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Is Health Care a “Right”, a “Privilege” – or Simply a “Necessity?”

Posted on | April 8, 2021 | 8 Comments

Mike Magee

I am currently knee-deep into preparations for an online lecture at the Presidents College at the University of Hartford on Wednesday, May 5th, at 1:30 PM titled “The Constitution. and Your “Right” to Health Care in America.”  

I’ve been at it for over a month. The classic debate centers on the Constitution’s emphasis on negative rights (that is protection of citizen prerogatives from overreaching of their federal and state governments), rather than positive enumerated rights, which carry with them implied obligations of enactment or enforcement (as in The Bill of Rights).

On a practical level, the same debate– from high schoolers to policy elites – reads from one source like this:

“Proponents of the right to health care say that no one in one of the richest nations on earth should go without health care. They argue that a right to health care would stop medical bankruptcies, improve public health, reduce overall health care spending, help small businesses, and that health care should be an essential government service.”

“Opponents argue that a right to health care amounts to socialism and that it should be an individual’s responsibility, not the government’s role, to secure health care. They say that government provision of health care would decrease the quality and availability of health care, and would lead to larger government debt and deficits.”

The 90-minute lecture, presaging a full-blown course this Fall, will place me in the middle of this debate – part practical, part esoteric, legal and nuanced. But the reality that I’m fast approaching is that it really doesn’t matter. That’s because – whether a “right” or “privilege”, universal, accessible, affordable and effective health care in America is now a “necessity.”

Here are three reasons why this is true:

1. Performance: By any measure available, our predatory and profit-driven approach is a 70-year old historic misstep that is roughly twice as expensive and half as effective as most of the 36 OCED comparator nations.

2. Economic: This highly inequitable and remarkably variable system now accounts for roughly 1/5 of our entire GDP, powered by a bureaucratic workforce with 16 workers for every physician, half of which have absolutely no clinical function. The resultant corporatized Medical Industrial Complex supports opaque pricing, legal kickbacks, and an integrated career ladder where medical scientists actively collude with CEOs from health insurance, hospital, pharmaceutical and research arenas.

3. Strategic: Our decentralized approach to care lacks any coordinated national strategic public health apparatus. There is no national plan. When stressed by the current pandemic, it failed on a massive scale resulting in the needless deaths of hundreds of thousands of citizens, vast damage to our economy, and near collapse of our major hospitals nationwide. In the process, it revealed historic underfunding of public health, prevention, and the social determinants of health, preferring instead to rely on last minute, high science intervention come to the rescue.

The question we need to be asking ourselves – whether you align with  “right” or “privilege” – is no longer a philosophical debate, but rather a practical question.

“What kind of system do we need to create to make America and all Americans healthy?”

Putting the Genie Back In The Bottle. Health Care For All Is the Cork.

Posted on | March 24, 2021 | No Comments

Mike Magee

Two years ago, James Comey wrote an editorial in the New York Times which began, “America has long had a radioactive racist soup in the center of our national life. Donald Trump thinks he is stirring it for political benefit. He’s actually doing something more dangerous.”

The January 6th insurrection, followed by the past weeks two mass shootings, add credence to his earlier warnings. Modern civilized societies rely on a double-armed approach to maintain order, peace and security.

The first arm is laws. But laws are of little value without enforcement. As Comey stated, “It was long a statutory crime to kill another human being; it just wasn’t against the law in practice to kill a black person in many places. The rights to vote and to equal treatment sounded muscular on paper, but they were weaklings in much of America.”

The second guard rail of civility is culture. MIT professor Edgar Schein  describes it this way: “Culture has three layers: the artifacts of a culture — our symbols and signs; its espoused values — the things we say we believe; and, most important, its underlying assumptions — the way things really are.”

In the Senate chamber this week, and in Republican controlled state houses across the nation,  Americans witnessed a colossal collision of reality and ideals in the form of new Jim Crow laws to suppress minority voting rights, and refusal to address gun violence in the wake of not one, but two mass shootings, involving sale of weapons of war to civilians. 

Were these the only flashing alerts signaling danger ahead, that would be enough to cause sleepless nights. But unenforced or unevenly enforced laws, and value dissonance in America, do not occur in isolation, but are supported by an even more erosive underpinning – greed-induced economic inequality.

A 2019 pre-pandemic report in the Wall Street Journal laid out the numbers. While the vast majority of growth in assets in the prior three decades went to the top 10% in the US, debt increased by $9 trillion with ¾ of the debt issued to the bottom 90% of American families. For the top 1% during this period, median net worth grew 178% to over $11 million. For the rest of us, earnings had been flat while housing prices increased 290%, four year college tuition soared 311%, and average per-capita health care expenditures rose 51%.

A May, 2021 WSJ report from the Federal Reserve reinforced the uneven impact of the pandemic: “Almost 40% of households earning less than $40,000 a year experienced at least one job loss in March, versus 19% of households earning between $40,000 and $100,000 and 13% of those earning more than $100,000, the Fed said. And while 85% of those with no work disruption said they could pay the current month’s bills in full, just 64% of those who had lost a job or had their hours cut said they could cover their expenses for the month.”

To put this genie back in the bottle, we must simultaneously address the nation’s values, its culture and its economics. To accomplish this, artificial barriers like the filibuster rules in the Senate must be dismantled.

Beyond this, the quickest, most direct pathway to address income inequlity, safety and security is now through universal health coverage. Not only would this offer the opportunity to distribute wealth more equitably, but it would also offer the country the opportunity to acknowledge mistakes of the past, and work anew at aligning our actual behaviors with our stated values of compassion, understanding and partnership.

Can the Bureau of Labor Statistics Predict America’s Appetite For Change?

Posted on | March 10, 2021 | No Comments

Mike Magee

This past month we added 379,000 jobs and Wall Street blushed. But the fact remains that there are 9.5 million fewer jobs in our economy compared to a year ago, and first-time jobless claims rose last week. As former Federal Reserve economist Julia Coronado reported, “We’re still in a pandemic economy.”

Pre-pandemic, the Bureau of Labor Statistics predicted a 3.7% growth for the coming decade. The newest update downgraded that to 1.9% if the pandemic impact is “strong”, and 2.9% if it is “moderate.” Even without this biological tragedy, permanent changes in the job market had been forecast including more remote work, higher tech service demands, further declines in travel and entertainment, and greater investment in public health and health services.

The 2019 study did a deep dive for hundreds of detailed occupations over the next decade. The largest declines, as you might expect, were projected in transportation, travel and hospitality. Hidden deeper were signs of a changing world order – like the fact that if you are a computer savvy teen with only a high school education, your likely employment in the future will be in software development, not as a cashier.

How good are these projections? It depends on who is doing the forecasts and what are the assumptions. For example, if the health care status quo persists in America, chasing cures and tolerating inequities, a prediction that the largest increases post-pandemic will be in the medical, health-science and technology fields is a pretty safe bet.

The sector is also America’s dominant employer. But at the same time, many of these jobs deliver zero benefits when it comes to patient care. In fact, there are 16 health care jobs for every one physician, and 8 of these 16 are non-clinical.

A shift to a centralized health insurance system, while preserving local choice and autonomy over care delivery, would carry estimated savings of up to $1 trillion off of our nearly $4 trillion annual health care expenditure. Of course that means many insurance agents, coders, billers, and data specialists would lose their jobs. What would become of them?

Likely they would follow the money. But how might that $1 trillion be best spent? The best answer was embedded in the startling fact that the U.S. is the only developed nation that spends more on health care than all other social services combined. These services – including housing, education, transportation, environmental protection, sanitation, safety and security –are all proven determinants of health.

Advancing health and wellness requires physical and technologic infrastructure. Once built, the physical and human scaffolding must be managed and maintained. Translation: jobs, jobs, jobs.

Pandemic Accelerants: The Time Is Right For Change.

Posted on | March 8, 2021 | No Comments

Mike Magee

 “…quietly below the surface, there are transformational forces underway fueled by pandemic accelerants.”  THCB Gang, March 4, 2021.

Change on a societal scale promotes opposing forces – fear and retrenchment battles innovation and exploration. As we’ve witnessed in Washington, the clash can be epic and violent with Democracy itself at stake.

Resolution sometimes involves compromise, other times brute power. That is pretty much where the Democrats and President Biden found themselves this week as they passed an historic $1.9 trillion coronavirus relief plan on a 50-49 vote in the Senate. The “pandemic accelerant” here was massive public support for the bill, including 77% of all voters and 59% of Republican voters.

Buried inside the bill was a range of funding for health care, and as important, for the social determinants of health care. For example, $125 billion in new federal funding for K-12 education, was added to the already committed $67 billion, for a total new funding of $192 billion or an additional infusion of $2,600 per K-12 student.

Paralysis of our public education system has had a profound impact on our physical, emotional and financial health. It has also demanded sacrifice, teamwork, empowerment, and momentum. A quick Education Week review of the past year helps explain why.

Jan. 29, 2020: 1st mention of possible need for pandemic safety in schools.

Feb.15, 2020: Temporary school closures in Washington and New York.

Feb. 25, 2020:  A CDC warning for schools.

March 5, 2020:  A move toward distance learning begins.

March 11, 2020:  WHO declares pandemic.

March 12, 2020:  Gov. DeWine closes Ohio schools.

March 16, 2020:  Schools now closed in 27 states.

March 17, 2020:  Kansas annouces closure of schools for the year.

March 25, 2020:  All US public school buildings closed.(Idaho is the last to go.)

May 6, 2020:  Nearly all states now close schools for the year.

May 19, 2020:  Teacher morale and student mental health surface as issues.

May 25, 2020:  Addressing the George Floyd murder remotely becomes an emotional challenge for teachers and students.

June 15, 2020:  Studies expose a “digital divide” between poor and rich students to broadband and computer devices.

July 28, 2020:  In a virtual town hall, Dr. Fauci tells teachers they are “part of the experiment.” Teachers union threatens to strike if “forced” to return.

September 15, 2020:  74% of the 100 largest school districts chose remote learning only for over 9 million students.

September 23, 2020:  400 educators have died from Covid-19.

October 15, 2020:  Majority of schools now embrace hybrid learning model.

November 2, 2020:  Research supports safe school opening with precautions and testing.

November 7, 2020:  Joe Biden elected President. He declares, “Everyone wants our schools to reopen. The question is how to make it safe, how to make it stick. Forcing educators and students back into the classroom in areas where the infection rate is going up or remaining very high is just plain dangerous.”

December 11, 2020: The first emergency authorization of a vaccine for Covid-19.

January 6, 2021: The insurrection at the Capitol.

January 7, 2021: U.S. Secretary of Education Betsy DeVos resigns.

January 20, 2021: President Joe Biden inaugurated.

February 7, 2021: Chicago Teachers Union agrees to reopen schools.

February 9, 2021: 1/5th of teachers vaccinated; another 1/5 scheduled. 70% state they will be vaccinated.

February 21, 2021: CDC Director Rochelle Walensky states, “I want to underscore that the safest way to open schools is to ensure that there is as little disease as possible in the community. Thus, enabling schools to open and remain open is a shared responsibility.”

March 1, 2021. New U.S. Secretary of Education Miguel Cardonais a champion of safe school reopening. 856 retired and active public schools teachers have died from Covid-19.

March 2, 2021: President Biden directs states to prioritize vaccinating teachers.

From the beginning of the pandemic, the nation’s school house has been in play. This unique tragedy has now claimed over a half million American lives, and carried with it economic devastation for many million more. The elimination of in-person schooling has also profoundly disrupted the labor market.

But after all we have been through over the past year,  the majority of parents surveyed feel going back to the way things were would be short-sighted. They find themselves in the camp of health reformers who seek something more ambitious and transformational.

The same holds true for other social systems that impact societal health, equity and fairness – like safety and security, transportation, the environment and housing. Americans fear slipping back into the status-quo, and missing this moment of opportunity.

Few have access to an expert in the field of Advocacy. I am fortunate to have a son, Marc Porter Magee, PhD, a sociologist and Director of Advocacy Labs at Georgetown University. Here are a few of his insights from “Insights Into Effective Advocacy From The Nation’s Leading Experts”:

Momentum:  “The hardest changes to secure are the modest ones. There is a natural friction to policy change, like trying to push an object across a table. Once you apply enough force to get it off its resting place, it is more likely to travel a foot than an inch.”

Empowerment:  “The powerful aren’t as powerful as you think. It seems logical to assume that the advocacy efforts of the powerful should succeed more often than those with less power, but this isn’t true. When it comes to seeking a policy change, powerful groups are no more likely to win than any other group.”

Teamwork:  “The most effective lobbying doesn’t look like lobbying. Arm-twisting, raised voices or threats rarely get results. Instead, most change happens when policy makers and outside advocates see themselves as members of the same team.”

Sacrifice:  “If you want people to stay involved, ask them to sacrifice. It’s natural to think that the best way to keep people involved in your cause is to make it easy for them to take action. However, it is the very act of sacrifice that generates a long-term, personal commitment to the cause.”

An Invitation to: “Elizabeth Blackwell and Florence Nightingale – Lifelong Sparring Partners.”

Posted on | March 3, 2021 | 4 Comments

Free Registration

Join me for an entertaining, free 1 hour Le Moyne College Webinar:

Elizabeth Blackwell and Florence Nightingale: Lifelong Sparring Partners.

When: Wednesday, March 24, 2021, Noon to 1PM online.

Where: Online sponsored by LeMoyne College as part of their celebration of Women’s History Month.

How: Register Online HERE.

Description: Born months apart, and dying in their 9th decade within weeks of each other, Elizabeth Blackwell and Florence Nightingale were lifelong sparring partners. But what they shared in common, including guiding values and mutual respect for the role of women in society, outweighed their differing pathways to success. How did they meet, compete, collaborate, and challenge each other? Most importantly, why do we remember them today, and what is their connection to Syracuse, NY?

Moderna – The Upstart That Digitized the Pharma Field.

Posted on | February 27, 2021 | 2 Comments

Mike Magee

As the saying goes, “Time is money.” 

When it comes to breakthrough innovation, time is also a marker or measure of success.

Let’s take for example, Moderna, an upstart in the world of biomedical science, dwarfed by the giants in the industry, household names like Pfizer, Merck, and J&J – and the subject of a recent Harvard Business Review case study.

December of 2019: Local health officials in Wuhan, China were alerted to the appearance of an unusual type of viral pneumonia.

January 3, 2020:  Moderna CEO Stéphane Bancel, on reading the alerts, emailed Anthony Fauci and his team at the NIH asking for more information. They were already close colleagues having developed a vaccine together that was active against MERS. Bancel also had deep relationships with the Gates Foundation.

January 5, 2020: They knew it was a coronavirus.

January 7, 2020: Chinese scientists announced they had completed the full genomic sequencing of the virus. This public declaration signaled to Bancel that this was a pandemic in the making, and that if Moderna involved itself, it would dominate (and potentially overwhelm) all other projects – 23 programs for drugs including 11 vaccines in design, two of which were against cancer.

January 11, 2020: The sequence was publicly posted on Virological.org, and the first human fatality from the virus was reported.

Januray 13, 2020:  Moderna finalized its design for a vaccine to challenge the new virus. Moderna’s Board gave the go-ahead to Bancel. Now it was “all hands on deck.”

February 7, 2020: Moderna had produced and quality controlled its first batch of the new vaccine.

February 24, 2020: Just 42 days after the viral gene sequence had been revealed, Moderna delivered its vaccine to the NIH for testing.

March 16, 2020: The first human volunteer was injected with the vaccine in Seattle, Washington. They had gone from viral sequence to human trial in just over two months. Prior to this, the fastest transit was 20 months.

April 16, 2020: Moderna received a $483 million grant to develop its COVID-19 vaccine. On the announcement, its’ stock price headed north, accelerating from $37.25 on April 15 to $80 on May 18, 2020.

July 27, 2020: The vaccine entered Phase III trials, having just received an additional federal grant of $472 million.

December 20, 2020: Just 5 months later, the FDA granted Emergency Use Authorization.

Moderna was founded in 2020, with $5.1 billion in venture capital backing,  “designed from the ground up as a digital biotech company with a factory for in-house manufacturing capabilities.” Up to this point, as they entered their 11th year, they had not brought a single product to market.

Moderna was the child born of Cambridge-based Flagship, run by Noubar Afeyan, an MIT bioengineer and world leader in bio-instumentation. His raison d’etre was “radical innovation.” He not only wanted to do big things, but do them faster than anyone else. As he said, “Asking ‘What if?’ questions propels you far into the future. It may be unrealistic or overly optimistic, but that’s how radical innovation happens.”

To accomplish this outsized ambition, he invested in a four-step process:

  1. Generate break-through innovation hypotheses (what-if’s).
  2. Explore the hypothesis. If it looks good, set-up a prototype company.
  3. If initials prove out, go permanent with a New Company.
  4. If promising, spin it off as a Growth Company.

One company that sailed through the 4 steps to spin off in record time was Moderna. The “big idea was Messenger RNA or mRNA. More on that in a moment. In 2012, Afeyan set his sights on a French scientist, Stéphane Bancel. A veteran life sciences engineer with years of prior experience at Lilly, he possessed two special qualities: 1) He was “impatient and wants to achieve impact fast.” 2) He “understood the power of digitization in the pharma field.”

Beginning in 2012, the two set about creating a fully digital integrated and vertical biomedical discovery and manufacturing firm that would optimize the Cloud, automation, robotics, algorithms and AI. “Scale with speed” was the mantra.

Whether by luck, foresight, or intuition, Moderna also possessed the perfect vehicle for this high-speed ride – mRNA.  Taking its ultimate assignments from cellular DNA, RNA mirror images contain coding to build the thousands of proteins, like insulin, that we need to survive. The RNA masters are able to generate temporary RNA travelers or messengers that head out into the cellular cytoplasm with instructions for the bodies miniature protein assembly factories called ribosomes.

What Moderna’s leaders keyed in on a decade ago was that mRNA, if injected like a drug, was actually a data platform or software instruction manual that would instruct a patient to make its own drugs inside the ribosomes. The “secret sauce” was specially designed lipid nano-particles (LNP) that wrapped around the designer mRNA and protected it in transport while facilitating its delivery.

Can Moderna meet future needs as Covid variants or new deadly viruses arise? Yes we can, says Moderna’s Drug Design Studio promotional video. Have a listen HERE.

Bancel’s bottom line? “We’re a technology company that happens to do biology.”

Laying Lies To Rest: The Pandemic Playbook.

Posted on | February 23, 2021 | No Comments

Mike Magee

When awakening from a long sleep, there is a transition period, when the brain struggles momentarily to become oriented, to “think straight.” When the sleep has extended four years, as with the Trump reign, it takes longer to clear the sleepy lies from your eyes.

We are emerging, but it will take time and guidance. This week President Biden and our First Lady showed us the way. As we together observed the startling passage of a half million dead, many needlessly, from the pandemic, the President gave us a crash course on grief. He compared it to entering a “black hole”, and acknowledged that whether you “held the hand” as your loved one passed on, or were unable (by logistics or regulation) to be there to offer comfort, time would heal. “You have to believe me, honey!”, as he is so prone to say.

As important, we saw the First Lady, without fanfare or conscious need for attention, at one moment, draw close to him, as she sensed that he was about to be overcome by his own sadness, and place her hand simply on his back, patting him gently, knowing that this was enough to get him through. She, by then, had done this many times before.

And we saw the Vice President and her husband, across from the first couple, there only for support. This was neither a speaking role or super-ceremonial. It was humble. It was supportive. It was human, and far away from a predecessor who for four years had to fawn, and lie, and grovel to satisfy his Commander-in-Chief.

As these four lead us back to sanity, we as a body politic are fast at work doing three things as once:

1. We are addressing this pandemic with vaccines and good public health processes, and managing our emotional and economic grief and shock.

2. We are beginning to address all the other challenges left unaddressed that demand “good government” whether they be getting kids back to school, or reforming police practice, or turning on the electricity in Houston.

3. We are relearning how to respect the truth, tell the truth, and demand the truth. As Mandela taught the world in 1995, this is not as easy as it sounds. It requires that we reconcile with our past, reform our present, and resolve together to build a better future.

A simple example of these processes at work is addressing the lie that the Obama Administration had never created a pandemic plan, or warned the incoming Trump administration of the threat. This was a false narrative surfaced in May, 2020 by Trump administration officials, and reinforced by David Popp, Majority Leader McConell’s spokesperson, to aid Republican candidates.

Ronald Klain, Obama’s man-in-charge of the Ebola respose (and now Chief of Staff to Biden) then produced the actual plan, and multiple witnesses to the transition. These included  Jeremy Konyndyk, who directed USAID’s Office of U.S. Foreign Disaster Assistance, who said, “They were extensively briefed, to the extent that they paid attention to these things during the transition.” Then there was  Lisa Monaco, former homeland security adviser to President Obama, who affirmed, “We absolutely did leave a plan. It was called a playbook.”

Four days later, White House  press secretary Kayleigh McEnany was forced to acknowledge the existence of the Obama pandemic playbook, but then obfuscated with a discussion of what constituted a “game plan.” 

This was a tricky proposition since the Appendix Materials in the 69 page document included: I. Declaration and Mitigation Options, II. Key Department and Agencies: International and Domestic, III. Sample Exercises, IV. Communications, V. Concept of Operations for Domestic Response.

But as we have tragically witnessed, setting the past record straight alone is inadeqaute absent power and control over the levers of government.  It took an election, and 5 dead from an insurrection at our Capitol on January 6th, to reclaim the present, and hopefully alter our future.

As difficult as that was, it leaves the critical third step ahead of us. Those who knowingly lied, who dishonored and spoiled the truth, must accept responsibility, apologize, and be held accountable. As Mandela taught us, this need not be punitive, but must be public, if trust and confidence in our Democracy is to be reestablished. Otherwise, history will repeat.

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