My thoughts, live from the White House.
Roaming the halls, some issues came to mind that I want to share with you.
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As many of you know, I had the opportunity to visit the White House in Washington, DC, on Friday and again on Saturday to meet with my good friend and colleague Dr. Alister Martin.
Dr. Martin trained with us in the Harvard Emergency Medicine residency which means that I had a small part in mentoring him during his time there. The reality is that the mentoring was and remains bidirectional. I've been learning from him from day one. He joined our faculty right after graduation. Currently, he's on leave, serving as a White House Fellow (assigned to the Vice President) and also working in the Office of Public Engagement.
Long story short, Dr. Martin is doing amazing work and I've been privileged to work with him and other members of his team on advancing important healthcare-related issues.
Here are a couple of still shots from my visit. These were taken at the Eisenhower Executive Office Building on the White House campus on Friday May 6th, 2022
On the Navy Steps of the Eisenhower Executive Office Building, across from the White House.
In the halls of the Eisenhower building, where a lot of our nation's work gets done.
Dr. Alister Martin and I catching up in the Eisenhower building at the White House. (I took off my mask briefly for a handful of photo ops!)
I also had a opportunity to sit down and take some video from the Eisenhower building. I recorded it "live to tape" rather than streaming it directly online because I wanted to make sure there were no reception issues. (The White House does not allow you to hop on their WiFi, as you might imagine!) The full 13-minute video is available on our members-only Inside Medicine Facebook group (which anyone reading this should have access to). So please watch the video there! The transcript of the video is also below, for those who prefer.
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Hey everybody, it's Jeremy Faust. And I'm coming to you right now from the White House in Washington, DC. You can probably get a sense for this room that I'm in. I am actually in the executive office building. This is across from the West Wing. This is where a lot of business happens and I am here visiting my very good friend, Dr. Alister Martin, who is a White House fellow, and who invited me to come spend a little time here. And Alister Dr. Martin is also working in the White House's Office of Public Engagement, which means that he really is trying to link all of us out there to the administration so that they know what's on our mind. And we know what's on theirs and it's really been great to, to be in that conversation. I've had a great opportunity to discuss issues that matter to me, to various groups here and in the Administration. And today Alister let me just kinda hang out in this room for a couple minutes while he takes care of something upstairs, I guess, and talk to you and just get a sense, give you an opportunity to see this, this, this beautiful room that I'm in. I'm just going to turn it around and show you just a bit and talk a little bit about what being here kind of feels like, and this is my little decal here being walking on the White House grounds and walking through these halls and you see these places and you feel the weight of it and a room like this, where big decisions are made.
And it makes me think about a few things. And as a physician, as a public health advocate, what's what, what comes to mind when I think about the, the people and the decisions they have to make about the world we live in and, and how it impacts all of us, it's really it's weighty. So you have a $1.9 trillion American rescue package. Like how does that get allocated? What is allocated? This is why getting involved is so important. And I guess maybe that's why Alister invited me is, is maybe just to catch up, see an old friend, but I think also to inspire me and maybe you to realize that we're not all that far away from people who really make huge decisions. And maybe I'm one step away by knowing a couple people here. If you don't know anyone, you know me, so you're two degrees of separation, so it's all very tight. So walking down these halls in this beautiful, I'll try to share a few pictures later. A couple things came to mind that I want to think about and use, use this moment, this opportunity to highlight some stuff. And one of them is what, what have they been doing here in this Administration? And one of the big things that I think's important that that recently happened, that I don't think a lot of people know about is the Affordable Care Act got a little bit of a boost. The Affordable Care Act, if you think about it is a very interesting compromise, right? It's not government driven healthcare. It's actually, it's saying, how can we make sure that more people have healthcare? And I always thought that it was an interesting compromise. And if you look at where it came from and came from, probably from our state, Massachusetts “Romneycare,” and it was a, you know, obviously controversial, but I think, we know that it has increased coverage in this country, which is huge. And, but there's always little glitches and gaps in this. And recently the so-called “family glitch” was actually addressed by this administration. And that is actually so that basically what happens is if you're a young person and you get your insurance through your job, you might get some financial help from the government with that. That's part of the ACA. But if your family can't afford it you're not in great shape. And then you're not covered. You're not really covered because your family's not covered. And as a parent, let me tell you that that's, that rings true. So the family glitch was addressed recently with an executive order--a rule--which has been proposed by the president. And I don't know, I'm not too privy to the, the exact ways these things move forward, but when rules are proposed, they have to then go through various steps. There's a rule making kind of like a lifespan. There's a chart that says, okay, sort of like a “how bill becomes a law”….“how does a rule become real?” and involves all kinds of things, including public comment period, so that you can actually go on there and make comments. And then the and then ultimately the government decides whether this rule is, is okay, and whether it's a good idea and how to enact it.
So that rule would, according to the Biden administration will give a 200,000 more people coverage that they can't afford. So that's good. And another million is what they're saying will have more affordable healthcare coverage, meaning that the, it won't take a big of a bite out of their bottom line to be able to get healthcare. And look, if the, if this pandemic taught me anything, I already knew this, but is that the difference between when you have healthcare and when you don't is massive, it's all these kinds of things like entering this pandemic without good preexisting health is a huge detriment. And it's a structural one in many cases. So we need to do everything we can to make it so that we plan ahead and this is, I thought that was a good move. That was one thing that Alister was excited about.
So he was talking to me about it and I looked at what they are putting out about this. And I think it's a, it's a very good, common sense thing. You know other things that I've thought about over the years is how do you amp up [i.e. subsidize] the premiums so that people actually can get good healthcare, you know, having healthcare, having access, having good access it, we've already spent a lot of money on this. If you spend a little more, you get a lot out of it. And so I think that one big, huge thing you want to do is make sure that these, these companies, these private health insurance companies can, you know, we think about them as being these big profit generating organizations, but they also have to stay in business and there's a balance there.
So I think that more premium support will get more people in that pool, which means that the system, the ACA system can persist longer, which I think is really good. We've seen some improvements. Look, we've seen again, this family glitch [fix] would be good. We've seen some expansion in some states with some of the provisions under the ACA. So that's good.
Next thing I was thinking about walking through these halls was, is pretty hard to ignore. We heard some protestors outside and Alister said, Dr. Martin, my old friend, Alister said, you can kind of tell what some people's minds in the news by what's being protested today. And I said, oh, do you think it's Roe v. Wade? He said, no, it's probably actually, maybe Ukraine. He couldn't really tell, but we weren't close enough.
But to me, like Roe kind of popped up because as you might know, I wrote about this in my newsletter Inside Medicine. And the what I wrote about was that there are some things about Roe v. Wade that really changed health for women in this country after Roe v. Wade, going into Roe into 1973, in the 60’s maternal death rates, that's people, women, dying at the time of giving birth, maternal mortality was already dropping a bunch. And a lot of this was because [pre-natal care] access was improving. But then in 1973, there was another huge drop in maternal mortality, 50% lower the year after, mostly in states that actually were required to then have lawful safe access to maternal health abortion after 1973. So look regardless of how you feel about the overall issue, we all agree that if, if women are dying at childbirth, that's very terrible.
So that was the thing that happened is that Roe v. Wade was really in my view, tightly linked to a time when maternal mortality went down, really big thing. Another thing that people don't always realize is that Roe v. Wade changed the way maternal health is delivered, and it, it led to earlier healthcare. And again, no matter how you feel about you know, being pro-choice or pro-life; abortions happen. And we actually know that countries where abortion is safe and legal have pretty similar rates to abortion compared to countries where it's not legal and therefore less safe. So banning abortions doesn't really ban abortions. It bans safe abortions, or it makes it less likely. And so Roe v. Wade happened, and then what happened was the abortions that were happening in this country started to happen earlier and earlier in pregnancy. So instead of being much more likely to happen in after nine weeks, they were much more likely to happen before nine weeks.
So [women] had healthcare, they weren't afraid to interact with the [healthcare] system. And then if they had to make that choice, it was an early choice, which is which I think everyone would support. Another thing that I wrote about, again, just being here just makes me think about it. Because just being in DC and being in the White House, you realize that all these decisions are made by, you know, just a very small number of people. And it's very humbling to think that so few people control all of our destinies.
But another thing that happened after Roe was that maternal healthcare abortions happened in a woman's home state a lot more often. So what was happening before Roe is people who had means would cross state lines and those who didn't would maybe do something like unsafe in their home state.
So after Roe, there was a lot less going across state lines to get that care, which is better for everybody, just on every single level. And in terms of just access in terms of equity, we know that people of color had less access before a Roe, and Roe helped with that. And people have said this, and I agree with it: Maternal care is healthcare. And if that’s not available in an equal way, then we've got work to do. So, I worry that if the rumors are true and that Roe is to be overturned, we're going to be going backwards on that equity and for everyone. So those were some really big things that I took away from that. And again, you know, walking around town and seeing these places, just, just realizing that so many things are dependent on the decisions that people make. And it makes me want to be more active. Maybe that's again, maybe that's why I'm here today. No official presentations today. I mean, we had a nice meeting and a discussion about some of these issues, but not like an official talk like I've done before virtually with the White House teams before.
And then I guess the last thing I will talk about because I, can't not--it's me--as I'm here at the White House, the place where so many decisions have been made about the pandemic. And Covid, it's hard for me not to think about that. Especially I spend so much of my time seeing Covid treating Covid as an ER, doctor writing about it, doing research about it. If you know me, you know, that's what I think about a lot lately and really concerned about the funding piece; are we going to have funding for the rest of this pandemic? Like up now, Congress has been really, I think have, has done the right thing.
And so we had vaccinations covered. We have therapeutics, we have testing (a little late on the testing, but we got it), and I love that. So do we have enough testing? Do we have enough therapeutics? Will we have access to these new vaccines that are coming down the pipeline. The $10 billion that was recently agreed upon by Congress for funding the pandemic response is better than nothing. But to get us through the fall in the winter and to have access, we need more and $20, $30, $40 billion is probably more like it. And look as, as anyone who knows me knows when you spend money on preventative care I'll tell you that you'll save money. So it's not about spending money. It's about saving money by investing upfront. And so we, we don't wanna be in a situation where the Covid response is privatized and left to our own devices.
Look, it's a pandemic folks. It's not at the time to have the debate. I'm a big believer in the system we have in terms of the ACA and a balance between, you know, seniors can have Medicare and Medicaid. People of my age can get their insurance privately through, through their employers. Like I think that system is a good one for us right now. And I think that in a pandemic environment though it makes more sense to make sure that we don't leave some people out, especially people who are underinsured, who have no insurance, because actually it'll not only have worse outcomes, which is just not humane, but it'll actually hurt all of us as a community. And then also less funding means less global help. And this pandemic doesn't end until the global pandemic is over.
So again, like not the reason I'm here, but it's just walking through the halls of the White House and looking in these rooms and seeing the different vantages and realizing that this is all where it happens. So it's a great opportunity to be here, to see my former resident, Dr. Alister Martin, who's now a Fellow at the White House and who works in the Office of Public Engagement. It's just beautiful to see him doing a lot of work. He's always lobbying sort of me to get messages out to you guys, and I'm always lobbying him to get messages into the White House, and it's a conversation. And I think that the listening is important and I think that it makes a difference. So it's a real great honor to be here. And to share these thoughts with you as I'm here. So I'm hoping to be able to do more of this tomorrow. And if so, I will see you then, but if not thanks for checking this out and also following my newsletter, which is Inside Medicine and that's on Bulletin. Inside Medicine do Bulletin.com and I write there about medicine and healthcare and what I'm thinking about. And I appreciate all the readers and the feedback. It's all about a conversation, just like this. So thanks so much and hope you all have a, a great day.
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