Janet Currie: Investing in Kids

Transcript

Harlan Krumholz: Welcome to Health & Veritas. I’m Harlan Krumholz.

Howard Forman: And I’m Howie Forman. We’re physicians and professors at Yale University, and we’re trying to get closer to the truth about health and healthcare. Our guest today is Professor Janet Currie, but first, always want to check in on hot topics in health and healthcare. Harlan, what do you have today?

Harlan Krumholz: Well, Howie, I want to talk about something that may not sound so exciting at first, but I think it could turn out to be one of the more important policy shifts in Medicare in years. Everyone’s riveted in all the agencies these days, there’s a lot going on, but they shouldn’t miss what’s happening at CMS.

They have something called the ACCESS Model. ACCESS stands for “Advancing Chronic Care with Effective, Scalable Solutions.” I think they made up the acronym just so they could say ACCESS, but it’s a little bit of a mouthful, but it’s a 10-year national test by CMS that begins in July 2026—so just a few months away—and focuses on chronic conditions that affect most people in Medicare, including things like high blood pressure, diabetes, chronic musculoskeletal pain, depression.

At its core, ACCESS asks a simple but pretty profound question: What if Medicare paid for improvement in health instead of just activity? This is the thing we’ve been complaining about forever. Medicare pays for volume, not quality, and paying for visits, procedures, devices, and codes pays when something’s done, but rarely pays, in a sense, looking at whether someone improved. For example, pays for a blood pressure visit but doesn’t actually pay for whether the blood pressure improves over time. Pays for a depression visit, but not necessarily whether depression improves over time.

This program introduces what’s being termed “outcome-aligned payments.” These are recurring payments to organizations that manage these chronic conditions, but full payment depends on measurable clinical improvement. So, for example, hypertension patients must achieve control or improvement in blood pressure in diabetes, improvement in this blood test, hemoglobin A1C, or other cardiometabolic measures.

In musculoskeletal pain, there must be improvement in validated patient-reported outcome measures. This is incredible! Whether people actually say that they feel better. Depression or anxiety: actual measurable change that improves. So, this is a key shift. They’re not paying for this app or device or visit. They’re incentivizing the use of new technologies or coaching sessions that might be able to achieve this.

But they’re not saying, “Implement this new device because it’s shown to improve blood pressure.” It’s saying, “No, improve blood pressure by whatever means you have, and you’ll be rewarded.” In the first year, the organizations must meet an outcomes attainment threshold of 50%. That means at least half of the patients need to meet defined outcome targets for the organization to get full payment.

So, if they’ve got a bunch of people in this, if you haven’t shown that half of them have shown progress towards goal, then you’re not going to get the extra payment. And this is a much more direct form of accountability than have existed in many quality programs. Essentially, it also explicitly encourages use of remote monitoring, digital behavioral health tools, connected devices, but these have to plug into real clinical workflows.

Participants must share care plans electronically, integrate with health information exchanges, so that the digital data that we all have about ourselves can move seamlessly for the benefit of the patient. So, it’s not just a payment reform, it’s a push towards digital integration and accountability. And then there’s this fascinating regulatory twist.

The FDA launched a regulatory parallel pilot called TEMPO. Michelle Telfer, I heard her talk about this this week. It’s designed to align with ACCESS. So, look, FDA is working with CMS. For many years, that did not happen. The FDA launched this, and it’s basically certain digital health devices that would normally require pre-market authorization. So, what does that mean? A lot of data before they get started.

They now operate under this discretion while collecting real-world data. So, they can say, “It’s plausible, it works. We believe it’s safe. You can start to implement it, but you just need to collect a lot of information about how it’s doing in the real world.” We rarely see this kind of payment reform and regulatory reform moving in parallel like this.

So, there’s a lot of open questions. We don’t yet know how this is exactly going to work. They just dropped the payment levels this week, but we’re still learning about exactly how this is going to work. The bar is high. Have they picked the right targets and thresholds? We’re going to find out more about that.

But I got to say this. It really is a major turn. Even if it fails, I think that it will be a good effort to try to say, “Can we turn our system toward rewarding actual benefit for patients?” And of course, every practice got different patients. Are we going to be able to take into account those differences? Lots of things going on here. But I think this is really going to bear watching closely. And we have to embrace the effort at innovation, and we’ll see how it works.

Howard Forman: It certainly is a big difference from the efforts at paying physicians more for just managing more complex patients without any regard for outcomes. And Medicare has been doing that as well—and there are reasons to do it—but this is a good example of something we’re at least hoping to get not only data but hopefully improvements. That’s great.

Harlan Krumholz: And some programs in the past have also penalized people. So, for example, the readmission program—if you had high readmissions, then you were penalized. What I like about this is, they’re saying, “Invest in improvements. And if you can show the improvements, we’re going to pay you more. We’re going to pay for that.” And anyway, I think it’s worth, like I said, worth watching, kind of an exciting new program.

Howard Forman: Thank you.

Harlan Krumholz: Let’s get to our guest today.

Howard Forman: Professor Janet Currie is the David Swenson Professor of Economics at Yale University, where she co-directs the Tobin-Cowles Health Economics and Policy Program. She is also co-director of the Program on Families and Children at the National Bureau of Economic Research. Professor Currie is one of the world’s most renowned economists and is widely recognized for pioneering the economic analysis of child development.

Her extensive body of research, spanning hundreds of published articles, has shaped how economists and policymakers understand the ways poverty, government anti-poverty policies, health systems, and the environment affect the lifelong health and well-being of children. She has been multiply honored over her career, and I really cannot even come close to summarizing any of these but including numerous honorary degrees and awards.

She’s an elected member of the National Academy of Medicine, the American Academy of Arts and Sciences, and the National Academy of Sciences. She also served as president of the American Economic Association. Before joining Yale, she held faculty appointments at UCLA, MIT, and Columbia University, where she served as the first female economics department chair, and at Princeton University, where she also served as department chair and co-directed the Center for Health and Wellbeing.

She was born and raised in Canada and received her bachelor’s and master’s degree at the University of Toronto before moving to Princeton, where she received her Ph.D. in economics. So, first of all, I want to welcome you to the podcast. Your work has been enormously influential over many decades, at first demonstrating the connection between poverty and outcomes, poverty and education, and the requirement that children have at birth to be properly endowed in order to succeed both in health, well-being, and financial outcomes.

I wanted to start off by asking you where did this particular interest begin? You were an economics major in college, but when did you first think this would be the focus of your scholarship?

Janet Currie: So, it wasn’t actually until sometime after I had done my Ph.D., which was about collective bargaining in the public sector. So, had nothing to do with any of my subsequent work. So, I was going around giving talks about collective bargaining in the public sector, and people kept saying to me things like, “Why should we care about unions when unions are dying?” And I thought about it, and I thought, “I want to work on something where people are gonna... no one’s going to say to me, ‘Why should I care about this?’”

And so, I thought, I want to look at determinants of infant mortality. And I defy anyone to stand up and say that “why do we care about infant mortality?” So, I started thinking about doing research on that topic, looked at a lot of research about anti-poverty programs, and saw that most of them focused on the effects on parents. So, did parents work less or more? And there was very little about what the effects were on children. So, when I saw that, I thought, “That’s what I’m going to work on.” And I have been more or less working on that ever since.

Harlan Krumholz: Let’s just start this off as like a big question. So, children’s well-being, in your view, and I think it sounds right, is the cornerstone of a healthy economy. And people think about infrastructures, roads, and bridges. But what is it to be thinking about it from an economic point of view? You’re coming as an economist. You’re not coming from the School of Public Health. You’re coming as an economist. So, give us a little bit of that economic framework that you come at this with that is both, in my view, very humane but also steeped in STEM, steeped in science and hard numbers too?

Janet Currie: Yes, I think there’s some precursors or parallels to the work I’ve been doing, looking at things like how the education of a population affects growth. The fact that places in Europe that were decimated during the war were able to recover quickly was not only because of the Marshall Fund but also because of the human capital of the people that were there.

So, we knew already that that was important, but that’s abstract. And mostly people were focusing on human capital as being what kind of college degrees did people have and not thinking that it starts even before birth. So, the way that I see my contribution is really focusing on the fetal period and the early childhood period, and recently a little bit more on adolescence and how all those building blocks come together to produce the human capital that we think of in a more abstract way as being essential for the economy.

Harlan Krumholz: One thing, it strikes me when you talk about this, because it is this investment in human capital that really makes a society, that really enables greatness to occur. I don’t hear a lot about how are we going to invest in human capital in this country. It’s not framed that way, and yet you’ve really tacked hard into that.

Do you feel that you’re making any progress convincing people that there really needs to be a national agenda to invest in people? Because when you have a big infrastructure bill, people will say... and it’s true, we do need, our bridges are fraying. We need... there’s a whole bunch of physical, structural infrastructure in this country. But I am worried that we live in a country where we’re not making education free all the way through to the end of your education. We’re not investing in people in skills development, reskilling people, all the kinds of things. And most importantly, in the early childhood. We’re not taking that moment to say, “Let’s think 20 years, 30 years out. What will the world be like? What will have happened because we made that investment? Are we making any progress?”

Janet Currie: Well, actually, until recently, I would say we were making a lot of progress. So, there’s been huge improvements over time in things like public health insurance for children. Up until the recent cuts to Medicaid, for example, 40% of births are paid for by Medicaid in the United States.

Most children have health insurance either through Medicaid or through their parents’ health insurance. That progress is going to be undermined in the next year or so. But that’s one example. Preschool education has really expanded hugely. There’s a lot more public preschool education. There are other examples of investments that are being made in children, and the amount of money that was being spent on children was still behind other rich countries, but was approaching what is spent in other rich countries.

So, the irony of the situation is that we were making substantial progress, and we had the research to show that these programs are effective and were making a big difference. And now that we were on the right track and we can show that it was working, now all of a sudden, we reverse course and try and dismantle all of these programs.

Howard Forman: And I just want to emphasize your work over decades has included proving that Head Start has a positive impact, that Medicaid expansion has a positive impact, and I believe, indirectly at least, that SNAP benefits, nutritional benefits, can have a positive impact on outcomes for our children.

One of the other things that you’ve tackled a couple of different ways, and I’ll let you describe it better than I can, is that environmental health can have a positive impact on children. And before we started taping, one of the topics that you and I were talking about, which I find fascinating, is how lead toxicity is so directly connected to behavioral problems in children, how those behavioral problems lead to worse educational outcomes, and how inexpensive it is to reduce lead poisoning, and how your work has shown that.

Can you speak more broadly to how environmental effects have been proven to have positive and negative effects on children and why the current deregulatory climate might put that at risk?

Janet Currie: Yes, that’s a really important question. So, the example you were talking about with lead, one way to see the progress, both in our knowledge and in what’s going on, is just look at the thresholds for lead poisoning. So, probably in your lifetime as a practitioner, those thresholds have gone down from, say, 15 microliters per deciliter to 10 to 5 to 3 1/2, and now they’re saying none, right?

So, because it’s been shown that even these very low levels are damaging to children in all sorts of ways, because the lead goes in your blood and then it doesn’t stay there. It gets deposited in all your organs, brains, but also kidneys, everywhere. So, that’s just one example. And we’ve shown that, for example, when you reduce lead toxicity, you narrow the difference in Black children and White children’s test scores, because the Black children are much more likely to be exposed to lead poisoning.

If we look at air pollution, things like particulates, those have really systemic effects. Those have been going down, but recently, well, starting in 2017, both with cutbacks and enforcement of the Clean Air Act, increases in wildfires, we’ve had now increases in particulates for the first time in 20 years. Those are very strongly associated with things like fetal losses, low birth weight, prematurity, other things that put children at risk from the get-go.

So, there’s a... unfortunately, it’s another place where we’re moving backwards after having moved forwards very consistently for more than 20 years.

Harlan Krumholz: You’ve had such an illustrious career. I wonder if you could tell us, of all your papers, which one are you the most proud of?

Janet Currie: I really like my paper, “Does Head Start Make a Difference?” Because it was the first paper to look at that question.

Harlan Krumholz: So, that’s a hard thing to study because we’re not really randomizing people to Head Start. These are mostly observational data, unless you were able to leverage a natural experiment. But how did you do it? What was the method that you used to try to make that inference?

Janet Currie: So, in that paper, we were looking at siblings. And so, the idea was that you could compare two siblings. One went to Head Start, the other one didn’t go to Head Start. They have similar family backgrounds. And then try and see, on average, whether the one that went to Head Start does better. And that’s not a perfect way to do things because siblings aren’t identical to each other. So, we did a lot of extra work to try and see, was it usually the older sibling or the younger sibling that went to Head Start? What happens if you control for birth order? That sort of thing.

Harlan Krumholz: And what was the endpoint? What did you study for the outcome of that?

Janet Currie: So, in that paper, we were looking at their test scores at the end of Head Start. And then we could also look up to three years later and see whether there was fade-out in the impact of Head Start, which is another thing that even the earlier experimental studies on early childhood programs had found.

And what we found was that there was fade-out for the Black children but not for the White children. And in subsequent work, we showed that was probably because the Black children ended up going to worse schools. So, then the benefits that they had gotten were undermined. That was a controversial finding at the time.

In some of the subsequent work on Head Start, people have done things like look at the data from the Head Start Impact Study, which was a real randomized experiment. And when they look at that, the problem is that the experiments aren’t perfect either. So, in that particular experiment, the control group was very likely to go to some other kind of preschool. And so you had to deal with that. But when you dealt with that, then you still saw positive effects of Head Start.

Harlan Krumholz: As we get to the end of this, you’re talking to two doctors, and I noticed that you did a working paper, NBER Working Paper, on doctor decision-making and patient outcomes. And I wonder if you wanted to just share with us some of your insights that may have come from you studying us.

Janet Currie: The overall takeaway would be, it’s complicated making decisions, and there are many different factors. So, one of the things we were trying to do was just point out that when you see, for example, doctors treating White patients and Black patients differently—which you see—that does not necessarily mean that the doctors are explicitly or implicitly discriminating. There could be other factors going on there.

One thing that’s really important, probably, is communication between doctors and patients, which may be better when people are concordant than when they’re not. And that’s not directly prejudiced in the way that we think about it. So, I think telling doctors all the time, like, “Oh, we see differences in outcome, and that must be because you’re prejudiced,” is not necessarily helping. What might be more helpful is trying to identify the problem. If it’s a communication problem, how can we remedy that?

Harlan Krumholz: One of the things I thought was interesting in your piece was that you were really reflecting on how economic considerations affect the quality of decision-making. It shouldn’t be a surprise, but it still remains an issue within quality that a lot of decisions are being made not on differences that the patients exhibit between themselves, but differences that doctors have between themselves and the way they look.

And these included training and experience, peer effects, financial incentives, time constraints. Again, not surprising, but I thought it was interesting the way that you were surfacing these issues that... we sort of think, “I need to find a good doctor,” as if the assumption is “That good doctor would give me the same advice as any other good doctor. I mean, it’s just a matter of ‘Is it a good doctor?’” But the truth is that the premise to me is that even good doctors might differ dramatically in what recommendations they might make based on other factors about them that... and some of them are economic factors. And again, I don’t want to belabor the point, you’re an economist, but that... so, what did you learn that was new out of that? Or what did you feel that was an insight there with regard to thinking about the variation among physicians with regard to their decision-making?

Janet Currie: So, one important thing with respect to the financial aspects is, there’s a lot of literature showing that doctors respond to financial incentives. That’s hardly surprising, because everybody responds to financial incentives. But it doesn’t mean that you can fix things by jiggering the prices, right? So, we see attempts to do something like, “Oh, we think there’s too many C-sections, we should have fewer C-sections, so let’s lower the price of C-sections.”

That will give you less C-sections, but it’ll be across the board. And so, that will mean that some people who need a C-section don’t get them, as well as saying people who maybe didn’t need them won’t get them, right? So, like, the price is a really crude instrument for trying to affect behavior. I think one of the things we concluded is that there needs to be a lot more research on training, and what’s an effective way to train doctors? If doctors are making systematic mistakes, how can we detect that first, and then what can we do to help them be better doctors?

Howard Forman: One of your more recent forays has been in mental health in adolescents and children. And before we let you go, I just wonder if you could just say a few words about what your observations are there at a high level, and what you think we need to answer for going forward?

Janet Currie: So, I’ll just say three things. So, one thing is, there is definitely a mental health crisis, but I think the extent to which it’s gotten worse has been exaggerated because there is a lot more screening, a lot more sensitivity about it, and a lot less stigma, which is a good thing. So, more people are getting diagnosed, but the increase in diagnoses is much greater than the increase in the actual underlying conditions. So that’s the first thing.

The second thing is that when people talk about mental health treatment, they almost always talk about there being shortages of providers, which is true. So, say people aren’t getting treated because there’s no one to treat them. But another part of it is that a lot of the treatment that people are getting is not very good. And so, I think we need to pay attention not only to increasing the number of providers but also looking at what providers are doing and having more evidence-based care in mental health for kids.

Howard Forman: Are there things that we should be investigating going forward with regard to the use of smartphones and social media that you think are higher on the list versus lower, because everybody’s talking about whether access to, I shouldn’t say just social media, but access to smartphones and screens is something we should be acutely concerned about?

Janet Currie: Yeah, I think it’s something that we should be concerned about. That’s another place where we were going in one direction, and now we’ve reversed course, right? Because we’re actually going in the direction of trying to take off really horrible content off of the internet. And now, it’s like, “No, we’re not going to censor anything, people can do whatever they want.”

I think it would be good for everyone to have a little bit more screening of content on social media, personally, not just for kids. The issue is that most of the research that’s actually looked at social media and kids is pretty mixed in the sense of finding some negative effects, like some increases in anxiety and body image problems and things like that, but also some positive effects in terms of social connection, communicating with friends.

There’s even a lot of places in the world where it’s a really important way for kids to be able to do their homework or connect with the internet more generally. So, it’s not clear to me that the movement towards bans is actually the right thing to do. It’s the easy way to regulate this. It’s like, “Oh, we’re just going to not have it for some people,” instead of the hard way, which would be to say, “We’re actually going to try and do something about the content.”

Howard Forman: But Australia may offer a natural experiment for us, right?

Janet Currie: Yeah. No, it’ll be interesting to see how effective the ban is and also what impact it has on mental health. My prediction is it doesn’t have a huge effect on youth mental health.

Howard Forman: I think you’ll be right. Well, this has been awesome.

Harlan Krumholz: Howie, I think we should title this podcast, “It’s Complicated.” Because almost in every one of these areas—except for the investment in early childhood; that one’s not complicated.

Howard Forman: The overall body of work…it gets narrower and narrower in having very good answers to it. And you started a lot of it. So, really thankful for what you’ve done for everyone, and great to have you at Yale.

Janet Currie: Yes, thank you for having me. It’s been a lot of fun.

Harlan Krumholz: Yeah, it’s terrific to meet you. Thanks for coming on the program.

Janet Currie: Oh, it’s lucky for me too. It’s been great.

Harlan Krumholz: And welcome to Yale. Welcome to Yale. You’ve been here for a while—

Howard Forman: Thank you.

Harlan Krumholz: ... a little bit now, but it’s like, how lucky for us. Hey, great interview, amazing person.

Howard Forman: She’s amazing.

Harlan Krumholz: Thanks for arranging that, Howie. So, let me get to another favorite part of my program, which is the Howie Forman part. What’s on your mind this week?

Howard Forman: Oh, God. So, maybe it’s because we had a blizzard, but in the last few days, I’ve just been born witness to some of the worst misinformation in a long while. Not that this is even new, but I do think that the sheer magnitude and breadth is astonishing. There was a physician claiming that actor Eric Dane’s death from ALS was a COVID vaccine injury.

There are numerous social media posts about COVID vaccines causing an explosion of cancers in young people, often anchoring to recent celebrity cancer deaths. And by the way, there’s no evidence of either of these things, at least at the present time. And then there’s the usual posts that imply or otherwise state that one or more vaccines causes autism.

Not to mention that our health secretary, RFK Jr., with no evidence, has suggested that his spasmodic dysphonia, his speaking voice disorder, is caused by the flu vaccine, a claim that is not backed by any research or even a case series. And while we have strong evidence that flu vaccination does save lives and reduce harm, our leading health official is actively dissuading people from getting vaccinated.

And I can just keep going on. But instead of perseverating over this, I thought I would pivot to a more positive way of viewing all of this right now. First of all, there’s a thoughtful STAT News opinion piece from the president of the American Academy of Family Physicians entitled, “It’s Time for a New Era of Advocacy for Physicians,” subtitled “Doctors Can’t Advocate Quietly Anymore.” And I thought the final sentence of this editorial was particularly apt, quote, “The exam room will always be the heart of our work, but it cannot be the limit of our influence.” I just like that very much.

And then earlier this week, I had the occasion to speak with our friend and colleague Dr. Kevin Schulman of Stanford, who’s working with two former students on a novel, emerging student-led initiative that is focused on addressing medical myths and disinformation through merging the current medical consensus with marketing insights using management science and marketing science to help counter myths and disinformation.

This is a more organized strategy than I have seen recently, and it’s additionally supported by Dr. Robert Califf, our former FDA commissioner and a friend of yours as well. I was very impressed with their presentation, and I’m hoping to find some Yale students to support the effort locally with the chapter and to encourage other students to consider organizing a chapter at their schools.

And if anyone is interested, please reach out to me, and I will direct you to that group. I am not going to lose faith here, but I do want to urge people to avoid complacency. Vaccination rates are lower and lower each year, and we are already suffering the consequences. This began before COVID, and it continues.

Trust in our public health and physician workforce is lower than it has been in our lifetimes. We can either accept failure and wait to rebuild when thousands of folks are suffering from vaccine-preventable disease, when thousands more are dying due to avoidance of mainstream medicine and embrace of modern versions of laetrile—or in this case, ivermectin—or when the enormous benefits of what we have learned from advances in science are put to the side while grifters sell snake oil. Or we can all do our part to push back against these malevolent forces and anchor to science, evidence, and the best that medicine can offer. And at the moment, I’m going to choose the latter.

Harlan Krumholz: Well, there’s a lot in what you just said. I had talked to Rob about this effort. I thought it was a really nice idea of getting people engaged and talking about this. I harken back to what Francis Collins, the former director of the NIH, wrote in The New York Times a while back, where you have to segment out things because there are things that you and I might think are crazy, but actually are in dispute.

That is, yeah, some things that we don’t think are in dispute, but other people do. And honestly, if a third party looked at it, you’d say, “Yeah, there are some edgy things going on here.” And even like the work I’m doing with Akiko on post-vaccination syndrome, which I believe is very science-bound, there are people who accuse us of—

Howard Forman: Right, and I think we need to distinguish.

Harlan Krumholz: ... being anti-science, even though we’re trying to be very deliberate.

Howard Forman: Right.

Harlan Krumholz: But then there’s this other stuff that... is just nuts, crazyville, that is honestly threatening people’s health because there’s just no basis for it. And even though there will be some people who are standing up and saying it’s legit, there’s just no world in which there’s any evidence to support it.

Howard Forman: Yeah, Harlan, when someone tells me that they personally have seen 10% of all ALS cases in their clinic in West Hollywood, I know that that’s a lie. Like, we know what the incidence of ALS is. If it had quadrupled in a short period of time, we would start to notice that as a signal. And that’s what I’m talking about.

Harlan Krumholz: I think it’s like someone saying, “Hey, I went down the street yesterday, and there are a bunch of aliens here.” And the truth is, I can’t say for sure that there aren’t aliens in the street impersonating humans. I don’t think I could ever say that with 1,000% certainty, but I can say there’s no evidence, absolutely no evidence that we have seen that says it’s plausibly true that aliens are on the streets of New Haven impersonating people. But again, I could be proven wrong one day.

Howard Forman: And again, if someone shows me evidence of any type, even if they show me a good case series, I could start with that.

Harlan Krumholz: Right, but when you’ve got something that’s dangerous and for which there’s no legitimate evidence, it is time for us to speak out. It’s just, we have to be respectful of the fact that even within our profession, there are a lot of different legitimate opinions about things that are political.

Howard Forman: Different.

Harlan Krumholz: And that’s where we get into trouble, for example, in the State of the Union address. It was a highly contentious, mean-spirited speech, but he did say some things that everyone should have stood up for. But the Democrats wouldn’t stand up for anything.

Howard Forman: But that’s a political decision, that’s not a...

Harlan Krumholz: It’s a political decision, but it gets you in the sense where, when one side says one thing, everything must be wrong, the other side... we’ve got to be able to find the common space where we agree, and then we got to be able to acknowledge there are differences. And he’s not—

Howard Forman: You and I...

Harlan Krumholz: ... modeling in the best way, but we have to be able to do this.

Howard Forman: Right. You and I do not get to be political on this podcast. We can express that we have political opinions, but you and I on this podcast have many times said, we think that this policy of the Republicans or Trump is a good policy, or RFK or whatever…

Harlan Krumholz: And I just said, I think the ACCESS, CMS ACCESS.

Howard Forman: That’s right. And many of the efforts that improve our health and food supply.

Harlan Krumholz: We are not reflexively saying no because it comes from this administration.

Howard Forman: No, that’s right.

Harlan Krumholz: You’ve been listening to Health & Veritas with Harlan Krumholz and Howie Forman.

Howard Forman: So, how do we do? To give us your feedback, to keep the conversation going, email us at health.veritas@yale.edu, or follow us on any social media, including our Instagram account.

Harlan Krumholz: Yeah, we love the feedback. Write us, post anything about it, it helps people find us. It’s a great way to engage with the podcast.

Howard Forman: Health & Veritas is produced with the Yale School of Management and the Yale School of Public Health. To learn more about Yale SOM’s MBA for Executives program, visit som.yale.edu/emba. And to learn more about the School of Public Health’s Executive Master of Public Health program, visit sph.yale.edu/emph.

Harlan Krumholz: We always like to give a shout-out to our superstar undergraduates. We’re very fortunate to work with them, Tobias Liu, Gloria Beck, now Donovan Brown, their amazing producer, Miranda Shafer, and that I get to work with the very best in the business, Howie Forman.

Howard Forman: Thanks very much, Harlan.

Harlan Krumholz: Thanks, Howie. Talk to you soon.

Howard Forman: Thanks, Harlan. Talk to you soon.