good evening i'm lugosi in and welcome to another edition of open source my guest tonight is chris grant who is the former new jersey cabinet member and commissioner of health and senior services and we're we having an exciting and very lengthy discussion about health care and national state policy and how you can learn more about the resources impact state and national policy and i'm very fortunate to have chris on the show tonight because he's a well sort after speaker and consultant and she's worked in the private sector as well as the government sector and everybody always tries to grab hold of her to hear her thoughts and her projections as to what's happening now and what's going to happen hopefully in the future through her health care crystal ball some time so chris thank you very much for coming on the show i think it's a really good opportunity and then the fun to talk about some of the things which can resonate to the general public i think people don't know that you have such a long a long and lengthy history about working with and public health and business law in philanthropy and as commissioner crist with teams implementing a variety of health care access and sureness coverage programs including in the state hospital rate setting uncompensated care immunization a hiv prevention pandemic planning maternal and child health anti tobacco policies nursing home community based and pharmaceutical services for seniors as a national health care finance and reimbursement specialist she advises advocated for a variety of national and state program improvements she served on a variety of boards including national science advisory board and she's chair of the american bar association science and technology second she serves as a pharmaceutical executive and she has been also an early staff member of the robert wo johnson foundation in princeton for which she remains the advisory board chair for new jersey health initiatives besides that she has degrees in science law and business is a certified mediator has written numerous academic articles as well as participating in numerous television producer concerning health care and i'm very pleased i'm very honored to have you on the show today so i want to talk immediately about health issues that are on the front burner i want to talk about the national discussion that's going on right now and although the national discussion  focused on the short term fate of the affordable care act and what is going on in the big picture today in american health care that is affecting most americans today on a day by day basis i call this the lobster effect  lou as we have been so focused on what is going on in washington with respect to the next chapter in the affordable care act a lot of people aren't aware of the larger issues that are going on in the country there's a net there was a natural break at the time of what i like to call the great recession because we have had a fundamental change in both the demographics of people who do or do not have health care coverage as well as people who do or do not have employment in large organizations which used to cover them and that is they have now had to find new approaches not only to their day to day life but defined coverage for health care so one of the main changes that have gone gone on is that while we still are a country that primarily uses private employment based insurance that is over half of the insured americans receive often share in the cost of insurance that is purchased by their employer which has all the efficiencies that go with that approach but the big change has been that there was for twenty twenty five thirty years the fact that our country is aging and more people were covered under medicare and increasing  publicly covered and fewer were covered under medicaid aid for the poor those covered under medicaid used to be primarily very low income women and children and they still are covered but and i know you're aware of this that programs for medicaid are often they are funded by both the state and the federal government and from time to time they are risk so while we're focused on the act we have a situation in the united states that we now have more people on medicaid including many people who lost their jobs in the great recession people fifty to sixty and so the fate of medicaid and the decisions by states is very important another big trend is the very nature of health care such a inching we've gone from a per visit kind of approach where you or i would maybe go for an annual physical or miss our annual physical and go when we had a stomach ache that when go away or the flu but now we have highly sophisticated interventions that are increasingly available to the population and there's a lot of friction we don't have a system in place yet to make it very clear with all the new genetic therapies with the advance an oncology cancer care for people we don't really have the mechanisms in place to pay for once in a life time very large treatments transplant transplanted ation of organs there is a very new development which is so exciting right out of  pennsylvania where a one time treatment for a congenital disease which causes blindness can be actually cured in a young child but we're talking about a million dollars expenditure so this is another big trend that that we are facing what are how are we going to handle the very large infrequent expenditures the third big issue that's going on around us again like a lobster we're not aware until we suddenly tune in is that hospitals are continuing to consolidate and in addition to hospitals consolidating or having very strong partnerships with on main university's center which we see here in central jersey for example our own princeton plainsboro hospital has a very major evolving relationship with a major university center out of state we saw a couple years ago our universities of medicine and dentistry system in new jersey actually has now merged with a very large private health care system these are all issues which are going to affect our access and so while we're focusing on what congress is doing we have to be better equipped to manage and to get navigate our own system we just saw this past week for example that there's a potential for s the pharmacy company one of very large american company talking about taking over at the health care now this has not happened it's huge it was big that would be very huge what kind of what would you call that company  which is both a pharmacy and insurance company so it's these big trends that are going to have impact on individual lives at the local level and we have to be aware of that and think about how we can negotiate those systems through a lot of people who live in this area you know of also talk about how the bigger picture affects the small picture which has those what's going on at the national level what are the impacts that will impact new jersey residents generally and specifically those right here in central new jersey well that's that's is a very good question because yes indeed our health care system while often regulated and legislated at the federal level the reality is it's implemented at the local level as each of us receives health care and in the near term we have an incoming governor who's going to be facing a lot of issues that relate to health care one of the main issues that has to be addressed i'm i mentioned a couple minutes ago the increasing importance of medic a medicaid program for the poor but poor really means four times the poverty level for a family of four so a lot of people in new jersey now more than those on medicare are eligible for medicaid but the state of new jersey is going to have to decide is it going to maintain this expansion of medicaid which allows low or moderate income families to buy into that program or not and that's going to be a big legislative decision coming up we have other elements that really again very recently as part of the tax reform act i think most of us had hoped that there would be no question that what was called the chip program the children's health insurance program would be maintained that wasn't really thought to be much of a question but as we are in the late stages of two thousand and seventeen it's unclear when and if the chip program will be re reauthorized and that's going to be a very important issue and then you have things coming in from the side sort of things hitting us from the side that are unexpected new to the incoming administration and exist some existing state senators in the state have made it very clear they would like to have the legalization of marijuana access in new jersey one think they want them well good question there certainly are questions of civil justice involved with the current criminal justice system as it relates to people who possess small amounts of marijuana and or  basically deal in small amounts and there is six school of i thought that that has disproportionately adversely affected given federal sentencing  communities and they would like to see a decriminalization aspect but that could be accomplished without the actual legalization of recreational use of marijuana it's true the penalties could be less the penalties could be less and that would solve in my personal view a large part of the concern of those who feel it's disproportionately affecting certain communities but the notion of legalizing marijuana is a very new idea in the country we don't have time to go into all the stud or all entanglements because marijuana is still on a what's called the schedule one which means it is not legal to dispense it except for very specific medical uses and but but leaving that issue aside how would we work through the federal entanglements i must say that new jersey is the most diverse the most densely populated state in the country the whole world comes through new jersey north south east west and to go in that direction i think there will have to be a very important conversation held as to how we will protect not only the public's health particularly the health of pregnant women young children the bill would not allow the bills that are being discussed would not allow purchase or used by people under twenty one but it does not in my view really address yet how to protect young families and young children nor does it really explain how we are going to handle as we have so many people coming in and out of the state the uses the influx potentially of the people coming to this date for that particular purpose because we would be the first state on the east coast to seriously consider this it's true though that's true but it's funny that you know kristie talk about legalizing marijuana and the revenue that it could generate and how boss that some of the lack of revenue in the state  treasury right now but it's funny that it's being mentioned at the same time both at the state level and at the national level there's been declarations of a serious opioid addiction epidemic which allows us know individuals and families some of us know individuals who've been affected by this the opioid crisis so how does how does the two go hand in hand i mean are the health risks i mean what what are we really talking about are we saying one thing and then we're not paying attention to the other well i'm not here to give a brief i think that be great to have people in the room and have to continue that conversation another time i think a lot of people are are questioning why when we are in the middle of an opioid epidemic and new jersey sadly have have many many individuals disproportionately affected by it and we're talking heroin addiction and and the notion of why are we going to open the door to it to a casual use of another substance there is there is a conflict the point is that that's why people have to weigh in and watch this issue that is sort of going to hit us from an angle where we've got our eyes straight ahead and we should we should continue to talk about that let's talk about the federal health care insurance mandate for a second which requires everyone to show proof of having health insurance or to pay some type of  penalty if the mandate is limited eliminated there's a whole bunch of things that will happen there's some alternatives to the mandate to some people have made up their minds say they know what the answer to the whole thing is they know that it's medicare for everybody should have medicare and not wait until you go you had sixty five would not be reasonable pro choice well let me just i'll jump to the medicare for all first interesting way recently  i was in front of an audience tended to be more medicare oriented and i asked and the answer answer four simple questions and to basically get even gave them some suggestions as to what medicare for all meant  them and the answers were telling and basically people want simplicity over the current system they want a sense that everyone pays into the system and they want a sense that they can get everything they want and so you would have a lot of education to do to explain if you really start digging into what medicare for all w because we have a very we have different demographics around the country in some areas you have larger numbers of young families some states are older the point is that our system is currently some would say quite a jumble of different systems others would say it has to be responsive so our current medicare system is a fairly rigid set of benefits that may or may not fit everyone's needs so that's one reason it would be tough the second issue is the current system as you know pay you pay and through your employer the employer matches the employee share for medicare there's even been an additional medicare tax there's about a half a dozen sources of revenue and people in this albeit very small local sample we're talking about a simple add on tax well we know how popular add on taxes can be so it's not clear how we would change the financing that wouldn't be a raise concerns of once again income equality because people if you're paying through a lifetime your circumstances change with the taxes change wouldn't be there at the at the end of the day so that's it's it's there is no question that we're going to have to address better systems that ensure would have always been the forelegs to the cost reasonable cost access the quality of the care and the assurance that a system will have the innovation we need and we've seen in other countries the more similar they are the more one size they fit all the harder it is to have those innovative therapies i mentioned earlier brought into a system right so we were in it for the long haul these are issues that will be living with for our lifetime how do we get a simpler system i think what we have to focus on in addition is how we're going to train the providers of tomorrow in the numbers that we will need we this is another sort of bigger picture issue before we can really get to an a one system for three hundred some million americans ok let's switch over to resources where the times people are listening to things and companies what are some of the best sources of information or help that we can really talk about if a person is having trouble accessing doctors were specialty or just basic hospi care it's complicated and i like to use the example again there's there's been a phenomenon that we all look back on and that is coming through the great recession and i like to use the example of if you think for a minute how so much simpler it seems to go to the bank to make a deposit to make a withdrawal to see a piece of paper about the interest rates that kind of interaction with large providers it's been more to push down to you most of us are now expected to be online to do our bit they would love us to do the banking online they'd love us to do most of most of the work that is a phenomenon of american enterprise now they're coming out of the recession they want to push to maintain their cost structure so i'm not saying that the health care system is exactly like that but the point i would make to the public is that as unwelcome a comment as it might be is that we're going to have to spend some more time on figuring out what is it that concerns us about our health care system if we don't have a primary care physician there are certainly resources you can depending on if you need a pediatrician or a specialist or an older person and you're interested in someone who's but has particular interest in the the issues of the elderly and perhaps your interest in  living you can use the computer is your friend in this regard and if you don't if you can't do it yourself perhaps your significant other your adult child your adult grandchild can help get you started by  searching for resources in your area and then of course word of mouth is still still quite good the financial issues are always very important and just as in many parts of our lives you often can negotiate with your providers and we have to be more comfortable in particularly if your insurance isn't going to cover particular procedure is dental care may be an easier one to talk about we're actually seeing a phenomenon where dentist are because they know that insurance coverage is often in adequate for their patients they are willing to basically give you their own plan that you know for several so you have to ask that's what i was start with now at the state level we have there is a special program called the senior health insurance program and that is a source of individuals you can go online to the ship  the dot dot gov health dot gov excuse me health dot gov and what is probably the least used resource is your own insurance company now you have to be prepared to sit at home have it on a speaker and wait for your time to come but it will have questions particularly if these are questions about what if you have know you have a problem and can't find a physician your insurer is really obligated to help you through that process we also have a new jersey a patient bill of rights if you need hospital care and i often hear about this with respect to emergency room care and you have a right to be told what things are going to cost ahead of time even if you are because usually when you go to the emergency room particularly if it's not a life threatening emergency but weekend situation you and you are likely to be waiting you have the right to ask in advance what's this going to cost me what does my insurance cover and and then frankly ask for find some financial forgiveness if that's not possible we americans are often reluctant to ask for a discount unless somebody offers it right but i would say that in health care it's not a magic well potion at all but it is a tool available to you ok you work in the pharmaceutical industry a lot of times people say thank god i have good health coverage because paying for these medicines would just be impossible i didn't have some type of good health coverage a few years ago people were concerned about don't hold on pharmaceutical coverage and now we hear a lot more about the cost of fusion project of products and genetics therapies when we talk about that we talk about the cost i talk about the ford ability and what you think we could see going forward in the future  well i would say in twenty years we have come a long way you remember there was not even a what we call a part d to medicare which now covers pharmaceuticals and then for the first fifteen years of those twenty years the way the financing was set up there was this quote donut hole after your expenses for medicines hit a certain amount you then went  hundred percent out of pocket and that was untenable to continue for seniors and so congress alternately that being a federal program moved beyond that and we now don't have the donut hole but i would say what we need to do is to make sure that we let congress know that we have to stay ahead of the innovations and medicines i mentioned earlier that we are facing a situation where we're going to we have fabulous new products coming online that may address genetic issues may address stem cell they'll ability but and they are issues which not all of us will need and we may need once in a lifetime and they will be very very expensive and they we need to keep pressure on conversations going with pharmaceutical companies we've seen a couple high profile conversations in the last couple  years between congress and particular companies and i think that's something that's healthy that's healthy to push back my experience having worked with several very high profile in my view very ethical companies is that they have they try to get the medicines through it is a multi multi hundred million dollar proposition to invent and manufacture and provide today's medicines and they need to recover that that cost over time so they can invent new medicines and that's a reality but it doesn't mean that if you feel that you just can't get the medicine you need people should write that pharmaceutical company they should ask their physician the physician usually for particular diseases will have is if these are very high cost items will often have a source of what is a service semi charitable group that can help you pay pay for that but it's comes back to you really need to make sure you think about that issue upfront and that you ask your insurer for this for some opportunities if you're not in medicare and have the party to make sure you don't neglect the medicines as part of  as part of your insurance package ok well we're going to talk a lot more about what can we see coming out of trenton with the new governor and the state legislature in twenty eighteen and we'll talk about that and hopefully everybody will stay tuned as we continue our discussion on health and related issues and next week as we talk to chris grant and we'll be getting back and focusing on what can we expect from the