose families have been touched the way that yours has are waiting for the president to take more substantive action. Many of them are saying they’ve heard promising statements, like the public health emergency declaration, but that they lack substance. So what would you tell them?
I would tell them that number one, the president formed his commission on opioids back in March. They put out nine different recommendations in the initial report, and the Department of Health and Human Services has addressed all nine of those recommendations. They’ve put out another 50 plus recommendations in the final report. And we’ve already been working on most of those.
While folks are frustrated, and I understand that they’re frustrated because we’ve got over 150 people dying every day from overdoses, we’ve had our foot on the gas from day one that I’ve been in this position, and even before, the president came out and said, this is his top health priority. We will get there, I’m confident we will, but we will only get there working together.
Ana Lucia Murillo and Elise Hu contributed to this report.
Massachusetts Set To Approve Law Protecting Access To Birth Control
Supporters of women’s health rally outside the Supreme Court in Washington, D.C., March 23, 2016, as the Court hears oral arguments in seven cases dealing with religious organizations that want to ban contraceptives from their health insurance policies on religious grounds.
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Massachusetts Gov. Charlie Baker was expected to sign legislation on Monday that would cement in state law the Obama-era mandate for free birth control regardless of changes in federal policy or future repeal of the Affordable Care Act.
The bill quickly sailed through the state legislature earlier this month, after President Trump signed an executive order in October allowing any company or nonprofit organization to opt out of providing coverage due to a religious or moral objection.
The Massachusetts law will go into effect immediately after it is signed, though insurance companies have six months to implement the changes, Carey Goldberg, editor of WBUR’s CommonHealth blog, tells Here & Now’s Robin Young.
The law is “basically saying to Massachusetts women, ‘Look, don’t worry. No matter what happens in Washington, here in Massachusetts your birth control is going to stay covered and free’ ” with no co-pays, she says.
The law also goes one step further and expands coverage, Goldberg says, by allowing insurers to cover a full year of birth control pills at once and emergency contraception, such as the morning after pill, must be covered without a prescription.
After Trump approved the policy change, the Department of Health and Human Services said only a small percentage of women would likely be affected by it. They said only about 200 companies who sued the federal government after the Affordable Care Act became law are expected to request waivers.
But some health policy experts warned the new rule creates a loophole that allows any employer to claim an exemption, which would require female employees to pay the full cost of birth control out of pocket.
Adam Sonfield, a senior policy manager at the Guttmacher Institute, echoed that concern, telling NPR last month “these new exemptions are sweeping,” adding that there are no provisions in the law to appeal them.
Goldberg says the Massachusetts law essentially circumvents the executive order and any future policy changes at the federal level.
“Massachusetts insurers can only get an exemption from this law and opt out if they’re a church or another religious institution,” she explains. “If they don’t qualify for that category, then they can’t opt out of birth control coverage, and if they try, that’s probably a matter for the courts.”
In fact, Trump issued the new rule in response to the Supreme Court’s split rulings on the issue. Several organizations filed suit against the birth control mandate, which says all employer-provided health insurance must cover preventative health care, including “all Food and Drug Administration approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity.”
In 2014, the court ruled in favor of the Hobby Lobby chain of craft stores, saying private companies could reject the requirement on religious grounds.
In a similar suit brought by the Catholic religious order The Little Sisters of the Poor, the justices were divided, arguing the nuns shouldn’t face fines for refusing to follow the rule. The court ordered both sides to work out a solution, but before an agreement was reached, Trump changed the rule.
More than a dozen states have already moved to shore-up birth control laws since Trump took office, according to the Guttmacher Institute.
Though Massachusetts legislators have been working on this bill for months, the fast, near-unanimous passage of the law sends a message to the Trump administration and other states, says Elana Margolis of Blue Cross Blue Shield of Massachusetts.
“We’re setting an example. We’re showing how different thoughts and opinions can come together and find common goals,” she says. “And we’re saying that we’re willing to move first, fast and frankly, furiously to get it done.”
The Many Forms, Faces And Causes Of PTSD
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Post-traumatic stress disorder is often associated with combat, but trauma comes in many forms.
About 7 or 8 percent of people experience PTSD at some point in their lives, according to the Department of Veterans Affairs. The rate is higher for women than for men: about 10 percent compared with 4 percent. Experiencing sexual assault or child sexual abuse, or living through accidents, disaster or witnessing death can all be contributing factors, in addition to time in combat with the military.
NPR’s Weekend Edition wanted to hear from those people who have struggled with PTSD, but not because of the reasons we often hear about.
Michael Coleman says he faced stress on a daily basis as a social worker in North Carolina. He worked for the government investigating foster care in the state for 13 years.
“When you knock on someone’s door, they’re not happy to see you,” he tells NPR’s Lulu Garcia-Navarro.
“There’s physical abuse or sexual abuse,” he says. “There’s pretty severe neglect in cases.”
He’s shown up to houses with kids bleeding; he’s interviewed kids with bruises at school. He had to visit “known drug houses,” where his knees would start shaking before he even got out of his car.
Coleman didn’t notice any symptoms of PTSD until after he quit that job to become a vocational counselor.
If someone asked him about his old job, he’d get emotional, he says, even at the bar with friends. “When you’re crying into your beer, you’re like, ‘Why is this happening?’ “
His new supervisor suggested seeing an employee assistance counselor after he would get emotional at work and have to go home early some days.
The idea of having PTSD didn’t even cross his mind.
“My father is a Vietnam vet. My mother is a refugee. I have been around military veterans all my life and never would associate their PTSD the way I would with me,” he says.
“I’ve never been through things like that, so once again it just never occurred to me.”
The counselor asked if he’d worked with people who experienced domestic violence: yes. Did he work with people who were sexually and physically abused? Yes. Did they experience PTSD? Yes.
” ‘Well, they weren’t veterans,’ ” Coleman remembers the counselor telling him. “Then she kind of turned it around on me, she goes, ‘Then why not you?’ That just hit me really heavy.”
He says he’s doing better now — “I’m comfortable where I’m at.”
Some of the symptoms Coleman talked about matched the “classic symptoms” of PTSD, Sandro Galea of the Boston University School of Public Health says.
Re-experiencing traumatic events; feeling both jumpy and withdrawn at the same time; avoiding reminders of his “time around the traumatic event.”
Galea says having “post-traumatic” as part of the condition’s name can be a little misleading.
“We know now that the lifetime experience before the trauma, the nature of the trauma itself, and what happens to you after the trauma — even though unrelated to trauma — all matter for whether you are going to get PTSD,” he explains.
Unrelated stress afterward can have an effect on the symptoms, he says.
It’s possible for most people to recover from PTSD with treatment — both cognitive behavioral therapy (talking) and medications have been shown to be effective.
But fewer than a third of people who could benefit from help actually get it, Galea says.
If you don’t know where to turn, he says a good first step is reaching out to a primary care doctor, who can connect you with the right mental health professional.
The goal of treatment, he says, is “helping the person suffering these symptoms [to] recognize the physiological stimuli, adapt to them, and move on with what the person would like to do.”
Mileha Soneji: Can Simple Innovations Improve The Lives of Parkinson's Patients?
Part 1 of the TED Radio Hour episode Simple Solutions
About Mileha Soneji’s TED Talk
When designer Mileha Soneji’s uncle got Parkinson’s, his quality of life deteriorated rapidly. Mileha couldn’t cure her uncle’s disease, so she designed simple ways to improve his everyday life.
About Mileha Soneji
Mileha Soneji is a strategic product designer from Pune, India. She studied design at MIT and earned a master’s degree in strategic product design from Delft University in the Netherlands.
Her experience working as a designer in India and the Netherlands has taught her the importance of thorough research to find innovations that will best serve the user.
Her work includes designs for people with disabilities, from the No Spill Cup to a staircase illusion that helps Parkinson’s patients walk more easily.
Amos Winter: How Do You Build An All-Terrain Wheelchair For Under $200?
Part 5 of the TED Radio Hour episode Simple Solutions
About Amos Winter’s TED Talk
In many countries, uneven and unpaved roads make it hard to get around in a standard wheelchair. MIT engineer Amos Winter describes his design for a lever-powered all-terrain wheelchair under $200.
About Amos Winter
Amos Winter is an Assistant Professor of Mechanical Engineering at MIT. He is the Director of the Global Engineering and Research (GEAR) Lab, which creates technological solutions for emerging markets and developing countries.
Winter is the principal inventor of the Leveraged Freedom Chair, an all-terrain wheelchair designed for developing countries that was a winner of a 2010 R&D 100 award. He is a founder of Global Research Innovation and Technology (GRIT).
Canadians Root For An Underdog Health Policy Idea From The U.S.
The Centers for Medicare and Medicaid Services — and its controversial center for innovation — is part of the U.S. Department of Health and Human Services, and has its headquarters outside D.C., in Woodlawn, Md.
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Jay Mallin/Bloomberg via Getty Images
Ask people in Canada what they make of U.S. health care, and the answer typically falls between bewilderment and outrage.
Canada, after all, prides itself on a health system that guarantees government insurance for everyone. And many Canadians find it baffling that there’s anybody in the United States who can’t afford a visit to the doctor.
So even as Canadians throw shade at the American hodgepodge of public plans, private insurance, deductibles and copays, they hold in high esteem a little-known Affordable Care Act initiative: the federal Center for Medicare & Medicaid Innovation.
CMMI was a hot topic on a reporter’s recent visit to Toronto to study the single-payer health care system.
Wonky as it seems, the center’s mission — testing innovations to hold down health care costs while increasing quality — is drawing praise from many policy analysts. Researchers and clinicians talk about its potential to foster experimentation and how it has led the United States to think creatively about payment and reimbursement models.
“It is gaining traction in many circles here,” says Dr. Robert Reid, who researches health care quality at the University of Toronto.
Thanks to the ACA, the center for innovation is equipped with $10 billion each decade and sponsors on-the-ground experiments with doctors, health systems and payers. The idea is to devise and implement payment approaches for health care services that reward quality and efficiency, rather than the number of procedures performed.
“There have been some good efforts — they have tried more things than we have,” agrees Dr. Kaveh Shojania, an internist at same university who studies health care quality and safety.
Still, despite the praise emanating from north of the border, the U.S. program doesn’t get the same love on the homefront. Since taking office, President Donald Trump has moved to roll back the center’s reach.
Canada has its own reasons for seeing potential in this sort of systemic test kitchen.
Health care’s growing price tag — and a payment system that doesn’t always reward keeping people healthy — is not just an American problem. The vast majority of Canadian doctors are paid through what Americans call the “fee-for-service” model. And Canadian policymakers are also looking for strategies to curb health care costs — which are a big part of federal and provincial budgets in Canada, too.
“The whole world is confronting the same issue, which is, ‘How do you pay and incentivize doctors to keep people out of the hospital and keep them healthy?’ ” says Dr. Ezekiel Emanuel, a former adviser to President Barack Obama, who pushed for the center’s initial development.
“Different places are looking at how to break out of that system, because everyone knows its perversions,” Emanuel says. “This is one place where … we are in the world among the most innovative groups.”
Emanuel says he’s not surprised to hear of the center’s appeal in Canada. He has received similar feedback from health ministers in Belgium and France, he says.
Even so, U.S. critics say CMMI’s work is a waste of money or a federal overreach.
And, so far, the Trump administration has taken steps to reduce by half the size of one high-profile Obama administration project that bundles payments for hip and knee replacements. Under the bundling program, the hospitals performing those are paid a set amount, rather than for individual services. The administration has also canceled other scheduled “bundling” projects that target payment for cardiac care and other joint replacements.
Seema Verma, Trump’s administrator of the Centers for Medicare and Medicaid Services, wrote in The Wall Street Journal in September that the innovation center was going to begin moving “in a new direction.”
A federal document recently issued by CMS suggests that the center for innovation will now emphasize cutting health care costs through strategies like market competition, eliminating fraud and helping consumers actually shop for care. It also says the innovation center will favor smaller-scale projects.
At least for now, it’s hard to interpret exactly what this means, says Jack Hoadley, a health policy analyst at Georgetown University who has previously worked at the Department of Health and Human Services.
Limiting CMMI’s footprint in the U.S. would be problematic, Emanuel says.
Meanwhile, the center’s influence in Canada, seems to be growing.
“We definitely looked to it as a model as something we can do. Like look, this happened, and why can’t we do the same thing here?” says Dr. Tara Kiran, a Toronto-based primary care doctor who also researches health care quality.
The nonprofit health newsroom Kaiser Health News is an editorially independent part of the Kaiser Family Foundation.Shefali Luthra covers health care for KHN. She’s on Twitter @shefalil.
What To Make Of A Head-To-Head Test Of Addiction Treatments
Greg Miller shows the Suboxone medication in 2016 that he has taken daily for his addiction to painkillers.
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Addiction specialists caution against reading too much into a new study released this week that compares two popular medications for opioid addiction. This much-anticipated research is the largest study so far to directly compare the widely used treatment Suboxone with relative newcomer Vivitrol.
Researchers who compared the two drugs found them equally effective once treatment started. But there are fundamental differences in the way treatment begins, which makes these findings difficult to interpret.
Vivitrol, an injection of naltrexone that lasts 28 days, has gained a foothold among treatment providers, especially those working with the criminal justice system.
Until recently, no major study had compared it to Suboxone, a combination of buprenorphine and naloxone that is taken by mouth daily.
Now researchers have found the two medications to be equally effective at preventing relapse once patients start treatment, according to a study published Tuesday in The Lancet. A smaller, shorter study out of Norway that was published in October came to a similar conclusion.
But the Lancet study highlights a limitation for patients starting on extended-release naltrexone: Patients have to detox before receiving their first dose of Vivitrol. That requirement creates a significant barrier to beginning treatment, says Dr. Joshua Lee, associate professor at the NYU School of Medicine and lead author of the report.
“It’s going to take a few days or a week or more to get them on naltrexone in the first place,” he says. “And that detox hurdle does not exist for buprenorphine.”
Still, the research indicates that it would be advisable for treatment providers to offer both medications, he said. “Relapse rates are extremely high if you don’t get onto and continue a medication,” said Lee.
The two medications work in very different ways. Buprenorphine (like another addiction medication, methadone) is a long-acting opioid that’s taken daily. There are decades of research showing that it helps reduce cravings and prevent withdrawal symptoms.
The Lancet study looked at a combination of buprenorphine and naloxone, which reverses the effects of opioids and is designed to prevent users from injecting or snorting the medication. Naltrexone is an antagonist — it blocks receptors in the brain and prevents opioids from having any effect. Vivitrol, which is delivered as a monthly injection, was approved to treat opioid use disorder in 2010 and until recently, no studies comparing buprenorphine and Vivitrol had been published.
“We’ve had trials of each one, but not together,” said Lee. The latest study followed 570 patients from inpatient detoxification centers. They were randomly assigned to one of the drugs for six months. “Once people were on either one, they did reasonably well over time,” said Lee.
But because extended-release naltrexone can throw people into withdrawal if administered too soon after opioid use, patients must first go through detox — abstaining from drug use — which often causes debilitating flu-like symptoms for several days. More than a quarter of patients assigned to naltrexone didn’t complete detox, and most of them relapsed.
Buprenorphine treatment doesn’t require patients to go through detox. “So up front there’s a clear clinical advantage,” said Lee. “Buprenorphine products are clearly easier to use.”
Alkermes, the company that manufactures Vivitrol, has heavily marketed its flagship product to nonmedical professionals. As NPR and Side Effects reported earlier this year, the company has targeted lawmakers, judges and other criminal justice officials — people who may be ideologically opposed to using opioids to treat opioid addiction — in order to boost sales of its drug.
Given the tendency for criminal justice officials to favor non-opioid treatment options, Dr. Camila Arnaudo, an addiction psychiatrist who teaches at the Indiana University School of Medicine in Indianapolis, said she worries people will oversimplify the results of the study. “I’m a little bit concerned about headlines that I’ve already seen,” she said, many of which have indicated that the products are equally effective, leaving out the caveat that many people initially failed out of treatment with extended-release naltrexone. “I’m concerned that it’s going to lead to policies where patients are shunted into treatment with extended-release naltrexone, which is more acceptable to the criminal justice system.”
She cautions people against reading too much into any one study, and pointed again to the detox hurdle. “You’re weeding out the less committed people,” she said, potentially skewing the results in favor of extended-release naltrexone. She said some patients will do better on one drug or the other depending on the case.
“I think we can say that both are viable options for patients and they prevent opioid use,” she said. “I think what we cannot say, though, is that they’re equivalent based on this study.”
She added that some of the study authors reported receiving financial support and consulting fees from Alkermes.
Vivitrol treatment is more expensive. Each Vivitrol shot costs more than $1,200, according to Medicaid data, while a monthly supply of Suboxone can cost a few hundred dollars, depending on the dose.
Some inpatient treatment centers may also be ideologically opposed to starting someone on buprenorphine, particularly after detox, said Lee, but his study shows that it can be an effective option even starting in an inpatient setting. And in any event, relapse rates are higher among people who don’t use medications for their opioid addiction.
“Detox episodes are brief,” he said. “They don’t generally last in terms of how you look a week later.”
He added that if patients enter treatment with hopes of getting on Vivitrol but can’t make it through detox, they should be offered buprenorphine. The bottom line, he said, is that both medications should be widely available and offered to patients suffering from opioid addiction.
“We’re not doing a good enough job in this country of getting people into treatment and offering them these types of medications,” said Lee. “So were just going around undertreating the opiate epidemic.”
This story was produced in partnership with WFYI and Side Effects Public Media, a news collaborative focused on public health.
Remembering Health Care Economist Uwe Reinhardt
Reinhardt, who died on Monday, helped shape the debate about health care by advocating for individual mandates and universal health care. Originally broadcast in 2009.
TERRY GROSS, HOST:
This is FRESH AIR. Health care economist Uwe Reinhardt died Monday at the age of 80. The cause was sepsis. He helped shape the debate about health care. And one of the ideas he advocated, the individual mandate which became a part of the Affordable Care Act, could now be repealed as part of a tax overhaul. He also advocated for universal health care and government subsidies for low-income families, which also became part of the ACA or Obamacare.
Reinhardt was born in Germany and witnessed the horrors of World War II. At the age of 18, he immigrated to Canada rather than be drafted by the army. Reinhardt was a professor at the Woodrow Wilson School of Public and International Affairs at Princeton, where he taught since 1968.
He served as a commissioner on the Physician Payment Review Committee established by Congress. Last month, he received the 2017 bipartisan Health Policy Leadership Award from the Alliance for Health Policy, a nonpartisan group.
I spoke with Reinhardt in 2009 as Congress was debating the Affordable Care Act. It was signed into law the next year. We talked about issues that are still relevant today. I asked him if health care were mandated, how could it be made affordable?
(SOUNDBITE OF ARCHIVED BROADCAST)
UWE REINHARDT: My own feeling on this would be the easy way to make sure, if you are reasonable, would be to have a debate on the following simple question – what percent of a family’s discretionary income – that is, income after housing and food and clothing, discretionary income – what percent of that should a family be expected to pay for its own health care?
If you look at upper-income people, like professors at Ivy League colleges, you could say, well, that should be 15 percent. Your income is such that we could expect you to eat at least 15 percent of your discretionary income. If you look at a waitress, you might say, you know, for her or him that couldn’t be more than 5 percent because the income is so low. But can you see, if we had a debate on what is it that one can reasonably ask fellow Americans to pay for their own health care, you could get somewhere.
GROSS: You say that Americans are really suffering from cognitive dissonance about health care, that they distrust government. They don’t want government running the health care system. And they supposedly have faith in markets. But you say they’re unwilling to accept the harsh verdicts of the market in health care like when you’re denied payment to reimburse you for a procedure. Talk a little bit more about this cognitive dissonance that you think we suffer from in America.
REINHARDT: Cognitive dissonance, of course, means that you hold two different theories that are in conflict with one another, but they’re both in your brain and in your soul. That’s what this means. Now, for example, you will have Americans say the government doesn’t have the right to tell me to buy health insurance. But the same Americans will say if I get hit by a truck and I lie bleeding in the street, society owes it to me to send an ambulance, and the emergency room doctors owe it to me to save my life. How could both be true? Even a teenager would blush at something this ridiculous. If you believe society has a duty to save your life when you get hurt, you have a duty to chip into a fund that pays for that.
GROSS: The things that you describe as irrational in America’s current health care system – can you find these problems in other developed countries?
REINHARDT: No, I don’t think so. The typical Canadian or German or Englishman understands that they have to pay taxes or premiums to be insured because you’re all in this together because you also expect society to save your life when you get in trouble. And they understand tit for tat.
I remember my own mother giving me a lecture once when she had to wait in Germany two weeks for the neighboring hospital to have a bed. And I said, oh, I can make a phone call and get you in earlier. And she said I was asocial. She says, then some other lady has to step back. How could this be decent? So here I felt lectured by my mother who had the sense of social solidarity that, yes, we have a good health system, but you also have to sometimes wait or step back to keep this affordable.
Americans complain about the cost of their health care. But they have the desire – I want everything my doctor prescribes, whether it’s appropriate or not, and I want it today. And then they go and look at God and complain about health care costs. This is extremely frustrating.
GROSS: Now, you know your way around health care policy, that’s for sure. And you know a lot about health care economics. What’s a typical problem you faced with getting your health care covered? Do you have to fight for things that you think should be insured (laughter) and then you’re told they’re not?
REINHARDT: No. Fortunately, that really hasn’t happened. You know, this complexity of claiming for health insurance is so awesome that my wife does it. This goes beyond the capacity of a Ph.D. in economics. So she does it, and she tells me that claiming for health insurance is far more time intensive and complex than the income tax, which she also does. So she deals with this because my attitude always is, oh, geez, I’m so busy. Why don’t we just pay it and not argue?
GROSS: (Laughter).
REINHARDT: But she will argue because she says it’s wrong. I mean…
GROSS: See, that’s where they get you, though, right? Like – ’cause I know some people are just not going to take the time.
REINHARDT: Slobs like me. Yeah, they won’t take the time. Now, if it were a really big bill, I’m sure she – but she fights even for smaller things if she thinks it’s just wrong. Well, you know, a guy like me would say I know it’s wrong, but my time is too busy. I’ll just eat it. And I think the insurance industry very often just relies on people like me and say we’ll just eat it. Professors really have it good. I mean, we don’t share the American experience, frankly, given we have tenure and given we, particularly Ivy League, we have good health insurance.
In some way, I personally don’t share the agony of the American people. On the other hand, I grew up in a tool shed, and I know how good it was that when we were paupers, my family, we had health insurance like everyone else in Germany. I’ve never forgotten that. And I would like the American people to have what I had and my mother had as a kid. So that is why I care. For me, personally, I’m fine.
GROSS: Any final thoughts you want to leave us with about the state of the current health care system or what changes you’d like to see made?
REINHARDT: Well, I would tell listeners stay away from people who try to solve the health care debate with cliches, like, oh, this is socialized medicine, and then you don’t have to think anymore. Try to actually think through the issues and say, what is your predicament? What kind of country would you want to live in? Do you want to live in a country where someone who loses their job loses their health insurance? Is that what you want? Do you want a system where kids come out of college and for the next 10 years they can’t get insurance? Do you want people who have family members struck with cancer to lose their house or their car?
I mean, ask yourself what kind of country do you want to live in. And all of these things I mentioned we have now. You lose your insurance with your job. You can lose your house and go bankrupt over a health care bill. No Canadians or Germans ever go bankrupt over medical bills. Why should we in America do that?
GROSS: Health care economist and Princeton professor Uwe Reinhardt, recorded in 2009. He died Monday at the age of 80. If you’d like to catch up on FRESH AIR interviews you missed, like our interview with New York Times investigative reporters Jodi Kantor and Megan Twohey about their process of uncovering allegations of sexual harassment and sexual assault, or our interview with Father Greg Boyle about his work helping gang members transition out of the life, check out our podcast. You’ll find lots of interviews to choose from.
FRESH AIR’s executive producer is Danny Miller. Our interviews and reviews are produced and edited by Amy Salit, Phyllis Myers, Sam Briger, Lauren Krenzel, Heidi Saman, Therese Madden, Mooj Zadie, Thea Chaloner and Seth Kelley. I’m Terry Gross.
And here’s something to look forward to next week. On Wednesday, my guest will be country music singer-songwriter Margo Price. We recorded the interview yesterday. She brought her guitar and sang several songs. She has a great voice. I really enjoyed this. Her new album is called “All American Made.” It’s just been released, and we’re going to close with the track from it.
(SOUNDBITE OF SONG, “DO RIGHT BY ME”)
MARGO PRICE: (Singing) I never won at scratch offs, but my daddy always bought them. My great aunt spent her life in Virginia pulling cotton. I don’t have no microwave or a flat-screen TV. If you don’t do right by yourself, do right by me. Do right by me. Long as the winters are, sometimes your mind breaks up. The bars are full by the afternoon and everybody’s drunk. Sometimes I look down the road for a sight I’ll never see. If you don’t do right by yourself, do right by me.
UNIDENTIFIED SINGERS: (Singing) Do right by me.
PRICE: (Singing) Do right by me.
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What If We Treated Gun Violence Like A Public Health Crisis?
More than 30,000 people a year are killed by gun violence, including 50 killed near the Los Vegas strip last month where this makeshift memorial stands.
Drew Angerer/Getty Images
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Drew Angerer/Getty Images
When U.S. officials feared an outbreak of the Zika virus last year, the Department of Health and Human Services and state officials kicked into high gear.
They tested mosquitoes neighborhood by neighborhood in Miami and other hot Gulf Coast communities where the virus was likely to flourish. They launched outreach campaigns to encourage people to use bug spray. And they pushed the development of a vaccine.
“The response was swift,” says former Surgeon General Vivek Murthy, and was even faster during the Ebola outbreak a year earlier.
But last month when 50 people died and more than 400 were injured in Las Vegas, and weeks later another 26 died in Texas of the same cause, public health officials have had almost no role.
That’s because the victims in Las Vegas and Texas were killed with guns. And over the last three decades, Congress has made it clear to that they don’t want the public health community looking too hard into the causes of the violence.
“If you look at the number of people who have died or been injured from gun violence, that dwarfs the number of people who have been affected by Zika or Ebola. There’s absolutely no comparison,” Murthy says.
More than 30,000 people are killed with guns in the U.S. every year. That’s more than die of AIDS, and about the same number as die in car crashes or from liver disease. But unlike AIDS or car crashes, the government doesn’t treat gun injuries or deaths as a public health threat.
Murthy and other public health experts say it should.
Funding For Research On Gun Violence Compared To Other Leading Causes Of Death
Funding represents the total funding awarded over the years 2004 to 2015. Dollar amounts have not been corrected for the year in which they were reported. (Note: Funding and mortality rate values are plotted on a logarithmic scale.)
Source: JAMA
“It should be no different than the approach we take to cancer, heart disease or diabetes,” he says.
But such an approach would have to start essentially from scratch. The government spends only about $22 million a year on research into gun violence — a tiny fraction of what it spends on other major health threats.
That’s because of Congress. Back in 1997, lawmakers added a provision in the bill that funds the Centers for Disease Control and Prevention barring the agency from doing anything that would “advocate or promote gun control.” At the same time, they cut CDC’s budget by the exact amount it had been spending in gun violence research up until then.
So government research into the causes of gun deaths virtually stopped.
The issue comes up routinely after mass shootings. Two years ago, after a young man killed nine people in a church in South Carolina, a reporter asked former Republican House Speaker John Boehner about the CDC restrictions.
“The CDC is there to look at diseases that need to be dealt with to protect the public health. I’m sorry but a gun is not a disease,” he said at the time.
After the most recent shootings, Democrats in Congress have called for more restrictions on guns while Republicans, including President Trump, say the problem is mental health.
But neither conclusion is backed by research, says Dr. Georges Benjamin, the executive director of the American Public Health Association.
“When a new disease, particularly an infectious disease, enters the community … we have a mechanism to anticipate it, track it, get our arms around it,” he says. “We do that when he have measles, mumps, chicken pox, zika. But firearm-related death and disability, we don’t.”
That kind of prior knowledge could lead to policies that reduce the toll of gun injuries without cutting off access to them.
“Firearms are a tool, and … a consumer product. And unlike other consumer products, we’re not working hard to make that consumer product safer,” he says.
Take cars for example. Benjamin points to the combination of safety features — airbags and seat belts — and safety policies like requiring licensing and banning drunk driving — that have made cars less lethal, while ensuring they’re still available.
A similar strategy with guns could lead to some laws or regulations that make them safer.
That could involve barring large ammunition clips to limit the number of shots a person could take, or requiring trigger locks that open by fingerprint, allowing only the gun owner to fire a weapon.
“We could think about where firearms ought not to be,” he says. “Alcohol and firearms and people who might get a little rowdy probably are not a good combination. There are solutions to that.”
Creating more shooting ranges may be a good idea so gun owners have a safe place to use their weapons, he says.
Today, Benjamin says, there is no data to show whether people are safer in communities with more or fewer guns.
Something has to change, because up until now, “We have done everything we can to ensure that this epidemic of death and disability from firearms is only going to get worse,” he says.
Health Policy Consultant On How The Senate GOP Tax Bill Could Affect Insurance Costs
Senate Republicans have proposed attaching a repeal of the Affordable Care Act’s individual mandate as a way to pay for tax cuts. Health policy consultant Robert Laszewski tells NPR’s Kelly McEvers that doing so would increase the cost of insurance for many Americans.