Secretary Dan Glickman, Sr. Fellow at the Bipartisan Policy Center

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Mark Masselli: This is conversations on healthcare I’m Mark Masselli.

Margaret Flinter: And I’m Margaret Flinter.

Mark Masselli: Well Margaret I was watching the proceedings of the final days of the
Supreme Court session and I know many peopl e were booed by their same sex rights
decision. But I was struck also by the fact that it’s been almost a year since the last
landmark ruling upholding the Affordable Care Act.

Margaret Flinter: That’s right Mark, and that decision a year ago send a sho ckwaves
across the country both in policy circles and certainly in the healthcare arena, and really
impacts all Americans. The Supreme Court upheld the legality of the Affordable Care
Act living at largely intact but still, you know, the drum beat against the law continues to
the stay supporters of meaningful health to form in the country take nothing for granted
as they go about their work.

Mark Masselli: We’re ten weeks out from the first day people can enroll in the plan and
there’s much work to do on its implementation. But many of our guest have reminded
us that we have to take the long view in looking at this legislation it will impact future
generations and there will certainly be changes to the legislation.

Margaret Flinter: Well one thing that hasn’t change of course is that we believe that
healthcare is a right and not a privilege and indeed the evidence is clear that access to
care for all Americans is the first step in improving health outcomes and on that note
many Americans of course are s uffering the ill effects of obesity in this country. And at
their recent annual meeting the AMA took a bold step forward and designated obesity
as a disease.

Mark Masselli: You know of American adults are obese, and one fifth of American
children are, a nd the attending health problems related to obesity are weighing heavily
on the healthcare system as well.

Margaret Flinter: Well Mark the designation by the AMA is a step in the right direction of
course it’s only one step, we have to do much more than recognize it as a disease we
need policies and initiatives that target the obesity epidemic, target behavior change if
we’re going to be able to have an impact on the problem and really we have no option
we have to make this one better.

Mark Masselli: A nd that’s something our guest today is working to achieve, Dan
Glickman is the Former Secretary of the US Department of Agriculture, under President
Clinton. He’s now with the bipartisan policy center nutrition and physical activity
imitative, his team is hoping to generate policies that will link the billions of dollars
earmarked for the nation’s farm bill and aligned it with policies aimed at reducing
obesity.

Margaret Flinter: And it’s a very interesting idea Mark, the bill that deals with both
suppor ting agriculture in this country is the same bill that provides food assistance to
those in need. And right now they’re not currently tie to nutrition directive so should be
a very interesting conversation.

Mark Masselli: We’ll also hear from Lori Rober tson, Managing Editor of Factcheck.org.
She’s been drilling into some of the details of the Affordable Care Act this past two
weeks, she’s helping to answer some of the unanswered questions about the
healthcare law.

Margaret Flinter: But no matter what the topic you can hear all of our shows by
Googling CHCradio and always if you have comments please e - mail us at
CHCradio.com or find us on Facebook or Twitter because we love to hear from you.

Mark Masselli: We’ll get to our interview with Secretary Dan Glickman in just a moment,
but first here’s our producer Marianne O’Hare with this week’s headline news.

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Marianne O’Hare: I’m Marianne O’Hare, with these Healthcare Headlines .

United Healthcare the nation’s largest insure is bowing out of the individual - market in
California, the healthcare company notified state regulators that it would withdraw itself
from the individual - market at the start of 2014 following at (03:24 Inaudible) a week
ago. Another signal that health insurance companies are a ltering strategies and
advance of full implementation of the Affordable Care Act, which require insurance
companies to accept all customers even those with pre existing conditions that could
prove costlier. Promotion and healthcare law it’s creating some unique partnerships,
the Obama A dministration is trying to generate interesting ways to get the message out
about the Affordable Care Act, and they’re banking on the idea that mama knows best
when it comes to gaining affordable health coverage through the new exchanges.
Health and human services secretary Kathleen Sebelius says they are enlisting health
from advocacy groups like moms rising all the way up to AARP to exert a little mom
generated guilt on the so called young invincible those past the age of 26 who are
uninsured healthy and regain coverage on the exchanges. HHS is also using local
community groups, local libraries and other home grown entities to get the message out
about the Affordable Care Act. But don’t expect an ACA booster message durin g half
time on the gridiron this coming football season, the National Football League is yielded
to pressure from conservative law makers on Capitol Hill, not to pull out their franchises
to be use to pitch the merits of the healthcare law. Bryan McCarthy vice president of
communication at the NFL said that the league has no plans to engaged in this area
and have no substance of contact with the administration about the Affordable Care Act.

The Obama administration has also reached out to the NBA, NASCAR and the
American and national baseball leagues, the Red Sox were very influential and getting

the message out about the Massachusetts healthcare law, back in 2006 under then
Governor Mitt Romney. The lazy days of summertime and children put away pencils,
pads and uniforms and pack on their pounds in an accelerated rate, a recent study
showed a rapid acceleration of weight gain among kids during summer break, seems
the worst habits are sedentary an increased junk food consumptions increase in
summer. Repor t by the journal of school health suggest fitness and nutrition programs
been extended throughout the year.

I’m Marianne O’Hare with these healthcare headlines.

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Mark Masselli: We’re speaking with Secretary Dan Glickman former Secretary of the
U S Department of Agriculture and senior fellow at the Bipartisan Policy Center where he
co - chairs the commission on political reform the nutrition and physical activity initiative
as well as the taskforce and defense Secretary Glickman spent 18 years repres enting
Kansas City in the US House of Representatives . Mr. Glickman is also Executive
Director of the Aspen Institute Congressional Program, a nonpartisan educational
program for members of the US Congress . Secretary Glickman welcome to
conversations on healthcare.

Secretary Dan Glickman: Thank you, good morning glad to be with you.

Mark Masselli: Your team at the bipartisan policy center just held a news conference
and issued the report on the need to promote more targeted food and farm policy that
w ill impact the obesity epidemic in this country. Problem so vast and scoped that your
organization and many others have warned it’s threat to our national security due to
obesity’s direct impact on healthcare cost, what’s the real impact on obesity epidem ic
on the nation’s healthcare system.

Secretary Dan Glickman: Well about 80% of the cost of healthcare is for chronic
disease, and most of that occurs for people over the age of 50 years old who have
diseases like diabetes, heart disease certain cancers and just back problems orthopedic
issues and much of that is caused by bad diet. And so if you look into the national
budget of the United States, most of the growth in the budget over the next few years is
going to occur in Medicare and Medicaid which i s healthcare cost, caused by chronic
disease, cause in large part by bad nutrition and poor physical activity. And so what we
eat has a lot do with this nation’s fiscal health as well and for folks who want to try to get
the deficit reduced there is no be tter alternative than trying to deal with healthier cost
and to do that you got to deal with the prevention side.

Margaret Flinter: So , S ecretary , a year ago your team at the bipartisan policy center
issued a report lots to lose how Americas health and obesity crisis threatens our
economic future and -- so we’re so appreciative if you’re making the link between policy
and this huge health problem and -- but your report May 26 specific recommendations
aimed at tackling the obesity epidemic, why are the fa rm bill and the government’s other

food and farm policy such vital and yet not well known tools in stemming obesity in this
country.

Secretary Dan Glickman: We tend to support five crops, wheat, corn, cotton, rice and
soybeans and then if you look at th e dietary guidelines put up by the government both
by the department of agriculture and department of health and human services. It really
advises people eat other things like fresh foods and vegetables so on the one hand
we’re providing money for farmers basically to produce certain items, but then we’re
telling people to deal with their health to eat other items. So there’s disconnect there
and that’s something that we pointed out in our report. The biggest part of the farm bill
is food stamp so the SN AP program, and SNAP was established as the way to help
people who are hurting and hungry to eat adequate amounts of food but nutrition was
suppose to be original a big part of it. And now for the most part we don’t devote as a
much attention to nutrition in the SNAP program as we should, so there are two public
policy issues I just mention that impact people’s health and disease because of the
issue of what folks eat.

Mark Masselli: You know I want to pull the thread on that a little secretary because y ou
know very well that the farm bill is really sort of design in silos and you’re really trying to
educate those who are working on this but the American public that theirs is all of these
are interconnected and the healthcare across in this country are re ally sky rocketing.
So talk to us a little bit about how this farm bill gets managed and incorporated in your
mind into the health policies and reforms the need to take place and, how do you get
that next larger context understood.

Secretary Dan Glickman : Well on the first place the current farm bill was voted down in
the house of representatives, so we -- right now we’re kind of been limbo in terms of
federal farm policy and one of the reasons it was voted down is because the cuts to the
food stamp prog ram were sufficiently large, so the great amounts of democrats
determine not to vote for it. You see the farm bill both the nutrition title and the farm title
so, they are suppose to be linked in some way but, you know, in recent years it’s been a
real st ruggle because of budgetary issues, as we deal with agriculture policy and food
policy we can no longer avoid thinking about nutrition as a key part of the billions and
billions and billions of dollars of tax payers pay out every year for these particular
policies. And so we have an obligation to look at what people aid and giving them
better information encouraging them to take care of themselves better because the farm
bill probably as is much to do with the health of individuals as is there any piece of
legislation.

Margaret Flinter: Well secretary you know it's only at the recent gathering of the
American medical association that the organization pastor resolution defining obesity as
a disease not just a primary disease but also the root cause of so m any other secondary
disease as you mentioned earlier, we see the effective obesity across the spectrum of
age and all aspects of healthcare. So what kind of impact do you think that the
designation of obesity as a disease is now going to have and how both medical

establishment and also policy makers address the obesity epidemic what would you like
to see people doing and what more will be require?

Secretary Dan Glickman: I adopt the American me dical association has ever even
thought about how the farm bi ll impacts a health policy. And I doubt that a lot of farm
groups have really thought about health and nutrition i s part of the farm policy. So the
fact that they designated obesity as a disease I think will impact the health insurance
industry and the m edical community doctors and others who really focus a lot more on
what it is that people eat. And that will then have an impact on farm policy because
ultimately farmers will grow what people want to eat. And so that link is strengthen by
the designatio ns of obesity as a disease.

Mark Masselli: We are speaking to day with Secretary Dan Glickman , Former Secretary
of the US department of agriculture and senior fellow with the Bipartisan Policy Center
where he co - chairs the commission on political reform a nd the nutrition and physical
activity initiativ e. Secretary Glickman is an 18 - year - veteran of the US Representatives .
You know I want to get back to the political landscape for a moment. You served in
congress and you are in trenched at a time when the re was distinctly far less
partisanship. I know you are really concerned about the entrance that’s happening in
C ongress. What do you think some of the solutions are not just on the food and farm
policy but the larger conversation that’s needs to happen in Washington, where people
need to speak to each other versus at each other?

Secretary Dan Glickman: It's a very good question, if I had the actual answer to it I write
a book and I made a lot of money. And I’ll open on radio station operate a talk sho w.
So but I would say you know there are many causes of what's happen ed you know the
money and politics , the taxation on raising money I think takes a lot of time out of the
system for members of C ongress that you spen t time focusing on the issues that 24
hour mediate cycle the growth of these outside groups, super packs and others. We
have a kind of tribal at mosphere in C ongress, both sides of the aisle partic i pate in it, it's
much more difficult to be a leader in C ongress or an executive branch for that matter
than it used to be but not withstanding all these things , our political system is still
resilience and ultimately the public has to speak up, they have to demand that their
political leaders solve problems and not just engage and bitter fighting yo u know we
don’t need a civil war between our -- in our political system, folks want these problems
deal with. But ultimately in our systems it's the public that has to push their members to
do this.

Margaret Flinter: Well , S ecretary , as you say that hav e two MG in my mind and one
images the Friday morning farmers market near my office where people bring their snap
vouchers and exchange them for fresh vegetables and fruits and other kinds of proto
where moms and kids have their wick vouchers. So , on that very granular local
neighborhood level we can see the impact of a lot of both local advoc acy and also state
and federal advocacy that allow us for things like the redemption the vouchers. My
question to you as you go up to the 50,000 foot level and you’r e looking at things which
I can barely comprehend like the core in subsidies and how all that works. Do we have

evidence to suggest that making a shift in policy at that level we'll have kind of direct line
benefit down to the ground level, what are we op erating on here in terms of evidence
based policy?

Secretary Dan Glickman: You know most of the Ag region in this country is grown on
these five crops I just mentioned and many of those crops are used to feed animals and
-- animal agriculture about half of the growth nation product so to sp eak of agriculture in
this country. And you know the government is not going to tell people what to eat and
we’re not going to have you know kind of police state in this regard but what our farm
policy needs to do is t o encourage the production of healthier foods. And that means a
good balanced diet which includes large quantities of foods and vegetables and
legumes and then we need better education of consumers by everybody in our system
including doctors and the medi cal community. You know their -- they’ve kind of been
the missing link in all this stuff because then what we’ve found in our Bipartisan Policy
Center Review is very few doctors and very few medical schools teach nutrition.
Doctors are very good on c e you ’ re sick not very good and how to prevent illness. So
there are a large institutions in our society that need to get en gage in this debate
beyond the government, another is the cooperate American which employees about 75
million people, you know more and more they’re finding and lost productivity due to
illness caused by bad diet or poor physical activity is a huge problem for them. So we
need to encourage the production of more fruits and vegetables which is like the
programs that you talked about but th ere is no one servable that I call there is a s ilver
buck shot. There was a merit ways to deal with these issues and remind s me that all
quote for every complicated problem there was a simple and a wrong solution, there are
no simple solutions to this pro blem.

Mark Masselli: Well one of the pallets in that buck shot has to be a health technology
and data sharing and I know little I'll feel farm and fruit policy but with this review big
nature of social media , cell phones , and the like , the ability to sha re information . So
how do you think technology is going to play role on trying to help and influence people
decision making?

Secretary Dan Glickman: Well certainly modern information blow will get people
information faster and as you say more (16:41 ina udible) way and everybody will be
able to have it on their hand held devices or whatever technology is coming down the
pipe. More and more people will be sharing best practices that something that you
know there is a lot of great things happening in this c ountry in terms of nutrition and
physical activity in the private sector and the schools and corporate America but that
information has to be shared so others can look at it , and so clearly the new technology
gives us a great opportunity and then of course science and we need to adequately
fun d research into the issues of nutrition. So you know people are often very confused
about you know what to eat and I think our diet is complex and we need better
information from the science and health community and t he kind of information that's
understan da ble by the American public they get bombarded by a lot s of different images
included advertising of not such good foods on television a nd so they need to able to
make better judgment for themselves.

Margaret Flinte r: Secretary , maybe as one final question just so we leave our listeners
no dou b t in their mind about the importance of this topic when I talk about threat to the
national security that the obesity epidemic represents it's a treat to certainly the health
and productivity the American public but also its a share economic burden maybe just
final wrap upon the dimensions of the economic burden of obesity?

Secretary Dan Glickman: Well first of all when you consider 70 to 80% of healthcare
cost private insura nce carriers, medicate i s due to chronic disease caused by bad
nutrition and physical activity practices , that's a huge problem for our federal
governments as a massive deficits and the biggest part of our -- the biggest growing
part of our deficit is heal thcare cost. So but not only it is a fact the cost of the federal
budget or your own personal cost , but even the military will tell you that there are seeing
large numbers of en list ees not qualified for a military enlistment because of either
overweight, bad teeth , other kinds of health condition caused by bad diet or poor
physical activity. So this is the real problem and it's a worst problem in America th a n it's
in another parts of the world where you know we have lived in great excellence for a
long pe riod of time and issues of nutrition haven't really been in the top of the game for
many, many American s and now we a re finding the chickens have come home to roost
and that the healthcare cost are big, big factor in our national debate on physical
securit y and national security.

Mark Masselli: We’ve been speaking today with Secretary Dan Glickman, Former
Secretary of the US Department of Agriculture and senior fellow with the Bipartisan
Policy Center where he co - chairs the commission on political reform and the nutrition
and physical activity initiative. You can find out more about the work they do by going
bipartisan - policy.org . Secretary Glickman , thank you so much for joining us today on
Conversations on Heathcare .

Dan Secretary Dan Glickman: I am very glad to be with you.

(Music)

Mark Masselli: At conversations on healthcare we want our audience to be truly in the
know when it comes to the facts ab out healthcare reform and policy . Lori Robertson is
an award - winning journalist and managing edito r of factcheck.org a nonpartisan, non
profit consumer advocate for voters that aim to reduce the level of deception i n US
p olitics . Lori , what have you got for us this week ?

Lori Robertson: Well Mark and Margaret, President Obama was pushing the new
ins urance exchanges recently and encouraging those who need to buy insurance on
their own to sing up through state base exchanges beginning October first. This
enrolment period will last through the end of March. The exchanges are a major part of
the Afford able Care Act currently 15.4 million Americans buy their own insurance on
which called the individual market, but that number is expected to increase to 24 million

by 2023 through the exchanges where millions of uninsured Americans will gain
coverage.

The Obama A dministration wants about seven million people to join the exchanges in
the open enrolment period that will begin in October and it wants about 2.6 million of
those to be young and healthy folks. There is a big push to get the young to join the
ex changes so that the risk pools are not overwhelmingly made up of older and less
healthy individuals which would bring premium cost up. And so other premiums will
cost more or less and people would pay without the lost, that depends a lot on
individuals an d their circumstances, where they buy in a cheap bare bones plan before,
do they have pre existing conditions that price them out of the individual market, what
kind of insurance protections existed in their home state before the federal law, will they
qua lified for premium subsides which will go to those earning up to 400% of the federal
poverty level. For now we recommended those who will buy their own coverage visit
the Kaiser Family Foundations online subside calculator, it’s nearly an estimate but you
can get an idea of what premiums might cost and what kind of subside you could
receive to offset the price.

And that’s my FactCheck for this week I’m Lori Robertson Managing Editor of
FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factu al accuracy from the country’s
major political players and is a project of the Annenberg public policy center at the
University of Pennsylvania. If you have a fact that you’d like checked e - mail us at
CHCradio.com we’ll have FactCheck.org’s Lori Robertson check it out for you here on
conversations on healthcare.

Mark Masselli: Each week conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. Asthma is one of the leading
causes of trips to the emerg ency room for children, and there are often a correlation
between high density low income neighborhoods and more trips to the hospital for
treatment and intervention. When officials at Boston Children’s Hospital notice a spike
in asthma outbreaks in certa in neighborhood clusters they decided to do something
about it. They launched the community asthma initiative, triggers for asthma are well
known dust mold pest mice and even over use of certain cleaning products can cost
trouble, they realize that if you could treat the environments in the patient’s home that
might reduce the need to treat the patient in the emergency room.

Dr. Elizabeth Wood : The home visiting efforts work with children and families that have
been identified through their hospitalizati ons and emergency room visits as an
identification of having poorly controlled asthma and also it’s a teachable moment when
families are open to making the changes in terms of care and environment within the
home.

Mark Masselli: But Dr . Elizabeth Wood he ads the program and says the first step is to
identify the frequent flyers, those kids who make repeated trips to the emergency room.

Then they matched with the community health worker who visit their home several times
and assess the home for asthma trig gers.

Dr. Elizabeth Wood : And they work on three areas, understanding asthma itself,
understanding the medications and the need for control medications and then working
on the environmental issues, within the home.

Mark Masselli: Families are given eve rything from Hepa filter vacuum cleaners to air
purifiers, they are told not to clean with certain toxic products and the homes are
monitored for the presence of pest or rodents. The results says Dr. Wood, has been
pretty dramatic.

Dr. Elizabeth Wood : W hat’s remarkable is that there was a 56% reduction in patients
with any emergency department visits and 80% reduction in patients with any
hospitalization.

Mark Masselli: And while this program is expensive about $2400 .00 per family there is
a return on investment in reduced hospital cost in healthier children. The program has
been so successful . It’s been deployed in other hospital communities around the
country . The community asthma initiative a simple re shifting of resources aimed at
removing the c ause of disease outbreaks in the community leading to healthier patient
populations , thus significantly reducing the need for hospital care . Now that’s a bright
idea.

(Music)

Margaret Flinter: This is conversations on healthcare I’m Margaret Flinter.

Mark Masselli: And I’m Mark Masselli peace and health.

Conversations on healthcare broadcast from the campus of WESU at Wesleyan
University, streaming live at WESUFM.org and brought to you by the Community Health
Center .