Dr. H. Jack Geiger, Physicians for Social Responsibility

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Mark Masselli: This is Conversations on Health Care, I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret the numbers have been rolled, the Americans continue to
climb. The administration announced that over eight million Americans have signed up
for coverage of this of th eir insurance exchanges.

Margaret Flinter: And there’s another estimate. Mark that about eight million
Americans signed up for co verage with private insurers and of these enrollees it ’ s
believe that about five - and - a - half million were previously uninsured. A l ot of new
customers.

Mark Masselli: But there were millions of Americans who are now covered as well
under the expand Medic aid program. In 25 states that choose to expand it. However in
states like Virginia and Florida there are louder drum beats touting the merits of
expanded coverage for those living near poverty. It’s becoming a more consistent
theme and more red states who refused to consider the Medicure expansion.

Margaret Flinter: We’ve been predict ing that among others the healthcare industry
professionals in these States would be exerting pressure on the politicians to tap into
the billions of healthcare dollars that are available to treat this uncovered population.
That’s real money its being left on the table by those States that refused to expand
Medicaid. It’s going to help alleviate disparities and access to care. And that is
something that today’s guest h as made his life’s work.

Mark Masselli: Our guest this week is Dr. H. Jack Geiger who is considered the founder
of the Community Health Cen t er Mov e ment in this country . Having opened up the first
Community Health Cen t e r s in the 1960s. He’s not only a physician, but a life - long
activist for health equity as well.

Margaret Flinter: And Dr. Gieger is an inspiration to so many of us who’ve worked in
the field of healthcare and in community health centers over these last decades. Mark,
so we really look forward to that conversation.

Mark Masselli: We do and we also are going to have a visit from Lori Robertson,
managing editor of Fact Check.Org, she’ll dispel another myth about Obama Care .

Margaret Flinter: And no matter what the topic you could he ar all of our shows, by
going to CHC Radio , and as always if you have comments, please email us at CHC
Radio .Com or find us on Facebook or Twitter, because we love to hear from you.

Mark Masselli: And we’ll get to our interview with Dr. H. Jack Geiger i n just a moment.
But, first here is out producer, Marianne O’Hare, with this week’s Headline News.

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Marianne O’Hare: I am Marianne O’Hare with these Health Care Headlines. Three - and
a - half Trillion dollars that the estimated saving s that could b e had by corporations by the
year 2025 according to our Standard and Poor’s Investor Report , which looked to the
likelihood, most corporation with 50 or more employees will offload those employees
onto health insurance exchanges by the year 2020. The affo rdable care act provides
incentive to corporations to subsidize their employees ’ health insurance purchases.
Currently just under 50% of Americans get their health coverage through their
employers. Spending at US hospitals could be impacted by proposed M edicare rules
seeking more transparency in hospital pricing from Medicare patients. Under the rule
payments for in - patient treatment at acute care hospitals were decreased by $ 241
million in 2015. The American Hospital Associations is suing the Centers f or Medicare
and Medicaid Services over the policy. Medicare will increase payments to Federally
qualified health centers by as much as 32% later this year, while scrapping the fee for
service model for one that ones that gives the facilities a bundled rat e for each patient
on counter. On October 1st, CMS will begin transitioning some 8 , 900 FQ H C’s to a new
perspective payment system. And don’t expect annual lung cancer screenings to be
paid for CMS either. They issued a determination not to pay for annua l CT Scans .
Smoking related lung cancer kills about 130,000 Americans each year . The five - year
overall survival rate for lung cancer patients is lows, due in large part to late state
diagnosis of the disease. I am Marianne O’Hare, with these healthcare headlines.

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Mark Masselli: We are speaking today with Dr. H. Jack Geiger , the founding member of
Physicians for Human Rights and Physicians for Social Responsibility . In the individual
acknowledges the Father of the Community Health Centre Movement in the United
States. Dr. Geiger is currently Professor of Narratives at the Sophie Davis School o f
bio - medical education in New York City. He’s a member of the National Academy of
Sciences in the Institute of Medicine wh ere he received IOM’s most prestigious award,
the Lion Heart award for outstanding contributions to minority health , and also was
awarded the Schw e itzer Prize for Huma n itarianism . Dr. Geiger welcome to
conversations on healthcare.

Jack Geiger: I am glad to be here.

Mark Masselli: You know, Jack, you are known as the Father of the Community Health
Centre Movement in this country. A model you proposed in 1965 based on your
experience as a young American medical student studying in this sort of new kind of
healthcare , which was called community oriented primary care in South Africa. What
was that new kind of healthcare that you saw? And how did it influence the proposals
you would later make for the development of the first community health centre in
A merica?

Jack Geiger: No, I think the most striking thing was the assumption of dual
responsibility . That is that this institution -- these community health centers were
responsible not just one by one for all of the individuals that came in as patients , but
equally for the health of the population from which they came. Ending the long standing
separation between primary care and public health. When I worked at the examining
rooms in South Africa . On the walls of every examining room were graphs, hist ograms
of the latest information on the prevalent conditions in that community. Incident rates
where infectious disease and the like you could not look at an individual patient without
knowing a lot about the population from which that person came, and re sponsibility for
doing something about it, to keep the next patient from coming in with that s a me
problem.

Margaret Flinter: Jack the seeds of the American Community Health Centre Movement ,
the two community health cente r s, one in Columbia Point in Bosto n and one in Mont
Bayou in the Mississippi Delta. But I find it kind of remarkable that the fundamental
requirement for an organization to be recognized by the Federal government as a
community health centre . Can you describe some of those principles and requirements
for us that you found essential to be in the guidance that would govern community
health centers in the US ?

Jack Geiger: The first was the idea that the most vulnerable populations in the United
States , the people with greatest needs and with the heaviest burden of disease, needed
something other than the fragmented primarily hospital centered care. We did a survey
at Columbia Point in Boston. For example the average door to door time for a patient at
Columbia Point to go get care in Boston , and come back home was 6 hours. And what
did you do if you had three small kids ? And what did you do if one of the children had
asthma , and that was a different clinic , which you had to go to, the next day. So, t he
first principal was of comprehensiveness, to put everything under one roof, to create a
physician , nurse, social worker, pharmacy, laboratory, all of the pieces that required you
to run around frantically if you were of limited means. And the second wa s the princi ple
of community participation , and ultimately community control of what was now a
community institution that belonged to the population that was being served. There’s no
other branch of the American healthcare system in which the patients the mselves have
that kind of voice in the services that they are going to rece i ve.

Mark Masselli: Dr. Geiger you work has been all about population health and about
understanding and addressing what is now called social determinan ts of health. And
you are now sort of looking at the affordable care out and it’s principle of patient
centered medical home . And you said that this is really great news about the
healthcare law , is that community health center practitioners no longer will have to carry
this weigh t alone ? Tell us how you see Obama Care addressing population health?

Jack Geiger: Well I think Obama Care is the first modest , but enormously important
step from moving us from very, very costly, very inefficient distribution and practice of
care , away from a f r ee for service emphasis and outcomes of what has become such an
outrageously expensive and inefficient system in those respects , we need to dispel the

myth however that underlies banking everything on Obama Care, to the health of the
popula tion is determined by the very things you mentioned. The social de t erminan ts of
health and what you are exposed to what happens to out in the real world whether
urban or rural. Your income, your housing, your food. What Obama Care will do is
number one ; greatly improve the quality and availability of primary care. Secondly by
greatly expanding insurance coverage , the number of people who have access to care.
Insurance alone doesn’t do it. But it’s critical in providing access to care and thus
bringing somewhere between 30 and 40 million more people with that kind of regular
access and providing the patient centered medical home . With an emphasis not on the
individual procedure but on the goodness of the outcome. It gives us the opportunity to
start a ddressing the social determinan ts of health. But we need to understand that
unless we create greater equality in the society . No, single healthcare system is by
itself going to suffice to produce healthy quality. The evidence is overwhelming that a
chil dhood and poverty leaves almost inevitably to a shorter life, one burdened by
ch r onic illness to lower educational opportunity. There is a whole series of studies
demonstrating that adversity and poverty in early childhood starts measurably to rewire
the brains of those infants. Healthcare system isn’t going to be able to address that by
itself.

Margaret Flinter: Well Dr. Geiger, think we are all feel like we’re still likely to fall short.
So, what’s your prognosis and what are your observations about the current generation
of students of the health professions, and how they feel about going into primary care
and the likelihood that they will ?

Jack Geiger: Most of the prediction for the coming shortage of primary care
practitioners, physicians at le ast , is in the range of high 30,000s or 40,000. Now we
know that simultaneously with Obama Care, there will be increased demand. We know
from what happened in Massachusetts w ith greatly expanded insurance coverage.
There is very good evidence for what h appens to medical students at present for a
variety of reasons. Idealism is very high when people enter medical school. That’s why
they came in main. And there’s very good evidence that declines sharply and steadily
over the first seven years of trainin g. There are at least two reasons for that. One is the
enormous burden of debt that all medical students start to accumulate, and find and that
almost insupportable burden that drives them away from primary care and into
procedure based higher income, su b - specialty practices . A second reason is a
distorted reimbursement system, and that has got to change if we have to have any
hope of solving this problem at all. Third we are going to have to recruit increasingly
from the pools that we know are likelies t to be interested in primary care, and even
more are likeliest to undertake practice in u n derserved area s of really vulnerable and
sick populations. What that really means is that we need to recruit f rom those very
populations and establish the kinds of pathways that remove the barriers both of poverty
and poverty of aspiration. We’re not doing nearly enough about that.

Mark Masselli: We’re speaking today with Dr. H. Jack Gieger who is considered a
Father of the modern Community Health Center Movement , is a member of the National
Academy of Sciences in the Institute of Medicine. Dr. Geiger your activities in

healthcare go far beyond the examination room. Been a founding member of
Physicians for Human Rights, Physicians for Social Responsibilities. Tell us about
relationship between health poverty ? And your thoughts about the social
responsibilities for this next generation of medical providers ?

Jack Geiger: One has the responsibility as a p hysician to join or create the
organizations that do that kind of work. To have a life that addresses what we know are
root causes in justice and in equity of disease in so many of the very patients that we’re
seeing. One of the first of those was physic ians for social responsibility , which way
back in the early 1960s , when our government was trying to tell the population that
nuclear war wouldn’t be so bad if you just dug a shelter in your backyard. You would
probably be okay. Of the doing the first re al analysis of the medical consequences of a
thermo - nuclear war , and that was followed during the 1980s and the worst of the
nuclear arms race by physicians doing what we call the bombing run. Going to city to
city across the United States, getting on te levision, putting up a map of wherever we
were, and saying here is the bulls - eye, that’ll be created by a one megaton thermo -
nuclear blast and it turned out to be a compelling contribution. Physicians for Human
Rights formed in 1986 , and both of those organizations ended up sharing the Nobel
Prize for Peace. Physicians for Human Rights was organized in exactly the same way
to bring the skills of physicians to the investigation and documentation, crimes against
humanity, war crimes. There was a marriage of that impulse with the creation of this
new community institution, the community health centre. Back in Mississippi we started
to address social determinan ts, because they were so overwhelming. What is it that
you do when you disco ver that people’s primary source of water was to collect to rain
water in old pesticide barrels ? What is it that you need to do when you discover that
people are literally trying to shoot squirrels or gather Pecan Nuts , because people have
virtually no i ncome, it was the mean when we arrived was less than $ 600 .00 a year for
a family of four. Whenever we saw a child and such a family with infectious disease
and malnutrition, we wrote prescriptions for food. So, much meat; so much milk, so
much vegetables , and arranged to have that family fill those prescriptions at local black
grocery stores, which sent the bill to the community health centre , which paid for that
out of the pharmacy budget. The Governor of Mississippi screamed his worst fears had
been re alized Soviet Communism , he thought had come to the Mississippi Delta, and
our funders in Washington got very upset and came down , and said what did I think we
were doing. And I said, what was wrong with it? And he said well the pharmacy and
health cente r is for drugs for the treatment of disease. And I said the last time I looked
in the book the therapy for mal - nutrition was food. And he went away because there
was really no honest answer to that question.

Mark Masselli: That’s great.

Jack Geiger: It is that spirit that still informs community health center and has to inform
our whole approach to what we do.

Margaret Flinter: Dr. Geiger, I know that you’ve lost none of your vision, looking to the
future. And I think, I’ve come to th e conclusion that it’s the case that every generation

needs to discover some of this anew. And that was brought home recently when we
had the pleasure of interviewing Dr. Rishi Manchanda, whose written a new book, ‘The
Upstream Doctors’, with all the new incredible technology tools at our disposal today.
Do you foresee a new er a in how we address those social determinants of health ? And
how do you think this generation of public health, their primary care practitioners will be
fighting them ?

Jack Geiger: Well, there’s a documentary about that First Mississippi Health Centre.
It’s really very easy to find. All you have to do is Goggle for the words “Out in the
Rural”. We attracted recruits for physicians and nurses and others that had alway s
wanted the opportunity to do this kind of work among vulnerable populations. And the
beautiful Jasper Health Centre they discovered that they were confronting a virtual
epidemic of hypertension . And then they discovered that the reason was that people
were drinking brackish surface water, their only source of supply , which had a
monstrous salt content. So, our major of their work became installing water systems
and gave people what most of the rest of the society had, decent clean, safe water.
The tas ks of providing medical care are so consuming without abandoning our interest
in social determ i nan ts to be actively promoting collaboration with other segments of
government and the private sector. That is the housing authorities, the education
authoritie s. We have at least four community health centers that now house charter
high schools within their walls. And so investments that we can make jointly with other
weak community health centre both public and private , in education , housing,
employment, job training, environmental protection are the way we have to start going
after those problems now. We are adding lawyers to the teams of community health
centers, college students through health leads to address that not just palliative efforts,
but structur al efforts to change the distributions of opportunity in the society.

Mark Masselli: We’ve been speaking today with Dr. H. Jack Geiger Father of the
Community Health Center Movement in this country and Founding member of
Physicians for Human Rights , a nd Physicians for Social Responsibilities. You can find
out more about this work by going to physiciansforhumanrights.org. Dr. Geiger thank
you so much of joining us on conversations on healthcare , and making a difference for
all Americans.

Jack Geiger: It’s been a pleasure to talk with you.

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Mark Masselli: At conversation on healthcare we want our audience to be truly in the
know when it comes to the facts about healthcare reform and policy. Lori Robertson is
a n award winning journalist and managing editor of Fact Check.Org. A non - partisan,
non - profit consumer advocate for voters that aim to reduce the level of deception in US
politics. Lori what have you got for us this week.

Lori : Well, since 2009 election campaigns have been filled with ads about the
affordable care act. Overwhelmingly those ad s have attacked the law, and those who

support it. The 2014 mid - term elections could be even more intense. A group that
tracks polit i cal ad spending, Kantar Media’ s campaign media analysis group has
predicted that this elections advertising would rival several years work of anti - affordable
care act spending. One clam we’ve seen again and again in such ads is that premiums
have sky - rocketed under the law, that’s mis leading. Premiums for those who buy their
own private insurance will go up or down . In some cases significantly depending on
individual circumstances. Such as health condition, age and what kind of insurance one
had before. And most of those purchasing plans through the exchanges will receive
fed e ral subsidies to help cover the cost. Most Americans 48% of the population have
been employers sponsored insurance where premiums aren’t sky - rocketing. In fact the
growth of those premiums it has been historically low rates in the past few years. A
sma ll increase in work based premiums can be linked to directly the ACA. However,
experts told us in 2011 that the law caused a 1% to 3% increase that year due to an
increase in required benefits. The law had eliminated pre - existing condition exclusion
for c hildren, required free preventive care , and coverage of the dependents on their
parents plans up to age 26, and it had increased CAPs on annual coverage. But most
of the increase in premiums that year was due to higher medical costs. The usual
culprit. A nd that’s my Fact Check for this week. I am Lori Robertson managing editor of
Fact Check.Org.

Margaret Flinter: Fact Check.Org is committed to factual accuracy from the countries
major political players, and is a project of the Annenburg Public Poli cy Center at the
University of the Pennsylvania. If you have a fact that you’d like checked email us at
CHC Radio.Com. We’ll have Fact Check.Org’s Lori Robertson check it out for you here
on conversations on healthcare.

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Margaret Flinter: E ach week conversations highlight ’ s a bright idea about how to make
wellness a part of our communities and everyday lives. Right now there are about
three - and - a - half billion people living in refugee camps around the world. Whether
displaced or wars or nat ural disasters. The plight of these people is often in the same .
Living in squalid conditions, intensities that provide little protection from harsh elements.
And these conditions pose serious threats to their health and well - being. The IKEA
Foundation has taken the parent companies wildly successful Do - IT - You r self approach
to home furnishing and applied it to the problem of inadequate housing for displaced
refugees. They have created D o - IT - You rself dwelling that can be shipped and
assembled anywhere.

Jonathan : Yeah, first and fore m ost there is the very well known flat tack approach to
IKEA a s pioneered . And secondly the materials and the products itself. So, its shelte r
it ’ s not a tent.

Margaret Flinter: Jonathan Stamp i n ato is the head of communications and strategic
planning at the IKEA Foundation. They are working closely with the United Nations

Organizations working on the ground , trying to assist refugees in Somalia and other
parts of the world

Jonathan : We extended that to also include funding for an innovation unit within the
UNHCR , so they could think more long - term.

Margaret Flinter: And since on average a person is likely to spend up to 12 years in a
refugee camp . These IKEA structures have some unique properties that can make the
experience more bearable.

Jonathan : The walls and the roof are made out of a new fancy version of basically a
plastic material that is much mo re durable , but very, very light weight.

Margaret Flinter: And true to IKEA the price point is going to come in under a $1000.00
per structure. A deliverable, affordable Do - I t - Yourself dwelling that provide some sense
of dignity privacy and protectio n for families who are struggling as refugees. Now that’s
bright idea.

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Margaret Flinter: this is conversations on health care. I am Margaret Flinter.

Mark Masselli: And I am Mark Maseelli, peace and health.

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Conversations on Health Care, broadcast from the campus of WESU at Wesleyan
University. Streaming live at www.wesufm.org and brought to you by the Community
Health Centre.
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