Pipes will be a part of Vator's Healthcare in Politics salon on Sept 9 and October 7Read more...
Barson will be a part of Vator's Healthcare in Politics salon on October 7
With the election right around the corner Vator and HP will be hosting their latest salon on October 7, called Healthcare in Politics (register for the event here!) where multiple panels of experts, policy makers and lawmakers who will be on hand to discuss topics related to healthcare policy and decision making.
One of the panels will center specifically around the U.S. response to COVID, including how to balance saving lives with saving livelihood, and how we should think about the problem going forward.
I spoke to one of our panelists, Emily Barson, Executive Director of United States of Care, about the US response to COVID, what a national strategy around the virus should look like and how to best get people back to work and into school.
VatorNews: Tell me a bit about yourself, your background and your work at United States of Care.
Emily Barson: United States of Care is a relatively new non-profit; we launched just about two and a half years ago around the bold mission that should be simple: that everyone should have access to quality, affordable health care, regardless of health status, social need or income. We believe that we will be part of bringing that about by, most importantly, building policies that focus on people’s shared and diverse healthcare needs. There's a lot that people can agree on that isn't necessarily reflected in the political narrative these days, and we have a vision for a healthcare system that works better for people. One where they can manage the cost for their health care, where they can access the care they need, and where they can have the security and freedom of healthcare coverage as life changes in a healthcare system that can be understandable for them to navigate.
We've gathered a group of what we call our Founder’s Council, and we've also got an Entrepreneurs Council, which are a diverse network of people from both sides of the political aisle and from throughout healthcare and beyond. They include business leaders, care providers, patients and patient advocates, everyday people, health care policy experts, public health and health equity experts, who have all aligned around that mission, so we really are able to bring that as our superpower towards meeting our goal.
Prior to coming to the United States of Care, I served for eight years at HHS during the Obama administration, and ended up running the Office of Intergovernmental and External Affairs, which is the department's liaison to state, local, and tribal governments. That also includes the big umbrella of external stakeholders as well, the advocates, constituency groups and private sector groups that have interests before the department. I really gave them a voice within the building, and also served as the liaison on so many of the priorities that happen at the community level; everything from ACA and Medicaid expansion to other public health crises that predated the current one. I was one of the folks focused outside of the Beltway on what was happening on the ground. So, the chance to come to United States of Care and continue that outside-in theory of change was just the natural next step for me.
VN: Let's get to the meat of what we'll be talking about on the panel: what is your view on the U.S. response to COVID? What did we do right, what did we do wrong?
EB: We, as a country, need to have a more unified response and a way to take the politics out of taking response seriously. There has certainly been an emphasis on some of the individual and community level activities, like wearing masks, closing down different types of businesses, or moving towards outdoor spaces. All of those things are super important but that needs to fall under a broader national strategy that brings all the pieces together and that Americans, no matter what political persuasion, can have confidence in. There has been a ton of leadership shown at the state and local level, so much support for providers and essential workers. There's really important work that's happening there, and creative solutions around how to move forward, but really what we need that at the national level. Until there’s a vaccine there will need to be mitigating steps taken and we need to have guidance that can transcend the political narrative and the ability for people to start moving towards normalcy in a way that they can trust they'll be safe.
VN: We had a very piecemeal approach, where one state shut down and another didn’t, so people were going back and forth, spreading the virus. What would a good national policy look like? What should we have done on that level that we didn't do?
EB: Even early on, certainly some places were very serious about the lock down, stay home, save lives, efforts, but it wasn't necessarily consistent. The message around the importance of that, as a way to get ahead of the virus and flatten that curve, was inconsistent. A national strategy doesn't necessarily mean that every locality is at the same phase because there are going to be certainly more levels of community spread in some places than others, but we need a consistent set of science-driven and data-driven metrics that can be agreed upon and followed.
We've seen some of these large scale events, like the event in South Dakota, where people go back home and, like you described, are bringing back a virus with them. So, having a set of metrics and guidelines that will be followed, especially related to some of these mass gatherings, would really bring us a long way towards getting to a level that can be sustained until there is a virus vaccine or other treatments that are able to keep the virus under control.
VN: Joe Biden has said that he would institute mandatory lockdown/shut down, but this could also have negative effects to our mental and financial health. If the scientists say we should lock down the entire country, do you believe we should do it?
EB: We should follow that the scientific guidelines are and I think there are scientists that will certainly take into account some of these other factors, like the mental health issues.
Look, I have two small kids, one of school age, and I would absolutely rather he be in kindergarten in person but right now he's doing it on Zoom. Nobody argues with the benefits of in-person schooling over kids sitting in front of a computer all day long but until we can have this sense of confidence, that we're doing all that we need to be doing to keep our kids safe based on the science, we need to be willing to follow the scientific guidelines.
VN: Since you mentioned education, let’s do a deeper dive into that. With many states struggling with the idea of whether or not to reopen schools, how can we make sure that kids get an education while staying safe?
EB: Again, listening to the experts and having a cohesive set of guidelines from the national level that can inform local decision making is going to be really important. This is another space where I don't think that there's a one size fits all, where every school in the country needs to be closed or open or hybrid. There are going to be local factors and, knowing that having children in school can contribute to the community spread, that data needs to be taken into account. I believe that most parents want their kids to be in school, but I think that their health and safety, and the health and safety of their teachers, the staff, the administrators, and the family members that they come home to, or community members they may interact with, has to take precedence.
We absolutely could get to a place within weeks where we can take enough steps to control community spread and have a safe reopening. There's always going to be trade-offs and priorities; many places over the summer decided to open restaurants or other entertainments and there was a lot of public outcry for that, but that may be what contributed to the spread. Communities are going to have to make those assessments and determinations but that has to be driven by the data of the best knowledge that we have at the time of how we can keep our children and our community safe.
VN: People in low income people and in rural areas may not be able to even do online learning. They may not have the broadband, they may not have the devices that are necessary. So, those kids need to be able to get an education.
EB: I would agree with all of that and this is an equity issue. Like you're pointing out, there are challenges with the technology and this is not limited to rural places, but there we've been hearing from someone who is a hospital administrator who had to make a choice because they didn't have enough broadband to support both her doing her job from home and her child being able to do virtual school. They had to make a choice to prioritize the job that supported that family. These are all incredibly difficult decisions. Some school districts are more equipped to provide the equipment or to have community hot spots, but there needs to be solutions that are not leaving particular communities, or essential workers families, behind.
That’s especially true knowing that the disproportionate impact this virus has had, in particular, on Black, Latinx and Native American communities, and that’s in part because you have higher numbers of essential workers in those communities, closer living quarters, and a virus that's amplifying some of the underlying health disparities that have already been present in those communities. All of that needs to be part of the conversation because doing a partial reopening that systematically leaves people behind is not acceptable and it's not an equitable way to go about it.
VN: What is the risk-reward ratio of opening up the economy? How do we balance saving lives with saving livelihood?
EB: Part of that has to involve resources from the federal government. The reality is the initial stimulus packages that were passed in the early days of the pandemic were critical to keeping people alive: the individual and family stimulus checks, the enhanced unemployment, the work that’s been done around rent and evictions. There needs to be extended resources from the federal government, which is really the only body that's going to have the scope to be able to do something as broad brush as that, as well as resources that go to the state and local communities, both for economic support and for the contact tracing and testing.
It’s a false choice to say it's a choice between saving the economy or responding to the virus, because you can't do one without the other. The reality is that states are facing budget shortfalls because of the economy and unemployment, and they’re going to need the federal support in order to be able to carry out the functions of both supporting the economies and controlling the spread of the virus.
VN: Obviously there's a big debate that's going on right now about the next stimulus, and whether or not anything is going pass or what's gonna be in it. It doesn’t seem likely to pass but, if it does, what would you like to see in that second stimulus bill?
EB: I can't get into the business of prognosticating the likelihood of that. We’ve seen this ‘will they or won’t they?’ throughout the summer. It is certainly frustrating for those who are waiting on this release, or for whom the $1,200 check was all that stood between them and being able to buy food or pay rent for their families. There's absolutely a challenge that the delay has caused, just in the reality of on the ground people feeling the effects of that. We at United States of Care put out recommendations related to federal action that are still hugely relevant in a number of priority areas, according to the ongoing public health response. That includes resources and funding for contact tracing, testing efforts, and the ability for state and local government to conduct those key public health functions, direct support for people in states, and the ability for states to continue operating with the budget shortfalls they have. You mentioned the mental health impacts and we certainly think there's a need for Congress to take action on mental health resources as well.
Looking ahead, we need to transform healthcare for the future, building a workforce to look ahead to future pandemics, being able to respond appropriately and strengthening the healthcare system to have the resilience for future pandemics. All of these need to work together and you can't talk about reopening the economy without getting the virus under control. While we get the virus under control, people still need to pay rent and pay their bills. All of these are really interlinked.
VN: What are some of the technologies that can get us back to work and school faster, as well as prevent another pandemic from getting this bad?
EB: I don't have expertise on this specific technologies. I will say that there is a level of public skepticism around some of the technology, and there's a certain distrust of some of the tracking or privacy issues that fully relying on technology implies. A big part of contact tracing has to be old fashioned, virtual shoe leather that public health officials and departments have done for many years around communicable diseases, tracking down where people have been. I know there are certainly other technologies that don't raise individual level privacy but can be triggered if you have been in proximity to someone who later test positive. This is something that a number of college campuses are piloting and it remains to be seen, based on the data, if that can be the answer. It has to be part of a more comprehensive set of contact tracing that includes, old fashioned, public health efforts, and also a level of public education and making sure people know what in fact they're signing up for if they download an app or sign on to the technology platform.
VN: We've been through six months of this pandemic and obviously we've learned a lot. Hopefully that will get put into place for the next time this happened. What are some of those lessons that we've learned and how can we implement them going forward?
EB: You'll notice a theme in what I’ve said: following the science, following the epidemiologists and the experts and finding a way to do the public education that bolsters confidence in the recommendations and in the response. We have to take this out of the political arena of being a badge of one side or the other, whether or not you're complying with public health recommendations. That is certainly a challenge that we need to take on around the narrative, to trust science and to have the public be confident in those activities.
There are certainly more concrete steps that can be taken, like funding of public health infrastructure and public health departments that have been systematically underfunded over the last many years. It's one of those functions that goes often unnoticed until it's needed, and that's something that we've come to realize. We do have some more specific recommendations around and workers that could be activated the next time there's a public health crisis and really getting that infrastructure funded and in place sooner; being proactive on that rather than reactive.
Frankly, there are also really systemic changes in how healthcare is delivered and paid for that could make the healthcare system more resilient. Certainly as the volume of people showing up for various health care services went dramatically down and people were sitting at home, that had a really devastating impact on many of the health care providers themselves, and it's changing how they're able to continue delivering care in their communities. So, looking at how we can do the work now to build more resiliency into our healthcare system.
VN: Is there anything else that you would like me to know?
EB: This has been an unprecedented crisis; none of us has really lived through something of this magnitude before. It is obviously just devastating for the people who have been sick with the virus, not knowing the ongoing impacts, etc. but there also have certainly been areas for optimism around some of the innovation, the communities coming together, the volunteerism and people meeting their neighbors needs in creative ways. There is certainly room for optimism for me in looking at all of those. I'm hopeful that we learn the lessons from this experience of doing the preparation work and the infrastructure that's needed before it's upon us, rather than trying to scramble and be reactive.
(Image source: arizona.edu)
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