Conversations on Health: How We Get There is a monthly podcast series about health care, health care systems and the connections we need to make outcomes better. Through health professionals and patients – each podcast will explore a different aspect of health or health care. Or a different country’s health care system as it compares to ours in the US. We’ll also look at social care as it affects health. As a veteran reporter – I want to know why so many Americans still don’t have access to the comprehensive health care so normal in other advanced countries. How are health systems dealing with higher costs and changing demographics? And if, after the disastrous response to COVID 19, the US and other nations are now prepared for another major public health crisis. Of ANY kind.

The podcast is available as a video on YouTube

And also as an audio podcast on Podbean and the Podbean App, on the Apple Podcast app and on other platforms. Including Deezer

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EPISODE NOTES

Episode 28: A Conversation with Ateev Mehrotra MD, MPH; Chair, Department of Health Services, Policy, and Practice, Brown University School of Public Health

Lots of us became well -acquainted with telemedicine during the pandemic. And while many of us have gone back to office appointments with our doctors – telemedicine remains useful. Especially for mental health issues. How useful? Well – recently I logged onto a fascinating Health Affairs Journal webinar on telemedicine. And with winter upon us – I thought it would make a timely episode. Joining me is one of the presenters – Ateev Mehrotra, MD, MPH. He’s a practicing physician as well as the Walter H. Annenberg Distinguished Professor and Chair of the Department of Health Services, Policy, and Practice at the Brown University School of Public Health. His research focuses on delivery innovations and their impact on access, quality, and spending. These include innovations such as telemedicine, remote patient monitoring, retail clinics and e-visits.  Our interview was recorded earlier this month  – before the Trump Administration takes office.

The Impact of Telemedicine on Medicare Utilization, Spending and Quality  2019-2022. Ateev Mehrotra MD, MPH and colleagues; published 4/27/2024 in Health Affairs Journal

Episode 27:  A Continued Conversation with Dr. Steven D. Culler, Associate Professor of Health Policy and Management at Emory University, on Medicaid and Obamacare Updates for 2025

Open enrollment for Medicare supplement plans, which continues until December 7, runs somewhat concurrently with the annual sign up period for the Affordable Care Act plans – commonly called Obamacare. The plans became available on state marketplaces on November 1 and the window closes on December 15 for coverage beginning January 1. We explained the major Medicare changes for 2025 in Episode 26 – check it out if you or someone in your family still needs the podcast’s actionable information. But right now let’s talk about the other actionable information – the 2025 Obamacare plans and who’s eligible for them. Back again is Dr. Steven D. Culler – our expert from Episode 26 and last year’s more extensive Episodes 14 and 15. He’s an Associate Professor at the Rollins School of Public Health, and Affiliated Associate Professor at the Goizueta Business School at Emory University in Atlanta.

Episode 26: A Conversation with Dr. Steven D. Culler, Associate Professor of Health Policy and Management at Emory University, on Medicare Updates for 2025

Once again it’s open enrollment time for Medicare plans  – which runs for just 6 weeks each year – from October 15 until December 7. Millions more Americans who don’t get health insurance through their jobs or Medicaid can find or change so-called Obamacare insurance plans from November 1 through January 15 of next year. 

In this episode we’re concentrating on the biggest changes to Medicare for 2025, including qualifications for weight loss drug Wegovy coverage and the Medicare Advantage plans used by about 50 percent of Medicare recipients. Episode 27 – dropping on November 15 – will catch you up on the Affordable Care Act changes and their relationship to the state-run Medicaid coverage. This is hard information you can – and should use right now. We’re also taking a look at the effect of the top Medicare changes on private, work–related insurance plans, which are likely to make adjustments for 2025.

If you need a primer on how these programs actually function – check out Episodes 14 and 15. Dr. Steven D. Culler – our expert from those earlier episodes – was kind enough to come back again for this update.  He’s an Associate Professor at the Rollins School of Public Health, and affiliated Associate Professor at the Goizueta Business School – at Emory University in Atlanta.

More info: Centers for Medicare & Medicaid Services – CMS

More info: Medicare Part D Premiums:

Episode 25: A Conversation with Dr. Mirella M.N. Minkman on Neighbors Helping Neighbors Toward Better Health in the Netherlands

Health experts in many countries – including the United States – are looking beyond standard health care and medical treatments to some kind of community-based care.  Both as a way to improve people’s general health – and as a way to cut the spiraling costs of medical procedures and new drugs.

The Netherlands appears to be well ahead of most countries with its varied efforts to re-invent what is generally called “social care” – starting right at the neighborhood level.

With the huge Boomer population aging quickly – the Netherlands also has a particular focus on integrated care for people with multiple health issues. Which includes giving them access to adequate health care before those issues become serious.

My guest is one of the Netherlands’ top experts in these areas – Professor Dr. Mirella M. N. Minkman of Tilburg University, Tias Business School and CEO of Vilans, National Center of Expertise for Care and Support. We cover a lot of territory – including what is a growing problem virtually everywhere – more and more young people with mental health needs. You’ll be surprised to find out how varied – and sometimes how simple social care can be.

Episode 24: A Conversation with Maggie and Suzanne About Having Friends and Loved Ones in Rehabilitation and Skilled Nursing Facilities

Do you know someone – perhaps in your own family – who has spent time in a rehabilitation facility? Maybe after an illness or operation? Lots of people – and particularly older people who live alone – find themselves in rehab or long term care facilities. These are somewhat different from the assisted living or independent care communities we talked about in Episode 10 – when we explored one family’s exhaustive effort to find a place for their Mom in North Carolina. Rehab facilities are often affiliated with hospital groups and deal with everything from recovering from knee replacements to stroke and even dementia care.  The residents may be there for just a few weeks – or much longer. My husband and I discovered that two good friends each have someone they care about in residential care at the same, independently owned, northern New Jersey facility. One day they started talking about the issues they’re encountering – like staffing, adequate physical therapy, mental stimulation and the overall differences between this independently owned facility and the more common and usually larger, company-owned facilities. My husband – the video editor and producer for this podcast series said – “you know -– this would make an interesting episode”. And I thought it may also be very helpful. We decided not to use the actual name of the place – or the names of our friends. So – cozy up with a cup of tea or coffee – and join “Maggie”, “Suzanne” and me for the conversation

Episode 23: A Conversation with Dr. Jihad Malasi, Primary Care Physician, Royal College of General Practitioners, Senior Fellow of the Faculty of Medical Leadership and Management, United Kingdom

We’re spending some time this summer revisiting the UK’s National Health Service. It’s celebrating its 76^th birthday this month – although I doubt anyone would use that exact word. Actually, right after the Labor Party swept the UK parliamentary elections on July 4^th – both the new Prime Minister Sir Keir Starmer and his new Health and Social Care Secretary Wes Streeting said flat out that the NHS is broken. Both promised to save it. And – both stressed it couldn‘t be done overnight. Small comfort to the nearly 10 million people the BBC says may be on NHS waiting lists for doctor visits, operations or tests. That’s somewhat more than the official NHS count of 7 million. But the lists do seem to depend on who’s counting. There’s a crisis in available hospital beds. In doctors to care for patients in those beds. And – at the point of first patient contact – a shortage of GPs or general practitioners. People in some parts of the UK can wait weeks or months to see their doctor, as overworked GPs retire without being replaced.

So – as the new UK government settles in – how do GPs feel about their own future? Do they think the Labor government – the first in 14 years – can make meaningful changes in the NHS? And make them quickly enough to save it – as the party has promised?

My guest on this episode is Dr. Jihad Malasi. He’s been a practicing physician in the UK for over 20 years and is trained in family medicine and psychiatry. His practice is in Kent and the borough of Medway – an area south of London. Dr. Malasi is a member of the Royal College of General Practitioners and a Senior Fellow of the Faculty of Medical Leadership and Management. His interests are in primary care, health economics and policy. He holds a Master of Science degree in Health Economics from the London School of Economics & Political Science (LSE) and works for the National Institute for Clinical Excellence (NICE) and Kent & Medway Integrated Care Board as Mental Health clinical lead. Full profile on LinkedIn. The interview was recorded AFTER the July 4th UK Parliamentary elections.

Episode 22: A Conversation with Dr. Amani Hassan, Practicing Child and Adolescent Psychiatrist NHS; Faculty Chair, Child and Adolescent Psychiatry Royal College of Psychiatrists, Wales, UK

As the US Surgeon General calls for a social media warning label similar to the one on cigarettes and alcohol, we focus on child and teenage mental health in this somewhat longer than usual episode. And about halfway through – we get into a really good discussion on that really big issue: the role of social media in the growing problems of Gen Z and the youngest children – Gen Alpha.

We’re talking about all this with a child psychiatrist from the United Kingdom’s storied but now struggling National Health System. And she has some ideas you probably haven’t heard before. This is one of several episodes revisiting the NHS and it’s ongoing shortages and waiting lists from the standpoint of the doctors who keep it functioning. Often with great difficulty.

If you haven’t heard or watched Episode 11 – perhaps you might want to for the overall story of the NHS and its current woes. A quick refresher:  the NHS began in 1948 – more than 75 years ago – and along with the slightly younger Swedish system – is the basic model for taxpayer financed, government controlled, universal health care. Free at the point of use for all.

Many of the NHS doctors that patients see are also its caretakers. Helping their local systems function while they also work in their specialties. Like my guest in this episode – who lives and works in Wales, one of the UK’s four devolved nations.

Dr. Amani Hassan is an experienced practicing child and adolescent psychiatrist  – a consultant, as many doctors are called in the NHS. She also chairs the Faculty of Child and Adolescent Psychiatry at the Royal College of Psychiatrists in Wales and works as well in learning disability psychiatry. Additionally, Dr. Hassan researches neuro-developmental disorders. She was the Training Program Director (2015 to 2018) of Child and Adolescent Psychiatry at Wales Deanery.

There is some discussion about mentally disturbed young people. So I’ve included information below on how to get help if you or someone you know needs it – in both the UK and the US.

IN THE UK: NHS National Suicide Prevention Line

0800 689 5652. 6pm to midnight. Backup: 0800 689 0880999 for life threatening emergencies. Or go to nearest A and E. https://spuk.org.uk

IN THE US: 988  Suicide and Crisis Lifeline 24/7

Reaches local crisis centers similar to the way  911 functions for all other emergencies. https://988lifeline.org/

Episode 21: A Conversation with Theodore Lawrence, MD, PhD, Professor of Radiation Oncology, University of Michigan

How many times have we all asked – when will they find a cure for cancer? Of course there is no one cure any more than there is just one type of cancer. Each one requires its own research pathway.  But there have been great strides in recent years. Some cancers which used to be a death sentence can now be basically cured or turned into treatable, chronic illnesses.

My guest for this episode is Theodore Lawrence, MD, PhD. He’s a Professor of Radiation Oncology at the University of Michigan and has an active oncology medical practice. He’s also researching better treatment outcomes for gastrointestinal and central nervous system cancer.  His research continues to be supported by the National Cancer Institute.

I’ve known Ted for many years – since he was still a medical student, recently married to my second cousin. He’s always been really excited about his work. And he has that rare ability to explain really complicated concepts in a way we can all clearly understand. 

Episode 20: A Conversation with  Mohammadali Habibi, MD – an electrophysiologist with The Valley Health System in New Jersey

This may surprise you with all the medical advances we’ve made in the last decade – but heart disease remains the leading cause of death in the US. As it has been since 1921. A recent poll conducted for the American Heart Association found 51 percent of respondents had no idea! According to the Centers for Disease Control and Prevention  –  one person dies every 33 seconds in the US from cardiovascular disease. And this may also surprise you. The CDC says in 2019 – the last year it lists – heart disease cost the US about 2 hundred and 40 billion dollars. Think about the inflation you’ve experienced in the last few years and you can imagine how big that number will be for all of 2024. One reason for the growing cost of heart disease is that much of what causes it is treatable now. And as the huge boomer cohort moves into the senior class – older people with heart disease are living longer. So I thought it would be interesting to talk to a heart specialist I know – who would likely have been doing something else just 30 or 40 years ago. Dr. Mohammadali Habibi is an electrophysiologist with the highly rated Valley Health System and Valley Hospital in New Jersey. Valley’s state-of-the-art, new hospital just opened. Valley is also partnered with the country’s top ranked heart hospital – The  Cleveland Clinic.

Episode 19: More of A Conversation with Catharina Barkman, Project Director, Forum for Health Policy in Stockholm on Sweden’s Universal Health Care System

Part 2:  I think we all learned a lot in episode 18 about Sweden’s pioneering universal health care system. Most countries except for the US have some version of this – health care that’s paid for by taxes, controlled by the government and essentially free at the point of use. But health care costs are skyrocketing everywhere. So now we going to talk about how AI and other data-driven innovations may help Sweden – and health care systems in general – cope with the demographic changes and expensive medical breakthroughs already straining budgets. This is the second half of my discussion with Catharina Barkman of Sweden’s Forum for Health Policy. It’s a non-profit, independent think tank aiming to boost innovation and development in the health care system. Catharina has also held several top positions within the system itself in the region of Stockholm – Sweden’s capital.

Episode 18: A Conversation with Catharina Barkman, Project Director, Forum for Health Policy, Stockholm on Sweden’s Universal Health Care System

Part 1:  Most of us are familiar with the idea of universal health care. Ideally – tax-paid, “free” health care for all. We know that in the US we don’t have it – while almost all other countries do – in some form. One of the first countries to adopt universal health care was Sweden – in the early 1950s. But how – exactly – does such a system work? And can it keep afloat as health costs keep rising?  I ask Catharina Barkman who heads Sweden’s Forum for Health Policy – a non-profit, independent think tank aiming to boost innovation and development in the health care system. Catharina has also held several top positions within the system itself in the region of Stockholm – Sweden’s capital. I think you’ll learn a lot about how universal health care works from our conversation – not only in Sweden but also in other countries. And you may be surprised – as I was – to see that even here in the US – we have some aspects of health care for all. 

Episode #17: Celebrating the Podcast’s First Year and a Half

We start the 2024 season by celebrating the podcast’s first year and a half. A fast review of some of the widely varied subjects and guests. Some are experts on health care systems. Others just people trying to navigate the way the privately-driven US system works. Or for many – doesn’t work.  Maybe you’ll find one or two conversations you missed?

Episode #16: A conversation with Alan Weil, Editor-in-Chief of Health Affairs and Podcast Host of A Health Podyssey on Why Drug Costs are So High in the US

I’m sure you’ve heard or read that Americans have better access to the newer, often life-saving drugs than people in other countries. But access and being able to pay for the drugs are two different matters. As anyone knows who has been to a pharmacist window lately – these great new drugs are really expensive. And in the United States – unlike other countries – they’re often not covered or poorly covered by insurance. Sadly in this rich country – some people actually have to chose between the drugs which control their disease – and feeding their kids. Or even themselves. Like so much else in health care – it’s complicated. Joining me is Alan Weil, Editor-in-Chief of Health Affairs since 2014 and the podcast host of “A Health Podyssey” – where he talks with leading researchers shaping the big ideas in health policy.

Episode #15: More of a Conversation with Dr. Steven D. Culler, Associate Professor of Health Policy and Management at Emory University, on Open Enrollment Period and Much More.

Part 2: Open enrollment for 2024 Medicare supplementary plans continues into December – while those under 65 who don’t have employer health insurance can look for Obamacare plans on state marketplaces until mid January. In Episode 14 we talked mainly about how those Obamacare plans work. Now we’re focusing more on Medicare. More on the difference between Medicare Advantage and purely supplementary plans. And toward the end – we do some “blue skying” about the future of Medicare and health care in general. And how to pay for it. Lots of useful info in the rest of my discussion with Dr. Steven D. Culler, Associate Professor at the Rollins School of Public Health, and Affiliated Associate Professor at the Goizueta  School of Business – at Emory University in Atlanta.

Read his just published, collaborative paper on Medicare spending here.

Episode #14: A Conversation with Dr. Steven D. Culler, Associate Professor of Health Policy and Management at Emory University, on Open Enrollment Period and More.

Part 1: Starting in mid October and ending January 15^th, millions of eligible Americans who don’t get health insurance through their jobs or Medicaid can use what is known as the Open Enrollment Period to sign up for or change various insurance plans.  Medicare recipients – mostly 65 or older – have 6 weeks ending on December 7^th this year to choose supplemental insurance or Advantage plans.  And those who have or want what most of us call “Obamacare” – health insurance created under the Affordable Care Act – can change or enroll from November 1^st.  That’s the easy part. The rest – like virtually everything about health care in the US – is really complicated. So I’m asking an expert from Atlanta’s Emory University – Dr. Steve D. Culler – to explain it all. You may not believe all the hidden pitfalls he points out.

Read his just published, collaborative paper on Medicare spending here.

Episode #13: A Conversation with Gina Mžourek on Her Health Care Experiences in the US, Germany and the Czech Republic

Talking about health care systems doesn’t have much meaning unless you know how they actually affect people. My friend Gina Mžourek is an American from New Jersey. She currently lives in Germany with her Czech husband.  But over the past 24 years she’s also lived in the Czech Republic, France and of course – the US.  Gina has a chronic illness so she’s very good at comparing the health care systems. They’re all state run except of course – ours here in the US. We talked on Zoom this summer – me in Prague, Gina in her small German town – and I think you’ll find her insights very helpful.  FYI – Zoom’s recording has some lag.

Episode #12: A Conversation with Teacher Martina Frybortova on the Czech Health Care System

Imagine what it’s like to know that if you get sick or need a knee replacement or just grow old – you’ll never have to worry about paying for your medical care? It’s something few Americans can even imagine. But something that is simply normal for most Europeans. So last month when my husband and I were in Prague – I had a conversation with a Czech friend who’s a public school English teacher and translator. She pays the usual high taxes into the state-run health care system. And then never gives the cost of her medical future another thought.

Episode #11: A Conversation with the UK’s David Hunter, Emeritus Professor, Newcastle University on the National Health Service at 75

We’re looking at the growing health care crisis in the United Kingdom in this episode. The government-funded and run National Health Service or NHS as it’s usually known was started in 1948 and most UK citizens really love it. It’s basically the international role model for health care services which are free at the point of use. Something most Americans can only dream of.  But ever since the COVID lockdowns ended – the NHS has been in real trouble. I’m sure you’ve seen or read about its huge financial and personnel issues. Doctors and nurses, ambulance drivers – seemingly everyone constantly on strike – demanding higher pay and more workers. Many Brits complain about waiting months just to see their general practitioners. Never mind complex surgery where waits can be years. What might fix the NHS? Money? Rejoining the EU? Better management? More emphasis on preventive health measures? I put the hard questions to David Hunter, Emeritus Professor of Health Policy and Management, Population Health Sciences Institute, Newcastle University.

Episode #10:  A Conversation with Rich on his Family’s Search for the Right Assisted Living Facility for Mom

After the last two episodes on mental health, we’re talking about another difficult issue many families are struggling with – when and how to find an affordable and caring assisted living facility for Mom or Dad. Rich’s 92 year old Mom is doing well in her new home and Rich shares a lot of helpful information if your family is just beginning to the emotionally draining search. I’m also giving you some useful U.S. research links below:

To find home-based services, contact Eldercare Locator at 1-800-677-1116 or visit https://eldercare.acl.gov. You can also call your local Area Agency on Aging, Aging and Disability Resource Center, Department of Human Services or Aging, or a social service agency.
https://longtermcare.acl.gov/

Episode #9:  More of A Conversation with PhDr. Radek Pěkný about Mental Health Issues and Care in the Czech Republic, the US and beyond.

Part 2: When Part 1 ended – we were talking about how life has changed after the COVID pandemic. and how many people seem to be having trouble just coping these days. Part 2 picks up there. And as we go on – I think you’ll feel almost like you’re in your own personal therapy session as we talk a lot about mental resilience and our lack of it, the effects of social media and how you know you need help. You don’t want to miss the rest of this thoughtful and wide-ranging conversation on mental health with Czech clinical psychologist and psychotherapist PhDr. Radek Pěkný.

Episode #8: A Conversation with PhDr. Radek Pěkný about Mental Health Issues and Care in the Czech Republic, the US and Beyond. Part 1.

Part 1: Many Americans seem to be having trouble coping with life these days  –  perhaps because the COVID pandemic changed life as we knew it. It changed life  everywhere – including in the Czech Republic. How do we deal with uncertainty? What does it mean to be a man in 2023? Are our children as mentally resilient as we were? What about the effect of social media? Do Czechs try to ignore mental health problems as many Americans do? This is a very thoughtful and wide-ranging conversation on mental health with Czech clinical psychologist and psychotherapist PhDr. Radek Pěkný. You’ll find we’re more alike than we are different.

Episode #7: A Conversation with Lisa Layne D.M.H.,M.I.A. On Just About Everything

It’s hard to characterize Dr. Lisa Layne because she’s worn so many hats. As a result – the way she looks at health care and our relationship with its delivery is quite unique. Dr. Layne went from being a Foreign Service Officer to earning a doctorate in Medical Humanities and later, certificates in Bioethics.  As you can imagine, we talk about a lot. We even share a few laughs. What did she learn from her years as a patient advocate at a New Jersey hospital? What’s it like to get sick in a foreign country compared to the US? And what are her COVID takeaways – as she continues to broaden cultural perspectives as an adjunct professor at Fairleigh Dickinson University.

Episode #7- Preview:  a Conversation with Lisa Layne D.M.H., M.I.A. On Just About Everything

It’s hard to characterize Dr. Lisa Layne because she’s worn so many hats. As a result the way she looks at health care and our relationship with its delivery is quite unique. As this preview of Episode 7 suggests – we talk a little about a lot. Dr. Layne went from being a Foreign Service Officer to earning a doctorate in Medical Humanities and later, certificates in Bioethics. What did she learn from her years as a patient advocate at a New Jersey hospital? What is it like to get sick in a foreign country compared to the US? And what are her COVID takeaways – as she continues to broaden cultural perspectives as an adjunct professor at Fairleigh Dickinson University. The full episode will drop on Friday  – that’s March 24.

Episode #6: Christine Dorn-Moldovan on Nursing

At the core of any country’s health system are the nurses. And  I’m sure many of you are aware of the continuing nurses’ strikes against the UK’s state-run health care system  – as well as the recent one here in New York City. Yes – nurses want pay hikes. But the biggest issue is the continued understaffing at hospitals and other care facilities. Christine Dorn-Moldovan is now a semi-retired school nurse who spent many years as a hospital nurse and supervisor at large New York hospitals. And also worked in the public health system.  What does she think has to change now to make the US health system work for burned-out nurses post COVID —  and the rest of us?

Episode #5: The Continuation of A Conversation with Richard Saltman, PhD, Health Policy Expert

Part 2: We continue to compare the US health care system with those of Sweden and other Nordic and European state-run systems. Does the US really have a mostly private system? Are countries already developing new, hybrid models as the cost of breakthrough medical procedures and designer drugs skyrockets? And can we really compare any single European country to our sprawling land of more than a hundred and 33 million people?

Episode #4: A Conversation with Richard Saltman, PhD, Health Policy Expert

Part 1: We’re delving into the mix of private insurers, doctor groups, regional hospital systems, Medicare, Medicaid, the Veterans Health Administration – plus a federal and state public health system- which together are considered the US health “system”. How does the US “system” compare to those in Europe and the Nordic countries? You may be surprised at what you hear.

Episode #3: Pam’s Healthcare Nightmare

Most of us have had some experience with the mish-mosh of health care in the US which substitutes for a real health system – the European kind you learned about in episodes 1 and 2. Both dealing with health care in the Czech Republic. But here in the United States – it’s not so simple. If you’ve had to navigate the maze of doctors, hospitals, health care alliances and insurance in the US – you probably have a horror story. Like my friend Pam Cookson.  Who lives in St. Augustine, Florida. Pam’s struggle to get a simple bladder infection treated – something millions of us have also done – is eye-opening. And sadly – likely to sound familiar to many of you.

Episode #2: When Writer Steve Fisher Nearly Died in Prague, CZ

Steve Fisher is a friend of mine who lives and works in the Czech Republic. A few years ago he got very sick and is very, VERY grateful for how well the Czech health system took care of him. It’s a very dramatic story.

Episode#1: A Conversation with Dr. David Marx, Charles University, Prague, Czech Republic

I started with a typical European, mostly public health care system in the Czech Republic because I spend a lot of time there. You can compare it to your own experience in our very fragmented PRIVATE system in the US. Like all the European and Scandinavian countries and the United Kingdom – working Czechs and their employers pay a lot in taxes and insurance fees to support most of the overall health care system. EVERYONE has similar, solid coverage. To get an overview of how the system works – I sat down with an internationally known expert on health care – Dr. David Marx – in his office in Prague. He heads the Department of Public Health of the Third Faculty of Medicine – part of the renown Charles University Medical program.