Admiral Joe Sestak, Democratic Presidential Contender, Talks Health Access, Cybersecurity and Caution on Swift March to Medicare For All

Joe Sestak

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Female : Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter, a show where we speak to the top thought leaders
in health innovation, health policy, care delivery, and the great minds
who are shaping the hea lthcare of the future. This week, Mark and
Margaret speak with Admiral Joe Sestak, 31 - year veteran o f the U.S.
Navy and Former Congressman from Pennsylvania , as well as
Candidate for the Democratic N omination for President , talks about
the lessons learned from lea ding th e military into battle the work of
n ational s ecurity roles he played in both Democratic and Republican
administrations and his quest to expand VA like healthcare systems
across the country to increase access for all Americans. Lori Robertson
also checks in , the Managing Editor of FactCheck.org, looks at
misstatements spoken about health policy in the public domain,
separating the fake from the facts.

We end with a bright idea that's improving health and well - being in
everyday lives. If you have comments, pl ease e - mail us at
[email protected] or find us on Face book, Twitter, or wherever you
listen to podcasts. You can also hear us by asking Alexa to play the
program Conversations on Health Care . Now, stay tuned for our
interview with Democratic Presidential Candidate , Admiral Joe Sestak ,
on Conversations on Health Care .

Mark Masselli: We're speaking today with the Retired Three - Star Navy Admiral Joe
Sestak, a Candidate for the Democratic Presidential nomination. He
repr esente d Pennsylvania's Seventh Congressional District from 2007
to 2011 in the U.S. House of Representatives . Admiral Sestak served
as Director of Defense Policy at the Office of National Security under
President Clinton, and served in the U.S. Navy for 31 years. Thank you
for your service . He is a graduate of the U.S. Naval Academy , earned
his Master's in Public Administration and his PhD in Political Economy
from the John F. Kennedy School of Government at Harvard
University . Admiral Sestak, welcome to Co nversations on Health Care .

Joe Sestak: Mark , it's good to be with you and with Margaret and , please , it's Joe.

Mark Masselli: Joe , that’s correct, Admiral Joe, if you do n't mind, I think that's how
people on the trail refer you to and you came into the pr ocess late,
you had reasons , of course , your teenage daughter was recently
treated for brain cancer for a second time . Y ou say that really shaped
your experience as you thought about engaging in politics. I'm
wondering the factors that drove you to enter t he race and your
thoughts on the Ame rican healthcare system as well.

Joe Sestak Right , got married late in life and come back from the war and my
daughter was four years old and had brain cancer. After the first
operation at Walter Reed Military Hospital , the doctors took us aside

Joe Sestak

and said we couldn't get a total resection and they said, we think it's
Glioblastoma . That probably means only about 90 days , and but
beca use of the military health care system, we were able to take her
elsewhere. From children’s to Mass General to one of the two proton
beam therapy machines at the time, all of a sudden I truly understo od
the n ational s ecurity begins at home in health security. I changed
from being an I ndependent to being an I ndependent who happens to
be a Democrat . I ran in nearly two to one Republican d istrict on one
refrain. National s ecurity begins at home in health security.

I ’ve taken in 2005; the soon - to - be - called Romneycare, Massachusetts
Health Care Plan and I ran on that. I kne w everybody needed
accessible , affordable health care to do the same thing I had and we
passed the Affordabl e Care Act. W hen my daughter's brain cancer
came back last year, however, I wasn't planning getting in this
presidential race. We were taken aback. Only 8% percent of children
e ver survived Glioblastoma . She was into the end zone and all of a
sudden, there it was. We went through it all again and after we had
the proton beam therapy the n the surgery, she couldn't go through
the same chemotherapy. They had one of these new drugs. It has only
been approved by the FDA called Metastatic breast cancer, but it had
the same element, same chromosome , so to speak, that's up in her
brain. But FDA hadn't approved it for that and so we were denied.

We eventually appealed and wanted , and I too k two lessons from this .
It was chromosome cancer or a gene cancer, and yet government
hadn't caught up with that. Government needs a better type of
relationship with the health care community. N umber two, is I began
to wonder if the middleman was really n ecessary where, why did I
need someone who wasn't even a medical doctor to be saying what
could or could n ot be? I got into this race for different purpose
obvio usly than health c are to try to unite our country and help to
convene the world again with some one who understands global
affairs , but I'm so still driven by n ational s ecurity begins at home and
how those lessons I j ust learned the second time around, move d me
towards a different approach to health care for all universal health
care.

Margaret Flinte r: Well , Admiral , I think it's fair to say that you're somebody who walks
the walk and I read th at during your political career in Pennsylvania ,
you are known to have walked across the entire s tate. That's a pretty
big state --

Joe Sestak : 122 miles.

Marga ret Flinter: -- i n an effort to truly connect with voters in your state, which has so
many very diverse regions and you want a decisive victory there . I
understand you've walked across New Hampshire ; but I imagine you
have a lot of stories about wha t you'v e learned from these

Joe Sestak

experiences and what are you learning from the walking towards this
time?

Joe Sestak : Well, the very first event I did was actually across the U.S. Navy
Seabee s Bridge , which connects Vermont with New Hampshire .

Margaret Flinter: That’ s right .

Joe Sestak : I wanted to go before I started the official walk into what's called
Brattleboro Retreat , which takes c are of 5 , 000 individuals who have
challenges in mental health. Once again, it struck me . The biggest
disease we have in Americ a is m ental health . We have less psychiatric
beds today than we did in 1850 s . In fact, the largest psychiatric
hospital is Rikers P rison , and I voted for this Mental Health and
Ad diction Equity Parity Act, but we aren't enforcing it. As I walked, I
met w ith soci al workers or others who work in this area , and I would
always go into prison on Veterans Day to visit my fellow veterans.
Again, there's so much lost assets and this pris on was the most
progressive prison I’ve met , w here the superintendent had sa id , you
c an't control as we're taught as corrections officer to control human
nature . Y ou can manage it with incentives and disincentives.

When you're brought in, if you behave and you sit down, no handcuffs
or anything, nobody sitting around you and you get up and sign in and
wait for somebody behind the desk to call you forward for check in , o r
you do not behave and you're thrown into a sm all little slammer right
there . H e begins to treat with respects or [inaudible 00:06:47] . W ith
that type of approach, the reent ry and recidivism programs are s o
much better and I saw wonderful people. I call them heroes , from
small business women trying to start up a brewery to stop by a gun
show, because I wanted to say that I respect the Second Amendment
R ight, the who decision said, b ut I didn't want assault weapons stands
there. All those experiences I tr easure from having walked across New
Hampshire.

Mark Masselli: We ’ve had the opportunity to talk with so me of your fellow
candidates around h ealth r eform and we hav e different camps. Some
folks are embracing Medicare for A ll , but you say that there's a better
approach focusing in on the Affordable Care Act as well as creating a
public option . I wonder if you could tell us what s ets your health
strategy apart.

Joe Sestak: In fact , I think , it's a worthy goal , Medicare for A ll , but in the military
you learn , piss poor planning get s piss poor execution . After you ’ve
had a government that decades ago could be at in four years, Japan
and Germany, but yet that same government was unable recently to
roll out a health care website . Y ou want to pause for a moment and
say what is the best approach to achieve it gaining the trust of
Americans ?

Joe Sestak

What I want to do is, as p resident is very immediately fix the
Affordable Care Act with all those ho rrible executive orders that ha d
been issued and ha d taken away what made it work . V ery fine
engineering model that did give coverage not only to so many, but it
also began to cut down upon the cost to our economy . As you well
know, according to Institute of Medicine, because the younger and
uninsured, we lose somewhere between 100 and $ 140 billion a year. I
tell everybody Obamacare was actually passed as one of the first or
second piece of legislation in 1789 with our first Congress . They
mandated that all the sailors had to have health care and actually had
to pay for part of it. They didn't want scurvy at sea to destroy the one
solid economy ’s keel ships that were going to bring raw material from
America to England to be turned back into finished products . As I tell
the Tea Party Patriots, your forefathers , th e Tea Party ha s actually
established Obamacare --

Margaret Flinter: I’m sure t hat goes ove rwhelming .

Joe Sestak: It's not just for the individual; it's for the common good of America.
We don't lose t hat 100 to $ 1 40 billion in our econom ies to go to the
emergency room sicker and lose more days. Then as I voted for in
Congress, you want to have a public option , but we need to make sure
it works , because 255 million Americans have some sort of private
he alth care. What we need to do is have it be a transition of choice
initially, to where if it does provide bett er access , better care at lower
costs, to where you’re -- of miss paying directly to a private hospital, a
for - profit hospital like Johns Hopkins o r Mass Ge neral, more and more
people will jump into it as it proves itself. Then after four to six to
eight years or so you can start saying it's wor king. W e begin to get an
idea of what the cost is, but we need to test it out , then you can move
towards th at Medicare for A ll .

People still want to select private health care code , but more
important than that is what about the world economy and my speech
here to the Polk County Democrats, the y said , “ Y ou know, you're
going to be losing 20% of your hospitals i n rural counties over the nex t
few years. ” In fact, the same percentages in New Hampshire , where
they're going to lose five of their remaining 70 , so what happen ed
with all these rural hospitals all their for - profit, no - for - profit is
possibl y is ever going to go back to the rural county is what I believe
the second track should be one towards the VHA , the Veterans
Administration Hospitals , which The New England Journal of Medicine
despite the bad news you see at times were a public institution as
compared t o like Mayo Clinic .

Yo u find New England Journal of Medicine has rated it equal to or
better than any private or public healthcare provider in America in 11
major industry. Therefore , you should have another track with an

Joe Sestak

option that smooth itself towards this government hospital ,
government doctors to see if that's what ca n survive in the rural
hospital. Here in the rural counties as they lost their hospitals , they
pay like $8 premium each month to have a m edevac commitment,
helicopter for an emergency , bu t they still get stuck with a $36,000
bill . W e need to step back in my party and say, “ W ait a moment , one
size doesn't fit all . ” You know, my party needs to make sure we don't
forget those in the rural .

Margaret Flinter: Well , Admiral, looking back on your career you've certainly been
engaged in passing some of the most significant legislation, the
Affordable Care Act that we talked about already , and you also
mentioned the Mental Health Parity Act. But t here's another act that
maybe doesn't get talked abou t as much now , but was really very
instrumental , t he American Recovery and Reinvestment Act in its
support for practic es moving large scale, from paper to electronics .
B ut it's been costly in some of the burdens that have placed on
providers and health car e systems that weren't there before. I'm sure
you're also hearing that this is also a big co ncern for people within
health care around the cost and the burden of the technology . Why
don't you share with us your thoughts on that transition a nd where
we are in the country?

Joe Sestak : I was a large pro ponent of the electronic medical records. In fact, I
had to go to the VA , now this was back like in 2005 time period . A s
you know the VA was the first to do electronic records.

Margaret Flinter: That’s right.

Jo e Sestak : I sat there in the doctor's office, he was doing one check up on me
and all of a sudde n someone calls me , said just a moment -- yep, tell I
just put in the medical order or something and I was -- back then that
was like g etting your first Xerox m achine on a -- in the early 70s . But I
have heard whether it was from the New Hampshire Medical Society
or whether as I met with doctors out here in Iowa, exactly what you
said. What has happened is this has become almost more overly done
because of billin g issues, g etting the right codes or the right paymen ts
are made vis - à - vis the insurance companies . Where the original
purpose of this, “ hey, everything's there is quick slips , you can see the
past history, to see all the past results and everything and th ere it is. ”
But if it's become overly burdensome, and everyone says it has
because of that , we need to streamline this. This could actually be
part of the benefit of eventually getting to Medicare for A ll . We don't
have that insurance company that is worri ed about profit and
payments. That's the central complaint I've heard about this system,
and part of it just might have to be to make sure this Medicare for A ll
system works , because it’s burdensome , and every doctor said that.

Mark Masselli: We're speakin g today with Reti red Three - Star Navy Admiral Joe

Joe Sestak

Sestak , a Candidate for the Democratic Presidential nomination,
Former Director of Defense Policy at the Office of National Security
under President Clinton. He also represented Pennsylvania Seventh
Congress ional District in the U.S. House of Representatives. Well ,
Admiral, it's prob ably easier to navigate the democratic landmines
than it was navigating the battles that you as a commander of the
aircraft carrier battle group during Afghanistan ?

Joe Sestak: Do n’t be so certain about that.

Mark Masselli: Well, I'm not sure. I was going to ask if there are some similarities. But
you also were somebody who made waves during your time in the
Bush Administration , recommend ing a large r share of the military
budget be diverted towards enhancing c ybersecurity and really sort of
st
thinking about the 21 Century technology. Talk to us about your sort
of plan for how we strengthen ed and harden ed our important dat a
that we're trying to protect.

Joe Sestak : I have been in thi s area ever since 1995 , where I was handed a folder
by my boss National Security Council and said, “ Y ou're the one who's
going to set up the portfolio on protecting crit ical infrastructure,
damn from being hit by cyber attacks .” This is 1995 or other types of
facilities that we rely upon , Wall Street being taken down and our
health records , all of a sudden the best of them and / or the damage
done to them. I n fact, as you mentioned, I carried it forward to the
Navy and as a Three - Star Admiral I said, “W e don' t need 375 ships.
We're still measuring ourselves unfortunately in this modern era on
how many pieces of units we have. It's the broad band capability that
shows you how good you can be. ”

In the military, I advocated that let’s go to about 260 shi p s, we can go
from about 12 carriers to 9 and I war game this with about 120 staff
with using computers for all this and say, “ L ook , if you're able to do a
strike, like we did into the centrifuges of Iran , take down their
centrifuges where they could use them, wow, how less expensive and
how much more effective that is and trying to drop thousands of
potentially bombs to get through 300 feet of rock to destroy that
facility. ” That's the change we need. In fact, that plan met with a great
opposition not just from the military industrial complex , because
President Eisenhower said , “ I t's really a congressional milit ary
industrial complex. ” As one senator said, when he met me and I was
running for Congress, he said, “ Joe, I remember you, you 're the
admiral that wanted to cut my submarine fleet . ” B ut the man who
work for me is now in charge of the Pacific and has actually said,
“ America is the first loss of command of the s eas by the U.S. Navy
since World War II , China has it now , and we need more cyberspace. ”

With regard t o our records, this is an immense issue. In particular, as
the 5 G network has being developed. As you know, you've seen in the

Joe Sestak

newspaper about Huawei and others like President Trump and what's
going on here . B ut the truth of the matter is this 5 G network w ireless
will revolutionize economy and warfare by different mean. China to
its Belt and Road Initiative has already had 70 c ountries that take its
predatory loans, it enforces them to buy digital road, which is you will
buy our 5 G network . W hoever build th e 5G network will own it, and
only three companies do.

Y ou put that piece there everything that you say , the wireless will go
t hrough this piece of equipment and you don't have to hack anymore .
I f you have a medical meeting, if artificial intelligence deve lopment
for medicine, if electronic records are passed via wireless, they will
see everything. All they have to do is download it off their server and
they can go down and take down any critical structure that's
connected to wireless without having to figh t through it . This is
probably , except for climate change , the greatest threat to America's
dream today. Yet , we aren't doing anything about it from our side.

There's only two things we need to do is remember much like
President Eisenhower said , “ W e need a road system . ” O r President
Lincoln sai d , “ W e need an intercontinental railroad. ” Wall Street
wasn't going to build it , it was too expensive and so he finished it up.
We need someone who understand this new infrastructure. The 5G
network needs a public pri vate venture to be done with it. Then
second, we n eed to do what America's greatest strength is , to
convene the world of allies and friends in a rules - based world order
that stands together and says this is fairness and just ice of how this
equipment will b e used or not used. Everything that will be in that
medical record as it's passed on wireless will be copied and done with .
Never mind the kind of warfare that can be done by taking down Wall
Street , just because the 5 G network has to be connected by Huawe i.

Second, we have to keep in mind , anything that doesn't go over
wireless goes to underground cables . Huawei and other Chinese
companies have now laid about a third of them 98% of
intercontinental communication goes by undersea cable way . This
critical in frastructure, this cyberspace, it is actually giving China all the
commercial intelligence it nee ds at no cost and all the military
capability it needs in order to -- at heigh intentions to damage . It's
what it's doing to its rigoro us citizens today . I f yo u go to my website
you can see how they've all been incarcerated not just physically , but
by digital incarceration wherever they walk , they have a government
phone and their faces are copied on street lights, etc. Sounds
daunting , but that is really cybers pace the new domain of warfare and
why another aircraft carrier isn't worth its cost when you can have
this whole capability to either use or protect yourself from.

Margaret Flinter: We've been speaking today with Retired Three - Star Navy Admiral Joe

Joe Sestak

Sestak , a c andidate for the Democratic Presidential nomination. You
can learn more about his very distinguished military career and his
contributions to political life by going to joesestak.com , or follow him
on Twitter @JoeSestak. Admiral, thank you so much for your service,
for your dedication to this country , for your insights and for joining us
on Conversations on Health Care today.

Joe Sestak: Thank you Margaret and Mark for having me aboard . It wa s a real
pleasure.

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Mark Masselli: A t Co nversations on Health Care, we want our audience to be truly in
the know when it comes to the facts about health care reform and
policy. Lori Robertson is an award winning journa list and Managing
Editor of FactCheck.org, a non - partisan, non - profit consumer
advocate for voters that aim to reduce the level of deception in U.S.
p olitics. Lori, what have you got for us this week ?

Lori Robertson: A popular Instagram post falsely claims that more than 1 , 100 people
died from reactions to the flu shot in 2018 and suggest that th e
immunization gave some children polio. The flu vaccine cannot give
anyone polio and there is no evidence to support the 1 , 100 figure. Flu
shot is the single best way to protect against seasonal influenza, a
viral disease that in some years kills tens of thousands of Americans.
Flu shots have a good safety record. As the Centers for Disease
Control and Prevention explain ed , the most likely side effects are mild
and include soreness or redness at the injection site, headache, fever
and nausea . A more concer ning side effect is a serious allergic
reaction, which could lead to anaphylaxis , but an analysis of CDC data
identified just 33 instances of vaccine triggered anaphylaxis after
more than 25 million vaccine doses. Of those cases, only one p erson
was hospit alized and no one died.

The Instagram posts claim that 1 , 100 people died from the flu vaccine
in a single year has no basis. Published studies rarely, if ever observed
deaths plausibly tied to the flu vaccine. The post second claim that the
flu shot may gi ve children polio is also fa lse . Polio is a potentially
deadly and highly infectio us disease caused by the polio virus . Flu
vaccine has nothing to do with polio and does not contain any polio
virus . Since 1979 no cases of polio have originated in the Unite d
States and that's my fact check for this week. I'm Lori Robertson,
Managing Editor of FactCheck.org .

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Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenberg Pub lic Policy
Center at the University of Pennsylvania. If yo u have a fact that you'd

Joe Sestak

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 Health Care.

[ Music ]

Mark Masselli: Each week Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. In the
emergency room, clinicians are confronted with a myriad of
unpredictable medical crisis that sometimes can be challenging to
diagnose .

D r. Josh Landy: This is really hard, especially if you're in a busy ter tiary care hospital
and you're there and it's 4:00 in the morning and there's almost
nobody else to talk to , unless yo u have a specific question to wake
somebody up to ask them. That's t he existential dread of medicine.

Mark Masselli: ICU Physician Dr. Josh Landy was noticing a growing trend of image
sharing via smartphones to C rowdsource second opini ons from
friends and colleagues across the country. He created figure one a
sort of Insta gram for doctors in which images can be de - identified,
but shared across a dedicated social media platform that would allow
input from c linicians within their network.

Dr. Josh Landy: What the network does is it lets you take a picture of a case and
submit it for conversation for learning , for teaching and for any other
reason why you might n eed to take a picture of a case.

Mark Masselli: Doctors are using the app to communicate not only with colleagues
within their hospital settings, but around the world w here someone
might have superior expe rtise with a certain condition.

Dr. Josh Landy: A nurse in Haiti put up a picture of a little baby. When this baby was
born with an un usual skin condition, she didn't know what it was and
if it was safe to let the baby leave. She put up a picture and within a
few hours 16,000 people logged hundreds of responses. What that
means is we can change what is the traditional way of a patient
accessing medical care .

Mark Masselli: A free downloa dable app offering secure HIPAA co mpliant image
sharing among clinicians around the world, tapping the collective
expert instantly. Now that is a bright idea.

[ Music ]

Mark Masselli: You've been listening to Conversations on Health Care. I'm Mark
Masselli.

Margaret Flinter: And I'm Margaret Flint er.

Mark Masselli: Peace and health.

Joe Sestak

Female : Conversations on Health Care is recorded at WESU at Wesleyan
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