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Health Affairs This Week places listeners at the center of health policy’s proverbial water cooler. Join editors from Health Affairs, the leading journal of health policy research, and special guests as they discuss this week’s most pressing health policy news. All in 15 minutes or less.
Hello and welcome to Health Affairs This Week. I am your host, Jeff Beyers. We're recording on 04/24/2025. This week, we published an ahead of print article by Yasha Sweeney Singh titled private equity owned physician practices decreased access to retinal detachment surgery twenty fourteen to 2022. Check that out.
Jeff Byers:She also wrote another paper on private equity that was published in the March issue as well, and Rob Lot spoke with her on a health policy podcast. So if you're interested in how private equity affects health care, check out the AOP, which you can find in the show notes and check out that podcast. On May 29, we are hosting an insider event on the FDA's first a hundred days under the second Trump administration. This is moderated by Rachel Sacks, and the panel will include Richard Hughes the fourth and Arty Rye. Check it out.
Jeff Byers:Become an insider today. Today marks the publication of our two hundredth episode of health affairs this week, so really excited about that. Thank you for listening to us over the years. We launched this podcast in December 2020, which truly feels like yesterdays in a lot of ways, but also feels like an eternity. A lot has changed in the last four and a half years.
Jeff Byers:To talk about what's changed and what remains the same, I'm joined by Health Affairs own Jessica Bylander. Jessica, welcome to the program.
Jessica Bylander:Hi. It's been a little while.
Jeff Byers:Yeah. Yeah. So four and a half years, you know, to put some context to that, I joined health affairs in August 2020. So five years ago, I wasn't even here yet. Also, welcomed the birth of a daughter.
Jeff Byers:What's, you know, big change for you since we started this podcast?
Jessica Bylander:Wow. Yeah. Well, I've I mean, I've I feel like I've been at health affairs forever, like, thirteen years. So over time, the years, like, kind of squished together a little bit more. I I was shocked to learn that this was the two hundredth episode and that we've been doing this for nearly five years.
Jessica Bylander:I thought that couldn't be right. Yeah. I guess since 2020, I had a second child and
Jeff Byers:Congrats.
Jessica Bylander:Kept working here and have had a lot of adventures and couple couple bouts of COVID nineteen. Yeah.
Jeff Byers:Yeah. So, Jess, do you consider health care fun? Is this a fun world?
Jessica Bylander:Is it a fun world? I think it's a I think it's a fun world. I think it's a very dynamic world. I think things are often changing, and there's always something new to learn about and to kind of catch up on. It is also hard to be an expert to me at least because things move so much, and there are so many different facets of healthcare to stay on top of, but I'm never bored, that's for sure.
Jeff Byers:Yeah. That's true. Never a boring day in healthcare. So one of the things we thought we would do today to celebrate our two hundredth episode would be to talk about what's changed since the program started. So this started in December 2020, as mentioned.
Jeff Byers:You can remember, 2020 was not an awesome time in American history. I think that's safe to say due to the COVID nineteen pandemic, which really gripped The United States, I believe, around March 2020. And we didn't have vaccines until April, maybe March of twenty twenty one. So December 2020 was locked in. The COVID nineteen pandemic was still gripping the world with uncertainty in this time.
Jeff Byers:Largely since then, lockdown measures have been lifted and people have gone on mostly to live their lives for the most part. What's happening today with COVID nineteen, Jessica?
Jessica Bylander:Yeah. I mean, it feels so different about five years later. You know, the the state of panic we were all gripped with and uncertainty. I remember the relief of getting my own vaccine in April 2021 and just what a difference that made. And, I mean, I I think we can all agree that that that period was, like, collectively traumatic of of just reading about deaths every day and just being so uncertain and not being able to kind of see family or or go where you wanted to go.
Jessica Bylander:So, obviously, you know, five years in, that's not the feeling. That's sort of not the vibe. And COVID nineteen doesn't really feel like this daily thread. It doesn't feel like something that's kind of top of mind at all times. Yeah.
Jessica Bylander:As I said, I know I've had it a couple times and, effects have been minimal. So, yeah, I mean, the data show that, you know, the deaths from COVID nineteen, have dropped from their sort of peak at more than five thousand deaths per day in 2021 to around two hundred eighty reported deaths per day at the February. So it's, you know, it's not dropped to nothing. It's not not a risk for everyone. I think it is worth knowing that it's still out there.
Jessica Bylander:There are still, you know, variants evolving. There are still, you know, a handful of percent of cases, you know, testing positive every week, both in US and and globally. But, yeah, we have vaccines. We have boosters that people get some sort of annually like the flu shot, and we have antiviral treatments for folks who do get sick from it. But, yeah, there are still people being hospitalized.
Jessica Bylander:There are still people dying. And as before, I think the people most at risk of of that are older folks, people who are immunocompromised, and who have underlying comorbidities. But yeah, so I think one interesting thing while COVID has gotten a lot less attention, there are, you know, growing reports of long COVID, which is when you have kind of lingering symptoms for weeks afterwards or months afterwards. So I think researchers say about eight percent of Americans have ever experienced long COVID. But actually a new study in BMJ Public Health recently found that among healthcare workers, the prevalence of long COVID could be like forty percent globally.
Jessica Bylander:So I thought that was really interesting that sort of how it's evolved into this long term possibly chronic condition and also how it's just become, you know, kind of a daily part of our lives, but not something folks are acutely concerned about all the time.
Jeff Byers:Yeah. As you as you were bringing us up to speed on what's happened in the last five years, I was just doing a quick Google search of, top headlines from the New York Times on Friday, 04/24/2020. Besides COVID, can you do you think you can guess what a what a top headline was?
Jessica Bylander:Oh my gosh.
Jeff Byers:I'm putting you on the spot, so my apologies.
Jessica Bylander:Yeah. I'm like, was it basketball? I'm not sure.
Jeff Byers:No. It from a one, jobless numbers are eye watering, but understate the crisis, which made me immediately look up what the unemployment rate in March 2020 was. The unemployment rate was in March 2020 was 4.4%. The unemployment rate today in March 2025, '4 point '2. Just to give some context there.
Jeff Byers:And another headline was one in five New Yorkers may have had COVID nineteen antibody tests suggest. Again, that was on Friday, 04/24/2020, which now I also have experienced a bout of COVID nineteen. Minimal symptoms on my end as well, and I believe most of us have known someone, if we have not experienced COVID nineteen, to experience it. But 2020 still hadn't benefited from the mRNA vaccine technology. The COVID nineteen was arguably, vaccine the COVID nineteen vaccine was a game changer, had a lot of people feel more comfortable to lead.
Jeff Byers:You know, Jessica, you mentioned the relief that you felt getting in. I know I felt relief getting the COVID nineteen vaccine at the time in 2021. How might we view vaccine policy from 2020 versus today?
Jessica Bylander:Yeah. I mean, it's a complicated question. I think, you know, on the one hand in 2021, probably vaccines were more in the news than ever before and more people were actually excited to get vaccinated than ever before. But also, I mean, it it it did become extremely political and extremely sort of, polarizing in some ways. So the CDC's morbidity and mortality weekly report, found that, childhood vaccines for one, rates were lower among children in 2020 born in 2020 and 2021 compared to those born before the pandemic.
Jessica Bylander:And, you know, the implications for that are obviously wide. And, yeah, it looks like under the Trump administration, vaccine policy will be reviewed, it may look a little bit different. So what we know is that the administration has taken some steps, according to the New York Times, halting funding for researchers who were who were studying vaccine hesitancy and how to overcome it and canceling, programs intended to discover new vaccines to prevent future pandemics. And HHS secretary Robert F. Kennedy has made some comments indicating concerns about vaccine safety.
Jessica Bylander:But on the other hand, you know, in the face of rising deaths from measles and, the current outbreaks, RFK recently endorsed the measles vaccine on social media, calling it the most effective way to prevent the spread of the disease.
Jeff Byers:Yeah. So not that there's a pandemic du jour per se, but we are hearing more about measles as a potential pandemic versus COVID nineteen these days. What is the state of measles and a potential outbreak in The United States currently?
Jessica Bylander:Yeah. So so as of, I think, last week, eight hundred measles cases were reported by 25 jurisdictions in The US, and most of those cases were in Texas. And three children have have died of measles according to the CDC. So just to put that in perspective, in 2024, there were only two hundred eighty five cases of measles reported in all of all of 2024 and no deaths reported. So this is something the CDC seems to actively tracking.
Jessica Bylander:I think they said they would be updating their website weekly with with new information on on cases and hospitalizations, deaths, and they even, include on that website that tracks it the percent of of cases who were vaccinated.
Jeff Byers:So during the COVID nineteen pandemic in 2020, Joe Biden had been elected in November but hadn't taken office until January 2021. So the first Trump administration did have that public health tracking of the COVID nineteen outbreak at that time. And then eventually, I think that was updated daily for a long time and then moved to weekly sometime after the the vaccine came out under the Biden administration. Are there any parallels to the COVID nineteen and measles outbreak?
Jessica Bylander:I think, you know, just trying to keep the information up to date. As I said, updating the CDC website every Friday, they said, and just ensuring, that folks have the most up to date information about that. I know in in 2023, the CDC launched a public health data strategy to address gaps in public health data and modernize US public health data systems. There was a lot of, criticism of the US government and and, agencies about our data 2020 and and its ability to, keep up with what's going on in, disease surveillance and to keep the public apprised of, like, the latest data. So efforts began around then and and really ramped up over the years to improve our ability to detect threats and to intervene quickly.
Jessica Bylander:And and there were some investments from congress in in that effort in 2020 as well. So, you know, CDC has said it's made good progress on updating its data infrastructure and, you know, exchanging some data automatically and covering more of the population. So I think it remains to be seen, like, our our data systems better able to identify new threats and respond to them.
Jeff Byers:Well, time will tell. Finally, telehealth got a bump in use as people didn't leave their homes as much in 2020. What does the telehealth market look like today?
Jessica Bylander:Yeah. So, you know, recent data from the Kaiser Family Foundation does show that telehealth use has declined since 2020, but it is still higher than pre pandemic levels. In the last quarter of twenty twenty three, more than 12.6% of Medicare beneficiaries received telehealth service. So it's definitely become more of a household practice, especially for people in remote areas or for people who are accessing specialists such as therapists and others. But yeah, so efforts now, I think, are kind of focusing on ensuring that telehealth flexibilities that were put into place during the pandemic are made permanent or continued.
Jessica Bylander:Groups such as the American Hospital Association are urging Congress to make those flexibilities such as, you know, eliminating geographic restrictions and allowing telehealth visits to occur anywhere that a patient is located and eliminating in person visit requirements for behavioral health that were granted during the pandemic permanent to avoid sort of losing momentum, that we've gained in telehealth over the years.
Jeff Byers:Well, Jessica, thanks for joining us again back on the program here at Health Affairs this week. If you, the listener, enjoyed this episode, send it to the time traveler in your life, and we will see you next week. Thanks all. Thanks.