What’s Different About Covering Health Policy in a Second Trump Term?

Ashish Jha: 00:00:05

Hey everybody. Ashish Jha here from Providence, Rhode Island, coming at you with another episode of a moment in health, a podcast where we talk about a data point, discuss a study and answer a question. And I'm going to jump right into it with a data point, kind of a depressing data point, but I'll get right into it, 91,000 deaths. It's a lot of deaths, about 3% of all people who die in America every year. That's the number of premature deaths that occur because of oil and gas driven air pollution. That comes from a study that was published recently in science advances. And I thought it'd be worth taking a minute to talk about this. It turns out that while burning carbon, burning oil and gas, has all sorts of problems for climate change, it has very direct effects on health. And I've talked about this in the podcast in the back in the past, we've been studies that show that kids in daycare that are near high traffic areas have more asthma. And this is a study that looks at specifically at burning oil and gas, the air pollution it generates, and the impact it's having on health of Americans, and estimates by 91,000 deaths. Most of those deaths are not going to be coded as air pollution deaths. They're going to be coded as lung cancer deaths. They're going to be coded as cardiovascular disease deaths, or heart attack deaths, stroke deaths, and that's one of the reasons why we continue to not see air pollution as a major, major public health problem, because we don't pay attention to air pollution directly. We tend to focus on the downstream effects. But if we burned less oil and gas, we would actually have a lot of health benefits. And I'm not even gonna get into the climate change effects, but anyway, important study, a good number, 91,000 premature deaths.

Ashish Jha: 00:01:55

Okay, I want to now shift to talking about the study of the week. And this is a sort of an oldie, but a goodie. It's a study from 2019 so I know it's a little bit old, six years old, but it's a study from the journal diabetes care, and it's entitled, long term effects of disasters on seniors with diabetes, evidence from hurricanes Katrina and Rita. So as I'm putting this podcast together, we're at about 20 years since Katrina landed in New Orleans, killed 1000 people, had far reaching consequences, not just for the people of New Orleans, but really in the way that we think about disasters in our country. And we've talked about this a little bit before in the podcast about the effects of these major storms, but this is a study that looked at both Katrina and then Rita, which arrived in Louisiana about a month later, not as devastating. And said, what's the long term effect for seniors? And focused their study particularly on seniors who have diabetes. And what did they find? They found that people had about a 40% higher all cause mortality in the first month after storms. And if you if you look at the study and read it, you can see that even six months a year out there is still an increased risk. That risk difference between people who are in the storm and not goes down, goes from about 40% down to about a 10% increased risk of death at five years. But pretty substantial. So why would a storm cause an increased risk of death if you survive the storm? Well, this too, we have discussed in the past, but I wanna take a minute to explain. When you have a major storm like this, things get disrupted. If you have diabetes. You need your diabetes medicines. All of a sudden, you may not have access to your diabetes medicines. You'll probably lose access to your primary care physician, because you may have to move, or you may end up not being able to get in to see somebody in clinic. The stress of having to go through something like this that has a big

Ashish Jha: 00:03:47

effect. So these storms, we often look at the deaths in the very short run. I mentioned 1000 people died from Hurricane Katrina, but that 1000 was the number that died in the intervening days, a few days after the storm, the real death toll from Katrina is probably in the 10s of 1000s, if you go on to measure it over months and years, another reason to be thinking about how to do a better job of managing these storms as they hit our country.

Ashish Jha: 00:04:20

All right. And now for the question of the week, and we have an extraordinarily special guest, colleague, friend, somebody I've known for over a decade, Margot Sanger Katz, correspondent for The New York Times, who has been covering healthcare, health policy for the times and for the upshot for since 2014 since the Obama administration. So Margo, thanks so much for joining us.

Unknown: 00:04:41

Oh, it's so fun to be on thank you so Margo. The question I had

Ashish Jha: 00:04:45

for you is, I mean, you've been covering healthcare well beyond the time you know, you've been at the times, but certainly for the times you started during the Obama administration, you covered health policy during the first Trump administration, then the Biden. Administration, and now, obviously the second Trump administration. The question for you is, I'm sure there are differences in variations across all the administrations, and how the issues, which issues are there? How do you see this current moment in terms of what's different about covering health policy now compared to other administrations, or even compared to the first Trump administration, does it feel different? Or does it just feel like, ah, there's variation from every administration, administration, and this is just variation or, or is there something more substantively different here? I think

Unknown: 00:05:33

there's a lot of stuff that's the same just about the job, you know, like, I have a colleague who once said to me, like, news is what happens when you're surprised. And we're in the news business, and so I think almost all stories are things that you were not expecting, that were not obvious. But I think that the volume of unexpected, surprising news coming out of this administration is just much higher than what I've seen in the past. And so I think what that means is that all of us that are covering health policy in this administration, have to sort of deploy really rapidly to try to understand things that we were not expecting. Lots of the kind of like logistical, blocking and tackling parts of the job are not that different. You know what I mean? Like the federal government always makes it hard to find out exactly what they're doing people who work in important government roles are always a little bit reluctant to talk to you on the record. You always have to have lots of sources in lots of places, and you also always want to be able to draw on a lot of outside expertise. But I do think the kind of density and velocity of true news, things that were not expected things that are important and surprising is just really, really high. And so I think that makes all of us feel like we're on a treadmill in a way that we certainly weren't during the Biden administration. I think I was thinking back, you know, over the time that I've been covering health policy, and I think the beginning of the covid pandemic felt similar to me in that way, not just because Trump was president, but because, you know, it was just an unprecedented global pandemic. None of us had ever experienced that before, and no one that I was talking to really knew how it was going to play out. And so I did feel like every day, we were getting up and trying to figure out something completely new, trying to answer very basic questions that readers had about the disease,

Unknown: 00:07:18

about their safety, about how they should live their lives, about what was going to happen to the economy, and lots of other things. Lots of other things as well. This is this moment is not quite the same as that, but I think it is the same in the sense that there's just so many new things happening, so many unexpected things happening, and the need to just be constantly deploying lots of journalistic resources to try to understand and communicate the volume and the density of change. So let me

Ashish Jha: 00:07:44

ask a follow up on that. I mean, is so that makes sense that in terms of both the volume the density, does it change? How you do things? Meaning, are there things that you might have said, Oh, I would have covered that, because that would have been something that would have risen to the level of something. But there's so many of these that I am now going to let some of this stuff go. I can imagine that you're making a different set of triage decisions, because at the end of the day, you're one human, you have a team, and other people work, but like you can only write so many articles. How do you think about that triage function, and does it make you does it based on importance or topics, or is it a mix? How do you think about that. I feel like

Unknown: 00:08:21

it's actually operating in both directions. I think I should just say a little bit about my job, which is like, I actually don't have a lot of news responsibility. There are reporters at the New York Times who cover the Department of Health and Human Services, and you know, when the Secretary does something, it's their job to cover it. I have colleagues that hover the insurance industry and the hospital industry, and when there are big announcements in those places, they cover those. I have colleagues that cover Congress and the White House, and when there's big news out of those, they cover those. And I have a job where I get to sort of float above all of those roles and try to make strategic choices about like, Where Can my expertise and the expertise of people on my team who are particularly skilled in data analysis and data visualization, like, Where can we add value without getting in the way of these really great reporters who also cover the news? So I think, of course, it's true, when there's lots of news, you can't cover it all, and you have to decide certain things are just going to get to the wayside, which I think, in a different kind of news environment where things were maybe a little bit more boring and predictable, you would pick up more of those things as they floated by as worth the effort. But I mean speaking only personally, over these last few months, I have felt a little bit of the opposite impulse, which is that it is not my job to cover every news development that happens. But I have felt that more and more of those news developments actually required our team to jump in and help, because the things were so important, because they were so complicated, because we thought that the resources that we could bring to bear in explaining them would be particularly valuable to readers. And so for that reason, I actually have published, like, way more articles this year than in a typical year. And again, I think those kind of early

Unknown: 00:09:53

months of covid are really the only other example I can think of where I've just been. You know, writing and publishing constantly, like.

Ashish Jha: 00:10:00

Us that's interesting, because I've certainly seen a lot more of your pieces. And it's not just because, as you said, you don't actually, you're not covering the news, per se, but you're helping people understand what is happening, and the need for that has become much more, much more substantial. Maybe the last kind of related question to all of this is that, because sort of the pace of policy change is so substantial, how do you feel people are consuming the information? Do you feel like people, your readers, New York Times readers, but kind of go beyond New York Times readers. I know you're primarily, obviously focused on your times readers, but generally you but generally, at times, I worry that it's too much that people just, in some ways, start tuning out because they're like, I just can't consume this volume of information. Do you worry about that? And then, how do you, in your role, help calibrate so that people are still following along without getting

Ashish Jha: 00:10:59

Margot Sanger-Katz: overwhelmed? I personally, as just a news consumer, find it completely overwhelming, and there are huge and important storylines that I care about or that I have covered that I just can't keep up with day to day. So I really do have a ton of sympathy for the average news reader who's going about their life and just can't keep track of what's happening on this or that, you know, legal challenge to this or that policy and, you know, there's just so many things where I'm like, Where does this even stand? And I think that there are so many really big things that are happening, you know, certainly outside of the realm of health policy. Over this last year, you know, there was a war with Iran, and there's a war in Gaza, and, you know, so many other really important domestic and global affairs in lots of areas. So I do feel this like incredible sympathy for anyone who's trying to keep up with the news. It's just really hard because there is so much of it, I've been trying to think a little bit strategically about what are the ways that we can kind of, like, summarize or aggregate or give people a thematic feel for things that are happening. I know that we're like, always successful in it, but, you know, I was writing a lot of stories about the big, beautiful bill, the big Republican domestic policy and tax legislation that passed recently. And a colleague of mine, Alicia parla piano, who's just amazing at this kind of thing, she just, like, generated a list of, like, everything that was in the bill with just short summaries. I mean, you know, lots of the stuff is like technical little tax credits for this, or whatever. Not, not all of it is going to be interesting to everyone, but it's just one place. It's a beautifully designed table. And you can just see, you can look at every single, you know, environmental program that changed, every single change to Medicaid. And you can go through them one at a time, and get a kind of real world,

Ashish Jha: 00:12:39

normal description of what it is, how much money it cost or saved. I think that those kinds of journalistic approaches that are sort of feel a little bit like lists or tables actually can be really helpful. And we've done a few of those early in the Trump administration, when the Office of Management and Budget put a pause on like, basically all federal spending for like, 24 hours, we just like, generate a list of, like, all of the programs that were subject to that pause. And, you know, we couldn't verify in real time whether money had stopped going out the door for all of those, but we did, like, provide a list. And I think it gave people a sense of, okay, this is the scope of action here. This is, this is the universe of things that are potentially affected. And I think it did help people understand it in a way that, you know, one story about this program got canceled. That program got canceled. I think can be a little hard. Another thing that I've learned from my colleague, David fahrenthold, who's a wonderful, very experienced investigative reporter who I've been doing a little bit of work with, is, I think sometimes you have to repeat yourself a little bit, you know, you kind of do a story, and then there's a slight development, and then you do a kind of similar story a couple of days later, and you just never know how busy a day it's going to be. Who read which one? You know, most people are not reading everything that we write. And so I think when something is important and it's happening again and again, it can be like, it can feel a little boring to me, like, Oh, I already wrote that one. But I do think that for things that are important, there is a value in just sort of telling people the information, because if it just catches them at the right moment, or it has the right kind of interesting detail, it is a way that people start to absorb what has

Ashish Jha: 00:14:15

happened. Yeah, yeah. Well, Margot, I want to say thank you for all of that. I mean, what's been interesting to me is so much of news coverage is sort of, it's sort of the horse race equivalent in in presidential politics, right? It's like, Who's, who's ended up voting for OB, BBB, who didn't, what happened? And it's and then all this little stuff like this is going to hurt nursing homes, it's going to do this, it's going to do that. And like having what you do so, well, I feel like, and there are obviously others at the times of being a source of education, where you can go and just read and learn what exactly is in it, what the impact is going to be, and helping people understand it is an incredible service. I feel like too few news outlets either have the luxury to do or prioritize, and you do it beautifully. So. Thank you for that work that you do, and thanks for coming on and chatting with us in the podcast. It was really great to have you.

Unknown: 00:15:06

It's wonderful to be here and to talk with you. Thank you so

Ashish Jha: 00:15:15

much. All right, so there you have it, another episode of a moment in health where we talked about one data point, 91,000 about 3% of all deaths in America are premature deaths that result from burning oil and gas and the air pollution that comes with it. We don't measure it as air pollution deaths. We measure it as heart attack deaths, stroke deaths, lung cancer deaths, but let's be very, very clear, it's coming from the air pollution that comes from burning dirty fuels like oil and gas. And then we talked about one study the long term effects of disasters for seniors with diabetes, and what they found was a 40% increase in all cause mortality in the first month among people who survived the storm and and while that 40% was a big number. Even five years later, you see about a 10% increased risk of death all cause mortality. And as I discussed, it was really because of all the disruptions that these storms cause in people who have chronic diseases. And then our guest was Margo Sanger Katz, who is an absolutely fabulous journalist at the New York Times. And I had asked her, what's different about covering health policy under the second Trump administration? Compared to previous administrations, including the previous Trump administration, and she had a whole set of, I thought, really interesting answers. Obviously, one of them is the high volume of surprises. The sheer amount of stuff that is happening is unprecedented. We've just never quite seen an administration putting out this much policy change this quickly. Now, Margo is a different type of a journalist in the sense that she doesn't do that much breaking news. She tends to take a step back and try to be an analyst and an explainer. But she mentioned how even in that context, when there's a lot more news you need to there's a lot more analysis and explaining to do. So she's typically doing a lot more than she used to. And then I thought there was a really important point that

Ashish Jha: 00:17:02

she made about readers feeling overwhelmed, that the high volume of stuff coming out of Washington, DC on domestic policy, more broadly, really can overwhelm people and desensitize people. And she and her colleagues use tools to try to help people navigate this complex moment, and I think she, personally is doing a fantastic job. And so it's great to hear from Margot, and great to hear about how a, really a top flight journalist, is looking at a moment like this and helping readers navigate through these waters. Thanks a lot for listening. We'll be back next week with another episode of a moment in health. You know what we're gonna do? We're gonna talk about a data point. We'll discuss the study, we'll answer a question. Have a great week, everybody. You.