Conversations on Health: How We Get There - with Stephani Shelton

Once again it’s open enrollment time for Medicare plans - which runs for just 6 weeks each year - from October 15 until December 7th. 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 1st through January 15th 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 19th – 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. Note: all episodes are also available in video form on YouTube https://www.kiplinger.com/retirement/medicare/three-medicare-changes-on-the-horizon-for-2025 https://www.kff.org/medicare/issue-brief/what-to-know-about-medicare-part-d-premiums/ https://www.cms.gov/

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. Note: all episodes are also available in video form on YouTube

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. Note: all episodes are also available in video form on YouTube

We’re spending some time this summer revisiting the UK’s National Health Service. It’s celebrating its 76th 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 4th – 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. Note: all episodes are also available in video form on YouTube

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. Note: all episodes are also available in video form on YouTube IN THE UK: NHS National Suicide Prevention Line 0800 689 5652. 6pm to midnight. Backup: 0800 689 0880 999 for life threatening emergencies. Or go to nearest A and E. https://www.spuk.org.uk/national-suicide-prevention-helpline-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/

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. Note: all episodes are also available in video form on YouTube

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. Note: all episodes are also available in video form on YouTube

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 U-S 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're 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. Note: all episodes are also available in video form on YouTube

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. Note: all episodes are also available in video form on YouTube.

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?

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. Note: all episodes are also available in video form on YouTube.

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. Note: all episodes are also available in video form on YouTube.

Starting in mid October and ending January 15th, 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 7th 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 1st. 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. Note: all episodes are also available in video form on YouTube.

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. Note: all episodes are also available in video form on YouTube.

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. Note: all episodes are also available in video form on YouTube.

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. Note: all episodes are also available in video form on YouTube.

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/ And please, DO subscribe so you won't miss any episodes. Thank you so much! Note: all episodes are also available in video form on YouTube.

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. And please, DO subscribe so you won't miss any new episodes. Thank you so much! Note: all episodes are also available in video form on YouTube.

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 Part 1 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. And please, DO subscribe so you won't miss any new episodes. Thank you so much! Note: all episodes are also available in video form on YouTube.

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. Note: all episodes are also available in video form on YouTube.