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Jane Sarasohn-Kahn: All you need is ... [listen to find out]!

Hello, kids.

We’re still in No Man’s Land when it comes to the Presidential transition - depending on who you talk, or listen, to, we’re either going to be saying “Hello, Mr. President” to Joe Biden on January 20, or we’re teed up for a smooth transition to a 2nd Trump term.

The first one - the President Biden one - is what the voters seem to have said. The second one is being touted by guys named Rudy Giuliani who are sweating through their own press conferences with hair mascara running down their cheeks.

Not a great look, for America or for a “presidential lawyer,” but it’s 2020, so anything goes.

Meanwhile, in the real world where I like to think I live, my good buddy health economist Jane Sarasohn-Kahn has lots of good things to say about how we can get out of this freakin’ pandemic econoquake without flushing ourselves down the trash chute of history.

She’s got a new book out, “Health Citizenship: How a virus opened up hearts and minds,” a follow-on from her 2019 book “Health Consuming: From health consumer to health citizen.” I talked to her about that, about what she thinks is up next in our very uncharted territory of a Presidential election in a pandemic, and what the most important pillar of health citizenship is.

So here we go.

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Casey Q: So, tell us about your new book, "Health Citizenship." What was the message you were trying to get across in that?

Jane Sarasohn-Kahn: Well, we ended the first book, "Health Consuming," with the question will health consumers in America morph into health citizens anytime soon? We begged the question at the end saying the seeds are being planted for Americans to own their health care and not rent it, as Esther Dyson once said to me. And, the first six months of the COVID-19 era led me to understand that indeed, we were accelerating toward a moment where Americans finally started to realize there is this concept called health citizenship, even though they might not think of it in those words. And here's why I got to this point. My last plane ride in 2020 was February 28th, coming home to Philadelphia from San Diego.

That day, the morning of the 28th, I was giving a talk to the medical directors at the Sharp Health System in San Diego, they're about 300 docs and executives in the room. And before my 9:00 AM keynote, the CEO of Sharp stood up in front of everyone and said, I have to warn everybody that we're going to have a PPE problem. Now, I didn't know what PPE stood for on February 28th.

I'm a health economist and I've been working at this stuff for 25 years. So, I learned PPE and I learned that Sharp Healthcare and many other American health systems, were getting their disposable gowns and gloves and masks from a place in Wuhan, China, which was the factory of 3M. Which was one of the largest manufacturing plants in the world for PPE, for American health providers.

Good prices, good quality, blah, blah, blah. So, I'm about to talk about the emerging healthcare consumer in America, to this Sharp group, as the CEO is warning doctors in the room, you better take inventory, your masks, your gowns, your gloves. And that was my trial by fire talking to people about consumers thinking there's a new message here.

And I don't know exactly what it is. So, I came home to Philly, hunkered down, in my home office, which I've had for years, and people started to call me from client groups. How do you have a home office? What is it like? How do you work at it? So, I came home and absorbed six months of consumer retail, data, healthcare data, data from JAMA, New England Journal, so medical data, clinical data, data from popular culture, and figured out there were some forces reshaping Americans, and really people all over the world, impacted by COVID.

And as I inventoried these five forces, which we can talk about, I end the book, I'll just spoil it by saying that in the last chapter, we know that Americans, most people in the US, would lock in again to get rid of this thing. Most people would wear a mask, are wearing masks in fact, when they have to, in essential places out and about, and this is the beginning of this movement of us figuring out the fourth pillar of health citizenship, which is a new social contract called love - wear a mask. In this instance, love is wearing the mask, in other instances, when there's a vaccine to be had that the FDA approves and that Dr. Fauci, the non-idiot, tells us to take.

This is what love is. This is what we do for each other. And I do see glimpses and green shoots of us caring for each other again in America. I'm not saying it's every town, it's every person, but I am looking at data on our behavior over the last six months, so I'm hopeful that "Health Citizenship" with the tagline "how a virus opened hearts and minds."

People are starting to get the fact that I care for you, you care for me, we lift each other. And I'm hopeful, I have to be hopeful this round, and we wait another couple of months to sort out where the election goes. And then we'll talk again and I'll tell you what the next book's going to be. 'Cause it's either going to be "yay, we're getting there" or, huh, let's revisit what I posited before.

Casey Q: Yeah. You say that the opening of the hearts and minds in our pandemic times is sort of the window into getting both past this, in the COVID sense, and also maybe starting to address some of the underlying ... I'll just say garbage of the American experiment, which has always sort of been sweeping it under the rug because we don't want to look at that. So where do you see, what's the over-under on how close we are to getting to a majority on that open hearts and minds, or at least a crunchy enough plurality, that we could get something done.

Jane Sarasohn-Kahn: Yeah, I think this convergence this summer of the pandemic with the economic recession, which we're still in, heavily a "shecession," impacting women more than men in terms of jobs, the ability to telework, working women having to leave the workplace, et cetera.

So, you have the physical virus, you have the economic recession, and then you have what George Floyd's death represented in the moment, the social and civil unrest, the sentinel event, even though we've had many other issues, death, before George, but George somehow brought White people a little more woken than before because of all of these forces happening at once.

So, you have the physical, the fiscal, the economic, the social-civil, and then ultimately, all that coming together, waking people up to say, Oh, social determinants of health! Again, not using those words, but the fact that health disparities is a real and long time, couple hundred years, history of American healthcare.

And the President coming out one day at one of the early coronavirus taskforces, this was in April, where he said, who knew that Black people could have such a higher mortality rate. So, the data points that I brought out in my book from April was that equal percentages of White people and Black people knew someone who contracted COVID, but twice as many Black people knew somebody who died from the coronavirus.

So, you have equal numbers exposed, but twice as many Black people, and all of a sudden in that one statistic, very simple and crisp, therein lies the problem. And then what's underneath that. So, I think we've really gotten woke to more people, to the role of education, a good job, a job with health insurance. Food security is another thing that really emerged this summer, actually early in April, you saw the lines and San Antonio and others that still remain in my mind, that picture of the car lines at San Antonio. And solidly middle-class people, if there are any left, needing to go to a food pantry who never, ever needed to do that before. These are White middle-class people.

Now, again, food security impacts people of color, Latinx people and Black people, more than White people, but more White people were food insecure this year and still are, based on that shecession factor that many women who were the main income earners in their homes, whether single moms or married, have had to stop working. So, food is a huge issue now in this crisis as well.

Casey Q: Yeah. The myth of American exceptionalism is under cut so deeply by this simultaneous myth of American rugged individualism. Like you're on your own, I got mine, or you gotta get your own, or any of the ... the John Wayne effect is what I call it. And I've always had a problem with that, but it's been made much more starkly visible over this past year. And I'm just praying that perhaps a few people who maybe didn't get the memo before would have gotten it by now, but stay tuned for updates. So worst-case scenario, and we know what I mean by that, what happens in the worst-case scenario, what do you think.

Jane Sarasohn-Kahn: Well, let's, again, my I'll toggle to my mom versus my dad. That's the light side, dark side, both very politically involved, but my mom was born in Canada, so she had a light side to her on that. So, this is what I know I know. In the pandemic, our Maslow's pyramids of basic needs were pushed down to the physiological, the safety, and the social, the bottom three rungs. Nobody feels self-actualized right now. Nobody's grabbing no brass ring right now.

Casey Q: Well, Jeff Bezos might be, but, you know,

Jane Sarasohn-Kahn: Yeah, but in the mainstream, which we're all pretty mainstream right now, hunkering down at home for the most part, it's hunting and gathering for food and toilet tissue and then the importance of wifi and connectivity to both work, go to school, and for social connectivity that you and I are doing right now. The pleasure of me actually looking at you, giving you a virtual hug is real and I'm loving it. So, in the moment. And I think there she is, we're in a podcast, but I'm telling you we're doing a virtual hug right now, my friends. So, we have, what we know we know is, we're hunkering down at home. We are on our own #AloneTogether.

Everybody is going through this. We are humbled, all of us who are taking the virus seriously. That is the bond that we have now. Cross religion, cross ethnicity, cross race, cross socioeconomic status, whether you make over a hundred thousand a year or under 50, if you have broadband and you could work at home, you are working at home.

You're figuring it out. You're humbled by the fact that you can't buy, a brand label you liked, you buy the store brand, you deal with it, right? First world problem. So, I think we are learning to cope and I'm really proud of us. You know, most of us who have figured out how to hack this life, the other great equalizer, which is a sad one, is the fact that even after the pandemic, a year from now, we will be left with our individual forms of PTSD, anxiety, stress, and mental health is again, one of these issues that is bonding us together. 'Cause we all can say it sucks. It's not fun. And, this is another force that I think is reshaping us into health citizens, saying we deserve better from, across the social determinants, 'cause it can't just be on healthcare's back to make things better. It's education, transportation, food systems, and all those cabinet posts, which need to get repopulated.

So, to your original question, the worst-case scenario, I'm saying people get it. In majorities, or pluralities, that are people who will vote now, people who will make their voices known from the local level, down ballot, all the way up. And again, we're just two weeks as we're recording this now two weeks ahead of the November 3rd election, but I am hopeful that there are people who get it and we're working at our local levels all the way up, and even cross state, interestingly enough, we're noticing down-ballot elections and other states that are important now, nationally.

So now I'm going to remain hopeful right now, and not go to the worst case in terms of the outcome, but have faith in people getting this and understanding that, you know, that Zika mosquito that flew from Miami to Boca, it didn't care what ZIP code it was in. And we know now with COVID, it doesn't care how rich you are, how poor you are. I mean, the President had COVID, right? And his son, and his wife. Viruses just don't care. And I think Americans, in the main, are starting to realize that science matters. The new Pew poll out this week shows that most people still believe in science in America. So, you know, I'm heartened.

Casey Q: Well, and I confess that I am too, but because of the long period of time that I spent covering national campaigns, when I worked in the network television news business, and then, you know, also, well, let's just call it PTSD from both 2000, because that was one of the presidential races that I helped cover, and then, 2016, which I saw coming and people in my circle were like, what are you talking about? What do you mean? That could never happen! I said, Oh really? You are listening to a bubble. I am not listening to a bubble. And I'm hearing very disturbing things. So, stand back, this could get wild. And, hello. Now let's just say, in the not worst-case scenario, that we manage to remove the infection from the Oval Office, that we get the other guy, and then what do you see happening? How do you see that unfolding? And particularly over the next year, as we still battle this pandemic.

Jane Sarasohn-Kahn: Yeah. So, you have the virus, you have the economy and they're interrelated. I'm always the health economist lens first, so Brookings came out with the report today that baby boomers are starting to retire, and Social Security and Medicare trust funds are broke much sooner now because of the tax cut the current President gave a couple of years ago, and the fact that this year tax receipts are down because fewer people are working. You must interweave these two things, the pandemic and the large economy.

So, the next president, whether it's the current President in office or Vice President Biden as President with Kamala Harris, it's crushing the pandemic, the way the New Zealand prime minister has done, who was just reelected this week in record numbers, great female leader, we must crush the crisis and preserve the economy. And what the smartest countries in the world are doing is to replace income of people who've lost income. We need stimulus. And by the way, the head of the Federal Reserve, Jerome Powell has said, wear a mask and increase stimulus. This is ...

Casey Q: Give people money, give people money.

Jane Sarasohn-Kahn: They don't get political at the Fed. They got political in the last six months saying where's the stimulus, which is the CARES Act by the way, is what we're talking about. Again, three months later, people who are out of work. gosh knows where money is coming from, how people are paying rent. I talked about food already. So, it's really having a national strategy to crush the virus. And at the same time increase the stimulus to individuals, not to big businesses, but to people who need to pay for their cell phone bill, so they have connectivity and don't go totally nuts. Pay for food so they can eat, so we don't have people in the street rioting for food, which can happen. And then stimulating the economy as we crushed the virus through national strategies, like PPE to every home, funding schools for testing, so kids can go back to school, which we all want to happen, but we haven't put that infrastructure in place. So that's what the next president should do, whoever it is. It's to couple the strategy together, fiscal and physical.

Casey Q: Yeah. We've had enough divide and conquer. I think we need to get a little bit more "let's all pull together on the same rope" or at least enough of us so that we can move this giant stone that we're confronting called the coronavirus pandemic and its economic impact. You mentioned that there was going to be another book. Are you going to tease us again? Tease us again. What's the next one going to be.

Jane Sarasohn-Kahn: The scenario on the next book, so how I came to finish the first book, "Health Consuming," was right before the 2016 election, of which you were so prescient.

Casey Q: I hate being right. I hate being right.

Jane Sarasohn-Kahn: You were prescient, darling. The Mighty Casey has got a mighty forecasting ball, which I didn't have at that time. I had that book finished in August of 2016, and an editor in New York that I was working with at the time said to me, let's wait until after the election. I said, why? He said, because you're making a big assumption that we're going to build on the ACA, which is the assumption I was making. Well, anyway, he was right. I was wrong. So, I actually went to my beloved Italy at that point with my husband, spent some weeks there to clear my mind after the election, because it was a tough, tough moment for me, in health policy and economics and consumer facing health care.

And, I got perspective by being out of country, and looking at great art and reading great books and, long story short, I reformulated that book, and I carry an Italian passport and have an EU citizenship, and I'm a health citizen in Europe, and I'm also covered by the GDPR as a privacy law when I'm in Europe, as a European. But in the States, of course, I'm not a health citizen because we don't have universal access to care.

Casey Q: Yeah, we don't have that here.

Jane Sarasohn-Kahn: We don't have a comprehensive privacy law, which is relevant to the way we live today. So, I rewrote much of that book. It became the book that's called "Health Consuming: From health consumer to health citizen." So, this scenario, this time it's going to be the same thing. after the election, whether it's a President Biden or President Trump, I do need to get some perspective away after this. And I will be in Europe sometime in the first quarter of 2021.

And I will draft another small book like this one, this book's only 112 pages, "Health Citizenship," and there will be a next book, which is, okay, this person is President now. and this is where I think things will go, again, moving toward empowering Americans as health citizens, and empowered patients, people, caregivers. And I will do that from across the pond.

Casey Q: Yeah, because I mean, consumer is certainly, you know, a semi-active word. You are actively consuming something. But a citizen, being a citizen, gives you an extra layer of responsibility and self-actuation that goes beyond just, okay, there's these shiny objects going by on a conveyor belt. And I'm going to pick the ones I like, which is the consumer side. So, I can't wait to see what number three is. Let's see. But we've moved from consumer to citizen, maybe, from your lips to God's ears, let's hope that this happens, but right now, stay tuned for updates. What do you think the over-under odds are on us knowing who the next president is by the 19th of November?

Jane Sarasohn-Kahn: I think the odds are good that we're going to know. I'm not going to say who.

Casey Q: You don't have to say who, just will we know.

Jane Sarasohn-Kahn: I think we see an amazing amount of engagement in the mail ballots. I know you had one. I had one. We both delivered our ballots personally to the polling place, which was important. We're just seeing amazing engagement, which is, again part of health citizenship. You're right. Health citizenship isn't just give me free healthcare. It's I need to be responsible for my own care, and care about my neighbor, too.

And it also is about voting because we want health baked in all public policy. Like climate change, like education, like transport, food, as I said earlier. So being a health citizen isn't just free healthcare. Yes. Universal healthcare is a pillar of health citizenship. Digital privacy is a pillar. Trust in science, trust in each other, is my third pillar. And my fourth pillar, as I said earlier, is the new social contract, love. And in this instance, immediately, wear the mask.

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All you need is love. That’s not just a line from a song, it’s a pretty solid pillar upon which to build a society, and a culture. Too bad we’re still so wedded to the rugged individualist version of American character, at least in the loud parts of our American landscape.

But we might be making progress. It does appear as though there might be an orderly transition of power on January 20, 2021. As to whether the current occupants will hand over the keys, or have to have those keys pried from their fingers … that’s still an open question.

If you’re in the US, have a happy Thanksgiving next week! There won’t be an ep posted next Thursday, since I’m taking Turkey Day off.

Next podcast will be up on December 3, with my buddy Grayson Schultz - we’ll be talking public health, equity, and lots of other fun stuff.

In the meanwhile, stay frosty.

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