Transcript of podcast interview with Juliette Kayyem, candidate for Governor of Massachusetts

This is the transcript of my recent podcast interview with Juliette Kayyem, Democratic candidate for Governor of Massachusetts. Visit the original post to listen to the podcast and read a summary. This is part of a series of interviews with all nine candidates for Governor. The full schedule is available here.David E. Williams: This is David Williams from the Health Business Blog. I'm speaking today with Juliettte Kayyem, candidate for Governor of Massachusetts.Juliette, thanks for your time today.Juliette Kayyem: Thanks for having me, David.Williams: Juliette, does Chapter 224 represent the right approach to addressing rising healthcare costs? And if not, where does it miss the mark and what would you do differently?Kayyem: It's absolutely the right approach in terms of Massachusetts being the first state to try to crack the nut of rising healthcare costs. It's a great start.People who see me on the trail know we're never done. There's no finish line, we just keep pushing. The legislation is a start to continue and strengthen our efforts: whether it's through transparency; whether it's through causes of action against healthcare industries; whether it's through capping healthcare cost. While it is a great start, there's no way we can think that we're done with the challenge of healthcare, both in terms of the burden that it places on our state budget, but also in terms of looking at other ways to relieve a healthcare system that's under stress.I am on the trail a lot. Part of my campaign - and maybe also as a mother - is to really focus on public health issues. If you think about the biggest costs of the healthcare system, it's individuals with chronic and yet preventable illnesses, whether it's diabetes, or obesity, or congestive heart failure. There are things that we can do on the front end to relieve the burdens that we're addressing in Chapter 224.Williams: Juliette, there are certain provider systems in Massachusetts that are reimbursed significantly more than others for the same services, even though there are virtually no differences in quality. Do you think the state has a part to play in addressing these disparities?Kayyem: I do. I think that part of what the state is doing in terms of transparency is a start. Anyone who is in the system, and certainly has children or family members in the system, knows that those bills you get that actually say “this is not a bill” in the mail are, completely incomprehensible to the average person, even someone running for Governor.There's more that the state can do. But we need to, realize that it's a competitive field and that there are going to be limitations to what the market can correct. Transparency is good, and litigating or having causes of action against abuses is good. Then let the market begin to drive some better behavior.Williams: There are more than a dozen state agencies that have a role in healthcare. Is there an opportunity to consolidate or rationalize them?Kayyem: Yes. I have been in state government and executive roles, and I have been in federal government. I'm actually the only candidate who's been in both. There is no question that rationalizing and consolidating them is important. I have done that in the past in state government, whether it was in my space, which is Homeland Security, which had a lot to do with healthcare preparedness and public health preparedness. We were looking at SARS at that time and H1N1.We are a home-rule state with 351 cities and towns and each of them has healthcare leaders. Each of them has NGOs working in the space, private facilities, and a lot of players. We need to work through all those different layers to ensure that agencies are working together. What we need to do, what the new Governor needs to do is to ask, can the delivery of service become more efficient?That doesn't necessarily mean a czar in the governor's office. Are we, the state government, more transparent for patients and for other government entities who are clearly much more intimate in the space?Williams: You mentioned working both in the federal and the state government. Well, both federal and state government policies have encouraged adoption of electronic medical records. However, there are many providers that complain about the systems and some of the benefits have been slow to materialize. Do you think that state government should play a role in helping to realize the promise of health information technology?Kayyem: Absolutely. Look, nothing happens in a day. I'm pretty honest about that on the campaign, and I'll be honest about that in government. Just think about the anniversary we just celebrated at Facebook. Ten years ago it was founded, and in that decade the way we manage data has fundamentally changed. Dropbox and Facebook have shown that cloud-based data storage is really a viable option for both public and private data, with all sorts of complications. I'm not washing over it, but with all sorts of complications.Medical data is the most private and therefore must be the most secure. It's understandable that medical records have taken some time to catch up. The state can do a lot to encourage hospitals to adopt and invent these new storage protocols and transfer protocols while protecting privacy. This is eminently doable with state government, both providing the best practices, the R&D, and the support for private and public hospitals to do this. In the next couple of years this will begin to come to fruition.Williams: Hepatitis C is three or four times more common than HIV. There are new drugs that can cure the infection that are coming on the market this year, but they're very expensive. What role should the state play in ensuring that residents are tested, linked to care and have access to these new medications?Kayyem: That question is about different pieces of the trajectory of Hepatitis C. My experience is not as a doctor in this space or in the healthcare space. When I was in the federal government, we responded to what was then the H1N1 outbreak, and realized the challenges of drug distribution - in that case a vaccine - and the challenges of getting it to the most people, what we call the “last mile”. We can make things, we can buy them in bulk, we can get them down to the right hospitals or community health centers, but can we actually get them to individuals? I'm committed to finding ways in which we can do what we call that “last mile”, which is most important.As a state, we have been at the forefront of advocating and pushing for access to affordable healthcare, and Hepatitis is no different. We need to look at whether the 97% that are covered can access these very expensive drugs. Most importantly, we need to look at prevention of Hepatitis C. That's only going to occur with strong public health education programs, and strong commitment to community health centers, and other public education providers that are out in communities helping people live healthier lives.Williams: Juliette, there are multiple healthcare-related ballot questions. What are your thoughts about them?Kayyem: As a general rule - and people know this about me and I think probably maybe most politicians are this way – I prefer ballot initiatives  going through the legislature. Ballot initiatives don't allow for the kind of negotiations that are often required for proper implementation.That being said, I would support both the fixed nurse-patient staffing ratio and the hospital financial question. If the citizens of the state pass them, I'm not going to oppose them. On the other hand, I would also like to work with the nurses' union, with hospitals and others to get the legislation that is necessary to ensure that nurses have adequate staffing levels, and whatever other legislation might be appropriate for this space.Williams: In your campaign platform, you talked about reducing health disparities in the Baystate’s underprivileged communities. Are there specific steps you have in mind to achieve this?Kayyem: Homeland Security –which we think of in terms of safety and security and terrorism and hurricane--,is really about buttressing preparedness through our various systems that protect people. That includes public health and citizen's health. As I've mentioned before, they're not in the spaces of threats that come from viruses that we don't have vaccine for - for example, H1N1. When you think about any crisis or any disaster that hits a community, the burden on public health and the health community are equally felt. It's not just the police issue or fire issue. We can think of any disaster with Mother Nature.I am committed to buttressing public health preparedness. Not only is that good for all communities, but also in underprivileged communities. It is, going back to these words, the community health centers that are really the most intimate in the relationship between the patient and the community to health and healthy living.I want to do more in terms of supporting our community health centers, not just empowering them, but actually helping to grow the partnerships between them and hospitals. This, will allow hospitals to adapt policies to properly accommodate changing populations in the state, such as the impoverished. I want an ecosystem of the delivery of services that go from the most elite hospitals in the state, which we are incredibly grateful for having, to the community health centers, which are really at the forefront of the delivery services to our underprovided communities.Williams: Much of the emphasis in healthcare reform is on adult patients. Do you think there is a need for a specific focus on children's health?Kayyem: Absolutely. I have three kids, 12, 10 and 8. A couple of things, one is vaccinations, flu vaccines, educating parents of the necessity of doing this. It's about public education. People have to understand that the health and livelihood of our children is dependent on responsible behavior of other parents about their children. As a mother, you keep them home, you make sure that they're vaccinated against harm, you teach them healthy living about drugs and alcohol. As a parent, and if I were to be Governor, I can speak honestly about the challenges that we need to address in our child population. It runs the gamut depending on what population you're talking about.In addition, you're looking at a system that is a huge burden on the state, and we've got to begin to relieve that burden. Healthy living for our children; the numbers I've seen - a million teenagers enter emergency rooms a year, nationally, for just drug and alcohol abuse - if you think of the burden on our healthcare system, a lot of that can be relieved by focusing on our children, and then being healthier in the future. Healthier now so that they are healthier adults.Finally, and I'll just say this because this is a big issue for me, I am into risk reduction. That is what Homeland Security is about. One of the risks that I see coming our way is the challenge of climate change and how that's going to impact our children's health. We have to begin to really focus on climate change adaptation because our kids are outside and have increased asthma. Access to healthy food becomes harder if the weather's changing too much. Just think about all the parts of healthy living that would be impacted by climate change. Climate change is a public health issue and that's why we need to begin to adapt to it as well for our children.Williams: Juliette, you've been very patient in answering my specific questions that I have on healthcare. I'd like to give you an opportunity if there's anything that you'd like to add that we haven't covered so far.Kayyem: I really appreciate this time. Campaigns have a tendency to make us have a healthcare policy, and an education policy, and then an employment and a criminal justice policy. Part of what I bring to this race, in conflicts and crisis management in both state and federal government, is a capacity to think about solving the problems of our time in a way that is very holistic. We should begin to view healthcare not as a separate issue reserved for the professionals in the health businesses and the healthcare providers, but one that is intimately tied to educating our children, the delivery of health services through our infrastructure, and that is tied to our economy and economic growth.  If we are healthy, businesses will want to come here.While I appreciate all these questions and the opportunity to answer them, part of what we need to do through the campaign, as well as a Governor, is to help people understand how all these things are related, in order to build a stronger, more prepared and more resilient Massachusetts. That's what I'm in the race for. So I appreciate the time.Williams: Juliette Kayyem, candidate for governor. Thank you very much.Kayyem: Thank you.