Catholic schools are closing their doors all across America, leaving future generations with nowhere to turn for the high-quality academics and values-based education so many families are seeking. The number of students attending Catholic schools in the US fell from about 5.2 million in 1965 to around two million in 2008.
Pioneer Institute believes these schools are worth preserving. For over a decade, we have raised our voice in support of these excellent academic options, and tools such as tax credit scholarships that would enable more families to attend.
Pioneer has held public forums, published research on the benefits of Catholic education, on successful models such as Cristo Rey, and on policy changes that would stop the Massachusetts education department from depriving religious school students of special needs services and school nurses. The Institute has also convened key stakeholders, appeared in local and national press, filed amicus briefs, produced a feature a documentary film, and much more.
Hubwonk host Joe Selvaggi talks with Pioneer Institute’s Dr. Bill Smith about his recently released paper entitled, “340B Drug Discounts, An Increasingly Dysfunctional Federal Program,” which analyzes the evolution of a well-intentioned program to offer discounted drugs to the uninsured from a benefit that had helped charitable hospitals to one that has exploded to generate billions in profits while serving fewer uninsured.
Guest:
William S. Smith is Senior Fellow and Director of the Life Sciences Initiative at Pioneer Institute. He has 25 years of experience in government and in corporate roles, including as vice president of public affairs and policy at Pfizer, and as a consultant to major pharmaceutical, biotechnology and medical device companies. He held senior staff positions for the Republican House leadership on Capitol Hill, the White House, and in the Massachusetts Governor’s office. He earned his PhD with distinction at The Catholic University of America (CUA).
Read a Transcript of This Episode
Please excuse typos.
Joe Selvaggi:
This is Hubwonk. I’m Joe Selvaggi.
Joe Selvaggi:
Welcome to Hubwonk, a podcast of Pioneer Institute, a think tank in Boston. In 1992, a well-intentioned targeted program named 340B required pharmaceutical companies to provide eligible hospitals with drugs at a substantial discount for the benefit of uninsured patients. Those hospitals were then to use any savings and profits from the program to provide comprehensive services for the poor and uninsured since its inception. However, healthcare systems have exploited the statutes guidance to re billions in profits by purchasing 340B drugs at a discount, and then selling those deeply discounted drugs to insured patients at retail prices. Perhaps more disturbing is a trend that while 340 B program profits have so access to discounted drugs and charity programs for the uninsured have been in steady. The numbers involved in this distorted drug program are staggering. Now exceeding the value of both the Medicaid drug benefit and Medicare part D how did this worthy program get so distorted and how can policy makers reform 340 B in a way that realigns incentives to better serve the uninsured?
Joe Selvaggi:
My guest today, Pioneer Institute’s senior fellow in life sciences, Dr. Bill Smith, who will talk about the findings of his recently released paper entitled “340 B discounts: An increasingly dysfunctional program.” In the paper, Dr. Smith describes the arc of how this well-intentioned program seems to have lost its direction and grown to generate massive profits for hospitals while sign simultaneously reducing drug benefits and charity programs for the uninsured, Bill will offer his views on what legislatures can do to realign program incentives, to better guarantee the uninsured receive their drug benefits and ensure the profits from the program go toward our poorest citizens. When I return, I’ll be joined by Pioneer Institute’s Dr. Bill Smith.
Joe Selvaggi:
Okay. We’re back. This is Hubwonk. I’m Joe Selvaggi, and I’m pleased be joined by Pioneer Institute’s visiting fellow in Life Sciences, Dr. Bill Smith. Welcome back to Hubwonk, Bill. Thank you, Joe. Glad to be here. Great. Well, bill, I found your recently released Pioneer report entitled 340B Discounts: An increasingly dysfunctional program. I found it somewhat alarming. I want to set the stage for our listeners that we’re talking about a federal program designed to help low-income uninsured people with medication. And it’s largely been exploited by the medical community to reap literally billions in profits with little of those billions going to, to where the statute was intended. So there’s a lot to unpack in your paper. So let’s start with some history. Let’s start at the beginning. What was the original idea behind 340B? And when did the program begin?
Dr. Bill Smith:
Well, it, it actually didn’t begin as a federal program. It just began when a number of drug companies, many drug companies actually started giving deep discounts to hospital that treated a large number of uninsured, low income patients. The drug companies knew that those hospitals would, were struggling financially. And so they made voluntary concessionary discounts available to them. And in 1992, the federal government decided the Congress decided, well, we’re, we should, we’re gonna make this program mandatory. So we’re gonna require the drug companies give discounts to hospitals to treat large numbers of low income or uninsured patients. And, and, you know, the program started out fine. I would’ve supported it in 1992. It, it, it targeted about 500 hospitals and clinics around the country. It was limited and, and it was largely limited to, to those hospitals and, and clinics that did treat large numbers of low income uninsured, but starting in about 10, 15 years ago, the program absolutely exploded.
Dr. Bill Smith:
You become eligible as a hospital for, to become eligible for these three 40 B discounts based on the number of patients, you Medicaid patients, you treat the federal government and the Congress thought that’s a proxy for your treating low income or uninsured patients. And when they expanded the affordable care act and Medicaid exploded in the number of patients, many, many more hospitals became eligible. So the program started out about 500 hospitals that now has about 2,500 hospitals. And those hospitals have expanded to satellite offices. So they’re now 37,000 covered entities in the program.
Joe Selvaggi:
So your your paper does suggest that much of the reason has exploded. And the eligibility has expanded is owed to the vaguery of the, the statute. You know, as you mentioned in your paper, it was originally designed to target quote unquote covered entities, but left it to the, the system itself to infer who was covered, say more about how these vagaries are easily exploited.
Dr. Bill Smith:
Well, let me first explain why the program is so popular with hospitals and why it exploded. So under the three 40 beat program, you can get a substantial discount when you purchase a drug. So let’s say a hospital just to, to make it simple. A hospital can, can purchase an oncology drug for $25,000. When this price of that oncology drug is a hundred thousand dollars. So they’re getting a 75% discount. So if you, as a, as a hospital administrator can lure into your hospital or to your satellite office, a patient that’s that has insurance and is wealthy. You can dispense that drug to that patient for $25,000, and then bill his insurance company, or Medicare for a hundred thousand dollars, and you can pocket the $75,000 spread. It, it, this is basic arbitrage. It, it happens in many areas of business, but this three 40 B program is now being arbitrage. And the, the statute getting back to your original question, the statute was written in poorly. So the program is not limited to only dispensing drugs to low income patients or in low income neighborhoods or to uninsured patients. So it there, the statute didn’t define anything about who’s eligible for the program and who might share in these, these dis drug discounts.
Joe Selvaggi:
I see. So now you said as growing substantially since its inception in your first answer, you did say the original program used medicaid patients as a proxy for implying that hospitals located where there are lots of Medicaid recipients and in inferred from that that there also must be lots of charity cases. Describe for our listeners, where were these original three 40 B participant hospitals, where have they, you know, sprung up now? Who, who who’s joining the system from where it used to be?
Dr. Bill Smith:
Yeah, so originally, Joe, that’s a good question. Originally these hospitals and clinics were in low income areas, both rural and urban areas that treated large numbers of low income patients. But since 2004, there’s a substantial data to suggest that a lot of these hospitals and their satellite offices are being located in wealthier areas that have higher rates of insurance. And, and that’s part in part due to the fact that they can arbitrize the drug discounts. So they wanna get patients in there that have Medicare or commercial insurance coverage as then they can bill for the full price of the drug, why they buy the drug at the discount.
Joe Selvaggi:
Now, your paper we, we’re talking about a program that was originally intended to help people who didn’t have insurance now in the, in the in the meantime, we’ve passed the affordable care act, it’s stated intent and it’s effect, I think has been to have more people become insured, both low income or people who had formally been on Medicaid or uninsured altogether. So if we have fewer people who would be in theory eligible for three 40 B benefits, did we see a decrease in the amount of three 40 B activity once the affordable care act was implemented,
Dr. Bill Smith:
Joe, just the opposite, you know, in 2012, there were only, there were 54 million people covered under Medicaid. And this year there are 83 million people covered under Medicaid. So the number of people insured has grown substantially. The number of uninsured has dropped dramatically. One would’ve expected given that the three 40 B program was supposed to treat the uninsured one, would’ve expected that the three 40 B program would’ve declined over the past decade, just the opposite that’s when it had its most explosive growth over the last decade. So it’s up to about 38 billion in sales and the three 40 B program will soon eclipse in size, both the Medicaid prog drug program, which has 83 million recipients and the Medicare Medicare part D program, which has over 50 million recipients and their senior citizens who tend to use a lot of drugs. So this, we made the longish talking about a three 40 B program that nobody really knows about, but it’s now the largest federal drug program in the, in the United States.
Joe Selvaggi:
Yeah, the numbers are staggering when you compare it to what we already consider fairly costly programs, Medicaid and Medicare part D to eclipse those programs is, is, is saying something. So I think that’s why this, this a program deserves our attention now. Let’s set aside that despite the fact that the ACA is, has more people insured and therefore one would think the byproduct of that would be fewer three 40 B claims. They went up. So that means hospitals were generating more money from this program than they had before the ACA another feature of that three 40 B, I don’t think we’ve addressed is that the program was supposed to help hospitals use the savings they get from those discounts and apply those to programs for charity. In other words, there chart supposed to take the benefit and apply that benefit to charitable patients. Have we seen an increase in the amount of money that hospitals are given to charity owing to their, you know, this windfall of, of a program?
Dr. Bill Smith:
Yeah, Joe, just, just the opposite. We’ve seen charity care decline, and it would’ve been very difficult for me to write a paper are critical of the three 40 B program had the billions of dollars that this program is generating, been devoted to programs for low income and uninsured, but that’s just not the case. I, I don’t wanna pick on mass general because they’re excellent hospital. They’re part of the whole life sciences ecosystem here in, in, in the greater Boston area. But in 2013, they were spending 3.8% of their revenues on charity care for low income people. And in 2020 that dropped to 1%, it’s been a straight line down as it has in many hospitals. And at the same time, they’re, we know that they’re expanding their three 40 B presence. They, they had one pharmacy dispensing their, their three 40 B drugs in 2017.
Dr. Bill Smith:
They now have 132 pharmacies ex dispensing their three 40 B drugs. So we know the revenues are growing. They’re not required to disclose the amount of revenue they’re getting from three 40 B, but it must be explosive if you’ve gone from one pharmacy to 132 pharmacies and mass general has expanded. They have offices now in some of the wealthiest towns in, in Massachusetts, Wellesley Concord, Walham Newton they even have offices in Nashville, New Hampshire and York Maine. So part of the reason for this growth is that they can leverage these three 40 B discounts in these areas. So it’s, it’s a troubling thing, particularly because the charity care numbers have been declining.
Joe Selvaggi:
I found a striking feature of your paper in that that originally the three 40 B was going to hospitals that did more charity work. Your paper are points to the research that indicates that what these newer hospitals, these bigger hospitals, I don’t wanna throw the mass general under the bus, but when compared with those hospitals that don’t participate in three 40 B in theory, those that don’t do substantial charity work, there’s actually less charity work being done in three 40 B hospitals. Then there are, and three 40 B hospitals, which is to say, there’s no correlation between one’s inclination to exploit three 40 B and one’s inclination to serve charity cases. This is very troubling. Say more about this phenomena.
Dr. Bill Smith:
Yeah, that’s, that’s precisely right that their, their are studies to suggest that three 40 B hospitals give less charity care than either government or for profit hospitals. And one would expect given the revenues that are generated from three 40 B program, which are estimated to be 40 billion for these hospitals, that the, the nonprofit three 40 B hospitals would be dispensing much more charity care, but the data suggests that’s not true.
Joe Selvaggi:
Well, you break down three types of hospitals, I suppose. I’ve never thought of this way, but there’s for profit, nonprofit and government. So for profit is supposed to be the bad guys, I suppose, in a, in a modern narrative nonprofits, the good guys your paper suggests that nonprofits are in measurable terms, doing the least amount of charity work when compared with for profit and go from in hospital, say more about that data.
Dr. Bill Smith:
Yeah. And I don’t want Joe, I don’t wanna cast the, the, I don’t wanna paint with too broad a brush here because we did find hospitals in urban areas in the Boston area, such as Boston medical center and Cambridge hospital Everett hospital that were, they were giving out a huge amount of charity care, you know, more than 10% of revenue, some years unlike mass general and, and, and UMass Memorial in Wooster and bay, state, and Springfield where the numbers are closer to 1%. So it there’s some hospitals in clinics that are really doing the Lord’s work when it comes to charity care. And so I don’t wanna paint with two broader brush, but on average charity care has been declining at these nonprofit three 40 B hospitals, which one would not have expected given the growth in the program.
Joe Selvaggi:
Sure. And you mentioned briefly that the the, the 340 B programs are, are branching out to smaller more affluent communities, but you know, local community physician groups themselves, how does the three 40 B program interfere with community physician practices?
Dr. Bill Smith:
Well, to be Frank, the hospitals are just buying up community based per practices. 51% of the community based oncology practices are now vertically integrated into a hospital system because they’ve been bought up. And the reason they’ve been bought up is obvious because in neurology and, and oncology, and, and in those specialty areas where you you’re dispensing expensive drugs the, you can keep the spread as a hospital system. And arbitrize the, the three 40 B discounts when you purchase an oncology practice and bring in a huge amount of revenue. So this is troubling because people like community based practices, they don’t want ’em to see their local community physician practice being bought up by a hospital. But it’s also the case that once these, these practices are bought up, there is an incentive not only to prescribe more drugs, but to prescribe more expensive drugs, because you’re going to be able to leverage those discounts. So it, it, it’s not great all the way around. And and you know, the, the, the oncology community is well aware of this problem. And, and they’ve been fighting back trying to avoid these, the purchase of these, some of these community based clinics.
Joe Selvaggi:
So if I’m someone who enjoys you know, a community physician practice somebody say, oh, I I’m in different to who owns, or how in vertically integrated my system is my doctor is, but what your paper points out is once it does join this integrated system, everything in that practice becomes substantially more expensive, not unlike where that practice to move into the city. The, the drugs, the physician visits, all go up in price. And you also mention in your, in your remark that given that the hospitals arbitrage, the difference between what a it’s, it’s a percentage base the more expensive the drug, the greater the discount, the greater, the profit, there’s a, a clear incentive to raise drug prices based on the difference between the retail and the three 40 B discount.
Dr. Bill Smith:
Yes. And, and, and again, it’s not just drug prices that go on overall healthcare costs in the hospital setting is, are more expensive generally. And so you know, I’m very sympathetic to hospitals. My sister’s a hospital administrator in New York, and I know it’s a difficult business, but it is more expensive to treat somebody in a hospital setting or a hospital satellite office than in the com community based physician practice. That’s just the reality. And so this expansion of hospitals into wealthy suburbs is gonna drive up healthcare costs and is driving up healthcare costs.
Joe Selvaggi:
So I sort of the icing on the keg before we shift gears into what you recommend as perhaps a, a useful remedy for many of these perverse incentives you, you describe a case whereby when combined with a Medicaid rebate, a drug company that sells a drug. I think you use a, a, you know, for instance, a hundred dollars drug that winds up costing the, the manufacture money to sell the drug, which seems unbelievable. But you know, many people like to trash to the reputations or, or incentives of drug companies, but to have a system whereby a drug company loses money for every pill sell to say more of how three 40 B and the Medicaid rebate might combine to make a negative a margin.
Dr. Bill Smith:
Yeah. So it’s, it’s, it’s simple, it’s called, it’s a problem called duplicate discounts, which were banned in the original statute. It’s actually a violation of federal law for a pharmacy to, to obtain duplicate discounts. So let, let’s say you you get it, you buy a drug at, at $25 which is the 340 B price. And then it, the, the patient goes to the pharmacy and the, the drug is purchased. And then the pharmacy bills, the drug manufacturer for a $35 rebate, the, the company now has just lost $10 on that sale because the they’re getting bill the three 40 B discount as well as a Medicaid rebate. And this is a common problem. It’s in the hundreds of millions of dollars, probably that these duplicate discounts happen every year. And it, again, it was banned in federal law. And one would think with our current software systems, they’d be able to solve this problem, but they haven’t and inspectors general, and also sorts of people, the justice department, others have, have come back and said, you gotta solve this problem, but they have not.
Joe Selvaggi:
Indeed, indeed. All right, so let’s, let’s stop piling on we, we established a three 40 B has created some perverse incentives and those of us who pay into this health system are all poorer for it. Let’s figure out how to, what you would recommend as, as reasonable steps towards finding some remedy or solution to this first. You you would recommend that we require hospitals to revol report three 40 B revenues. It seems odd, odd that we don’t already do that, but say more about why that’s important.
Dr. Bill Smith:
Well, that’s important because they, they do report. Although the definition of charity care needs to be tightened up, they do report in their Medicare cost reports, the amount of charity care that they dispense. So if we knew what they were securing in revenue from the three 40 B program, we could compare that with the amount of charity care that they’re giving out each year. And one, one would expect there’s a great disparity between the two numbers these days. And, you know, the transparency might shame them into spending more on charity care, which would be a good thing.
Joe Selvaggi:
Indeed, indeed. Now those presumably the it’s a positive number, the difference between the money they get from three 40 B and the money they give in charity care you would want to, your second recommendation is to require those covered entities to spend that money, that profit on charity care. That seems reasonable. Is that what you’re saying?
Dr. Bill Smith:
Yeah, that’s a, it’s a more directive than just the transparency option, but you could require that all revenue that’s secured from through the three 40 B program must be spent on community programs that serve low income and uninsured patients it’d be that simple. Right now we don’t know where all that revenue goes. It could go to hospital salaries. It could go to who knows, could be go to expanding the building. We, we don’t know where the money goes now. And requiring it to go to charity care would be a, a boom to charity care around the country.
Joe Selvaggi:
Indeed. That’s how it was intended. So it ought to go to the charity. You also want to better define who is eligible for the discounts and, and the charity care, which you addressed early in the paper that remarkably it doesn’t specifically define who should be eligible.
Dr. Bill Smith:
Yeah, I, I’m not sure why a three 40 B drug should be given to a millionaire in Wellesley. I just don’t, I don’t think that fits the, the, but that is happening. That is happening now. I, I don’t think that fits the original spirit of the program and the statute needs to be tightened up, so that doesn’t happen
Joe Selvaggi:
Indeed. And, and that that’s a, that dovetails well, well, with the next point, which disqualified three 40 B child sites, because satellite sites were using that term in wealthy communities. I’ll just say, let me qualify this. I’m sure there’s some low income people in wealthy, probably not many, but we keep going there. But let let’s, let’s say let’s use that example again. Why, why would we disqualify the three 40 B sites in, in wealthy communities? Well,
Dr. Bill Smith:
You, you know, charity care arises many times spontaneously, you know, it’s, it’s the homeless person who finds himself in the emergency room and doesn’t have insurance and, and the hospital has to eat the cost of that care. And so if you’re locating your satellite offices in wealthy neighborhoods where people have higher rates of insurance, you’re not gonna get that spontaneous charity care happening. So I, I think they ought to limit the, the places where these three 40 B sites can be to areas that are considered somewhat impoverished in the United States. And I, I don’t want to come up with an exact definition of impoverished, but it should be an areas where you are gonna get those walk in patients who aren’t insured and are very low income. And that originally when they first enacted this program that was happening, these, these, these hospitals and clinics were located in these areas. And there are some that are still located in these areas, but with the expansion they’ve more and more expanded this program into wealthier area is they have higher rates of insurance.
Joe Selvaggi:
And I think on the flip side of this is your next recommendation, which is not, not only define who is eligible, but when we’d say let’s take that money and give it dedicated to charitable programs, we should define what charitable programs look like and what community programs look like. We, we still haven’t done that.
Dr. Bill Smith:
Yeah. The definition’s not as tight as it should be. So for example, if a middle class patient comes in and they owe a deductible or a co-insurance payment on whatever treatment that they were given in the hospital and they never pay that, is that charity care. Well, some, some hospitals do define it as charity care because they’re eating the cost, but the patient is probably can afford the co-insurance payment and chooses not to pay it. So maybe it’s not charity care. I just think they, they should tighten the definition so that these are programs that are serving underserved populations.
Joe Selvaggi:
Also of course, want to reform how hospitals become eligible for this program. You wanna reform the disproportionate, share hospital, eligi eligibility requirements for the program and a sense, I think you’re implying that some hospitals ought not to even be in the program.
Dr. Bill Smith:
Yeah. You know, as, as we discussed, you know, when the affordable care act expanded Medicaid drug, I think it’s, it’s 11.75% is the, the percentage of Medicaid patients that you treat, you become eligible for it to become a three 40 B hospital. Once you cross that 11.75 threshold. And it’s clearly the case that some hospitals have lure in Medicaid patients to get to number obtained three 40 B status, and then not gone further their, their Medicaid patient numbers are still at that level. So they’re gaming the system to some degree, not all hospitals, but some hospitals, for sure. So I, I think they ought to look at Medicaid as a proxy for treating low income patients. I, I’m not sure is, is a workable definition any longer given the expansion of Medicaid. And they may be ought to look at other numbers like how much charity care they give out that that could be a threshold that, that makes you eligible for three 40 B status.
Joe Selvaggi:
That would be something to, to earn that status based on how much good you do rather than, and how many Medicaid people you lure in
Dr. Bill Smith:
Precisely.
Joe Selvaggi:
And the final one. I’m, I’m not sure, I, I know precisely why this is a benefit, but you suggest we should convert three 40 B programs from discounts to rebates. I guess there must be, then it must be conditioned that rebates conditioned on proof that it’s being used for the right thing. Yeah.
Dr. Bill Smith:
It’s, it’s complicated, but the rebate system would avoid the problem that we discussed with duplicate discounts, because you could, you’d have a little time to figure out who was a Medicaid patient and who wasn’t before you wrote the check who was getting a three 40 B drug and who wasn’t. And so the rebate system would help, would help solve that problem. It it’s a very, the pharmacy transactions are extremely complicated. But I’m told by people who know them well, that a rebate system would, would solve the duplicate discount problem.
Joe Selvaggi:
All right. So those are your recommendations. But our listeners may think, okay, this is fine, but you know what? We’re here in Massachusetts. We’re the good guys. Our hospitals are above reproach. But you name names in the end of the report and not all Massachusetts hospitals come out wearing the white hat, I guess. So let’s let’s name names, and talk about where, where we see problems and where we’ll call out. Some other hospitals for are doing a, a terrific job. But before we name names how do you measure you, you, you, you, you talk about in your report, who’s really not using the money for charity work. How do you measure charity care provided in a given system, in any given hospital?
Dr. Bill Smith:
Well, in our we looked at Medicare cost reports that hospitals have to file every year with CMS, the, the federal Medicaid, the Medicare Medicaid agency, and they’re required to report their charity care numbers based on their revenues. So what we did in the report is we, we picked five hospitals, randomly. We picked by geography. We wanted to see how across the state charity care was being given out. So we picked mass general in Boston. We picked UMass Memorial in Worcester. We picked bay state in Western mass. We picked Berkshire hospital system in the Berkshires and south coast hospitals in, in, in the, on the Cape. And what we found is those, those hospital systems were not PA picked in advance based on their charity care numbers. We hadn’t even looked at the charity care numbers, but what turned out to be the case is for all those five hospital systems that charity care numbers are a straight line down from 20 13, 20 14 to, to this year. So, so that’s a problem. And again, we didn’t wanna dust up all hospitals. So we looked at the numbers and we found there were, there were hospitals like Boston medical center and Cambridge hospital and Everett hospital that were giving out large amounts of charity care based on revenue. So again, I, I don’t wanna paint with too broad a brush, but in our random sample, based on geography, all the charity care numbers were down.
Joe Selvaggi:
So let’s put that in the enumerator, the denominator then is, is how much the program has grown in Massachusetts. You said some numbers, I don’t know if you have them, your fingertips, how in the last eight, 10 years the money’s grown, you’ve established that the money given to charity by those hospitals from the 340 B has been going has been going down, but the revenue coming in from 340 B has grown, can you put a, a fine point on how much it’s grown in Massachusetts?
Dr. Bill Smith:
Well, we don’t know because the hospitals aren’t required to disclose their revenues, which is one of their from 340 B, but we know nationally the program has grown from about 9 billion in 20,000, 2009 to 38 billion last year. So given that Massachusetts’ hospital intensive one would think they were reaping the benefits of that. And as I said, mass general only had one pharmacy in 2017 that dispensed three 40 B drugs, and now it has 132. So I think we can say with a high degree of confidence that revenues from the three 40 B program have exploded. We just don’t have an exact number because they’re not required to disclose
Joe Selvaggi:
All the money going to charity has been going down across the board by my reckoning, the money coming in from three 40 B across the country has back of the napkin quadrupled or seen a 400% increase over the last what do we see eight years that’s
Dr. Bill Smith:
Yes. And, and the 38 billion in actual sales, that’s the discounted sale price. But one economist did a study arguing that, that, that 38 billion in sales leveraged an additional 40 billion in revenue for the hospitals. So this is a huge program. You know, 78 billion in money is flowing through this program according to some estimates.
Joe Selvaggi:
Yeah. We can’t you know, go through all the findings of all the hospitals that you, you, you name, but let’s, let’s start with you mentioned mass general a few times. So let’s, let’s get to it. How, how did so-called man’s greatest hospital fair in your study when comparing its its revenue to its its expenditure?
Dr. Bill Smith:
Yeah. In, in 2013, based on the Medicare cost reports, mass general was devoting 3.8% of their revenue to charity care, which is a fair number. It’s not real high, but it’s fair number. And in 2020, their, their charity care number dropped to 1% of revenues. So it’s declined substantially. And we found that in the other four hospital systems around Massachusetts and as I said, one would expect that their three 40 B revenues are, are exploding because they’ve gone from one pharmacy to 132 pharmacies are dispensing three 40 B drugs. I, I just would like to see the numbers on, on their revenue from three 40 B and what it’s been over the past decade or so
Joe Selvaggi:
This is all interesting because I think adding to perhaps our listeners’ outrage is in, in the time between our two, four, 2014 and now the affordable care act is you know, is taken hold, which in theory would mean fewer people are uninsured. We know that that to be true so that this shifts from higher 340 B claims and lower charity is with the backdrop of saying there are a few people who ought to be eligible. So the hospitals have to either claim the, that there are more charitable patients despite ACA, which seems impossible or less need for charity despite the fact that their claims are going through the roof. Am I right?
Dr. Bill Smith:
Yes. in one study concluded, there’s an inverse relationship between charity care and growth in three 40 B programs, an inverse relationship as three 40 B grows, charity care declines was the conclusion of this one study which I, I think is unsupportable. I just you know, again, it would be hard to criticize the size and scope of this program. If all of this money, we we’re going to charity care, treating homeless people, uninsured people providing mental health services, doing whatever for patients that are really in need, but that doesn’t seem to be the case.
Joe Selvaggi:
This is a real shame. More than a shame I say, you know but let’s, let’s not call everybody out. We, we actually have some good actors in your, in your group that you say you chose randomly. There were some good actors who, who, who are have a high fidelity to their charitable mission. You call out Cambridge health Alliance and Boston medical center. What, what, what do their numbers look like?
Dr. Bill Smith:
Yeah, again, their numbers, weren’t a straight decline from 2013 to the present. It, they went down some years and then back up some years, but they were substantially higher, even 10 times higher than some of these other hospital systems. So I, I think there are some hospitals that are doing right by this program. And I also have the impression that there are a lot of clinic Ryan, white clinics, federally qualified health centers and, and smaller clinics that are located in very difficult, challenged neighborhoods that are providing great service. And they need these three 40 B discounts. And, and I, I don’t want this program to go away and I, I didn’t write the paper to say the PA the program shouldn’t exist. It just needs to be tightened up. And the people that really need these discounts should continue to get them. And the people that don’t shouldn’t
Joe Selvaggi:
Indeed. So where now we’re getting close to the end of our show, where can our listeners find your paper?
Dr. Bill Smith:
Well, pioneer pioneer institute.org. The pioneer institutes website has both the press release explaining the pro the the paper as well as the link to the paper itself. And it’s about 15 pages or so it’s not, it’s not burdensome to read.
Joe Selvaggi:
No. And I went deep into some of the footnotes copious number of footnotes also, which, which is good, supporting your, your observation. Now our listeners, again, this I’ll use this as our last question. Our listeners are, are our thinkers. They like think tanks, what they like to do. What would you suggest? I mean, you’ve laid out what, what let’s say lawmakers can do, would would you recommend that our listeners, if they’re persuaded, maybe, maybe they maybe some of our congressmen are listeners to the show, but those who are, are voters, what would they do if they want to encourage their legislator to, to, to jump on this out of you know, out of compassion for the poor and the desire to see this substantial amount of amount of money go to the right place? What should they do?
Dr. Bill Smith:
Yeah, I, I, I, I, I’m big on transparency. I think both on the state and federal level, there should be some disclosure on the part of hospitals about the amount of revenue they’re securing from the three 40 B program you know, requiring them to spend it on charity care, maybe, maybe not, but definitely disclosure and transparent. And, you know, if I were just an ordinary citizen meeting with my legislator, I’d say, well, how come, I don’t know how much mass general is getting from this program and how much they’re spending on charity care. And let’s look at the differential between those two, two numbers,
Joe Selvaggi:
Indeed. Transparency or sunshine is the best disinfectant. At the very least. We might be able to shame these hospitals into giving the money they’ve been given as charity themselves. It intended for charity. Make sure if they’re getting it we can then reasonably ask, well, what are you doing that money? Do I have that right?
Dr. Bill Smith:
I, I agree a hundred percent. I transparency you know, I’m not a big government guy. I don’t want the government to be, be directive on everything. But just knowing the amount of revenue that are flowing into these hospitals from this 340B program, and then comparing it on the amount of community programs for low income and uninsured, that would be a valuable data point.
Joe Selvaggi:
Wonderful. Well, let’s end our show there. Thank you again for being on Hubwonk, Bill. You’ve been great.
Dr. Bill Smith:
Thank you, Joe.
Joe Selvaggi:
This has been another episode of Hubwonk, a podcast of Pioneer Institute. If you enjoy today’s episode, there are several ways to support the show and Pioneer Institute. It would be easier for you and better for us. If you subscribe to Hubwonk on your iTunes podcast, catcher, if you’d like to help make it easier for others to find Hubwonk. It’s always welcome. If you want to offer a five star rating or a favorable review, we’re always grateful. If you share hub won with friends, if you have ideas or comments or suggestions about future episode topics, you’re welcome to email me at hubwonk@pioneerinstitute.org. Please join me next week for a new episode of Hubwonk.
Related Posts:
Boston, Massachusetts
Type: Full Time (schedule flexibility available in appropriate situations)
Experience: Mid-level and beyond, including recently retired.
What is PioneerLegal?
PioneerLegal (“PioneerLegal”) is a non-profit, nonpartisan, public interest law firm that through advocacy and litigation promotes inclusive educational and economic opportunity and open, accountable government. PioneerLegal works to preserve and enhance liberties grounded in the constitutions and civil rights laws of the United States and the individual New England states.
Organized in 2021 by a group of prominent lawyers and business leaders, PioneerLegal is affiliated with The Pioneer Institute, a research foundation based in Boston with a broad public interest mission that embraces reform and innovation in health care, public transit, education, immigration, civil rights and public governance. Governed by an independent board of directors, PioneerLegal will pursue high impact, cutting-edge cases that advance educational quality and opportunity for all students, especially those in underserved areas, open and accountable government, and enhanced economic opportunity for all, especially lower income and immigrant communities.
Why join PioneerLegal?
For all its rewards, law practice can be narrow and limiting. PioneerLegal offers attorneys, especially those at the beginning and end of their careers, the opportunity to step outside traditional professional boundaries and to focus on matters infused with a broad, public, intensely human impact. Attorneys, interns, fellows and staff at PioneerLegal will, through a variety of endeavors, open doors to opportunity for those most in need of it, and open windows on otherwise hidden government practices controlled by special interests. Working closely with outside pro bono counsel from leading law firms, our attorneys, interns and fellows will deploy and enhance their skills through case identification and development, direction of legal strategy and collaboration with a wide variety of subject matter experts.
Our lawyers will work on cases at every stage of the litigation process, from trial to appeals in state and federal court, and a regular part of our activities will include preparation of amicus briefs for the U.S. Supreme Court (where Pioneer Institute already has a winning track record) and the highest appellate courts throughout New England. And beyond a steady stream of amicus briefs for submission to trial and appellate courts, we will perform legal and factual research to identify litigation opportunities that align with our mission, with our attorneys developing case proposals for our litigation intake review process.
We are dedicated to developing a close and professional team culture with our board, affiliated pro bono external counsel, like-minded organizations, and our staff. As we are a public interest law firm, our attorneys also will be encouraged to be active outside the courtroom, including media writing and appearances, and public speaking. Active membership in state and national bar associations will be supported and encouraged.
What skills and achievements are we looking for?
How can I apply?
Submit a resume, a cover letter, a 10-page writing sample and, if admitted to practice in past five years, a law school transcript. In your cover letter, be sure to tell us why you are right for PioneerLegal’s special mission and why PioneerLegal is right for you at this point in your career.
What about compensation, benefits, and general perks?
Compensation is commensurate with experience and exceeds many other legal non-profits and comparable government pay scales. PioneerLegal also offers superior benefits including medical, dental, long-term disability, 401K retirement plan and paid leave. We also offer flexible work-day schedules, including regular work from home and other remote work location opportunities.
Applications should be submitted on or before May 6, 2022, to Mary Connaughton at mconnaughton@pioneerinstitute.org
PioneerLegal is an equal opportunity employer.
This week on “The Learning Curve,” co-hosts Cara Candal and Gerard Robinson talk with Dr. Arthur Levine, a scholar with New York University’s Steinhardt Institute for Higher Education Policy, a senior fellow and president emeritus of the Woodrow Wilson National Fellowship Foundation, and president emeritus of Columbia University’s Teachers College. He shares the main findings and recommendations of a new book he recently co-authored, The Great Upheaval: Higher Education’s Past, Present, and Uncertain Future. He discusses some of the key issues of academic quality, technology, administration, and cost in American higher education today, before and after COVID-19. He also offers thoughts on the role of teacher preparation programs in delivering better academic outcomes for students of all backgrounds. They explore how schools of education can be reformed to better prepare teachers with both the wide background knowledge and practical experience necessary to boost student achievement, and how they can achieve the stellar reputations enjoyed by law and medical schools. The interview concludes with Dr. Levine reading from his recent book.
This episode also features a shorter interview with Dr. Sephira Shuttlesworth, to commemorate her late husband, Civil Rights activist Rev. Fred Shuttlesworth, who would have turned 100 on March 18th, and share her current work to help students recover from trauma.
Stories of the Week: U.S. Education Secretary Cardona will award grants to enhance security measures at Historically Black Colleges and Universities (HBCUs), after 30 have been targeted with bomb threats over the past three months. Intel announced plans to invest $100 million over the next decade into Ohio schools and research collaborations with universities, community colleges and technical educators to develop skilled workers.
Guest
Dr. Arthur Levine is Distinguished Scholar of Higher Education at New York University, President Emeritus of Teachers College, Columbia University, and President Emeritus of the Woodrow Wilson National Fellowship Foundation. Levine has written 13 books, including The Great Upheaval: Higher Education’s Past, Present, and Uncertain Future, and published many articles in publications, such as the Wall Street Journal, New York Times, Washington Post, Los Angeles Times, Politico, Chronicle of Higher Education, Education Week, and Inside Higher Education. He has appeared on many media programs, including 60 Minutes, The Today Show, All Things Considered, Morning Edition, Open Mind, and Fox News. Levine has received a number of awards, including 26 honorary degrees and Carnegie, Fulbright, Guggenheim, and Rockefeller Foundation Fellowships. He is a member of the American Academy of Arts and Sciences.
The next episode will air on Weds., March 30th, with John Lewis Gaddis, the Robert A. Lovett Professor of Military and Naval History at Yale University, and the Pulitzer Prize-winning author of George F. Kennan: An American Life.
Tweet of the Week
Wealthy NJ Gov. Phil Murphy sends his own children to exclusive private schools but wants to force low-income black and Hispanic kids to attend some of the worst public schools in the state. Shame. @jasonrileywsj https://t.co/KCKZIudhzv via @WSJOpinion
— Jason Riley (@jasonrileywsj) March 16, 2022
News Links
Education Department will provide grants for HBCUs targeted by bomb threats
Intel announces details of plan to invest $100M into education
Read a Transcript of This Episode
Please excuse typos.
[00:00:00] GR: Hello listeners. This is Gerard Robinson saying hello again from beautiful Charlottesville, Virginia, where a week ago it was snowing. And right now it’s 70 degrees. And we are celebrating the Virginia festival, the book with people from all over the country who are here. And some of these people may one day find themselves on the learning curve.
[00:00:45] But of course, no matter what day it is in Virginia or what day it is in Massachusetts, we cannot have a learning curve without the person who always hits the ball out of the park. When a curve is coming, Ms. Cara.
[00:00:57] Cara: Oh, that you thought about [00:01:00] that one. you know what, I’ve never hit a ball out of the park in my life jar.
[00:01:04] GR: Sure.
[00:01:05] Cara: My eight year old could do it. here, you are celebrating, what did you say? The festival of the book, something, something area. Right. and lovely. And one of, so, but here in Boston, we continue to celebrate of course, St. Patrick’s day, which mm-hmm . I don’t know. I have lived here. Gosh, how long have I lived here now coming up on 17, 18 years.
[00:01:26] And I didn’t even realize that it’s actually a citywide holiday. I went to park my car downtown yesterday and the meters were, I thought, well, there you go. And the bars were packed at noon. I thought, well, this is my city. So you have your festival of the book, and we’ll be here drinking green beer.
[00:01:41] Although I’m not, , I’m drinking lemon water, which is not very exciting Gerard, but gotta keep my head on straight to hit to the park with you today, my friend. So good to hear your voice. As always listeners, we got a couple stories of the week coming at you and mine is it’s like bittersweet because [00:02:00] I’m glad that the education department is doing this, but I’m so sad and actually more than sad.
[00:02:05] It’s I, angry that there’s a reason for this, but this is from the NPR politics desk. I actually listened to it before I read it. And the title is of course education department will provide grants for HBCUs targeted by bomb threats. So for those of you who have been subsumed with. just so much of the other news that is coming at us constantly in a barrage.
[00:02:29] I keep waiting for the good news somewhere. It is, this has just been an ongoing thing for the past happening in recent years, but especially in the past three months that 30, historically black at colleges and universities across the country have been targeted with bomb threats. So I’m consistently amazed that this is still the society that we live in, but you know, these bomb threats were last month was black history month were particularly concentrated in black history month.
[00:02:57] And the quote from the education [00:03:00] department is that these bombs were against HBCUs, particularly concentrated in black history month constitute a uniquely traumatic event, given the history of bombings as a tactic to intimidate and provoke fear in black Americans during the long struggle for civil rights.
[00:03:15] So in a time when. Students everywhere are traumatized by, more things than we can count here. You have students at HBCUs, probably, , wondering day to day if it’s actually going to happen. So, secretary Cardona is going to award some grant money to HBC use. And these awards will range between 50 and $150,000.
[00:03:39] They’re from project serve. And that’s a program that supports schools that have experienced violent or traumatic incidents. So it’s not a ton of money, but it’s something. And I think that it’s in my book, good that the secretary is giving a no to the fact that this is so many things, but one among them traumatizing for students.
[00:03:57] The funds can be used to improve security or [00:04:00] increase mental health resources, ARD. I know that you are a graduate of an H B, C U we’ve had graduates of other HBCUs and professors from HBCUs on this program. Um, They are such a vital and important part of the American university system. I think you’ll probably know this statistic, but HBCUs graduate, a large percentage of, children, of color of black children who black students, I should say that attend college in this country.
[00:04:26] And so many of them go on to do such important, wonderful things like yourself. And this is just, like I said, at the outset it’s bittersweet. I’m glad that the education department is in a small way, very small way, recognizing the trauma these students are experiencing, but I’m also just sick to death and tired that.
[00:04:46] This is happening and that we continue to live in a country where this can happen to students, to faculty members. So anyway, gimme some Ray of hope Gerard what do you think?
[00:04:55]
[00:04:56] GR: Well, for sharing the story and bringing it up. I am a graduate [00:05:00] of H B C U Howard university in Washington, DC. And I received a number of E emails about this for months in part, because there are a group of H B, C U leaders who are part of the H B C U emergency management and wellness consortium.
[00:05:16] And they’ve been meeting for over a year. Independent of this, but to talk about the importance of utilizing resources, both academic, human, and otherwise who are on our campuses to provide support to the nation. In particular, there are a couple of scholars who are at Elizabeth city state university in North Carolina, where they actually offer training in emergency manage.
[00:05:38] And so they’ve taken this as an opportunity to elevate the voice of the consortium and to say, we’re here to help always good to see the us department of education get involved. I’m also sure even , the article, didn’t say this president Biden is a big supporter of HBCUs when, of course, when he was Senator for Delaware, big supporter of Delaware state university.
[00:05:59] So [00:06:00] I’m glad the secretary and leaders in Washington DC are making investments. And I am also aware that The white house initiative on HBCUs. They have a new executive director Dr. Trent, who is also an H B C U graduate Hampton university. She’s also the former secretary of education for Virginia, and she has a lot of experience in education.
[00:06:21] So she’s gonna be the new leader at the white house. And so I’m sure she’s gonna play an important role in this as well. And Cara you’re right. When you think about the fact that HBCUs make up 3% of the higher education institutions in the United States and produce roughly 24% of the engineers almost the equal number of doctors places like Morehouse college, number one, producer of black men, earning P DS places like Dillard.
[00:06:48] Number one pipeline in terms of black schools, sending people to medical school and North Carolina, a T not just H B, C U, but one of the top 20 producers of black engineering students black or white in [00:07:00] the country. So while people try to bomb, we will always rise from the ashes. And we even have a conversation about a,, someone who actually was once bombed Dr.
[00:07:10] Shuttlesworth who will be celebrating a hundredth anniversary today. But thank you for raising that story and shout out again to the H B C U consortium. Let’s support them as well.
[00:07:20] Cara: Absolutely,
[00:07:21] GR: So my story is a little different in the aspect that it is a partnership. Example, I would say between the private sector going to a state and saying we wanna work with you.
[00:07:34] So my article is from the hill and it’s talking about Intel, which is fortune 500 company headquartered in California. They have 79 billion in revenue hundred 21,000 employees. And as you know, Cara businesses need talent. And so when they decide to look at a state, they’re gonna look at a few things.
[00:07:57] Tax breaks. They’re gonna take a look at [00:08:00] cost of living. They’re gonna also look at the people who are there. And so Intel had a number of places to go and they decided they’re gonna go to Ohio to bill two chip manufacturing companies with an investment of 20 billion. So that’s a major in investment.
[00:08:17] And so one of the reasons they said that Intel personnel said they chose the state is because of its great higher education system. As we know many of our listeners. Ohio is one of the states that was created out of the Northwest ordinance of 1787. In that law, it actually has language to support schools and to really push it forward even before then 17 85 north Northwest ordinance also supported it.
[00:08:44] But Ohio has been a major leader in producing scholars and students focused on a number of things in education, but their higher education system, both public and private is one reason that Intel decided to invest. But that’s on the [00:09:00] manufacturing side and keep in mind 7,000. Construction jobs will be created because of this.
[00:09:07] You’re also gonna have 10,000 jobs created as derivatives from the work that’s gonna take place, but you’re also gonna have 3000 jobs where the average salary is $135,000. So that’s a major investment on the for-profit side offense. Well, let’s look at the higher education side of the fence. Intel said we’re also going to invest.
[00:09:27] 100 million to support education programs in the state. And this was good news to governor Mike DeWine of Ohio who had a chance to make an announcement at a community college. And so what they’re gonna do are three things. Number one 50 million will go directly to higher education Institute. Second 50 million will be distributed to educators and science programs nationwide to create a stem curriculum.
[00:09:54] So teachers who are listening this is something for you. If you’re outside of Ohio and third, get this [00:10:00] the national science foundation put in another 50 million to support research initiatives across the country. And as a governor said, You can’t have a strong Ohio without having a strong workforce.
[00:10:12] And you make this happen by using your two year and four year schools. But K12 S got role in this as well. Teachers who work in career and technical education teachers who are teaching stem, even instructors, who are starting to implement engineering, stem, or steam ideas in middle school. Here’s an opportunity for you in both places like Columbus, which is your capital, but also in the rural parts of the state, which we often overlook, particularly the Southern part.
[00:10:39] Here’s an opportunity for you to, and get ahold of some money and make some things happen. So here’s the recommendation. Number one, every Dean of a college of education, be it public or private four year, two year non-profit or for-profit you need to send an email to your president. And ask her [00:11:00] him or Bart requests that when money comes to the school, that you would like to use that money to endow a professorship at your school of education, focused on stem education.
[00:11:11] And I say this, having to work with universities for decades, it is tough, particularly for public universities to use public money to endow chairs. There are a lot of procurement laws, a lot of state statutes that shape it. But for this one, if you want to make sure you have the next generation of stem workers, they’re gonna have to come through our K12 system and our higher education system.
[00:11:32] So use this money to endow one professorship at minimum, maybe two, and bring in great talent or even elevate the talent you have internally. Number two, if you’re the president of a community college, this is a wonderful opportunity for you to partner with your local business work councils and say, listen, we have money coming in.
[00:11:52] Let’s do either a financial match from the local sector. Or guarantee some of the graduates who will leave your [00:12:00] community college, either with a license with a certificate, maybe an associate’s degree, let’s start working out on guaranteeing jobs or at least internships during the summer or externships, which can last one semester or a year and make sure they’re paid third.
[00:12:15] And this is two, our friends who are in the classroom, I’ve said for years, that one way that we can retain talent and attract talent, particularly in hard to serve stem areas is to start thinking like colleges, superintendents, you should also send a note and let your board know that when the money arrives at the local level, you want to endow chairs also focus on stem and in the summertime allow that teacher, if he or she is interested to work with Intel or to work with companies associated.
[00:12:44] So she or he can actually earn additional money in the summer. The same salary that he or she would earn if they were a full-time employee and then bring that knowledge back to the classroom. So I think this is just a wonderful example of the private sector working with the public sector, but making sure [00:13:00] higher education, isn’t the only one getting money, but that it trickles down to community colleges to K12, but in, they’re also looking for stem curriculum work across the states.
[00:13:10] So Massachusetts opportunity for you,
[00:13:13]
[00:13:13] Cara: Yeah. Massachusetts, are you listening? We have a lot of great tech companies here, biotech, et cetera, et cetera. And I think that we could do a better job in thinking about the connections between these things jar. I’d like to add one more recommendation to your list if yout of mind.
[00:13:26] And that is superintendents work closely with guidance counselors, with teachers, with parents, cetera, to help kids. Especially those interested in stem and other fields, understand what the career pathways are that are available to them. There should be a great awareness of this to kids as early as high school, so that they can start to think about their future and what it might look like.
[00:13:50] Whether they take the two year, four year path, whether they, go into one of these great new pathways that might not even require a two year or four year college degree [00:14:00] that Intel is offering. And I have to say, Gerard, I just love the idea. And this was president Biden actually talked about this partnership, right about Intel going to Ohio in the state of the union address, which I think he was quite proud of as he should be.
[00:14:13] It’s a re really great opportunity when we think about states and I love that education is at the, for, because what we’re doing here is creating what they’re doing here. I should say, you and I have nothing to do with this creating an ecosystem. Right. That brings all of these things together because in so many places, especially as you mentioned, rural places, kids don’t see in their local community a way to stay in the community, sometimes a way to stay in the state and be able to do the things they wanna do in give back.
[00:14:43] And when industries make investments in communities like this, it’s hopefully a virtuous circle of creating a web of prosperity that as you’ve pointed out, spans from the schools to colleges and universities to the workforce, and that [00:15:00] investment goes right back into the next generation of kids.
[00:15:03] So I really think of this as it’s not just about jobs, it’s about a whole new ecosystem. That’s really hopefully gonna make people healthy, happy, and prosperous in the long run. So that’s a, a great story, ARD. Thank you so much for bringing up. Okay. Our guest today might have a few things to say.
[00:15:23] about both of the topics that we talked about coming up in just a bit. We are gonna be speaking with Arthur Levine. Many of our guests will know him. He is the former president of Columbia teachers college. I’m sure that this is gonna be a fascinating conversation. We’ll be back in just a minute.[00:16:00]
[00:16:15] Listeners. We are privileged to have with us today, Dr. Arthur Levine. He is a distinguished scholar of higher education at New York university president emeritus of teachers, college, Columbia university, and president emeritus of the Woodrow Wilson national fellowship foundation. Many of you know him Levine has written 13 books, including the great upheaval higher or education’s past present and uncertain future and published many articles in publications.
[00:16:41] Such as the wall street journal, the New York times, Washington post Los Angeles, times political Chronicle of higher education ed week and inside higher education, he has appeared on many media programs, including 60 minutes. Fan favorite here, the today show all things considered morning edition, open mind, and [00:17:00] Fox news.
[00:17:00] Levine has received a number of awards, including 26 honorary degrees in Carnegie, Fulbright, Guggenheim and Rockefeller foundation fellowships. He is a member of the American academy of arts and sciences. Dr. Arthur Levine. We are privileged to have you with us today. Thank you for joining us on the learning curve.
[00:17:18] Arthur Levine: I’m very pleased to be with you. Thank you.
[00:17:21] Cara: Well, we wanna dig right in to some of your latest work. So, many of our listeners already know you as a leading voice in higher education, but you’ve recently, co-authored another book called the great upheaval higher education’s past present and certain future.
[00:17:38] Higher education is something that we Jordan, I always share stories of the week on this program and we talk a lot about higher education and indeed what it’s going through and, how the future of higher education will look, especially for kids like mine and Gerard. Can you talk to us a little bit about the main findings of your book and the recommendations within
[00:17:58] Arthur Levine: Americans going [00:18:00] through a transition. From a national analog industrial economy to a global digital knowledge economy. We’ve only experienced change on this rapidity, this magnitude, and this acceleration once before, which was the industrial revolution.
[00:18:16] And during that period, American higher is transformed and that’s going to happen again because we’re experiencing change at the degree we are. so there’s all content debate about what form that change will take will be disruption. The whole higher education system will disappear. Will it be adaptation, higher education can fix it to else.
[00:18:37] So we decided to look and see what the story was. And we looked in three directions. One was backward and past history. One was forward looking as a dramatic. Demographic economic and technological changes occurring. And the third is sideways looking at other industries that have been forced to change faster than we were, and those [00:19:00] would be movies and music and newspapers.
[00:19:04] when we finished all that, we found they’re going be four major change in higher education. None of it’s on making the first is there’s gonna be a dramatic expansion of new providers and distributors of higher education content. That’s going to create more competition for higher education. It’s gonna reduce cost and it’s going to increase student choice.
[00:19:26] the second thing we found was, you know, we have near universal access to digital technology. Students are going to ask from colleges and university exactly what they’re getting from Netflix. In Amazon, in terms of research universities, the nation desperately needs scientists and research. So those tools survive, but also in smaller numbers.
[00:19:48] And finally, the rest of my education will be disrupted, will be replaced with all the choice and the cornucopia of new providers, and that’s most likely to happen or the institution’s most [00:20:00] at risk of community colleges and regional universities. Those are the general finding our study.
[00:20:07] Cara: It’s really helpful Dr. Levine to have that laid out so clearly, because I think that. What so often lay people here is, two things about higher education. And the first is that something’s gotta change because nobody’s going to be able to afford it anymore. And the second is that when change occurs, it will just be disruption.
[00:20:27] And so to have you define what dis disruption really means in this context, I think is, pretty useful. The kind of disruption can you help me understand that you mentioned the pandemic and you mentioned the pandemic and COVID relief funds in the context of helping to support. Some of these smaller, at least here where I sit, as you, you mentioned in the Northeast, we’ve seen several closures in recent years of schools that, couldn’t afford to stay open due to declining enrollment among other things.
[00:20:56] And that you mentioned that the pandemic will give some of those institutions [00:21:00] a bump for a little while keep them open. But can you talk a little bit more about the other fault lines that the pandemic has really revealed? Not just about the cost of higher education, but also about the quality of an experience that students are actually getting when they pay in many cases, tens of thousands of dollars a year for their college degree,
[00:21:24] Arthur: the pandemic wasn’t an interruption.
[00:21:28] What it really was, was an accelerator. Of things that would’ve happened in higher education anyway, but over a longer period of time, and examples would be some closures. Examples of the online learning examples would be upskilling and reskilling, which were required by the changing markets and all also the competition in the rise of new providers, all that happened because the pandemic that, the pace that it did, but it would’ve happened anyway.
[00:21:59] [00:22:00] And there are certain events, you know, society that serve as accelerators. The 2008, 2009 recession was an extraordinary accelerator. Millions of jobs disappeared when they came back of the millions that required a high school diploma or less. Only 50,000 were restored. 90% of the new jobs that were created required some higher education that was changing to would’ve happened anyway, as we moved to a digital knowledge age, but it moved them faster. It got rid of the old jobs faster and created the new one faster. The pandemic did the same thing to higher education in every other social institution in America.
[00:22:42] Cara: So I’d like to ask you about another institution that I think, well, not a separate institution, but K to 12 education. Which I think many could argue has experienced some of the disruptions that you are describing [00:23:00] in higher education. So for example, we’ve seen in the past couple years, the pandemic, if you, if I like the term accelerator has accelerated, for example, parent demand for program that allow for learning outside of the classroom, that allow for parents to have more choice in the kind of educational experience their children have, whether that’s within the public system, outside of the public system or some hybrid of public and private providers.
[00:23:27] Now as we talk about higher education, one of the main reasons we, this nation produces teachers, in colleges of education, one of which you used to lead and we’ve been struggling , for decades about. What is actually the right way to prepare the future teachers of this country.
[00:23:49] Can you talk a bit about American teacher preparation programs what they look like, your read on how they’ve been doing to prepare America’s teachers and maybe [00:24:00] give us some insight into what you see coming for colleges of education.
[00:24:04] Arthur: about a decade and a half ago, I did a study of America’s education schools and on their teacher education programs, they weren’t nearly as good as they needed to do low in selectivity. Their standards for graduation weren’t high enough. They were disconnected from the schools. They were preparing students in fields.
[00:24:26] We really didn’t need, we didn’t need elementary school teachers. As much as we needed stem teachers for secondary school and they prepared lots of elementary school teachers, they had a curriculum that prepared students for the industrial age. And they also are, I guess, stands out is that they’re preparing people for a low paid profession, certainly low data profession and what the pandemic did was make all that worse.
[00:24:53] It encouraged retirements from the part of teachers who found the combination of in school, out of school online, [00:25:00] offline, really difficult masks, no masks that, and what it also did was. Make the teaching profession, less appealing. Enrollment had been going down to head school for quite a while.
[00:25:12] Well, they crashed during the pandemic so that we’re going to have to find ways to prepare teachers. I had to tell you about something that the president of M MIT and I did while I was a widow Wilson. We’ve decided to create the education school of the future, which is to say this would be a school that wasn’t time based students to grasp according to competencies, according to outcomes they passed.
[00:25:39] If you could achieve all the outcome, the day you entered, you’ve receiving diploma, the day you entered, by the way that wouldn’t have been possible. We had to assess all that. And that took while however, The notion was let’s have a curriculum that starts where the student is. Let’s have a student move along in this curriculum and [00:26:00] not in the same pace as everybody else.
[00:26:02] None of us learn in the same way as everybody else. None of us learn at the same pace as everybody else. There are things each of us know and don’t know things. Each us do well and don’t do well. But there a program that picks up all of that. So when the student graduates that student has the skills and knowledge, the competencies to be a teacher in a classroom and everything about this was difficult.
[00:26:28] It difficult figuring out how do you create a timeless education school, which doesn’t have semesters. And when students move according to mastery, how to create a curriculum. It’s mastery based. How do you make this affordable economically? How do you give students a skill to live in a world in which everything is changing quickly, profoundly.
[00:26:53] So we gave them an immersion and design thinking. Don’t ask to them the skills to enter a classroom [00:27:00] today. And we gave them the skills and knowledge to be able to move that classroom into the future. As things around them changed. The name of that graduate school is the high meadow graduate school of education at its located in Cambridge.
[00:27:14] GR: Thank you to Dr. Levine. So I had the honor to attend two schools of education, one at Harvard in one of the university of Virginia. At some point in our formal reading package or through conversations we would talk about books such as ed school, Folies uh, teacher wars, you know, other books that uplifted their profession.
[00:27:34] And when I worked in public policy, at some point we would have conversations about teacher preparation, cuz all of us know how important it is to have the right teacher in the right place in time. From your experience both professional and through the academic lens. What can we do to support the teacher in a way to help deliver the type of academic outcomes.
[00:27:54] One for students across the board.
[00:27:56] Arthur: I wanna tell you about a program we created [00:28:00] at the Wilson foundation. We called the Woodrow Wilson state teaching fellowship. And we went into states and we built a coalition, the governor, the chief state school officer, the state higher education executive officer universities, legislators on both sides of the aisle, schools, unions, and funders.
[00:28:20] And what we did was we picked several universities in that state and it ultimately was in Indiana, Ohio, Michigan, Pennsylvania, New Jersey, and Georgia. And we picked five or six universities in the state. And what we would do is offer them money. If they were willing to change their program, to create the kind of program today’s teachers truly need.
[00:28:44] And we offered them $500,000 for taking , on that assignment. And when they successfully completed it here to another $500,000, they had to agree to keep the curriculum. After the funding ended, we did one other thing. [00:29:00] We provided fellowships to students to a attend those schools, and we wanted stem teachers, top stem teachers,
[00:29:08] and we taught them. We got extraordinary people to go become stem teachers in each state. And they performed well in their classrooms. When they became teachers, they waiting their programs and they stayed longer than the average teacher. The bottom line here. It’s that it’s doable. What it is, is an active will.
[00:29:31] If states want to improve what they’re doing in teacher education, they can, it doesn’t come cheaply. The state of Indiana after the program ended funded the program to continue at those universities and Woodrow Wilson happily said goodbye. They created, they built it and they sustained it. And the universities we work with, they too sustained the program.
[00:29:55] Were they everything they could have been? No, of course not. But there was [00:30:00] so much better than what we originally found that those universities.
[00:30:03] GR: Let me just follow up with that wonderful example. You identify great teachers to work in stem, and we know that’s a hard to staff sub field with several subjects under it. How did you define the right type of student? Was it a combination of GPA, GRE other scores? Was it the school, the attended undergraduate major?
[00:30:27] What criteria did you use to identify the right students for this program?
[00:30:31] Arthur: That’s a great question. We were inundated with applications to this program, which was really, really pleasing. So the first cut we took was they wrote an essay. they got a set of recommendations and we looked at their grades and test scores.
[00:30:48] And then what we did was we took who remain and we interviewed them all. and what really mattered was there was certainly a threshold they had to cross in terms of academic quality. It was really [00:31:00] motivation. One of the things that everybody knows is you can’t get anybody to teach and stay in a rural school unless they’ve grown up in a rural area.
[00:31:09] It was those kinds of bodies kind of knowledge that enabled us to pick the right people. We really wanted diversity. That was critical to us. Since we were preparing teachers for the high need schools in each of those states in the most understaff subject stem, we wanted to recruit a group of fellows who looked like the school in which they’d be teaching.
[00:31:32] GR: Absolutely. There’s been a big push over the last 15 years in particular, but even longer to diversify , the teaching force because the student body they’re working with across the border are also changing. So you’ve had a chance to, leave one of the top education schools in the country teach education is one part of it.
[00:31:53] Research is another one of the digs that people make against education schools [00:32:00] is that we don’t have enough rigor in terms of academic research, the number of articles and peer review journals. I don’t buy it cause I know that in fact we do, but what did you do to recruit and retain some of the best and brightest scholars in the country?
[00:32:14] Who’ve dedicated their life to teach in the next generation of teachers
[00:32:18] Arthur: in terms of recruiting faculty. That hasn’t been the difficulty, the research issue that you raised is a real one, but not for the reason that you raised it. When teacher education came to the American university, which was in the late 19th century and early 20th century, what it was made to do was to look like arts sciences, it diminished the emphasis on practice.
[00:32:45] It diminished the emphasis on working with schools and in fact took it, its emphasis, the research focus that arts and science colleges have and what that did was twist what education school were about. Those subjects [00:33:00] that engaged in research rather than practice were the most important. What mattered truly.
[00:33:06] was not connections with the schools, but connections to journals we took and teacher education became the bottom of the heap. What we ended up doing in essence was crowning in the search crowning graduate education and diminishing teacher education. The university made teacher education schools do that, and they followed suit.
[00:33:30] There needs to be a commitment now to prepare teacher educators and teacher education schools that can work with their local school districts. What’s also true. These are too many universities of treated ed schools and teacher education as a catch cow. And I know of several instances in which ed schools were made to lower their admission standards to get their moments out.
[00:33:57] GR: Understandable last [00:34:00] question. And since you mentioned arts and science, I wanna talk about American law and medical schools that enjoy stellar reputations within the higher education establishment. And even in our , wider society. Could you discuss how these professional schools achieve their high academic status?
[00:34:15] does some key lessons from them that we can learn across the boards as relates to, reforming ed schools, but also the whole idea of accreditation and what that means for quality?
[00:34:25] Arthur: Yes. In 1910, the Carnegie foundation for the advance of teaching created something called they did a study of medical schools in the United States.
[00:34:38] Many of which were butcher shops. They were just horrible and. Man named Abraham fluster visited every medical school in the United States and Canada, and then wrote a report for the Carnegie foundation. That report was widely disseminated. That report changed in nature of medical education in the United [00:35:00] States, appoint to two models in 1910 ones with Johns Hopkins.
[00:35:05] And the other was Harvard. We took the ingredients that were necessary to create a good teacher, a good doctor, and said those needed to be requirements in every school. And they got adopted. Now, how could that possibly have happened? And the answer is the study was a set up. It was a prestigious foundation that had been asked by accreditors states.
[00:35:31] In the American medical association to do a real study of what this was like. And we release a report, which was then widely adopted by accreditors states and funders. That combination changed medical education America. And it’s what I talked about earlier. If coalitions and resources that make it possible to change education, any state can do it.
[00:35:59] [00:36:00] I know for example, Wyoming, which has only one teacher education program, one university, one at school is in the midst of doing many of the things we’ve talked about so far, it’s an exciting experiment to watch.
[00:36:14] GR: Well, I appreciate the lessons from history the identification of particular universities and schools of education that have decided to become a pioneer. Thanks also for the entrepreneurial approach that you worked out with. M I T I, in fact, I’m personally gonna look into that more because I’m interested in the future of edge schools.
[00:36:33] If you wouldn’t mind left up to you, we’d love for you to read something from your latest book. I’m sure all of us would glean some good wisdom from it.
[00:36:42] Arthur: Henry Adams sign of a family that produced two presidents attended Harvard and the midnight 19th century. He lamented the fact that he received an 18th century education that failed to prepare him for a world PLS into the 20th century.
[00:36:59] [00:37:00] Adams went to college at a time in which the classical college was dying. And the university of Valent forum, the models that would guide the future had not yet been created. There was a time, much like the present, an age of continuity and experimentation. We know a transformation is to come. The present cannot be sustained.
[00:37:29] GR: Thank you, Dr. Levine for the reading. And we look forward to conversations in the future with you about to not only the future of higher education, but the future of ideas, institutions. And I really like what you said about coalitions. We cannot as silos try to figure all this out. It’s gonna take a lot of helping hands coming together.
[00:37:51] Thank you for joining
[00:37:51] Arthur: Thank you for having me. I really enjoyed talking with you.[00:38:00]
[00:38:15] GR: So Cara, my tweet of the week is from Jason Riley from wall street journal. He’s been a guest here on our show and his tweet is from March 16th 21 2, and it says wealthy New Jersey. Governor Phil Murphy sends his own children to exclusive. Private schools, but wants to force low income black and Hispanic kids to attend some of the worst public schools in the state shame.
[00:38:38] As someone who has supported parental choice, both public and private going all the way back to 1991 I have seen this level of hypocrisy across the board. So Jason, thank you for keeping comments like this on the front burner. And guess what? It’s just not Democrats doing it. It’s Republicans as well.
[00:38:56] So Jason thank you for the tweet.
[00:38:59] Cara: It’s also [00:39:00] your local parents who send their kids to fancy private schools. And then question why anybody else should have a choice. So it’s, it’s systemic. Jason is amazing Gerard and we always thank him for his work. All right, now, Gerard, I’m gonna tell you.
[00:39:14] Who next week’s guest is, but also coming up after this, we have a treat. We’re gonna spend a couple minutes with friend of the show, wonderful human being Sephira Shuttlesworth. And so I know that you’ve got a couple of questions with her, but listeners before that, let me tell you that I hope you do join us again next week.
[00:39:31] And every week, next week on the learning curve, we are gonna be speaking with John Lewis Gaddis. He is professor of military and Naval history at Yale university and the pulitzer prize winning author of George F Kennan, An American Life. So Gerard we are gonna cut to one more treat of a conversation.
[00:39:53] I know you’re looking forward to it as much as I am, but let me say goodbye to you. Now, my friend have a great week. We’ll talk soon.
[00:40:33] GR: Hello listeners. Welcome back to The Learning Curve. Today is March 18th, 2022. It’s just not any day. In fact, it is the 100th anniversary of the birth of Reverend Shuttlesworth. Many of you know him as a civil rights icon. As an educator and as someone who helped change the face of American politics and policy in many unique ways and to talk about his life, [00:41:00] to talk about the role she played in helping do that, but also the work that she’s doing right now to address a different type of trauma in the United States.
[00:41:09] I want to welcome Dr. Sephira Shuttlesworth to the show.
[00:41:13] Sephira Shuttlesworth: Well, hello, good afternoon. And thank you for having me on. And yes, as you said today, would’ve been the 100th birthday of Reverend Fred Shuttlesworth. And if our listeners aren’t familiar with him, I invite you to Google him.
[00:41:28] He was an extraordinary American who to heart for humankind. And he spent the balance of his life trying to leave the world better than he found it. I am sitting here today thinking back over our time together. Fred and I were friends for 20 years, and then we were married for the last five years of his life.
[00:41:51] And, oh my gosh, what uh, ride? That was he was an extraordinary man who had some large ideas about what we could [00:42:00] do as human beings and what. Kind of work we could do together and how we could heal this land together. And the word together itself was huge. In his mind, someone asked me just the other day, what was his purpose?
[00:42:13] What was his motivating factor. And I said, love, it was good, old fashion love. And he would tell you to love the neighbor as you love yourself and do unto others as you would have them do unto you the golden rule. And as a young man, he said, he recognized that there was work that he needed to be doing, that he was called to do a special kind of work, and the Lord prepared him for that work.
[00:42:39] And as you will see, if you look further into his life, you’ll see where he was bombed and beaten and all of that. But at the end of the day he was able to be around to see our first black president to be elected to the United States. And so he got a lot of his just desserts before he transitioned on over to heaven.[00:43:00]
[00:43:00] GR: Well, speaking of the bombing, Cara and I earlier during show, her story of the week was about HBCUs that have had a number of bomb threats over the past several months. And the us department of education is investing money to help address that. And I mentioned, because I know of a story that you shared when we were on a panel together in Boston one time.
[00:43:21] I said, you know, black people have been bombed a lot. Yes. Even, just across the board. Would you mind sharing with our readers who were listening about the story of your husband? Him being bombed and walking out in the words he shared after he had come up from it.
[00:43:39] Sephira: It was his same favorite story to tell, but yes, basically Christmas night of 1957, I believe it was, he had preached, it was a funny, he had preached that day and he was lying in his bed sitting, talking to one of his deacons.
[00:43:55] He was in the bed, the deacon was sitting and talking and A bomb went off [00:44:00] and he said he knew what it was. He knew it was meant for him. And as the dust settled, he found himself lying on the mattress in a hole in the floor. So he was on the ground, the mattress was on the ground. And so he said he emerged, he got up and shook.
[00:44:16] The dynamite dust, blew the dynamite dust out of his nose. And he grabbed his coat, which was hanging on a wall now that it was leaning at a 45 degree angle. And so he got his coat and he put it on. He emerged from the back of the house. And by this time a big group of people had gathered and the front of the house and was trying to get to their pastor.
[00:44:35] And of course the police were there. The police were already there. And they were holding the crowd back. And so when he emerged around from the back of the house, people were gasping and went on. And he said he saw a big police officer standing there. He stood much taller than he did. And he said, the police officer looked at him and he rubbed his eyes as if there was an apparition.
[00:44:55] And he said, as I took one step forward, he’d take two steps back. [00:45:00] He said, so finally I stopped moving. He said, and I was standing there and he said, the police officer said to me Reverend, he says I know these people and I didn’t think they’d go this far, but if you don’t mind, I have some advice for you.
[00:45:13] And that is if I were, I’d get outta town as quickly as possible. And so Fred responded to him, he says, well, you’re not me. And you go back and tell your clan brethren that if the Lord could save me from this right here, I am here for the duration and the war has just begun. It was his favorite story to tell
[00:45:34] GR: well, thank you for telling it to our listeners.
[00:45:37] Absolutely. We are dealing with a lot of trauma today in the United States. A lot of it driven by challenges associated with COVID. It’s impacted students, teachers, families impacted businesses. You, as a leader, you as an educator yourself, you decided not just to talk about, about it, but to do something about it.
[00:45:55] So I’d love for you to share with us. what’s taking place with your new trauma program that you’re affiliated [00:46:00] with.
[00:46:00] Sephira: I will do that. You know, it all started with I had COVID December of 2020, I was diagnosed with COVID along with five other family members, including my 95 year old mother.
[00:46:12] And so of course, you know, when you get that diagnosis, you just, I don’t know, my mind just went into fight, fight. We’re fighting, we’re fighting this. And so fight we did. And we all emerged we lived and that was the thrill of it all. But the young man who was responsible for us getting it, who was a friend of my sisters, he had gone over and they were playing cards.
[00:46:36] And so she and her been got it and passed it off to the rest of us. And he was, gone in like five days. And so in the midst of it, when, , you’ve been diagnosed and the person you got it from is dead. Now that just. Exacerbates the fear and the stress associated with having the disease. And so then you just kick it into as high gear as possible.
[00:46:59] [00:47:00] For us, we started doing all kinds of research and eating things like sea Mo stuff that I don’t even know what it is, but , you know, we found out that those things, what you had to do with build your immune system. And so we worked hard , to build that immune system and to keep each other going and motivate each other.
[00:47:18] I’d go over and stand at my mother’s window, look through , her bedroom window and talk to her through the window because I wanted to make sure that she was fighting also. And so in my downtime, and I was thinking about, you know, what, this is just too much to ask almost of people, and I want to do something.
[00:47:37] I’m gonna make it out of this. And then the question becomes, how can I help others? What can I do? And I thought about the people in my profession, and I said to somebody, you know, Second in line to the first responders who I have the utmost respect for are the educators. I said, you know, I don’t know if anybody’s thinking about the educator.
[00:47:57] School is hard. It was [00:48:00] hard before the pandemic ever showed up. We had our struggles and I used to say, when I was reading schools, John Q, that has no notion of what it is we deal with in a day’s time. And so now add the stress of not knowing if you’re gonna be in school next week or not. You Sunday night, we’re gonna get that phone call.
[00:48:19] We don’t know what we’re doing. I don’t know if I’m supposed to report. If I’ve got little children, who’s gonna watch my child, all of the mountain stress. And then the children, I have a 12 year old grandson and , he’d come home sometimes go gram. So and so wasn’t wearing their mask today and he was standing too close to me.
[00:48:37] I, children are afraid. They don’t even know how to tell you that they’re afraid and they have every right to be afraid and fear and stress. If you carry it long enough, it becomes trauma. So I decided I need to find out who knows something about managing trauma. We need to help people with the trauma [00:49:00] that has been exacerbated by this pandemic.
[00:49:02] So I went in search and I found something called brain stimulated wellness, and it is a protocol whereby we teach the brain to respond before the mind can react to stress. When the mind reacts toque, we can get into all kinds of trouble, all kinds of places we didn’t intend to be. And we’ve got enough evidence of that, but we can teach the brain.
[00:49:25] If we know the different parts of the brain and how they respond, we can teach the brain and give it a set of event to choose from a set of techniques to choose from so that we can take down the stress and the trauma. And the, good thing about this program is there’s even a blood test. If you wanna see whether or not your stress level has been taken down, you can have your blood drawn.
[00:49:50] Have it looked at under a black field and. It will show you that while you’re stressed, your cells are [00:50:00] all different sizes and they’re jumbled up and they’re not moving in the direction they’re supposed to. In any of that, you can just see that they are out of order. And then you use the hand technique, what we call the hand technique, which is simply you take one hand and fold it over the other in a certain way that opens up the channels of your brain.
[00:50:22] So that wellness can get in and then you draw the blood again, look at it under the very scope. And what you’ll see is perfectly round, beautifully red and white cells, one red, one white, one red, one white, where they’re supposed to be doing what they’re supposed to be doing. And so it is fascinating work.
[00:50:44] This program has been in existence for over 20 years, largely in Canada and a few other places around the world. And they’ve won all kinds of Awards because not only is it a program about trauma, but we’re also looking at [00:51:00] how to help communities heal economically because our economics have gotten all skewed throughout this, pandemic also, but we can help businesses to lower their insurance costs.
[00:51:13] We can schools to get some of the things that they’ve always needed and needed more of by having a second income in place. And we can talk all about that as to anybody is interested, but here’s what I wanna close with. We have a program a series of videos called closing the door to suicide. I’m gonna say that again, closing the door to suicide because the trauma and stress by now has mounted in such ways that there are a lot of people who are considering.
[00:51:47] Just because of what we’ve been through. They’re considering making the pain stop but that’s not the best way we want you to think about who you will [00:52:00] harm if you take that. So anybody who is hearing my voice and who knows somebody who needs to hear this www dot, closing the door to suicide.com to date, we’ve had over 283,000 people to log on and to the information that is there, you’ll find videos that speak to teachers.
[00:52:27] And there’s one that speaks to college students and one that speaks to first responders. And so you just click on whichever one resonates with you and listen to that. As many times as you feel like you need to listen to it so that you can breathe to date. We have not had anybody out of 234,000 plus people to commit suicide.
[00:52:54] So basically what I’m here to do is to save lives. I’m more working with [00:53:00] the program that helps you to gain wellness while you’re here and to save your life in the event that you were thinking about not being here.
[00:53:11] GR: Well, Dr. Shuttlesworth, thank you so much. First of all, for your commitment to education across the board.
[00:53:17] Thank you for sharing the great work you’re doing with this program, but also thank you for keeping alive, literally and figuratively through your life, through your words and through your action. At a point in American history, we don’t see enough examples of this. You’re a living example of it. So thank you for being a friend to The Learning Curve.
[00:53:36] Oh,
[00:53:36] Sephira: absolutely. Thank you so much for having me on take care.
Related Content
In Massachusetts, the Know-Nothing amendments prevent more than 100,000 urban families with children in chronically underperforming school districts from receiving scholarship vouchers that would allow them access to additional educational alternatives. These legal barriers, also known as Blaine amendments, restrict government funding from flowing to religiously affiliated organizations in nearly 40 states and are a violation of the first and fourteenth amendments.
The U.S. Supreme Court will hear a case this year, Espinoza v. Montana Department of Revenue, that could end these amendments. In 2018, Pioneer produced a 30-minute documentary on the impact of the Blaine amendments on families in Massachusetts, Georgia, and Michigan.
“She’s a good girl. She helps me a lot. She has big, big dreams. I don’t have the money, but she has big dreams. I hope she’s going to get everything, but she works so hard. She works so hard in school.”
“Our family is needing to make some really big sacrifices because we believe this is important, and so, we’re basically going to do whatever it takes… Sometimes we look at each other and go ‘I don’t know if I can do it again another month…’”
“A lot of the families have to sacrifice and work multiple jobs… And just scraping together enough money to just make tuition, just the basics.”
“It is discriminatory, that parents who want to choose an alternative to public school for their children, would not in any way receive any compensation for that, whether it be tax credit, whether it be a voucher…”
In the 1840s, nativist movement leaders formed official political parties and local chapters of the national Native American Party (later the American Party), although they continued to be commonly known as the Know-Nothing Party. Politicians sought to insert provisions into state constitutions against Catholics who refused to renounce the pope. The Know-Nothing movement brought bigotry and hatred to a new level of violence and organization.
The party’s legacy endured in the post-Civil War era, with laws and constitutional amendments it supported, still today severely limiting parents’ educational choices. A federal constitutional amendment was proposed by Speaker of the House James Blaine prohibiting money raised by taxation in any State to be under the control of any religious sect; nor shall any money so raised or lands so devoted be divided between religious sects or denominations. These were then named the Blaine Amendments of 1875.
in recent decades, often in response to challenges to school choice programs, the U.S. Supreme Court has demonstrated great interest in examining the issues of educational alternatives and attempts limit parental options. Massachusetts plays a key role in this debate. The Bay State was a key center of the Know-Nothing movement and has the oldest version of Anti-Aid Amendments in the nation, as well as a second such amendment approved in 1917. Two-fifths of Massachusetts residents are Catholic, and its Catholic schools outperform the state’s public schools, which are the best in the nation.
Help families like the Costons in Michigan to end the bigoted Blaine amendments in their state that are blocking tuition scholarships and other types of financial support that would make it possible for families to send their children to high-quality schools that are best suited for their children.
[ytp_video source=”uN8dMHYzofA”]
SHARE THIS STORY ON SOCIAL MEDIA!
Hubwonk host Joe Selvaggi talks with Pioneer Institute’s Dr. Bill Smith about his recently released paper entitled, “340B Drug Discounts, An Increasingly Dysfunctional Federal Program,” which analyzes the evolution of a well-intentioned program to offer discounted drugs to the uninsured from a benefit that had helped charitable hospitals to one that has exploded to generate billions in profits while serving fewer uninsured.
Guest:
William S. Smith is Senior Fellow and Director of the Life Sciences Initiative at Pioneer Institute. He has 25 years of experience in government and in corporate roles, including as vice president of public affairs and policy at Pfizer, and as a consultant to major pharmaceutical, biotechnology and medical device companies. He held senior staff positions for the Republican House leadership on Capitol Hill, the White House, and in the Massachusetts Governor’s office. He earned his PhD with distinction at The Catholic University of America (CUA).
Read a Transcript of This Episode
Please excuse typos.
Joe Selvaggi:
This is Hubwonk. I’m Joe Selvaggi.
Joe Selvaggi:
Welcome to Hubwonk, a podcast of Pioneer Institute, a think tank in Boston. In 1992, a well-intentioned targeted program named 340B required pharmaceutical companies to provide eligible hospitals with drugs at a substantial discount for the benefit of uninsured patients. Those hospitals were then to use any savings and profits from the program to provide comprehensive services for the poor and uninsured since its inception. However, healthcare systems have exploited the statutes guidance to re billions in profits by purchasing 340B drugs at a discount, and then selling those deeply discounted drugs to insured patients at retail prices. Perhaps more disturbing is a trend that while 340 B program profits have so access to discounted drugs and charity programs for the uninsured have been in steady. The numbers involved in this distorted drug program are staggering. Now exceeding the value of both the Medicaid drug benefit and Medicare part D how did this worthy program get so distorted and how can policy makers reform 340 B in a way that realigns incentives to better serve the uninsured?
Joe Selvaggi:
My guest today, Pioneer Institute’s senior fellow in life sciences, Dr. Bill Smith, who will talk about the findings of his recently released paper entitled “340 B discounts: An increasingly dysfunctional program.” In the paper, Dr. Smith describes the arc of how this well-intentioned program seems to have lost its direction and grown to generate massive profits for hospitals while sign simultaneously reducing drug benefits and charity programs for the uninsured, Bill will offer his views on what legislatures can do to realign program incentives, to better guarantee the uninsured receive their drug benefits and ensure the profits from the program go toward our poorest citizens. When I return, I’ll be joined by Pioneer Institute’s Dr. Bill Smith.
Joe Selvaggi:
Okay. We’re back. This is Hubwonk. I’m Joe Selvaggi, and I’m pleased be joined by Pioneer Institute’s visiting fellow in Life Sciences, Dr. Bill Smith. Welcome back to Hubwonk, Bill. Thank you, Joe. Glad to be here. Great. Well, bill, I found your recently released Pioneer report entitled 340B Discounts: An increasingly dysfunctional program. I found it somewhat alarming. I want to set the stage for our listeners that we’re talking about a federal program designed to help low-income uninsured people with medication. And it’s largely been exploited by the medical community to reap literally billions in profits with little of those billions going to, to where the statute was intended. So there’s a lot to unpack in your paper. So let’s start with some history. Let’s start at the beginning. What was the original idea behind 340B? And when did the program begin?
Dr. Bill Smith:
Well, it, it actually didn’t begin as a federal program. It just began when a number of drug companies, many drug companies actually started giving deep discounts to hospital that treated a large number of uninsured, low income patients. The drug companies knew that those hospitals would, were struggling financially. And so they made voluntary concessionary discounts available to them. And in 1992, the federal government decided the Congress decided, well, we’re, we should, we’re gonna make this program mandatory. So we’re gonna require the drug companies give discounts to hospitals to treat large numbers of low income or uninsured patients. And, and, you know, the program started out fine. I would’ve supported it in 1992. It, it, it targeted about 500 hospitals and clinics around the country. It was limited and, and it was largely limited to, to those hospitals and, and clinics that did treat large numbers of low income uninsured, but starting in about 10, 15 years ago, the program absolutely exploded.
Dr. Bill Smith:
You become eligible as a hospital for, to become eligible for these three 40 B discounts based on the number of patients, you Medicaid patients, you treat the federal government and the Congress thought that’s a proxy for your treating low income or uninsured patients. And when they expanded the affordable care act and Medicaid exploded in the number of patients, many, many more hospitals became eligible. So the program started out about 500 hospitals that now has about 2,500 hospitals. And those hospitals have expanded to satellite offices. So they’re now 37,000 covered entities in the program.
Joe Selvaggi:
So your your paper does suggest that much of the reason has exploded. And the eligibility has expanded is owed to the vaguery of the, the statute. You know, as you mentioned in your paper, it was originally designed to target quote unquote covered entities, but left it to the, the system itself to infer who was covered, say more about how these vagaries are easily exploited.
Dr. Bill Smith:
Well, let me first explain why the program is so popular with hospitals and why it exploded. So under the three 40 beat program, you can get a substantial discount when you purchase a drug. So let’s say a hospital just to, to make it simple. A hospital can, can purchase an oncology drug for $25,000. When this price of that oncology drug is a hundred thousand dollars. So they’re getting a 75% discount. So if you, as a, as a hospital administrator can lure into your hospital or to your satellite office, a patient that’s that has insurance and is wealthy. You can dispense that drug to that patient for $25,000, and then bill his insurance company, or Medicare for a hundred thousand dollars, and you can pocket the $75,000 spread. It, it, this is basic arbitrage. It, it happens in many areas of business, but this three 40 B program is now being arbitrage. And the, the statute getting back to your original question, the statute was written in poorly. So the program is not limited to only dispensing drugs to low income patients or in low income neighborhoods or to uninsured patients. So it there, the statute didn’t define anything about who’s eligible for the program and who might share in these, these dis drug discounts.
Joe Selvaggi:
I see. So now you said as growing substantially since its inception in your first answer, you did say the original program used medicaid patients as a proxy for implying that hospitals located where there are lots of Medicaid recipients and in inferred from that that there also must be lots of charity cases. Describe for our listeners, where were these original three 40 B participant hospitals, where have they, you know, sprung up now? Who, who who’s joining the system from where it used to be?
Dr. Bill Smith:
Yeah, so originally, Joe, that’s a good question. Originally these hospitals and clinics were in low income areas, both rural and urban areas that treated large numbers of low income patients. But since 2004, there’s a substantial data to suggest that a lot of these hospitals and their satellite offices are being located in wealthier areas that have higher rates of insurance. And, and that’s part in part due to the fact that they can arbitrize the drug discounts. So they wanna get patients in there that have Medicare or commercial insurance coverage as then they can bill for the full price of the drug, why they buy the drug at the discount.
Joe Selvaggi:
Now, your paper we, we’re talking about a program that was originally intended to help people who didn’t have insurance now in the, in the in the meantime, we’ve passed the affordable care act, it’s stated intent and it’s effect, I think has been to have more people become insured, both low income or people who had formally been on Medicaid or uninsured altogether. So if we have fewer people who would be in theory eligible for three 40 B benefits, did we see a decrease in the amount of three 40 B activity once the affordable care act was implemented,
Dr. Bill Smith:
Joe, just the opposite, you know, in 2012, there were only, there were 54 million people covered under Medicaid. And this year there are 83 million people covered under Medicaid. So the number of people insured has grown substantially. The number of uninsured has dropped dramatically. One would’ve expected given that the three 40 B program was supposed to treat the uninsured one, would’ve expected that the three 40 B program would’ve declined over the past decade, just the opposite that’s when it had its most explosive growth over the last decade. So it’s up to about 38 billion in sales and the three 40 B program will soon eclipse in size, both the Medicaid prog drug program, which has 83 million recipients and the Medicare Medicare part D program, which has over 50 million recipients and their senior citizens who tend to use a lot of drugs. So this, we made the longish talking about a three 40 B program that nobody really knows about, but it’s now the largest federal drug program in the, in the United States.
Joe Selvaggi:
Yeah, the numbers are staggering when you compare it to what we already consider fairly costly programs, Medicaid and Medicare part D to eclipse those programs is, is, is saying something. So I think that’s why this, this a program deserves our attention now. Let’s set aside that despite the fact that the ACA is, has more people insured and therefore one would think the byproduct of that would be fewer three 40 B claims. They went up. So that means hospitals were generating more money from this program than they had before the ACA another feature of that three 40 B, I don’t think we’ve addressed is that the program was supposed to help hospitals use the savings they get from those discounts and apply those to programs for charity. In other words, there chart supposed to take the benefit and apply that benefit to charitable patients. Have we seen an increase in the amount of money that hospitals are given to charity owing to their, you know, this windfall of, of a program?
Dr. Bill Smith:
Yeah, Joe, just, just the opposite. We’ve seen charity care decline, and it would’ve been very difficult for me to write a paper are critical of the three 40 B program had the billions of dollars that this program is generating, been devoted to programs for low income and uninsured, but that’s just not the case. I, I don’t wanna pick on mass general because they’re excellent hospital. They’re part of the whole life sciences ecosystem here in, in, in the greater Boston area. But in 2013, they were spending 3.8% of their revenues on charity care for low income people. And in 2020 that dropped to 1%, it’s been a straight line down as it has in many hospitals. And at the same time, they’re, we know that they’re expanding their three 40 B presence. They, they had one pharmacy dispensing their, their three 40 B drugs in 2017.
Dr. Bill Smith:
They now have 132 pharmacies ex dispensing their three 40 B drugs. So we know the revenues are growing. They’re not required to disclose the amount of revenue they’re getting from three 40 B, but it must be explosive if you’ve gone from one pharmacy to 132 pharmacies and mass general has expanded. They have offices now in some of the wealthiest towns in, in Massachusetts, Wellesley Concord, Walham Newton they even have offices in Nashville, New Hampshire and York Maine. So part of the reason for this growth is that they can leverage these three 40 B discounts in these areas. So it’s, it’s a troubling thing, particularly because the charity care numbers have been declining.
Joe Selvaggi:
I found a striking feature of your paper in that that originally the three 40 B was going to hospitals that did more charity work. Your paper are points to the research that indicates that what these newer hospitals, these bigger hospitals, I don’t wanna throw the mass general under the bus, but when compared with those hospitals that don’t participate in three 40 B in theory, those that don’t do substantial charity work, there’s actually less charity work being done in three 40 B hospitals. Then there are, and three 40 B hospitals, which is to say, there’s no correlation between one’s inclination to exploit three 40 B and one’s inclination to serve charity cases. This is very troubling. Say more about this phenomena.
Dr. Bill Smith:
Yeah, that’s, that’s precisely right that their, their are studies to suggest that three 40 B hospitals give less charity care than either government or for profit hospitals. And one would expect given the revenues that are generated from three 40 B program, which are estimated to be 40 billion for these hospitals, that the, the nonprofit three 40 B hospitals would be dispensing much more charity care, but the data suggests that’s not true.
Joe Selvaggi:
Well, you break down three types of hospitals, I suppose. I’ve never thought of this way, but there’s for profit, nonprofit and government. So for profit is supposed to be the bad guys, I suppose, in a, in a modern narrative nonprofits, the good guys your paper suggests that nonprofits are in measurable terms, doing the least amount of charity work when compared with for profit and go from in hospital, say more about that data.
Dr. Bill Smith:
Yeah. And I don’t want Joe, I don’t wanna cast the, the, I don’t wanna paint with too broad a brush here because we did find hospitals in urban areas in the Boston area, such as Boston medical center and Cambridge hospital Everett hospital that were, they were giving out a huge amount of charity care, you know, more than 10% of revenue, some years unlike mass general and, and, and UMass Memorial in Wooster and bay, state, and Springfield where the numbers are closer to 1%. So it there’s some hospitals in clinics that are really doing the Lord’s work when it comes to charity care. And so I don’t wanna paint with two broader brush, but on average charity care has been declining at these nonprofit three 40 B hospitals, which one would not have expected given the growth in the program.
Joe Selvaggi:
Sure. And you mentioned briefly that the the, the 340 B programs are, are branching out to smaller more affluent communities, but you know, local community physician groups themselves, how does the three 40 B program interfere with community physician practices?
Dr. Bill Smith:
Well, to be Frank, the hospitals are just buying up community based per practices. 51% of the community based oncology practices are now vertically integrated into a hospital system because they’ve been bought up. And the reason they’ve been bought up is obvious because in neurology and, and oncology, and, and in those specialty areas where you you’re dispensing expensive drugs the, you can keep the spread as a hospital system. And arbitrize the, the three 40 B discounts when you purchase an oncology practice and bring in a huge amount of revenue. So this is troubling because people like community based practices, they don’t want ’em to see their local community physician practice being bought up by a hospital. But it’s also the case that once these, these practices are bought up, there is an incentive not only to prescribe more drugs, but to prescribe more expensive drugs, because you’re going to be able to leverage those discounts. So it, it, it’s not great all the way around. And and you know, the, the, the oncology community is well aware of this problem. And, and they’ve been fighting back trying to avoid these, the purchase of these, some of these community based clinics.
Joe Selvaggi:
So if I’m someone who enjoys you know, a community physician practice somebody say, oh, I I’m in different to who owns, or how in vertically integrated my system is my doctor is, but what your paper points out is once it does join this integrated system, everything in that practice becomes substantially more expensive, not unlike where that practice to move into the city. The, the drugs, the physician visits, all go up in price. And you also mention in your, in your remark that given that the hospitals arbitrage, the difference between what a it’s, it’s a percentage base the more expensive the drug, the greater the discount, the greater, the profit, there’s a, a clear incentive to raise drug prices based on the difference between the retail and the three 40 B discount.
Dr. Bill Smith:
Yes. And, and, and again, it’s not just drug prices that go on overall healthcare costs in the hospital setting is, are more expensive generally. And so you know, I’m very sympathetic to hospitals. My sister’s a hospital administrator in New York, and I know it’s a difficult business, but it is more expensive to treat somebody in a hospital setting or a hospital satellite office than in the com community based physician practice. That’s just the reality. And so this expansion of hospitals into wealthy suburbs is gonna drive up healthcare costs and is driving up healthcare costs.
Joe Selvaggi:
So I sort of the icing on the keg before we shift gears into what you recommend as perhaps a, a useful remedy for many of these perverse incentives you, you describe a case whereby when combined with a Medicaid rebate, a drug company that sells a drug. I think you use a, a, you know, for instance, a hundred dollars drug that winds up costing the, the manufacture money to sell the drug, which seems unbelievable. But you know, many people like to trash to the reputations or, or incentives of drug companies, but to have a system whereby a drug company loses money for every pill sell to say more of how three 40 B and the Medicaid rebate might combine to make a negative a margin.
Dr. Bill Smith:
Yeah. So it’s, it’s, it’s simple, it’s called, it’s a problem called duplicate discounts, which were banned in the original statute. It’s actually a violation of federal law for a pharmacy to, to obtain duplicate discounts. So let, let’s say you you get it, you buy a drug at, at $25 which is the 340 B price. And then it, the, the patient goes to the pharmacy and the, the drug is purchased. And then the pharmacy bills, the drug manufacturer for a $35 rebate, the, the company now has just lost $10 on that sale because the they’re getting bill the three 40 B discount as well as a Medicaid rebate. And this is a common problem. It’s in the hundreds of millions of dollars, probably that these duplicate discounts happen every year. And it, again, it was banned in federal law. And one would think with our current software systems, they’d be able to solve this problem, but they haven’t and inspectors general, and also sorts of people, the justice department, others have, have come back and said, you gotta solve this problem, but they have not.
Joe Selvaggi:
Indeed, indeed. All right, so let’s, let’s stop piling on we, we established a three 40 B has created some perverse incentives and those of us who pay into this health system are all poorer for it. Let’s figure out how to, what you would recommend as, as reasonable steps towards finding some remedy or solution to this first. You you would recommend that we require hospitals to revol report three 40 B revenues. It seems odd, odd that we don’t already do that, but say more about why that’s important.
Dr. Bill Smith:
Well, that’s important because they, they do report. Although the definition of charity care needs to be tightened up, they do report in their Medicare cost reports, the amount of charity care that they dispense. So if we knew what they were securing in revenue from the three 40 B program, we could compare that with the amount of charity care that they’re giving out each year. And one, one would expect there’s a great disparity between the two numbers these days. And, you know, the transparency might shame them into spending more on charity care, which would be a good thing.
Joe Selvaggi:
Indeed, indeed. Now those presumably the it’s a positive number, the difference between the money they get from three 40 B and the money they give in charity care you would want to, your second recommendation is to require those covered entities to spend that money, that profit on charity care. That seems reasonable. Is that what you’re saying?
Dr. Bill Smith:
Yeah, that’s a, it’s a more directive than just the transparency option, but you could require that all revenue that’s secured from through the three 40 B program must be spent on community programs that serve low income and uninsured patients it’d be that simple. Right now we don’t know where all that revenue goes. It could go to hospital salaries. It could go to who knows, could be go to expanding the building. We, we don’t know where the money goes now. And requiring it to go to charity care would be a, a boom to charity care around the country.
Joe Selvaggi:
Indeed. That’s how it was intended. So it ought to go to the charity. You also want to better define who is eligible for the discounts and, and the charity care, which you addressed early in the paper that remarkably it doesn’t specifically define who should be eligible.
Dr. Bill Smith:
Yeah, I, I’m not sure why a three 40 B drug should be given to a millionaire in Wellesley. I just don’t, I don’t think that fits the, the, but that is happening. That is happening now. I, I don’t think that fits the original spirit of the program and the statute needs to be tightened up, so that doesn’t happen
Joe Selvaggi:
Indeed. And, and that that’s a, that dovetails well, well, with the next point, which disqualified three 40 B child sites, because satellite sites were using that term in wealthy communities. I’ll just say, let me qualify this. I’m sure there’s some low income people in wealthy, probably not many, but we keep going there. But let let’s, let’s say let’s use that example again. Why, why would we disqualify the three 40 B sites in, in wealthy communities? Well,
Dr. Bill Smith:
You, you know, charity care arises many times spontaneously, you know, it’s, it’s the homeless person who finds himself in the emergency room and doesn’t have insurance and, and the hospital has to eat the cost of that care. And so if you’re locating your satellite offices in wealthy neighborhoods where people have higher rates of insurance, you’re not gonna get that spontaneous charity care happening. So I, I think they ought to limit the, the places where these three 40 B sites can be to areas that are considered somewhat impoverished in the United States. And I, I don’t want to come up with an exact definition of impoverished, but it should be an areas where you are gonna get those walk in patients who aren’t insured and are very low income. And that originally when they first enacted this program that was happening, these, these, these hospitals and clinics were located in these areas. And there are some that are still located in these areas, but with the expansion they’ve more and more expanded this program into wealthier area is they have higher rates of insurance.
Joe Selvaggi:
And I think on the flip side of this is your next recommendation, which is not, not only define who is eligible, but when we’d say let’s take that money and give it dedicated to charitable programs, we should define what charitable programs look like and what community programs look like. We, we still haven’t done that.
Dr. Bill Smith:
Yeah. The definition’s not as tight as it should be. So for example, if a middle class patient comes in and they owe a deductible or a co-insurance payment on whatever treatment that they were given in the hospital and they never pay that, is that charity care. Well, some, some hospitals do define it as charity care because they’re eating the cost, but the patient is probably can afford the co-insurance payment and chooses not to pay it. So maybe it’s not charity care. I just think they, they should tighten the definition so that these are programs that are serving underserved populations.
Joe Selvaggi:
Also of course, want to reform how hospitals become eligible for this program. You wanna reform the disproportionate, share hospital, eligi eligibility requirements for the program and a sense, I think you’re implying that some hospitals ought not to even be in the program.
Dr. Bill Smith:
Yeah. You know, as, as we discussed, you know, when the affordable care act expanded Medicaid drug, I think it’s, it’s 11.75% is the, the percentage of Medicaid patients that you treat, you become eligible for it to become a three 40 B hospital. Once you cross that 11.75 threshold. And it’s clearly the case that some hospitals have lure in Medicaid patients to get to number obtained three 40 B status, and then not gone further their, their Medicaid patient numbers are still at that level. So they’re gaming the system to some degree, not all hospitals, but some hospitals, for sure. So I, I think they ought to look at Medicaid as a proxy for treating low income patients. I, I’m not sure is, is a workable definition any longer given the expansion of Medicaid. And they may be ought to look at other numbers like how much charity care they give out that that could be a threshold that, that makes you eligible for three 40 B status.
Joe Selvaggi:
That would be something to, to earn that status based on how much good you do rather than, and how many Medicaid people you lure in
Dr. Bill Smith:
Precisely.
Joe Selvaggi:
And the final one. I’m, I’m not sure, I, I know precisely why this is a benefit, but you suggest we should convert three 40 B programs from discounts to rebates. I guess there must be, then it must be conditioned that rebates conditioned on proof that it’s being used for the right thing. Yeah.
Dr. Bill Smith:
It’s, it’s complicated, but the rebate system would avoid the problem that we discussed with duplicate discounts, because you could, you’d have a little time to figure out who was a Medicaid patient and who wasn’t before you wrote the check who was getting a three 40 B drug and who wasn’t. And so the rebate system would help, would help solve that problem. It it’s a very, the pharmacy transactions are extremely complicated. But I’m told by people who know them well, that a rebate system would, would solve the duplicate discount problem.
Joe Selvaggi:
All right. So those are your recommendations. But our listeners may think, okay, this is fine, but you know what? We’re here in Massachusetts. We’re the good guys. Our hospitals are above reproach. But you name names in the end of the report and not all Massachusetts hospitals come out wearing the white hat, I guess. So let’s let’s name names, and talk about where, where we see problems and where we’ll call out. Some other hospitals for are doing a, a terrific job. But before we name names how do you measure you, you, you, you, you talk about in your report, who’s really not using the money for charity work. How do you measure charity care provided in a given system, in any given hospital?
Dr. Bill Smith:
Well, in our we looked at Medicare cost reports that hospitals have to file every year with CMS, the, the federal Medicaid, the Medicare Medicaid agency, and they’re required to report their charity care numbers based on their revenues. So what we did in the report is we, we picked five hospitals, randomly. We picked by geography. We wanted to see how across the state charity care was being given out. So we picked mass general in Boston. We picked UMass Memorial in Worcester. We picked bay state in Western mass. We picked Berkshire hospital system in the Berkshires and south coast hospitals in, in, in the, on the Cape. And what we found is those, those hospital systems were not PA picked in advance based on their charity care numbers. We hadn’t even looked at the charity care numbers, but what turned out to be the case is for all those five hospital systems that charity care numbers are a straight line down from 20 13, 20 14 to, to this year. So, so that’s a problem. And again, we didn’t wanna dust up all hospitals. So we looked at the numbers and we found there were, there were hospitals like Boston medical center and Cambridge hospital and Everett hospital that were giving out large amounts of charity care based on revenue. So again, I, I don’t wanna paint with too broad a brush, but in our random sample, based on geography, all the charity care numbers were down.
Joe Selvaggi:
So let’s put that in the enumerator, the denominator then is, is how much the program has grown in Massachusetts. You said some numbers, I don’t know if you have them, your fingertips, how in the last eight, 10 years the money’s grown, you’ve established that the money given to charity by those hospitals from the 340 B has been going has been going down, but the revenue coming in from 340 B has grown, can you put a, a fine point on how much it’s grown in Massachusetts?
Dr. Bill Smith:
Well, we don’t know because the hospitals aren’t required to disclose their revenues, which is one of their from 340 B, but we know nationally the program has grown from about 9 billion in 20,000, 2009 to 38 billion last year. So given that Massachusetts’ hospital intensive one would think they were reaping the benefits of that. And as I said, mass general only had one pharmacy in 2017 that dispensed three 40 B drugs, and now it has 132. So I think we can say with a high degree of confidence that revenues from the three 40 B program have exploded. We just don’t have an exact number because they’re not required to disclose
Joe Selvaggi:
All the money going to charity has been going down across the board by my reckoning, the money coming in from three 40 B across the country has back of the napkin quadrupled or seen a 400% increase over the last what do we see eight years that’s
Dr. Bill Smith:
Yes. And, and the 38 billion in actual sales, that’s the discounted sale price. But one economist did a study arguing that, that, that 38 billion in sales leveraged an additional 40 billion in revenue for the hospitals. So this is a huge program. You know, 78 billion in money is flowing through this program according to some estimates.
Joe Selvaggi:
Yeah. We can’t you know, go through all the findings of all the hospitals that you, you, you name, but let’s, let’s start with you mentioned mass general a few times. So let’s, let’s get to it. How, how did so-called man’s greatest hospital fair in your study when comparing its its revenue to its its expenditure?
Dr. Bill Smith:
Yeah. In, in 2013, based on the Medicare cost reports, mass general was devoting 3.8% of their revenue to charity care, which is a fair number. It’s not real high, but it’s fair number. And in 2020, their, their charity care number dropped to 1% of revenues. So it’s declined substantially. And we found that in the other four hospital systems around Massachusetts and as I said, one would expect that their three 40 B revenues are, are exploding because they’ve gone from one pharmacy to 132 pharmacies are dispensing three 40 B drugs. I, I just would like to see the numbers on, on their revenue from three 40 B and what it’s been over the past decade or so
Joe Selvaggi:
This is all interesting because I think adding to perhaps our listeners’ outrage is in, in the time between our two, four, 2014 and now the affordable care act is you know, is taken hold, which in theory would mean fewer people are uninsured. We know that that to be true so that this shifts from higher 340 B claims and lower charity is with the backdrop of saying there are a few people who ought to be eligible. So the hospitals have to either claim the, that there are more charitable patients despite ACA, which seems impossible or less need for charity despite the fact that their claims are going through the roof. Am I right?
Dr. Bill Smith:
Yes. in one study concluded, there’s an inverse relationship between charity care and growth in three 40 B programs, an inverse relationship as three 40 B grows, charity care declines was the conclusion of this one study which I, I think is unsupportable. I just you know, again, it would be hard to criticize the size and scope of this program. If all of this money, we we’re going to charity care, treating homeless people, uninsured people providing mental health services, doing whatever for patients that are really in need, but that doesn’t seem to be the case.
Joe Selvaggi:
This is a real shame. More than a shame I say, you know but let’s, let’s not call everybody out. We, we actually have some good actors in your, in your group that you say you chose randomly. There were some good actors who, who, who are have a high fidelity to their charitable mission. You call out Cambridge health Alliance and Boston medical center. What, what, what do their numbers look like?
Dr. Bill Smith:
Yeah, again, their numbers, weren’t a straight decline from 2013 to the present. It, they went down some years and then back up some years, but they were substantially higher, even 10 times higher than some of these other hospital systems. So I, I think there are some hospitals that are doing right by this program. And I also have the impression that there are a lot of clinic Ryan, white clinics, federally qualified health centers and, and smaller clinics that are located in very difficult, challenged neighborhoods that are providing great service. And they need these three 40 B discounts. And, and I, I don’t want this program to go away and I, I didn’t write the paper to say the PA the program shouldn’t exist. It just needs to be tightened up. And the people that really need these discounts should continue to get them. And the people that don’t shouldn’t
Joe Selvaggi:
Indeed. So where now we’re getting close to the end of our show, where can our listeners find your paper?
Dr. Bill Smith:
Well, pioneer pioneer institute.org. The pioneer institutes website has both the press release explaining the pro the the paper as well as the link to the paper itself. And it’s about 15 pages or so it’s not, it’s not burdensome to read.
Joe Selvaggi:
No. And I went deep into some of the footnotes copious number of footnotes also, which, which is good, supporting your, your observation. Now our listeners, again, this I’ll use this as our last question. Our listeners are, are our thinkers. They like think tanks, what they like to do. What would you suggest? I mean, you’ve laid out what, what let’s say lawmakers can do, would would you recommend that our listeners, if they’re persuaded, maybe, maybe they maybe some of our congressmen are listeners to the show, but those who are, are voters, what would they do if they want to encourage their legislator to, to, to jump on this out of you know, out of compassion for the poor and the desire to see this substantial amount of amount of money go to the right place? What should they do?
Dr. Bill Smith:
Yeah, I, I, I, I, I’m big on transparency. I think both on the state and federal level, there should be some disclosure on the part of hospitals about the amount of revenue they’re securing from the three 40 B program you know, requiring them to spend it on charity care, maybe, maybe not, but definitely disclosure and transparent. And, you know, if I were just an ordinary citizen meeting with my legislator, I’d say, well, how come, I don’t know how much mass general is getting from this program and how much they’re spending on charity care. And let’s look at the differential between those two, two numbers,
Joe Selvaggi:
Indeed. Transparency or sunshine is the best disinfectant. At the very least. We might be able to shame these hospitals into giving the money they’ve been given as charity themselves. It intended for charity. Make sure if they’re getting it we can then reasonably ask, well, what are you doing that money? Do I have that right?
Dr. Bill Smith:
I, I agree a hundred percent. I transparency you know, I’m not a big government guy. I don’t want the government to be, be directive on everything. But just knowing the amount of revenue that are flowing into these hospitals from this 340B program, and then comparing it on the amount of community programs for low income and uninsured, that would be a valuable data point.
Joe Selvaggi:
Wonderful. Well, let’s end our show there. Thank you again for being on Hubwonk, Bill. You’ve been great.
Dr. Bill Smith:
Thank you, Joe.
Joe Selvaggi:
This has been another episode of Hubwonk, a podcast of Pioneer Institute. If you enjoy today’s episode, there are several ways to support the show and Pioneer Institute. It would be easier for you and better for us. If you subscribe to Hubwonk on your iTunes podcast, catcher, if you’d like to help make it easier for others to find Hubwonk. It’s always welcome. If you want to offer a five star rating or a favorable review, we’re always grateful. If you share hub won with friends, if you have ideas or comments or suggestions about future episode topics, you’re welcome to email me at hubwonk@pioneerinstitute.org. Please join me next week for a new episode of Hubwonk.
Related Posts:
Boston, Massachusetts
Type: Full Time (schedule flexibility available in appropriate situations)
Experience: Mid-level and beyond, including recently retired.
What is PioneerLegal?
PioneerLegal (“PioneerLegal”) is a non-profit, nonpartisan, public interest law firm that through advocacy and litigation promotes inclusive educational and economic opportunity and open, accountable government. PioneerLegal works to preserve and enhance liberties grounded in the constitutions and civil rights laws of the United States and the individual New England states.
Organized in 2021 by a group of prominent lawyers and business leaders, PioneerLegal is affiliated with The Pioneer Institute, a research foundation based in Boston with a broad public interest mission that embraces reform and innovation in health care, public transit, education, immigration, civil rights and public governance. Governed by an independent board of directors, PioneerLegal will pursue high impact, cutting-edge cases that advance educational quality and opportunity for all students, especially those in underserved areas, open and accountable government, and enhanced economic opportunity for all, especially lower income and immigrant communities.
Why join PioneerLegal?
For all its rewards, law practice can be narrow and limiting. PioneerLegal offers attorneys, especially those at the beginning and end of their careers, the opportunity to step outside traditional professional boundaries and to focus on matters infused with a broad, public, intensely human impact. Attorneys, interns, fellows and staff at PioneerLegal will, through a variety of endeavors, open doors to opportunity for those most in need of it, and open windows on otherwise hidden government practices controlled by special interests. Working closely with outside pro bono counsel from leading law firms, our attorneys, interns and fellows will deploy and enhance their skills through case identification and development, direction of legal strategy and collaboration with a wide variety of subject matter experts.
Our lawyers will work on cases at every stage of the litigation process, from trial to appeals in state and federal court, and a regular part of our activities will include preparation of amicus briefs for the U.S. Supreme Court (where Pioneer Institute already has a winning track record) and the highest appellate courts throughout New England. And beyond a steady stream of amicus briefs for submission to trial and appellate courts, we will perform legal and factual research to identify litigation opportunities that align with our mission, with our attorneys developing case proposals for our litigation intake review process.
We are dedicated to developing a close and professional team culture with our board, affiliated pro bono external counsel, like-minded organizations, and our staff. As we are a public interest law firm, our attorneys also will be encouraged to be active outside the courtroom, including media writing and appearances, and public speaking. Active membership in state and national bar associations will be supported and encouraged.
What skills and achievements are we looking for?
How can I apply?
Submit a resume, a cover letter, a 10-page writing sample and, if admitted to practice in past five years, a law school transcript. In your cover letter, be sure to tell us why you are right for PioneerLegal’s special mission and why PioneerLegal is right for you at this point in your career.
What about compensation, benefits, and general perks?
Compensation is commensurate with experience and exceeds many other legal non-profits and comparable government pay scales. PioneerLegal also offers superior benefits including medical, dental, long-term disability, 401K retirement plan and paid leave. We also offer flexible work-day schedules, including regular work from home and other remote work location opportunities.
Applications should be submitted on or before May 6, 2022, to Mary Connaughton at mconnaughton@pioneerinstitute.org
PioneerLegal is an equal opportunity employer.
This week on “The Learning Curve,” co-hosts Cara Candal and Gerard Robinson talk with Dr. Arthur Levine, a scholar with New York University’s Steinhardt Institute for Higher Education Policy, a senior fellow and president emeritus of the Woodrow Wilson National Fellowship Foundation, and president emeritus of Columbia University’s Teachers College. He shares the main findings and recommendations of a new book he recently co-authored, The Great Upheaval: Higher Education’s Past, Present, and Uncertain Future. He discusses some of the key issues of academic quality, technology, administration, and cost in American higher education today, before and after COVID-19. He also offers thoughts on the role of teacher preparation programs in delivering better academic outcomes for students of all backgrounds. They explore how schools of education can be reformed to better prepare teachers with both the wide background knowledge and practical experience necessary to boost student achievement, and how they can achieve the stellar reputations enjoyed by law and medical schools. The interview concludes with Dr. Levine reading from his recent book.
This episode also features a shorter interview with Dr. Sephira Shuttlesworth, to commemorate her late husband, Civil Rights activist Rev. Fred Shuttlesworth, who would have turned 100 on March 18th, and share her current work to help students recover from trauma.
Stories of the Week: U.S. Education Secretary Cardona will award grants to enhance security measures at Historically Black Colleges and Universities (HBCUs), after 30 have been targeted with bomb threats over the past three months. Intel announced plans to invest $100 million over the next decade into Ohio schools and research collaborations with universities, community colleges and technical educators to develop skilled workers.
Guest
Dr. Arthur Levine is Distinguished Scholar of Higher Education at New York University, President Emeritus of Teachers College, Columbia University, and President Emeritus of the Woodrow Wilson National Fellowship Foundation. Levine has written 13 books, including The Great Upheaval: Higher Education’s Past, Present, and Uncertain Future, and published many articles in publications, such as the Wall Street Journal, New York Times, Washington Post, Los Angeles Times, Politico, Chronicle of Higher Education, Education Week, and Inside Higher Education. He has appeared on many media programs, including 60 Minutes, The Today Show, All Things Considered, Morning Edition, Open Mind, and Fox News. Levine has received a number of awards, including 26 honorary degrees and Carnegie, Fulbright, Guggenheim, and Rockefeller Foundation Fellowships. He is a member of the American Academy of Arts and Sciences.
The next episode will air on Weds., March 30th, with John Lewis Gaddis, the Robert A. Lovett Professor of Military and Naval History at Yale University, and the Pulitzer Prize-winning author of George F. Kennan: An American Life.
Tweet of the Week
Wealthy NJ Gov. Phil Murphy sends his own children to exclusive private schools but wants to force low-income black and Hispanic kids to attend some of the worst public schools in the state. Shame. @jasonrileywsj https://t.co/KCKZIudhzv via @WSJOpinion
— Jason Riley (@jasonrileywsj) March 16, 2022
News Links
Education Department will provide grants for HBCUs targeted by bomb threats
Intel announces details of plan to invest $100M into education
Read a Transcript of This Episode
Please excuse typos.
[00:00:00] GR: Hello listeners. This is Gerard Robinson saying hello again from beautiful Charlottesville, Virginia, where a week ago it was snowing. And right now it’s 70 degrees. And we are celebrating the Virginia festival, the book with people from all over the country who are here. And some of these people may one day find themselves on the learning curve.
[00:00:45] But of course, no matter what day it is in Virginia or what day it is in Massachusetts, we cannot have a learning curve without the person who always hits the ball out of the park. When a curve is coming, Ms. Cara.
[00:00:57] Cara: Oh, that you thought about [00:01:00] that one. you know what, I’ve never hit a ball out of the park in my life jar.
[00:01:04] GR: Sure.
[00:01:05] Cara: My eight year old could do it. here, you are celebrating, what did you say? The festival of the book, something, something area. Right. and lovely. And one of, so, but here in Boston, we continue to celebrate of course, St. Patrick’s day, which mm-hmm . I don’t know. I have lived here. Gosh, how long have I lived here now coming up on 17, 18 years.
[00:01:26] And I didn’t even realize that it’s actually a citywide holiday. I went to park my car downtown yesterday and the meters were, I thought, well, there you go. And the bars were packed at noon. I thought, well, this is my city. So you have your festival of the book, and we’ll be here drinking green beer.
[00:01:41] Although I’m not, , I’m drinking lemon water, which is not very exciting Gerard, but gotta keep my head on straight to hit to the park with you today, my friend. So good to hear your voice. As always listeners, we got a couple stories of the week coming at you and mine is it’s like bittersweet because [00:02:00] I’m glad that the education department is doing this, but I’m so sad and actually more than sad.
[00:02:05] It’s I, angry that there’s a reason for this, but this is from the NPR politics desk. I actually listened to it before I read it. And the title is of course education department will provide grants for HBCUs targeted by bomb threats. So for those of you who have been subsumed with. just so much of the other news that is coming at us constantly in a barrage.
[00:02:29] I keep waiting for the good news somewhere. It is, this has just been an ongoing thing for the past happening in recent years, but especially in the past three months that 30, historically black at colleges and universities across the country have been targeted with bomb threats. So I’m consistently amazed that this is still the society that we live in, but you know, these bomb threats were last month was black history month were particularly concentrated in black history month.
[00:02:57] And the quote from the education [00:03:00] department is that these bombs were against HBCUs, particularly concentrated in black history month constitute a uniquely traumatic event, given the history of bombings as a tactic to intimidate and provoke fear in black Americans during the long struggle for civil rights.
[00:03:15] So in a time when. Students everywhere are traumatized by, more things than we can count here. You have students at HBCUs, probably, , wondering day to day if it’s actually going to happen. So, secretary Cardona is going to award some grant money to HBC use. And these awards will range between 50 and $150,000.
[00:03:39] They’re from project serve. And that’s a program that supports schools that have experienced violent or traumatic incidents. So it’s not a ton of money, but it’s something. And I think that it’s in my book, good that the secretary is giving a no to the fact that this is so many things, but one among them traumatizing for students.
[00:03:57] The funds can be used to improve security or [00:04:00] increase mental health resources, ARD. I know that you are a graduate of an H B, C U we’ve had graduates of other HBCUs and professors from HBCUs on this program. Um, They are such a vital and important part of the American university system. I think you’ll probably know this statistic, but HBCUs graduate, a large percentage of, children, of color of black children who black students, I should say that attend college in this country.
[00:04:26] And so many of them go on to do such important, wonderful things like yourself. And this is just, like I said, at the outset it’s bittersweet. I’m glad that the education department is in a small way, very small way, recognizing the trauma these students are experiencing, but I’m also just sick to death and tired that.
[00:04:46] This is happening and that we continue to live in a country where this can happen to students, to faculty members. So anyway, gimme some Ray of hope Gerard what do you think?
[00:04:55]
[00:04:56] GR: Well, for sharing the story and bringing it up. I am a graduate [00:05:00] of H B C U Howard university in Washington, DC. And I received a number of E emails about this for months in part, because there are a group of H B, C U leaders who are part of the H B C U emergency management and wellness consortium.
[00:05:16] And they’ve been meeting for over a year. Independent of this, but to talk about the importance of utilizing resources, both academic, human, and otherwise who are on our campuses to provide support to the nation. In particular, there are a couple of scholars who are at Elizabeth city state university in North Carolina, where they actually offer training in emergency manage.
[00:05:38] And so they’ve taken this as an opportunity to elevate the voice of the consortium and to say, we’re here to help always good to see the us department of education get involved. I’m also sure even , the article, didn’t say this president Biden is a big supporter of HBCUs when, of course, when he was Senator for Delaware, big supporter of Delaware state university.
[00:05:59] So [00:06:00] I’m glad the secretary and leaders in Washington DC are making investments. And I am also aware that The white house initiative on HBCUs. They have a new executive director Dr. Trent, who is also an H B C U graduate Hampton university. She’s also the former secretary of education for Virginia, and she has a lot of experience in education.
[00:06:21] So she’s gonna be the new leader at the white house. And so I’m sure she’s gonna play an important role in this as well. And Cara you’re right. When you think about the fact that HBCUs make up 3% of the higher education institutions in the United States and produce roughly 24% of the engineers almost the equal number of doctors places like Morehouse college, number one, producer of black men, earning P DS places like Dillard.
[00:06:48] Number one pipeline in terms of black schools, sending people to medical school and North Carolina, a T not just H B, C U, but one of the top 20 producers of black engineering students black or white in [00:07:00] the country. So while people try to bomb, we will always rise from the ashes. And we even have a conversation about a,, someone who actually was once bombed Dr.
[00:07:10] Shuttlesworth who will be celebrating a hundredth anniversary today. But thank you for raising that story and shout out again to the H B C U consortium. Let’s support them as well.
[00:07:20] Cara: Absolutely,
[00:07:21] GR: So my story is a little different in the aspect that it is a partnership. Example, I would say between the private sector going to a state and saying we wanna work with you.
[00:07:34] So my article is from the hill and it’s talking about Intel, which is fortune 500 company headquartered in California. They have 79 billion in revenue hundred 21,000 employees. And as you know, Cara businesses need talent. And so when they decide to look at a state, they’re gonna look at a few things.
[00:07:57] Tax breaks. They’re gonna take a look at [00:08:00] cost of living. They’re gonna also look at the people who are there. And so Intel had a number of places to go and they decided they’re gonna go to Ohio to bill two chip manufacturing companies with an investment of 20 billion. So that’s a major in investment.
[00:08:17] And so one of the reasons they said that Intel personnel said they chose the state is because of its great higher education system. As we know many of our listeners. Ohio is one of the states that was created out of the Northwest ordinance of 1787. In that law, it actually has language to support schools and to really push it forward even before then 17 85 north Northwest ordinance also supported it.
[00:08:44] But Ohio has been a major leader in producing scholars and students focused on a number of things in education, but their higher education system, both public and private is one reason that Intel decided to invest. But that’s on the [00:09:00] manufacturing side and keep in mind 7,000. Construction jobs will be created because of this.
[00:09:07] You’re also gonna have 10,000 jobs created as derivatives from the work that’s gonna take place, but you’re also gonna have 3000 jobs where the average salary is $135,000. So that’s a major investment on the for-profit side offense. Well, let’s look at the higher education side of the fence. Intel said we’re also going to invest.
[00:09:27] 100 million to support education programs in the state. And this was good news to governor Mike DeWine of Ohio who had a chance to make an announcement at a community college. And so what they’re gonna do are three things. Number one 50 million will go directly to higher education Institute. Second 50 million will be distributed to educators and science programs nationwide to create a stem curriculum.
[00:09:54] So teachers who are listening this is something for you. If you’re outside of Ohio and third, get this [00:10:00] the national science foundation put in another 50 million to support research initiatives across the country. And as a governor said, You can’t have a strong Ohio without having a strong workforce.
[00:10:12] And you make this happen by using your two year and four year schools. But K12 S got role in this as well. Teachers who work in career and technical education teachers who are teaching stem, even instructors, who are starting to implement engineering, stem, or steam ideas in middle school. Here’s an opportunity for you in both places like Columbus, which is your capital, but also in the rural parts of the state, which we often overlook, particularly the Southern part.
[00:10:39] Here’s an opportunity for you to, and get ahold of some money and make some things happen. So here’s the recommendation. Number one, every Dean of a college of education, be it public or private four year, two year non-profit or for-profit you need to send an email to your president. And ask her [00:11:00] him or Bart requests that when money comes to the school, that you would like to use that money to endow a professorship at your school of education, focused on stem education.
[00:11:11] And I say this, having to work with universities for decades, it is tough, particularly for public universities to use public money to endow chairs. There are a lot of procurement laws, a lot of state statutes that shape it. But for this one, if you want to make sure you have the next generation of stem workers, they’re gonna have to come through our K12 system and our higher education system.
[00:11:32] So use this money to endow one professorship at minimum, maybe two, and bring in great talent or even elevate the talent you have internally. Number two, if you’re the president of a community college, this is a wonderful opportunity for you to partner with your local business work councils and say, listen, we have money coming in.
[00:11:52] Let’s do either a financial match from the local sector. Or guarantee some of the graduates who will leave your [00:12:00] community college, either with a license with a certificate, maybe an associate’s degree, let’s start working out on guaranteeing jobs or at least internships during the summer or externships, which can last one semester or a year and make sure they’re paid third.
[00:12:15] And this is two, our friends who are in the classroom, I’ve said for years, that one way that we can retain talent and attract talent, particularly in hard to serve stem areas is to start thinking like colleges, superintendents, you should also send a note and let your board know that when the money arrives at the local level, you want to endow chairs also focus on stem and in the summertime allow that teacher, if he or she is interested to work with Intel or to work with companies associated.
[00:12:44] So she or he can actually earn additional money in the summer. The same salary that he or she would earn if they were a full-time employee and then bring that knowledge back to the classroom. So I think this is just a wonderful example of the private sector working with the public sector, but making sure [00:13:00] higher education, isn’t the only one getting money, but that it trickles down to community colleges to K12, but in, they’re also looking for stem curriculum work across the states.
[00:13:10] So Massachusetts opportunity for you,
[00:13:13]
[00:13:13] Cara: Yeah. Massachusetts, are you listening? We have a lot of great tech companies here, biotech, et cetera, et cetera. And I think that we could do a better job in thinking about the connections between these things jar. I’d like to add one more recommendation to your list if yout of mind.
[00:13:26] And that is superintendents work closely with guidance counselors, with teachers, with parents, cetera, to help kids. Especially those interested in stem and other fields, understand what the career pathways are that are available to them. There should be a great awareness of this to kids as early as high school, so that they can start to think about their future and what it might look like.
[00:13:50] Whether they take the two year, four year path, whether they, go into one of these great new pathways that might not even require a two year or four year college degree [00:14:00] that Intel is offering. And I have to say, Gerard, I just love the idea. And this was president Biden actually talked about this partnership, right about Intel going to Ohio in the state of the union address, which I think he was quite proud of as he should be.
[00:14:13] It’s a re really great opportunity when we think about states and I love that education is at the, for, because what we’re doing here is creating what they’re doing here. I should say, you and I have nothing to do with this creating an ecosystem. Right. That brings all of these things together because in so many places, especially as you mentioned, rural places, kids don’t see in their local community a way to stay in the community, sometimes a way to stay in the state and be able to do the things they wanna do in give back.
[00:14:43] And when industries make investments in communities like this, it’s hopefully a virtuous circle of creating a web of prosperity that as you’ve pointed out, spans from the schools to colleges and universities to the workforce, and that [00:15:00] investment goes right back into the next generation of kids.
[00:15:03] So I really think of this as it’s not just about jobs, it’s about a whole new ecosystem. That’s really hopefully gonna make people healthy, happy, and prosperous in the long run. So that’s a, a great story, ARD. Thank you so much for bringing up. Okay. Our guest today might have a few things to say.
[00:15:23] about both of the topics that we talked about coming up in just a bit. We are gonna be speaking with Arthur Levine. Many of our guests will know him. He is the former president of Columbia teachers college. I’m sure that this is gonna be a fascinating conversation. We’ll be back in just a minute.[00:16:00]
[00:16:15] Listeners. We are privileged to have with us today, Dr. Arthur Levine. He is a distinguished scholar of higher education at New York university president emeritus of teachers, college, Columbia university, and president emeritus of the Woodrow Wilson national fellowship foundation. Many of you know him Levine has written 13 books, including the great upheaval higher or education’s past present and uncertain future and published many articles in publications.
[00:16:41] Such as the wall street journal, the New York times, Washington post Los Angeles, times political Chronicle of higher education ed week and inside higher education, he has appeared on many media programs, including 60 minutes. Fan favorite here, the today show all things considered morning edition, open mind, and [00:17:00] Fox news.
[00:17:00] Levine has received a number of awards, including 26 honorary degrees in Carnegie, Fulbright, Guggenheim and Rockefeller foundation fellowships. He is a member of the American academy of arts and sciences. Dr. Arthur Levine. We are privileged to have you with us today. Thank you for joining us on the learning curve.
[00:17:18] Arthur Levine: I’m very pleased to be with you. Thank you.
[00:17:21] Cara: Well, we wanna dig right in to some of your latest work. So, many of our listeners already know you as a leading voice in higher education, but you’ve recently, co-authored another book called the great upheaval higher education’s past present and certain future.
[00:17:38] Higher education is something that we Jordan, I always share stories of the week on this program and we talk a lot about higher education and indeed what it’s going through and, how the future of higher education will look, especially for kids like mine and Gerard. Can you talk to us a little bit about the main findings of your book and the recommendations within
[00:17:58] Arthur Levine: Americans going [00:18:00] through a transition. From a national analog industrial economy to a global digital knowledge economy. We’ve only experienced change on this rapidity, this magnitude, and this acceleration once before, which was the industrial revolution.
[00:18:16] And during that period, American higher is transformed and that’s going to happen again because we’re experiencing change at the degree we are. so there’s all content debate about what form that change will take will be disruption. The whole higher education system will disappear. Will it be adaptation, higher education can fix it to else.
[00:18:37] So we decided to look and see what the story was. And we looked in three directions. One was backward and past history. One was forward looking as a dramatic. Demographic economic and technological changes occurring. And the third is sideways looking at other industries that have been forced to change faster than we were, and those [00:19:00] would be movies and music and newspapers.
[00:19:04] when we finished all that, we found they’re going be four major change in higher education. None of it’s on making the first is there’s gonna be a dramatic expansion of new providers and distributors of higher education content. That’s going to create more competition for higher education. It’s gonna reduce cost and it’s going to increase student choice.
[00:19:26] the second thing we found was, you know, we have near universal access to digital technology. Students are going to ask from colleges and university exactly what they’re getting from Netflix. In Amazon, in terms of research universities, the nation desperately needs scientists and research. So those tools survive, but also in smaller numbers.
[00:19:48] And finally, the rest of my education will be disrupted, will be replaced with all the choice and the cornucopia of new providers, and that’s most likely to happen or the institution’s most [00:20:00] at risk of community colleges and regional universities. Those are the general finding our study.
[00:20:07] Cara: It’s really helpful Dr. Levine to have that laid out so clearly, because I think that. What so often lay people here is, two things about higher education. And the first is that something’s gotta change because nobody’s going to be able to afford it anymore. And the second is that when change occurs, it will just be disruption.
[00:20:27] And so to have you define what dis disruption really means in this context, I think is, pretty useful. The kind of disruption can you help me understand that you mentioned the pandemic and you mentioned the pandemic and COVID relief funds in the context of helping to support. Some of these smaller, at least here where I sit, as you, you mentioned in the Northeast, we’ve seen several closures in recent years of schools that, couldn’t afford to stay open due to declining enrollment among other things.
[00:20:56] And that you mentioned that the pandemic will give some of those institutions [00:21:00] a bump for a little while keep them open. But can you talk a little bit more about the other fault lines that the pandemic has really revealed? Not just about the cost of higher education, but also about the quality of an experience that students are actually getting when they pay in many cases, tens of thousands of dollars a year for their college degree,
[00:21:24] Arthur: the pandemic wasn’t an interruption.
[00:21:28] What it really was, was an accelerator. Of things that would’ve happened in higher education anyway, but over a longer period of time, and examples would be some closures. Examples of the online learning examples would be upskilling and reskilling, which were required by the changing markets and all also the competition in the rise of new providers, all that happened because the pandemic that, the pace that it did, but it would’ve happened anyway.
[00:21:59] [00:22:00] And there are certain events, you know, society that serve as accelerators. The 2008, 2009 recession was an extraordinary accelerator. Millions of jobs disappeared when they came back of the millions that required a high school diploma or less. Only 50,000 were restored. 90% of the new jobs that were created required some higher education that was changing to would’ve happened anyway, as we moved to a digital knowledge age, but it moved them faster. It got rid of the old jobs faster and created the new one faster. The pandemic did the same thing to higher education in every other social institution in America.
[00:22:42] Cara: So I’d like to ask you about another institution that I think, well, not a separate institution, but K to 12 education. Which I think many could argue has experienced some of the disruptions that you are describing [00:23:00] in higher education. So for example, we’ve seen in the past couple years, the pandemic, if you, if I like the term accelerator has accelerated, for example, parent demand for program that allow for learning outside of the classroom, that allow for parents to have more choice in the kind of educational experience their children have, whether that’s within the public system, outside of the public system or some hybrid of public and private providers.
[00:23:27] Now as we talk about higher education, one of the main reasons we, this nation produces teachers, in colleges of education, one of which you used to lead and we’ve been struggling , for decades about. What is actually the right way to prepare the future teachers of this country.
[00:23:49] Can you talk a bit about American teacher preparation programs what they look like, your read on how they’ve been doing to prepare America’s teachers and maybe [00:24:00] give us some insight into what you see coming for colleges of education.
[00:24:04] Arthur: about a decade and a half ago, I did a study of America’s education schools and on their teacher education programs, they weren’t nearly as good as they needed to do low in selectivity. Their standards for graduation weren’t high enough. They were disconnected from the schools. They were preparing students in fields.
[00:24:26] We really didn’t need, we didn’t need elementary school teachers. As much as we needed stem teachers for secondary school and they prepared lots of elementary school teachers, they had a curriculum that prepared students for the industrial age. And they also are, I guess, stands out is that they’re preparing people for a low paid profession, certainly low data profession and what the pandemic did was make all that worse.
[00:24:53] It encouraged retirements from the part of teachers who found the combination of in school, out of school online, [00:25:00] offline, really difficult masks, no masks that, and what it also did was. Make the teaching profession, less appealing. Enrollment had been going down to head school for quite a while.
[00:25:12] Well, they crashed during the pandemic so that we’re going to have to find ways to prepare teachers. I had to tell you about something that the president of M MIT and I did while I was a widow Wilson. We’ve decided to create the education school of the future, which is to say this would be a school that wasn’t time based students to grasp according to competencies, according to outcomes they passed.
[00:25:39] If you could achieve all the outcome, the day you entered, you’ve receiving diploma, the day you entered, by the way that wouldn’t have been possible. We had to assess all that. And that took while however, The notion was let’s have a curriculum that starts where the student is. Let’s have a student move along in this curriculum and [00:26:00] not in the same pace as everybody else.
[00:26:02] None of us learn in the same way as everybody else. None of us learn at the same pace as everybody else. There are things each of us know and don’t know things. Each us do well and don’t do well. But there a program that picks up all of that. So when the student graduates that student has the skills and knowledge, the competencies to be a teacher in a classroom and everything about this was difficult.
[00:26:28] It difficult figuring out how do you create a timeless education school, which doesn’t have semesters. And when students move according to mastery, how to create a curriculum. It’s mastery based. How do you make this affordable economically? How do you give students a skill to live in a world in which everything is changing quickly, profoundly.
[00:26:53] So we gave them an immersion and design thinking. Don’t ask to them the skills to enter a classroom [00:27:00] today. And we gave them the skills and knowledge to be able to move that classroom into the future. As things around them changed. The name of that graduate school is the high meadow graduate school of education at its located in Cambridge.
[00:27:14] GR: Thank you to Dr. Levine. So I had the honor to attend two schools of education, one at Harvard in one of the university of Virginia. At some point in our formal reading package or through conversations we would talk about books such as ed school, Folies uh, teacher wars, you know, other books that uplifted their profession.
[00:27:34] And when I worked in public policy, at some point we would have conversations about teacher preparation, cuz all of us know how important it is to have the right teacher in the right place in time. From your experience both professional and through the academic lens. What can we do to support the teacher in a way to help deliver the type of academic outcomes.
[00:27:54] One for students across the board.
[00:27:56] Arthur: I wanna tell you about a program we created [00:28:00] at the Wilson foundation. We called the Woodrow Wilson state teaching fellowship. And we went into states and we built a coalition, the governor, the chief state school officer, the state higher education executive officer universities, legislators on both sides of the aisle, schools, unions, and funders.
[00:28:20] And what we did was we picked several universities in that state and it ultimately was in Indiana, Ohio, Michigan, Pennsylvania, New Jersey, and Georgia. And we picked five or six universities in the state. And what we would do is offer them money. If they were willing to change their program, to create the kind of program today’s teachers truly need.
[00:28:44] And we offered them $500,000 for taking , on that assignment. And when they successfully completed it here to another $500,000, they had to agree to keep the curriculum. After the funding ended, we did one other thing. [00:29:00] We provided fellowships to students to a attend those schools, and we wanted stem teachers, top stem teachers,
[00:29:08] and we taught them. We got extraordinary people to go become stem teachers in each state. And they performed well in their classrooms. When they became teachers, they waiting their programs and they stayed longer than the average teacher. The bottom line here. It’s that it’s doable. What it is, is an active will.
[00:29:31] If states want to improve what they’re doing in teacher education, they can, it doesn’t come cheaply. The state of Indiana after the program ended funded the program to continue at those universities and Woodrow Wilson happily said goodbye. They created, they built it and they sustained it. And the universities we work with, they too sustained the program.
[00:29:55] Were they everything they could have been? No, of course not. But there was [00:30:00] so much better than what we originally found that those universities.
[00:30:03] GR: Let me just follow up with that wonderful example. You identify great teachers to work in stem, and we know that’s a hard to staff sub field with several subjects under it. How did you define the right type of student? Was it a combination of GPA, GRE other scores? Was it the school, the attended undergraduate major?
[00:30:27] What criteria did you use to identify the right students for this program?
[00:30:31] Arthur: That’s a great question. We were inundated with applications to this program, which was really, really pleasing. So the first cut we took was they wrote an essay. they got a set of recommendations and we looked at their grades and test scores.
[00:30:48] And then what we did was we took who remain and we interviewed them all. and what really mattered was there was certainly a threshold they had to cross in terms of academic quality. It was really [00:31:00] motivation. One of the things that everybody knows is you can’t get anybody to teach and stay in a rural school unless they’ve grown up in a rural area.
[00:31:09] It was those kinds of bodies kind of knowledge that enabled us to pick the right people. We really wanted diversity. That was critical to us. Since we were preparing teachers for the high need schools in each of those states in the most understaff subject stem, we wanted to recruit a group of fellows who looked like the school in which they’d be teaching.
[00:31:32] GR: Absolutely. There’s been a big push over the last 15 years in particular, but even longer to diversify , the teaching force because the student body they’re working with across the border are also changing. So you’ve had a chance to, leave one of the top education schools in the country teach education is one part of it.
[00:31:53] Research is another one of the digs that people make against education schools [00:32:00] is that we don’t have enough rigor in terms of academic research, the number of articles and peer review journals. I don’t buy it cause I know that in fact we do, but what did you do to recruit and retain some of the best and brightest scholars in the country?
[00:32:14] Who’ve dedicated their life to teach in the next generation of teachers
[00:32:18] Arthur: in terms of recruiting faculty. That hasn’t been the difficulty, the research issue that you raised is a real one, but not for the reason that you raised it. When teacher education came to the American university, which was in the late 19th century and early 20th century, what it was made to do was to look like arts sciences, it diminished the emphasis on practice.
[00:32:45] It diminished the emphasis on working with schools and in fact took it, its emphasis, the research focus that arts and science colleges have and what that did was twist what education school were about. Those subjects [00:33:00] that engaged in research rather than practice were the most important. What mattered truly.
[00:33:06] was not connections with the schools, but connections to journals we took and teacher education became the bottom of the heap. What we ended up doing in essence was crowning in the search crowning graduate education and diminishing teacher education. The university made teacher education schools do that, and they followed suit.
[00:33:30] There needs to be a commitment now to prepare teacher educators and teacher education schools that can work with their local school districts. What’s also true. These are too many universities of treated ed schools and teacher education as a catch cow. And I know of several instances in which ed schools were made to lower their admission standards to get their moments out.
[00:33:57] GR: Understandable last [00:34:00] question. And since you mentioned arts and science, I wanna talk about American law and medical schools that enjoy stellar reputations within the higher education establishment. And even in our , wider society. Could you discuss how these professional schools achieve their high academic status?
[00:34:15] does some key lessons from them that we can learn across the boards as relates to, reforming ed schools, but also the whole idea of accreditation and what that means for quality?
[00:34:25] Arthur: Yes. In 1910, the Carnegie foundation for the advance of teaching created something called they did a study of medical schools in the United States.
[00:34:38] Many of which were butcher shops. They were just horrible and. Man named Abraham fluster visited every medical school in the United States and Canada, and then wrote a report for the Carnegie foundation. That report was widely disseminated. That report changed in nature of medical education in the United [00:35:00] States, appoint to two models in 1910 ones with Johns Hopkins.
[00:35:05] And the other was Harvard. We took the ingredients that were necessary to create a good teacher, a good doctor, and said those needed to be requirements in every school. And they got adopted. Now, how could that possibly have happened? And the answer is the study was a set up. It was a prestigious foundation that had been asked by accreditors states.
[00:35:31] In the American medical association to do a real study of what this was like. And we release a report, which was then widely adopted by accreditors states and funders. That combination changed medical education America. And it’s what I talked about earlier. If coalitions and resources that make it possible to change education, any state can do it.
[00:35:59] [00:36:00] I know for example, Wyoming, which has only one teacher education program, one university, one at school is in the midst of doing many of the things we’ve talked about so far, it’s an exciting experiment to watch.
[00:36:14] GR: Well, I appreciate the lessons from history the identification of particular universities and schools of education that have decided to become a pioneer. Thanks also for the entrepreneurial approach that you worked out with. M I T I, in fact, I’m personally gonna look into that more because I’m interested in the future of edge schools.
[00:36:33] If you wouldn’t mind left up to you, we’d love for you to read something from your latest book. I’m sure all of us would glean some good wisdom from it.
[00:36:42] Arthur: Henry Adams sign of a family that produced two presidents attended Harvard and the midnight 19th century. He lamented the fact that he received an 18th century education that failed to prepare him for a world PLS into the 20th century.
[00:36:59] [00:37:00] Adams went to college at a time in which the classical college was dying. And the university of Valent forum, the models that would guide the future had not yet been created. There was a time, much like the present, an age of continuity and experimentation. We know a transformation is to come. The present cannot be sustained.
[00:37:29] GR: Thank you, Dr. Levine for the reading. And we look forward to conversations in the future with you about to not only the future of higher education, but the future of ideas, institutions. And I really like what you said about coalitions. We cannot as silos try to figure all this out. It’s gonna take a lot of helping hands coming together.
[00:37:51] Thank you for joining
[00:37:51] Arthur: Thank you for having me. I really enjoyed talking with you.[00:38:00]
[00:38:15] GR: So Cara, my tweet of the week is from Jason Riley from wall street journal. He’s been a guest here on our show and his tweet is from March 16th 21 2, and it says wealthy New Jersey. Governor Phil Murphy sends his own children to exclusive. Private schools, but wants to force low income black and Hispanic kids to attend some of the worst public schools in the state shame.
[00:38:38] As someone who has supported parental choice, both public and private going all the way back to 1991 I have seen this level of hypocrisy across the board. So Jason, thank you for keeping comments like this on the front burner. And guess what? It’s just not Democrats doing it. It’s Republicans as well.
[00:38:56] So Jason thank you for the tweet.
[00:38:59] Cara: It’s also [00:39:00] your local parents who send their kids to fancy private schools. And then question why anybody else should have a choice. So it’s, it’s systemic. Jason is amazing Gerard and we always thank him for his work. All right, now, Gerard, I’m gonna tell you.
[00:39:14] Who next week’s guest is, but also coming up after this, we have a treat. We’re gonna spend a couple minutes with friend of the show, wonderful human being Sephira Shuttlesworth. And so I know that you’ve got a couple of questions with her, but listeners before that, let me tell you that I hope you do join us again next week.
[00:39:31] And every week, next week on the learning curve, we are gonna be speaking with John Lewis Gaddis. He is professor of military and Naval history at Yale university and the pulitzer prize winning author of George F Kennan, An American Life. So Gerard we are gonna cut to one more treat of a conversation.
[00:39:53] I know you’re looking forward to it as much as I am, but let me say goodbye to you. Now, my friend have a great week. We’ll talk soon.
[00:40:33] GR: Hello listeners. Welcome back to The Learning Curve. Today is March 18th, 2022. It’s just not any day. In fact, it is the 100th anniversary of the birth of Reverend Shuttlesworth. Many of you know him as a civil rights icon. As an educator and as someone who helped change the face of American politics and policy in many unique ways and to talk about his life, [00:41:00] to talk about the role she played in helping do that, but also the work that she’s doing right now to address a different type of trauma in the United States.
[00:41:09] I want to welcome Dr. Sephira Shuttlesworth to the show.
[00:41:13] Sephira Shuttlesworth: Well, hello, good afternoon. And thank you for having me on. And yes, as you said today, would’ve been the 100th birthday of Reverend Fred Shuttlesworth. And if our listeners aren’t familiar with him, I invite you to Google him.
[00:41:28] He was an extraordinary American who to heart for humankind. And he spent the balance of his life trying to leave the world better than he found it. I am sitting here today thinking back over our time together. Fred and I were friends for 20 years, and then we were married for the last five years of his life.
[00:41:51] And, oh my gosh, what uh, ride? That was he was an extraordinary man who had some large ideas about what we could [00:42:00] do as human beings and what. Kind of work we could do together and how we could heal this land together. And the word together itself was huge. In his mind, someone asked me just the other day, what was his purpose?
[00:42:13] What was his motivating factor. And I said, love, it was good, old fashion love. And he would tell you to love the neighbor as you love yourself and do unto others as you would have them do unto you the golden rule. And as a young man, he said, he recognized that there was work that he needed to be doing, that he was called to do a special kind of work, and the Lord prepared him for that work.
[00:42:39] And as you will see, if you look further into his life, you’ll see where he was bombed and beaten and all of that. But at the end of the day he was able to be around to see our first black president to be elected to the United States. And so he got a lot of his just desserts before he transitioned on over to heaven.[00:43:00]
[00:43:00] GR: Well, speaking of the bombing, Cara and I earlier during show, her story of the week was about HBCUs that have had a number of bomb threats over the past several months. And the us department of education is investing money to help address that. And I mentioned, because I know of a story that you shared when we were on a panel together in Boston one time.
[00:43:21] I said, you know, black people have been bombed a lot. Yes. Even, just across the board. Would you mind sharing with our readers who were listening about the story of your husband? Him being bombed and walking out in the words he shared after he had come up from it.
[00:43:39] Sephira: It was his same favorite story to tell, but yes, basically Christmas night of 1957, I believe it was, he had preached, it was a funny, he had preached that day and he was lying in his bed sitting, talking to one of his deacons.
[00:43:55] He was in the bed, the deacon was sitting and talking and A bomb went off [00:44:00] and he said he knew what it was. He knew it was meant for him. And as the dust settled, he found himself lying on the mattress in a hole in the floor. So he was on the ground, the mattress was on the ground. And so he said he emerged, he got up and shook.
[00:44:16] The dynamite dust, blew the dynamite dust out of his nose. And he grabbed his coat, which was hanging on a wall now that it was leaning at a 45 degree angle. And so he got his coat and he put it on. He emerged from the back of the house. And by this time a big group of people had gathered and the front of the house and was trying to get to their pastor.
[00:44:35] And of course the police were there. The police were already there. And they were holding the crowd back. And so when he emerged around from the back of the house, people were gasping and went on. And he said he saw a big police officer standing there. He stood much taller than he did. And he said, the police officer looked at him and he rubbed his eyes as if there was an apparition.
[00:44:55] And he said, as I took one step forward, he’d take two steps back. [00:45:00] He said, so finally I stopped moving. He said, and I was standing there and he said, the police officer said to me Reverend, he says I know these people and I didn’t think they’d go this far, but if you don’t mind, I have some advice for you.
[00:45:13] And that is if I were, I’d get outta town as quickly as possible. And so Fred responded to him, he says, well, you’re not me. And you go back and tell your clan brethren that if the Lord could save me from this right here, I am here for the duration and the war has just begun. It was his favorite story to tell
[00:45:34] GR: well, thank you for telling it to our listeners.
[00:45:37] Absolutely. We are dealing with a lot of trauma today in the United States. A lot of it driven by challenges associated with COVID. It’s impacted students, teachers, families impacted businesses. You, as a leader, you as an educator yourself, you decided not just to talk about, about it, but to do something about it.
[00:45:55] So I’d love for you to share with us. what’s taking place with your new trauma program that you’re affiliated [00:46:00] with.
[00:46:00] Sephira: I will do that. You know, it all started with I had COVID December of 2020, I was diagnosed with COVID along with five other family members, including my 95 year old mother.
[00:46:12] And so of course, you know, when you get that diagnosis, you just, I don’t know, my mind just went into fight, fight. We’re fighting, we’re fighting this. And so fight we did. And we all emerged we lived and that was the thrill of it all. But the young man who was responsible for us getting it, who was a friend of my sisters, he had gone over and they were playing cards.
[00:46:36] And so she and her been got it and passed it off to the rest of us. And he was, gone in like five days. And so in the midst of it, when, , you’ve been diagnosed and the person you got it from is dead. Now that just. Exacerbates the fear and the stress associated with having the disease. And so then you just kick it into as high gear as possible.
[00:46:59] [00:47:00] For us, we started doing all kinds of research and eating things like sea Mo stuff that I don’t even know what it is, but , you know, we found out that those things, what you had to do with build your immune system. And so we worked hard , to build that immune system and to keep each other going and motivate each other.
[00:47:18] I’d go over and stand at my mother’s window, look through , her bedroom window and talk to her through the window because I wanted to make sure that she was fighting also. And so in my downtime, and I was thinking about, you know, what, this is just too much to ask almost of people, and I want to do something.
[00:47:37] I’m gonna make it out of this. And then the question becomes, how can I help others? What can I do? And I thought about the people in my profession, and I said to somebody, you know, Second in line to the first responders who I have the utmost respect for are the educators. I said, you know, I don’t know if anybody’s thinking about the educator.
[00:47:57] School is hard. It was [00:48:00] hard before the pandemic ever showed up. We had our struggles and I used to say, when I was reading schools, John Q, that has no notion of what it is we deal with in a day’s time. And so now add the stress of not knowing if you’re gonna be in school next week or not. You Sunday night, we’re gonna get that phone call.
[00:48:19] We don’t know what we’re doing. I don’t know if I’m supposed to report. If I’ve got little children, who’s gonna watch my child, all of the mountain stress. And then the children, I have a 12 year old grandson and , he’d come home sometimes go gram. So and so wasn’t wearing their mask today and he was standing too close to me.
[00:48:37] I, children are afraid. They don’t even know how to tell you that they’re afraid and they have every right to be afraid and fear and stress. If you carry it long enough, it becomes trauma. So I decided I need to find out who knows something about managing trauma. We need to help people with the trauma [00:49:00] that has been exacerbated by this pandemic.
[00:49:02] So I went in search and I found something called brain stimulated wellness, and it is a protocol whereby we teach the brain to respond before the mind can react to stress. When the mind reacts toque, we can get into all kinds of trouble, all kinds of places we didn’t intend to be. And we’ve got enough evidence of that, but we can teach the brain.
[00:49:25] If we know the different parts of the brain and how they respond, we can teach the brain and give it a set of event to choose from a set of techniques to choose from so that we can take down the stress and the trauma. And the, good thing about this program is there’s even a blood test. If you wanna see whether or not your stress level has been taken down, you can have your blood drawn.
[00:49:50] Have it looked at under a black field and. It will show you that while you’re stressed, your cells are [00:50:00] all different sizes and they’re jumbled up and they’re not moving in the direction they’re supposed to. In any of that, you can just see that they are out of order. And then you use the hand technique, what we call the hand technique, which is simply you take one hand and fold it over the other in a certain way that opens up the channels of your brain.
[00:50:22] So that wellness can get in and then you draw the blood again, look at it under the very scope. And what you’ll see is perfectly round, beautifully red and white cells, one red, one white, one red, one white, where they’re supposed to be doing what they’re supposed to be doing. And so it is fascinating work.
[00:50:44] This program has been in existence for over 20 years, largely in Canada and a few other places around the world. And they’ve won all kinds of Awards because not only is it a program about trauma, but we’re also looking at [00:51:00] how to help communities heal economically because our economics have gotten all skewed throughout this, pandemic also, but we can help businesses to lower their insurance costs.
[00:51:13] We can schools to get some of the things that they’ve always needed and needed more of by having a second income in place. And we can talk all about that as to anybody is interested, but here’s what I wanna close with. We have a program a series of videos called closing the door to suicide. I’m gonna say that again, closing the door to suicide because the trauma and stress by now has mounted in such ways that there are a lot of people who are considering.
[00:51:47] Just because of what we’ve been through. They’re considering making the pain stop but that’s not the best way we want you to think about who you will [00:52:00] harm if you take that. So anybody who is hearing my voice and who knows somebody who needs to hear this www dot, closing the door to suicide.com to date, we’ve had over 283,000 people to log on and to the information that is there, you’ll find videos that speak to teachers.
[00:52:27] And there’s one that speaks to college students and one that speaks to first responders. And so you just click on whichever one resonates with you and listen to that. As many times as you feel like you need to listen to it so that you can breathe to date. We have not had anybody out of 234,000 plus people to commit suicide.
[00:52:54] So basically what I’m here to do is to save lives. I’m more working with [00:53:00] the program that helps you to gain wellness while you’re here and to save your life in the event that you were thinking about not being here.
[00:53:11] GR: Well, Dr. Shuttlesworth, thank you so much. First of all, for your commitment to education across the board.
[00:53:17] Thank you for sharing the great work you’re doing with this program, but also thank you for keeping alive, literally and figuratively through your life, through your words and through your action. At a point in American history, we don’t see enough examples of this. You’re a living example of it. So thank you for being a friend to The Learning Curve.
[00:53:36] Oh,
[00:53:36] Sephira: absolutely. Thank you so much for having me on take care.
Related Content
Exploiting Charity Drugs: Hospital Program Earns Billions But Forgets Mission
/in Blog: Healthcare, Featured, Healthcare, Podcast Hubwonk /by Editorial StaffHubwonk host Joe Selvaggi talks with Pioneer Institute’s Dr. Bill Smith about his recently released paper entitled, “340B Drug Discounts, An Increasingly Dysfunctional Federal Program,” which analyzes the evolution of a well-intentioned program to offer discounted drugs to the uninsured from a benefit that had helped charitable hospitals to one that has exploded to generate billions in profits while serving fewer uninsured.
Guest:
William S. Smith is Senior Fellow and Director of the Life Sciences Initiative at Pioneer Institute. He has 25 years of experience in government and in corporate roles, including as vice president of public affairs and policy at Pfizer, and as a consultant to major pharmaceutical, biotechnology and medical device companies. He held senior staff positions for the Republican House leadership on Capitol Hill, the White House, and in the Massachusetts Governor’s office. He earned his PhD with distinction at The Catholic University of America (CUA).
Get new episodes of Hubwonk in your inbox!
Read a Transcript of This Episode
Please excuse typos.
Joe Selvaggi:
This is Hubwonk. I’m Joe Selvaggi.
Joe Selvaggi:
Welcome to Hubwonk, a podcast of Pioneer Institute, a think tank in Boston. In 1992, a well-intentioned targeted program named 340B required pharmaceutical companies to provide eligible hospitals with drugs at a substantial discount for the benefit of uninsured patients. Those hospitals were then to use any savings and profits from the program to provide comprehensive services for the poor and uninsured since its inception. However, healthcare systems have exploited the statutes guidance to re billions in profits by purchasing 340B drugs at a discount, and then selling those deeply discounted drugs to insured patients at retail prices. Perhaps more disturbing is a trend that while 340 B program profits have so access to discounted drugs and charity programs for the uninsured have been in steady. The numbers involved in this distorted drug program are staggering. Now exceeding the value of both the Medicaid drug benefit and Medicare part D how did this worthy program get so distorted and how can policy makers reform 340 B in a way that realigns incentives to better serve the uninsured?
Joe Selvaggi:
My guest today, Pioneer Institute’s senior fellow in life sciences, Dr. Bill Smith, who will talk about the findings of his recently released paper entitled “340 B discounts: An increasingly dysfunctional program.” In the paper, Dr. Smith describes the arc of how this well-intentioned program seems to have lost its direction and grown to generate massive profits for hospitals while sign simultaneously reducing drug benefits and charity programs for the uninsured, Bill will offer his views on what legislatures can do to realign program incentives, to better guarantee the uninsured receive their drug benefits and ensure the profits from the program go toward our poorest citizens. When I return, I’ll be joined by Pioneer Institute’s Dr. Bill Smith.
Joe Selvaggi:
Okay. We’re back. This is Hubwonk. I’m Joe Selvaggi, and I’m pleased be joined by Pioneer Institute’s visiting fellow in Life Sciences, Dr. Bill Smith. Welcome back to Hubwonk, Bill. Thank you, Joe. Glad to be here. Great. Well, bill, I found your recently released Pioneer report entitled 340B Discounts: An increasingly dysfunctional program. I found it somewhat alarming. I want to set the stage for our listeners that we’re talking about a federal program designed to help low-income uninsured people with medication. And it’s largely been exploited by the medical community to reap literally billions in profits with little of those billions going to, to where the statute was intended. So there’s a lot to unpack in your paper. So let’s start with some history. Let’s start at the beginning. What was the original idea behind 340B? And when did the program begin?
Dr. Bill Smith:
Well, it, it actually didn’t begin as a federal program. It just began when a number of drug companies, many drug companies actually started giving deep discounts to hospital that treated a large number of uninsured, low income patients. The drug companies knew that those hospitals would, were struggling financially. And so they made voluntary concessionary discounts available to them. And in 1992, the federal government decided the Congress decided, well, we’re, we should, we’re gonna make this program mandatory. So we’re gonna require the drug companies give discounts to hospitals to treat large numbers of low income or uninsured patients. And, and, you know, the program started out fine. I would’ve supported it in 1992. It, it, it targeted about 500 hospitals and clinics around the country. It was limited and, and it was largely limited to, to those hospitals and, and clinics that did treat large numbers of low income uninsured, but starting in about 10, 15 years ago, the program absolutely exploded.
Dr. Bill Smith:
You become eligible as a hospital for, to become eligible for these three 40 B discounts based on the number of patients, you Medicaid patients, you treat the federal government and the Congress thought that’s a proxy for your treating low income or uninsured patients. And when they expanded the affordable care act and Medicaid exploded in the number of patients, many, many more hospitals became eligible. So the program started out about 500 hospitals that now has about 2,500 hospitals. And those hospitals have expanded to satellite offices. So they’re now 37,000 covered entities in the program.
Joe Selvaggi:
So your your paper does suggest that much of the reason has exploded. And the eligibility has expanded is owed to the vaguery of the, the statute. You know, as you mentioned in your paper, it was originally designed to target quote unquote covered entities, but left it to the, the system itself to infer who was covered, say more about how these vagaries are easily exploited.
Dr. Bill Smith:
Well, let me first explain why the program is so popular with hospitals and why it exploded. So under the three 40 beat program, you can get a substantial discount when you purchase a drug. So let’s say a hospital just to, to make it simple. A hospital can, can purchase an oncology drug for $25,000. When this price of that oncology drug is a hundred thousand dollars. So they’re getting a 75% discount. So if you, as a, as a hospital administrator can lure into your hospital or to your satellite office, a patient that’s that has insurance and is wealthy. You can dispense that drug to that patient for $25,000, and then bill his insurance company, or Medicare for a hundred thousand dollars, and you can pocket the $75,000 spread. It, it, this is basic arbitrage. It, it happens in many areas of business, but this three 40 B program is now being arbitrage. And the, the statute getting back to your original question, the statute was written in poorly. So the program is not limited to only dispensing drugs to low income patients or in low income neighborhoods or to uninsured patients. So it there, the statute didn’t define anything about who’s eligible for the program and who might share in these, these dis drug discounts.
Joe Selvaggi:
I see. So now you said as growing substantially since its inception in your first answer, you did say the original program used medicaid patients as a proxy for implying that hospitals located where there are lots of Medicaid recipients and in inferred from that that there also must be lots of charity cases. Describe for our listeners, where were these original three 40 B participant hospitals, where have they, you know, sprung up now? Who, who who’s joining the system from where it used to be?
Dr. Bill Smith:
Yeah, so originally, Joe, that’s a good question. Originally these hospitals and clinics were in low income areas, both rural and urban areas that treated large numbers of low income patients. But since 2004, there’s a substantial data to suggest that a lot of these hospitals and their satellite offices are being located in wealthier areas that have higher rates of insurance. And, and that’s part in part due to the fact that they can arbitrize the drug discounts. So they wanna get patients in there that have Medicare or commercial insurance coverage as then they can bill for the full price of the drug, why they buy the drug at the discount.
Joe Selvaggi:
Now, your paper we, we’re talking about a program that was originally intended to help people who didn’t have insurance now in the, in the in the meantime, we’ve passed the affordable care act, it’s stated intent and it’s effect, I think has been to have more people become insured, both low income or people who had formally been on Medicaid or uninsured altogether. So if we have fewer people who would be in theory eligible for three 40 B benefits, did we see a decrease in the amount of three 40 B activity once the affordable care act was implemented,
Dr. Bill Smith:
Joe, just the opposite, you know, in 2012, there were only, there were 54 million people covered under Medicaid. And this year there are 83 million people covered under Medicaid. So the number of people insured has grown substantially. The number of uninsured has dropped dramatically. One would’ve expected given that the three 40 B program was supposed to treat the uninsured one, would’ve expected that the three 40 B program would’ve declined over the past decade, just the opposite that’s when it had its most explosive growth over the last decade. So it’s up to about 38 billion in sales and the three 40 B program will soon eclipse in size, both the Medicaid prog drug program, which has 83 million recipients and the Medicare Medicare part D program, which has over 50 million recipients and their senior citizens who tend to use a lot of drugs. So this, we made the longish talking about a three 40 B program that nobody really knows about, but it’s now the largest federal drug program in the, in the United States.
Joe Selvaggi:
Yeah, the numbers are staggering when you compare it to what we already consider fairly costly programs, Medicaid and Medicare part D to eclipse those programs is, is, is saying something. So I think that’s why this, this a program deserves our attention now. Let’s set aside that despite the fact that the ACA is, has more people insured and therefore one would think the byproduct of that would be fewer three 40 B claims. They went up. So that means hospitals were generating more money from this program than they had before the ACA another feature of that three 40 B, I don’t think we’ve addressed is that the program was supposed to help hospitals use the savings they get from those discounts and apply those to programs for charity. In other words, there chart supposed to take the benefit and apply that benefit to charitable patients. Have we seen an increase in the amount of money that hospitals are given to charity owing to their, you know, this windfall of, of a program?
Dr. Bill Smith:
Yeah, Joe, just, just the opposite. We’ve seen charity care decline, and it would’ve been very difficult for me to write a paper are critical of the three 40 B program had the billions of dollars that this program is generating, been devoted to programs for low income and uninsured, but that’s just not the case. I, I don’t wanna pick on mass general because they’re excellent hospital. They’re part of the whole life sciences ecosystem here in, in, in the greater Boston area. But in 2013, they were spending 3.8% of their revenues on charity care for low income people. And in 2020 that dropped to 1%, it’s been a straight line down as it has in many hospitals. And at the same time, they’re, we know that they’re expanding their three 40 B presence. They, they had one pharmacy dispensing their, their three 40 B drugs in 2017.
Dr. Bill Smith:
They now have 132 pharmacies ex dispensing their three 40 B drugs. So we know the revenues are growing. They’re not required to disclose the amount of revenue they’re getting from three 40 B, but it must be explosive if you’ve gone from one pharmacy to 132 pharmacies and mass general has expanded. They have offices now in some of the wealthiest towns in, in Massachusetts, Wellesley Concord, Walham Newton they even have offices in Nashville, New Hampshire and York Maine. So part of the reason for this growth is that they can leverage these three 40 B discounts in these areas. So it’s, it’s a troubling thing, particularly because the charity care numbers have been declining.
Joe Selvaggi:
I found a striking feature of your paper in that that originally the three 40 B was going to hospitals that did more charity work. Your paper are points to the research that indicates that what these newer hospitals, these bigger hospitals, I don’t wanna throw the mass general under the bus, but when compared with those hospitals that don’t participate in three 40 B in theory, those that don’t do substantial charity work, there’s actually less charity work being done in three 40 B hospitals. Then there are, and three 40 B hospitals, which is to say, there’s no correlation between one’s inclination to exploit three 40 B and one’s inclination to serve charity cases. This is very troubling. Say more about this phenomena.
Dr. Bill Smith:
Yeah, that’s, that’s precisely right that their, their are studies to suggest that three 40 B hospitals give less charity care than either government or for profit hospitals. And one would expect given the revenues that are generated from three 40 B program, which are estimated to be 40 billion for these hospitals, that the, the nonprofit three 40 B hospitals would be dispensing much more charity care, but the data suggests that’s not true.
Joe Selvaggi:
Well, you break down three types of hospitals, I suppose. I’ve never thought of this way, but there’s for profit, nonprofit and government. So for profit is supposed to be the bad guys, I suppose, in a, in a modern narrative nonprofits, the good guys your paper suggests that nonprofits are in measurable terms, doing the least amount of charity work when compared with for profit and go from in hospital, say more about that data.
Dr. Bill Smith:
Yeah. And I don’t want Joe, I don’t wanna cast the, the, I don’t wanna paint with too broad a brush here because we did find hospitals in urban areas in the Boston area, such as Boston medical center and Cambridge hospital Everett hospital that were, they were giving out a huge amount of charity care, you know, more than 10% of revenue, some years unlike mass general and, and, and UMass Memorial in Wooster and bay, state, and Springfield where the numbers are closer to 1%. So it there’s some hospitals in clinics that are really doing the Lord’s work when it comes to charity care. And so I don’t wanna paint with two broader brush, but on average charity care has been declining at these nonprofit three 40 B hospitals, which one would not have expected given the growth in the program.
Joe Selvaggi:
Sure. And you mentioned briefly that the the, the 340 B programs are, are branching out to smaller more affluent communities, but you know, local community physician groups themselves, how does the three 40 B program interfere with community physician practices?
Dr. Bill Smith:
Well, to be Frank, the hospitals are just buying up community based per practices. 51% of the community based oncology practices are now vertically integrated into a hospital system because they’ve been bought up. And the reason they’ve been bought up is obvious because in neurology and, and oncology, and, and in those specialty areas where you you’re dispensing expensive drugs the, you can keep the spread as a hospital system. And arbitrize the, the three 40 B discounts when you purchase an oncology practice and bring in a huge amount of revenue. So this is troubling because people like community based practices, they don’t want ’em to see their local community physician practice being bought up by a hospital. But it’s also the case that once these, these practices are bought up, there is an incentive not only to prescribe more drugs, but to prescribe more expensive drugs, because you’re going to be able to leverage those discounts. So it, it, it’s not great all the way around. And and you know, the, the, the oncology community is well aware of this problem. And, and they’ve been fighting back trying to avoid these, the purchase of these, some of these community based clinics.
Joe Selvaggi:
So if I’m someone who enjoys you know, a community physician practice somebody say, oh, I I’m in different to who owns, or how in vertically integrated my system is my doctor is, but what your paper points out is once it does join this integrated system, everything in that practice becomes substantially more expensive, not unlike where that practice to move into the city. The, the drugs, the physician visits, all go up in price. And you also mention in your, in your remark that given that the hospitals arbitrage, the difference between what a it’s, it’s a percentage base the more expensive the drug, the greater the discount, the greater, the profit, there’s a, a clear incentive to raise drug prices based on the difference between the retail and the three 40 B discount.
Dr. Bill Smith:
Yes. And, and, and again, it’s not just drug prices that go on overall healthcare costs in the hospital setting is, are more expensive generally. And so you know, I’m very sympathetic to hospitals. My sister’s a hospital administrator in New York, and I know it’s a difficult business, but it is more expensive to treat somebody in a hospital setting or a hospital satellite office than in the com community based physician practice. That’s just the reality. And so this expansion of hospitals into wealthy suburbs is gonna drive up healthcare costs and is driving up healthcare costs.
Joe Selvaggi:
So I sort of the icing on the keg before we shift gears into what you recommend as perhaps a, a useful remedy for many of these perverse incentives you, you describe a case whereby when combined with a Medicaid rebate, a drug company that sells a drug. I think you use a, a, you know, for instance, a hundred dollars drug that winds up costing the, the manufacture money to sell the drug, which seems unbelievable. But you know, many people like to trash to the reputations or, or incentives of drug companies, but to have a system whereby a drug company loses money for every pill sell to say more of how three 40 B and the Medicaid rebate might combine to make a negative a margin.
Dr. Bill Smith:
Yeah. So it’s, it’s, it’s simple, it’s called, it’s a problem called duplicate discounts, which were banned in the original statute. It’s actually a violation of federal law for a pharmacy to, to obtain duplicate discounts. So let, let’s say you you get it, you buy a drug at, at $25 which is the 340 B price. And then it, the, the patient goes to the pharmacy and the, the drug is purchased. And then the pharmacy bills, the drug manufacturer for a $35 rebate, the, the company now has just lost $10 on that sale because the they’re getting bill the three 40 B discount as well as a Medicaid rebate. And this is a common problem. It’s in the hundreds of millions of dollars, probably that these duplicate discounts happen every year. And it, again, it was banned in federal law. And one would think with our current software systems, they’d be able to solve this problem, but they haven’t and inspectors general, and also sorts of people, the justice department, others have, have come back and said, you gotta solve this problem, but they have not.
Joe Selvaggi:
Indeed, indeed. All right, so let’s, let’s stop piling on we, we established a three 40 B has created some perverse incentives and those of us who pay into this health system are all poorer for it. Let’s figure out how to, what you would recommend as, as reasonable steps towards finding some remedy or solution to this first. You you would recommend that we require hospitals to revol report three 40 B revenues. It seems odd, odd that we don’t already do that, but say more about why that’s important.
Dr. Bill Smith:
Well, that’s important because they, they do report. Although the definition of charity care needs to be tightened up, they do report in their Medicare cost reports, the amount of charity care that they dispense. So if we knew what they were securing in revenue from the three 40 B program, we could compare that with the amount of charity care that they’re giving out each year. And one, one would expect there’s a great disparity between the two numbers these days. And, you know, the transparency might shame them into spending more on charity care, which would be a good thing.
Joe Selvaggi:
Indeed, indeed. Now those presumably the it’s a positive number, the difference between the money they get from three 40 B and the money they give in charity care you would want to, your second recommendation is to require those covered entities to spend that money, that profit on charity care. That seems reasonable. Is that what you’re saying?
Dr. Bill Smith:
Yeah, that’s a, it’s a more directive than just the transparency option, but you could require that all revenue that’s secured from through the three 40 B program must be spent on community programs that serve low income and uninsured patients it’d be that simple. Right now we don’t know where all that revenue goes. It could go to hospital salaries. It could go to who knows, could be go to expanding the building. We, we don’t know where the money goes now. And requiring it to go to charity care would be a, a boom to charity care around the country.
Joe Selvaggi:
Indeed. That’s how it was intended. So it ought to go to the charity. You also want to better define who is eligible for the discounts and, and the charity care, which you addressed early in the paper that remarkably it doesn’t specifically define who should be eligible.
Dr. Bill Smith:
Yeah, I, I’m not sure why a three 40 B drug should be given to a millionaire in Wellesley. I just don’t, I don’t think that fits the, the, but that is happening. That is happening now. I, I don’t think that fits the original spirit of the program and the statute needs to be tightened up, so that doesn’t happen
Joe Selvaggi:
Indeed. And, and that that’s a, that dovetails well, well, with the next point, which disqualified three 40 B child sites, because satellite sites were using that term in wealthy communities. I’ll just say, let me qualify this. I’m sure there’s some low income people in wealthy, probably not many, but we keep going there. But let let’s, let’s say let’s use that example again. Why, why would we disqualify the three 40 B sites in, in wealthy communities? Well,
Dr. Bill Smith:
You, you know, charity care arises many times spontaneously, you know, it’s, it’s the homeless person who finds himself in the emergency room and doesn’t have insurance and, and the hospital has to eat the cost of that care. And so if you’re locating your satellite offices in wealthy neighborhoods where people have higher rates of insurance, you’re not gonna get that spontaneous charity care happening. So I, I think they ought to limit the, the places where these three 40 B sites can be to areas that are considered somewhat impoverished in the United States. And I, I don’t want to come up with an exact definition of impoverished, but it should be an areas where you are gonna get those walk in patients who aren’t insured and are very low income. And that originally when they first enacted this program that was happening, these, these, these hospitals and clinics were located in these areas. And there are some that are still located in these areas, but with the expansion they’ve more and more expanded this program into wealthier area is they have higher rates of insurance.
Joe Selvaggi:
And I think on the flip side of this is your next recommendation, which is not, not only define who is eligible, but when we’d say let’s take that money and give it dedicated to charitable programs, we should define what charitable programs look like and what community programs look like. We, we still haven’t done that.
Dr. Bill Smith:
Yeah. The definition’s not as tight as it should be. So for example, if a middle class patient comes in and they owe a deductible or a co-insurance payment on whatever treatment that they were given in the hospital and they never pay that, is that charity care. Well, some, some hospitals do define it as charity care because they’re eating the cost, but the patient is probably can afford the co-insurance payment and chooses not to pay it. So maybe it’s not charity care. I just think they, they should tighten the definition so that these are programs that are serving underserved populations.
Joe Selvaggi:
Also of course, want to reform how hospitals become eligible for this program. You wanna reform the disproportionate, share hospital, eligi eligibility requirements for the program and a sense, I think you’re implying that some hospitals ought not to even be in the program.
Dr. Bill Smith:
Yeah. You know, as, as we discussed, you know, when the affordable care act expanded Medicaid drug, I think it’s, it’s 11.75% is the, the percentage of Medicaid patients that you treat, you become eligible for it to become a three 40 B hospital. Once you cross that 11.75 threshold. And it’s clearly the case that some hospitals have lure in Medicaid patients to get to number obtained three 40 B status, and then not gone further their, their Medicaid patient numbers are still at that level. So they’re gaming the system to some degree, not all hospitals, but some hospitals, for sure. So I, I think they ought to look at Medicaid as a proxy for treating low income patients. I, I’m not sure is, is a workable definition any longer given the expansion of Medicaid. And they may be ought to look at other numbers like how much charity care they give out that that could be a threshold that, that makes you eligible for three 40 B status.
Joe Selvaggi:
That would be something to, to earn that status based on how much good you do rather than, and how many Medicaid people you lure in
Dr. Bill Smith:
Precisely.
Joe Selvaggi:
And the final one. I’m, I’m not sure, I, I know precisely why this is a benefit, but you suggest we should convert three 40 B programs from discounts to rebates. I guess there must be, then it must be conditioned that rebates conditioned on proof that it’s being used for the right thing. Yeah.
Dr. Bill Smith:
It’s, it’s complicated, but the rebate system would avoid the problem that we discussed with duplicate discounts, because you could, you’d have a little time to figure out who was a Medicaid patient and who wasn’t before you wrote the check who was getting a three 40 B drug and who wasn’t. And so the rebate system would help, would help solve that problem. It it’s a very, the pharmacy transactions are extremely complicated. But I’m told by people who know them well, that a rebate system would, would solve the duplicate discount problem.
Joe Selvaggi:
All right. So those are your recommendations. But our listeners may think, okay, this is fine, but you know what? We’re here in Massachusetts. We’re the good guys. Our hospitals are above reproach. But you name names in the end of the report and not all Massachusetts hospitals come out wearing the white hat, I guess. So let’s let’s name names, and talk about where, where we see problems and where we’ll call out. Some other hospitals for are doing a, a terrific job. But before we name names how do you measure you, you, you, you, you talk about in your report, who’s really not using the money for charity work. How do you measure charity care provided in a given system, in any given hospital?
Dr. Bill Smith:
Well, in our we looked at Medicare cost reports that hospitals have to file every year with CMS, the, the federal Medicaid, the Medicare Medicaid agency, and they’re required to report their charity care numbers based on their revenues. So what we did in the report is we, we picked five hospitals, randomly. We picked by geography. We wanted to see how across the state charity care was being given out. So we picked mass general in Boston. We picked UMass Memorial in Worcester. We picked bay state in Western mass. We picked Berkshire hospital system in the Berkshires and south coast hospitals in, in, in the, on the Cape. And what we found is those, those hospital systems were not PA picked in advance based on their charity care numbers. We hadn’t even looked at the charity care numbers, but what turned out to be the case is for all those five hospital systems that charity care numbers are a straight line down from 20 13, 20 14 to, to this year. So, so that’s a problem. And again, we didn’t wanna dust up all hospitals. So we looked at the numbers and we found there were, there were hospitals like Boston medical center and Cambridge hospital and Everett hospital that were giving out large amounts of charity care based on revenue. So again, I, I don’t wanna paint with too broad a brush, but in our random sample, based on geography, all the charity care numbers were down.
Joe Selvaggi:
So let’s put that in the enumerator, the denominator then is, is how much the program has grown in Massachusetts. You said some numbers, I don’t know if you have them, your fingertips, how in the last eight, 10 years the money’s grown, you’ve established that the money given to charity by those hospitals from the 340 B has been going has been going down, but the revenue coming in from 340 B has grown, can you put a, a fine point on how much it’s grown in Massachusetts?
Dr. Bill Smith:
Well, we don’t know because the hospitals aren’t required to disclose their revenues, which is one of their from 340 B, but we know nationally the program has grown from about 9 billion in 20,000, 2009 to 38 billion last year. So given that Massachusetts’ hospital intensive one would think they were reaping the benefits of that. And as I said, mass general only had one pharmacy in 2017 that dispensed three 40 B drugs, and now it has 132. So I think we can say with a high degree of confidence that revenues from the three 40 B program have exploded. We just don’t have an exact number because they’re not required to disclose
Joe Selvaggi:
All the money going to charity has been going down across the board by my reckoning, the money coming in from three 40 B across the country has back of the napkin quadrupled or seen a 400% increase over the last what do we see eight years that’s
Dr. Bill Smith:
Yes. And, and the 38 billion in actual sales, that’s the discounted sale price. But one economist did a study arguing that, that, that 38 billion in sales leveraged an additional 40 billion in revenue for the hospitals. So this is a huge program. You know, 78 billion in money is flowing through this program according to some estimates.
Joe Selvaggi:
Yeah. We can’t you know, go through all the findings of all the hospitals that you, you, you name, but let’s, let’s start with you mentioned mass general a few times. So let’s, let’s get to it. How, how did so-called man’s greatest hospital fair in your study when comparing its its revenue to its its expenditure?
Dr. Bill Smith:
Yeah. In, in 2013, based on the Medicare cost reports, mass general was devoting 3.8% of their revenue to charity care, which is a fair number. It’s not real high, but it’s fair number. And in 2020, their, their charity care number dropped to 1% of revenues. So it’s declined substantially. And we found that in the other four hospital systems around Massachusetts and as I said, one would expect that their three 40 B revenues are, are exploding because they’ve gone from one pharmacy to 132 pharmacies are dispensing three 40 B drugs. I, I just would like to see the numbers on, on their revenue from three 40 B and what it’s been over the past decade or so
Joe Selvaggi:
This is all interesting because I think adding to perhaps our listeners’ outrage is in, in the time between our two, four, 2014 and now the affordable care act is you know, is taken hold, which in theory would mean fewer people are uninsured. We know that that to be true so that this shifts from higher 340 B claims and lower charity is with the backdrop of saying there are a few people who ought to be eligible. So the hospitals have to either claim the, that there are more charitable patients despite ACA, which seems impossible or less need for charity despite the fact that their claims are going through the roof. Am I right?
Dr. Bill Smith:
Yes. in one study concluded, there’s an inverse relationship between charity care and growth in three 40 B programs, an inverse relationship as three 40 B grows, charity care declines was the conclusion of this one study which I, I think is unsupportable. I just you know, again, it would be hard to criticize the size and scope of this program. If all of this money, we we’re going to charity care, treating homeless people, uninsured people providing mental health services, doing whatever for patients that are really in need, but that doesn’t seem to be the case.
Joe Selvaggi:
This is a real shame. More than a shame I say, you know but let’s, let’s not call everybody out. We, we actually have some good actors in your, in your group that you say you chose randomly. There were some good actors who, who, who are have a high fidelity to their charitable mission. You call out Cambridge health Alliance and Boston medical center. What, what, what do their numbers look like?
Dr. Bill Smith:
Yeah, again, their numbers, weren’t a straight decline from 2013 to the present. It, they went down some years and then back up some years, but they were substantially higher, even 10 times higher than some of these other hospital systems. So I, I think there are some hospitals that are doing right by this program. And I also have the impression that there are a lot of clinic Ryan, white clinics, federally qualified health centers and, and smaller clinics that are located in very difficult, challenged neighborhoods that are providing great service. And they need these three 40 B discounts. And, and I, I don’t want this program to go away and I, I didn’t write the paper to say the PA the program shouldn’t exist. It just needs to be tightened up. And the people that really need these discounts should continue to get them. And the people that don’t shouldn’t
Joe Selvaggi:
Indeed. So where now we’re getting close to the end of our show, where can our listeners find your paper?
Dr. Bill Smith:
Well, pioneer pioneer institute.org. The pioneer institutes website has both the press release explaining the pro the the paper as well as the link to the paper itself. And it’s about 15 pages or so it’s not, it’s not burdensome to read.
Joe Selvaggi:
No. And I went deep into some of the footnotes copious number of footnotes also, which, which is good, supporting your, your observation. Now our listeners, again, this I’ll use this as our last question. Our listeners are, are our thinkers. They like think tanks, what they like to do. What would you suggest? I mean, you’ve laid out what, what let’s say lawmakers can do, would would you recommend that our listeners, if they’re persuaded, maybe, maybe they maybe some of our congressmen are listeners to the show, but those who are, are voters, what would they do if they want to encourage their legislator to, to, to jump on this out of you know, out of compassion for the poor and the desire to see this substantial amount of amount of money go to the right place? What should they do?
Dr. Bill Smith:
Yeah, I, I, I, I, I’m big on transparency. I think both on the state and federal level, there should be some disclosure on the part of hospitals about the amount of revenue they’re securing from the three 40 B program you know, requiring them to spend it on charity care, maybe, maybe not, but definitely disclosure and transparent. And, you know, if I were just an ordinary citizen meeting with my legislator, I’d say, well, how come, I don’t know how much mass general is getting from this program and how much they’re spending on charity care. And let’s look at the differential between those two, two numbers,
Joe Selvaggi:
Indeed. Transparency or sunshine is the best disinfectant. At the very least. We might be able to shame these hospitals into giving the money they’ve been given as charity themselves. It intended for charity. Make sure if they’re getting it we can then reasonably ask, well, what are you doing that money? Do I have that right?
Dr. Bill Smith:
I, I agree a hundred percent. I transparency you know, I’m not a big government guy. I don’t want the government to be, be directive on everything. But just knowing the amount of revenue that are flowing into these hospitals from this 340B program, and then comparing it on the amount of community programs for low income and uninsured, that would be a valuable data point.
Joe Selvaggi:
Wonderful. Well, let’s end our show there. Thank you again for being on Hubwonk, Bill. You’ve been great.
Dr. Bill Smith:
Thank you, Joe.
Joe Selvaggi:
This has been another episode of Hubwonk, a podcast of Pioneer Institute. If you enjoy today’s episode, there are several ways to support the show and Pioneer Institute. It would be easier for you and better for us. If you subscribe to Hubwonk on your iTunes podcast, catcher, if you’d like to help make it easier for others to find Hubwonk. It’s always welcome. If you want to offer a five star rating or a favorable review, we’re always grateful. If you share hub won with friends, if you have ideas or comments or suggestions about future episode topics, you’re welcome to email me at hubwonk@pioneerinstitute.org. Please join me next week for a new episode of Hubwonk.
Related Posts:
Attorney – PioneerLegal
/in Featured, News /by Editorial StaffBoston, Massachusetts
Type: Full Time (schedule flexibility available in appropriate situations)
Experience: Mid-level and beyond, including recently retired.
What is PioneerLegal?
PioneerLegal (“PioneerLegal”) is a non-profit, nonpartisan, public interest law firm that through advocacy and litigation promotes inclusive educational and economic opportunity and open, accountable government. PioneerLegal works to preserve and enhance liberties grounded in the constitutions and civil rights laws of the United States and the individual New England states.
Organized in 2021 by a group of prominent lawyers and business leaders, PioneerLegal is affiliated with The Pioneer Institute, a research foundation based in Boston with a broad public interest mission that embraces reform and innovation in health care, public transit, education, immigration, civil rights and public governance. Governed by an independent board of directors, PioneerLegal will pursue high impact, cutting-edge cases that advance educational quality and opportunity for all students, especially those in underserved areas, open and accountable government, and enhanced economic opportunity for all, especially lower income and immigrant communities.
Why join PioneerLegal?
For all its rewards, law practice can be narrow and limiting. PioneerLegal offers attorneys, especially those at the beginning and end of their careers, the opportunity to step outside traditional professional boundaries and to focus on matters infused with a broad, public, intensely human impact. Attorneys, interns, fellows and staff at PioneerLegal will, through a variety of endeavors, open doors to opportunity for those most in need of it, and open windows on otherwise hidden government practices controlled by special interests. Working closely with outside pro bono counsel from leading law firms, our attorneys, interns and fellows will deploy and enhance their skills through case identification and development, direction of legal strategy and collaboration with a wide variety of subject matter experts.
Our lawyers will work on cases at every stage of the litigation process, from trial to appeals in state and federal court, and a regular part of our activities will include preparation of amicus briefs for the U.S. Supreme Court (where Pioneer Institute already has a winning track record) and the highest appellate courts throughout New England. And beyond a steady stream of amicus briefs for submission to trial and appellate courts, we will perform legal and factual research to identify litigation opportunities that align with our mission, with our attorneys developing case proposals for our litigation intake review process.
We are dedicated to developing a close and professional team culture with our board, affiliated pro bono external counsel, like-minded organizations, and our staff. As we are a public interest law firm, our attorneys also will be encouraged to be active outside the courtroom, including media writing and appearances, and public speaking. Active membership in state and national bar associations will be supported and encouraged.
What skills and achievements are we looking for?
How can I apply?
Submit a resume, a cover letter, a 10-page writing sample and, if admitted to practice in past five years, a law school transcript. In your cover letter, be sure to tell us why you are right for PioneerLegal’s special mission and why PioneerLegal is right for you at this point in your career.
What about compensation, benefits, and general perks?
Compensation is commensurate with experience and exceeds many other legal non-profits and comparable government pay scales. PioneerLegal also offers superior benefits including medical, dental, long-term disability, 401K retirement plan and paid leave. We also offer flexible work-day schedules, including regular work from home and other remote work location opportunities.
Applications should be submitted on or before May 6, 2022, to Mary Connaughton at mconnaughton@pioneerinstitute.org
PioneerLegal is an equal opportunity employer.
NYU’s Dr. Arthur Levine on Higher Education’s Future & Improving K-12 Teacher Preparation
/0 Comments/in Civil Rights Podcasts, Featured, Podcast /by Editorial StaffThis week on “The Learning Curve,” co-hosts Cara Candal and Gerard Robinson talk with Dr. Arthur Levine, a scholar with New York University’s Steinhardt Institute for Higher Education Policy, a senior fellow and president emeritus of the Woodrow Wilson National Fellowship Foundation, and president emeritus of Columbia University’s Teachers College. He shares the main findings and recommendations of a new book he recently co-authored, The Great Upheaval: Higher Education’s Past, Present, and Uncertain Future. He discusses some of the key issues of academic quality, technology, administration, and cost in American higher education today, before and after COVID-19. He also offers thoughts on the role of teacher preparation programs in delivering better academic outcomes for students of all backgrounds. They explore how schools of education can be reformed to better prepare teachers with both the wide background knowledge and practical experience necessary to boost student achievement, and how they can achieve the stellar reputations enjoyed by law and medical schools. The interview concludes with Dr. Levine reading from his recent book.
This episode also features a shorter interview with Dr. Sephira Shuttlesworth, to commemorate her late husband, Civil Rights activist Rev. Fred Shuttlesworth, who would have turned 100 on March 18th, and share her current work to help students recover from trauma.
Stories of the Week: U.S. Education Secretary Cardona will award grants to enhance security measures at Historically Black Colleges and Universities (HBCUs), after 30 have been targeted with bomb threats over the past three months. Intel announced plans to invest $100 million over the next decade into Ohio schools and research collaborations with universities, community colleges and technical educators to develop skilled workers.
Guest
The next episode will air on Weds., March 30th, with John Lewis Gaddis, the Robert A. Lovett Professor of Military and Naval History at Yale University, and the Pulitzer Prize-winning author of George F. Kennan: An American Life.
Tweet of the Week
News Links
Education Department will provide grants for HBCUs targeted by bomb threats
https://www.npr.org/2022/03/16/1087028271/education-secretary-cardona-on-grant-funds-for-hbcus-after-recent-bomb-threats
Intel announces details of plan to invest $100M into education
https://thehill.com/homenews/state-watch/598598-intel-announces-details-of-plan-to-invest-100-million-into-education
Get new episodes of The Learning Curve in your inbox!
Read a Transcript of This Episode
Please excuse typos.
[00:00:00] GR: Hello listeners. This is Gerard Robinson saying hello again from beautiful Charlottesville, Virginia, where a week ago it was snowing. And right now it’s 70 degrees. And we are celebrating the Virginia festival, the book with people from all over the country who are here. And some of these people may one day find themselves on the learning curve.
[00:00:45] But of course, no matter what day it is in Virginia or what day it is in Massachusetts, we cannot have a learning curve without the person who always hits the ball out of the park. When a curve is coming, Ms. Cara.
[00:00:57] Cara: Oh, that you thought about [00:01:00] that one. you know what, I’ve never hit a ball out of the park in my life jar.
[00:01:04] GR: Sure.
[00:01:05] Cara: My eight year old could do it. here, you are celebrating, what did you say? The festival of the book, something, something area. Right. and lovely. And one of, so, but here in Boston, we continue to celebrate of course, St. Patrick’s day, which mm-hmm . I don’t know. I have lived here. Gosh, how long have I lived here now coming up on 17, 18 years.
[00:01:26] And I didn’t even realize that it’s actually a citywide holiday. I went to park my car downtown yesterday and the meters were, I thought, well, there you go. And the bars were packed at noon. I thought, well, this is my city. So you have your festival of the book, and we’ll be here drinking green beer.
[00:01:41] Although I’m not, , I’m drinking lemon water, which is not very exciting Gerard, but gotta keep my head on straight to hit to the park with you today, my friend. So good to hear your voice. As always listeners, we got a couple stories of the week coming at you and mine is it’s like bittersweet because [00:02:00] I’m glad that the education department is doing this, but I’m so sad and actually more than sad.
[00:02:05] It’s I, angry that there’s a reason for this, but this is from the NPR politics desk. I actually listened to it before I read it. And the title is of course education department will provide grants for HBCUs targeted by bomb threats. So for those of you who have been subsumed with. just so much of the other news that is coming at us constantly in a barrage.
[00:02:29] I keep waiting for the good news somewhere. It is, this has just been an ongoing thing for the past happening in recent years, but especially in the past three months that 30, historically black at colleges and universities across the country have been targeted with bomb threats. So I’m consistently amazed that this is still the society that we live in, but you know, these bomb threats were last month was black history month were particularly concentrated in black history month.
[00:02:57] And the quote from the education [00:03:00] department is that these bombs were against HBCUs, particularly concentrated in black history month constitute a uniquely traumatic event, given the history of bombings as a tactic to intimidate and provoke fear in black Americans during the long struggle for civil rights.
[00:03:15] So in a time when. Students everywhere are traumatized by, more things than we can count here. You have students at HBCUs, probably, , wondering day to day if it’s actually going to happen. So, secretary Cardona is going to award some grant money to HBC use. And these awards will range between 50 and $150,000.
[00:03:39] They’re from project serve. And that’s a program that supports schools that have experienced violent or traumatic incidents. So it’s not a ton of money, but it’s something. And I think that it’s in my book, good that the secretary is giving a no to the fact that this is so many things, but one among them traumatizing for students.
[00:03:57] The funds can be used to improve security or [00:04:00] increase mental health resources, ARD. I know that you are a graduate of an H B, C U we’ve had graduates of other HBCUs and professors from HBCUs on this program. Um, They are such a vital and important part of the American university system. I think you’ll probably know this statistic, but HBCUs graduate, a large percentage of, children, of color of black children who black students, I should say that attend college in this country.
[00:04:26] And so many of them go on to do such important, wonderful things like yourself. And this is just, like I said, at the outset it’s bittersweet. I’m glad that the education department is in a small way, very small way, recognizing the trauma these students are experiencing, but I’m also just sick to death and tired that.
[00:04:46] This is happening and that we continue to live in a country where this can happen to students, to faculty members. So anyway, gimme some Ray of hope Gerard what do you think?
[00:04:55]
[00:04:56] GR: Well, for sharing the story and bringing it up. I am a graduate [00:05:00] of H B C U Howard university in Washington, DC. And I received a number of E emails about this for months in part, because there are a group of H B, C U leaders who are part of the H B C U emergency management and wellness consortium.
[00:05:16] And they’ve been meeting for over a year. Independent of this, but to talk about the importance of utilizing resources, both academic, human, and otherwise who are on our campuses to provide support to the nation. In particular, there are a couple of scholars who are at Elizabeth city state university in North Carolina, where they actually offer training in emergency manage.
[00:05:38] And so they’ve taken this as an opportunity to elevate the voice of the consortium and to say, we’re here to help always good to see the us department of education get involved. I’m also sure even , the article, didn’t say this president Biden is a big supporter of HBCUs when, of course, when he was Senator for Delaware, big supporter of Delaware state university.
[00:05:59] So [00:06:00] I’m glad the secretary and leaders in Washington DC are making investments. And I am also aware that The white house initiative on HBCUs. They have a new executive director Dr. Trent, who is also an H B C U graduate Hampton university. She’s also the former secretary of education for Virginia, and she has a lot of experience in education.
[00:06:21] So she’s gonna be the new leader at the white house. And so I’m sure she’s gonna play an important role in this as well. And Cara you’re right. When you think about the fact that HBCUs make up 3% of the higher education institutions in the United States and produce roughly 24% of the engineers almost the equal number of doctors places like Morehouse college, number one, producer of black men, earning P DS places like Dillard.
[00:06:48] Number one pipeline in terms of black schools, sending people to medical school and North Carolina, a T not just H B, C U, but one of the top 20 producers of black engineering students black or white in [00:07:00] the country. So while people try to bomb, we will always rise from the ashes. And we even have a conversation about a,, someone who actually was once bombed Dr.
[00:07:10] Shuttlesworth who will be celebrating a hundredth anniversary today. But thank you for raising that story and shout out again to the H B C U consortium. Let’s support them as well.
[00:07:20] Cara: Absolutely,
[00:07:21] GR: So my story is a little different in the aspect that it is a partnership. Example, I would say between the private sector going to a state and saying we wanna work with you.
[00:07:34] So my article is from the hill and it’s talking about Intel, which is fortune 500 company headquartered in California. They have 79 billion in revenue hundred 21,000 employees. And as you know, Cara businesses need talent. And so when they decide to look at a state, they’re gonna look at a few things.
[00:07:57] Tax breaks. They’re gonna take a look at [00:08:00] cost of living. They’re gonna also look at the people who are there. And so Intel had a number of places to go and they decided they’re gonna go to Ohio to bill two chip manufacturing companies with an investment of 20 billion. So that’s a major in investment.
[00:08:17] And so one of the reasons they said that Intel personnel said they chose the state is because of its great higher education system. As we know many of our listeners. Ohio is one of the states that was created out of the Northwest ordinance of 1787. In that law, it actually has language to support schools and to really push it forward even before then 17 85 north Northwest ordinance also supported it.
[00:08:44] But Ohio has been a major leader in producing scholars and students focused on a number of things in education, but their higher education system, both public and private is one reason that Intel decided to invest. But that’s on the [00:09:00] manufacturing side and keep in mind 7,000. Construction jobs will be created because of this.
[00:09:07] You’re also gonna have 10,000 jobs created as derivatives from the work that’s gonna take place, but you’re also gonna have 3000 jobs where the average salary is $135,000. So that’s a major investment on the for-profit side offense. Well, let’s look at the higher education side of the fence. Intel said we’re also going to invest.
[00:09:27] 100 million to support education programs in the state. And this was good news to governor Mike DeWine of Ohio who had a chance to make an announcement at a community college. And so what they’re gonna do are three things. Number one 50 million will go directly to higher education Institute. Second 50 million will be distributed to educators and science programs nationwide to create a stem curriculum.
[00:09:54] So teachers who are listening this is something for you. If you’re outside of Ohio and third, get this [00:10:00] the national science foundation put in another 50 million to support research initiatives across the country. And as a governor said, You can’t have a strong Ohio without having a strong workforce.
[00:10:12] And you make this happen by using your two year and four year schools. But K12 S got role in this as well. Teachers who work in career and technical education teachers who are teaching stem, even instructors, who are starting to implement engineering, stem, or steam ideas in middle school. Here’s an opportunity for you in both places like Columbus, which is your capital, but also in the rural parts of the state, which we often overlook, particularly the Southern part.
[00:10:39] Here’s an opportunity for you to, and get ahold of some money and make some things happen. So here’s the recommendation. Number one, every Dean of a college of education, be it public or private four year, two year non-profit or for-profit you need to send an email to your president. And ask her [00:11:00] him or Bart requests that when money comes to the school, that you would like to use that money to endow a professorship at your school of education, focused on stem education.
[00:11:11] And I say this, having to work with universities for decades, it is tough, particularly for public universities to use public money to endow chairs. There are a lot of procurement laws, a lot of state statutes that shape it. But for this one, if you want to make sure you have the next generation of stem workers, they’re gonna have to come through our K12 system and our higher education system.
[00:11:32] So use this money to endow one professorship at minimum, maybe two, and bring in great talent or even elevate the talent you have internally. Number two, if you’re the president of a community college, this is a wonderful opportunity for you to partner with your local business work councils and say, listen, we have money coming in.
[00:11:52] Let’s do either a financial match from the local sector. Or guarantee some of the graduates who will leave your [00:12:00] community college, either with a license with a certificate, maybe an associate’s degree, let’s start working out on guaranteeing jobs or at least internships during the summer or externships, which can last one semester or a year and make sure they’re paid third.
[00:12:15] And this is two, our friends who are in the classroom, I’ve said for years, that one way that we can retain talent and attract talent, particularly in hard to serve stem areas is to start thinking like colleges, superintendents, you should also send a note and let your board know that when the money arrives at the local level, you want to endow chairs also focus on stem and in the summertime allow that teacher, if he or she is interested to work with Intel or to work with companies associated.
[00:12:44] So she or he can actually earn additional money in the summer. The same salary that he or she would earn if they were a full-time employee and then bring that knowledge back to the classroom. So I think this is just a wonderful example of the private sector working with the public sector, but making sure [00:13:00] higher education, isn’t the only one getting money, but that it trickles down to community colleges to K12, but in, they’re also looking for stem curriculum work across the states.
[00:13:10] So Massachusetts opportunity for you,
[00:13:13]
[00:13:13] Cara: Yeah. Massachusetts, are you listening? We have a lot of great tech companies here, biotech, et cetera, et cetera. And I think that we could do a better job in thinking about the connections between these things jar. I’d like to add one more recommendation to your list if yout of mind.
[00:13:26] And that is superintendents work closely with guidance counselors, with teachers, with parents, cetera, to help kids. Especially those interested in stem and other fields, understand what the career pathways are that are available to them. There should be a great awareness of this to kids as early as high school, so that they can start to think about their future and what it might look like.
[00:13:50] Whether they take the two year, four year path, whether they, go into one of these great new pathways that might not even require a two year or four year college degree [00:14:00] that Intel is offering. And I have to say, Gerard, I just love the idea. And this was president Biden actually talked about this partnership, right about Intel going to Ohio in the state of the union address, which I think he was quite proud of as he should be.
[00:14:13] It’s a re really great opportunity when we think about states and I love that education is at the, for, because what we’re doing here is creating what they’re doing here. I should say, you and I have nothing to do with this creating an ecosystem. Right. That brings all of these things together because in so many places, especially as you mentioned, rural places, kids don’t see in their local community a way to stay in the community, sometimes a way to stay in the state and be able to do the things they wanna do in give back.
[00:14:43] And when industries make investments in communities like this, it’s hopefully a virtuous circle of creating a web of prosperity that as you’ve pointed out, spans from the schools to colleges and universities to the workforce, and that [00:15:00] investment goes right back into the next generation of kids.
[00:15:03] So I really think of this as it’s not just about jobs, it’s about a whole new ecosystem. That’s really hopefully gonna make people healthy, happy, and prosperous in the long run. So that’s a, a great story, ARD. Thank you so much for bringing up. Okay. Our guest today might have a few things to say.
[00:15:23] about both of the topics that we talked about coming up in just a bit. We are gonna be speaking with Arthur Levine. Many of our guests will know him. He is the former president of Columbia teachers college. I’m sure that this is gonna be a fascinating conversation. We’ll be back in just a minute.[00:16:00]
[00:16:15] Listeners. We are privileged to have with us today, Dr. Arthur Levine. He is a distinguished scholar of higher education at New York university president emeritus of teachers, college, Columbia university, and president emeritus of the Woodrow Wilson national fellowship foundation. Many of you know him Levine has written 13 books, including the great upheaval higher or education’s past present and uncertain future and published many articles in publications.
[00:16:41] Such as the wall street journal, the New York times, Washington post Los Angeles, times political Chronicle of higher education ed week and inside higher education, he has appeared on many media programs, including 60 minutes. Fan favorite here, the today show all things considered morning edition, open mind, and [00:17:00] Fox news.
[00:17:00] Levine has received a number of awards, including 26 honorary degrees in Carnegie, Fulbright, Guggenheim and Rockefeller foundation fellowships. He is a member of the American academy of arts and sciences. Dr. Arthur Levine. We are privileged to have you with us today. Thank you for joining us on the learning curve.
[00:17:18] Arthur Levine: I’m very pleased to be with you. Thank you.
[00:17:21] Cara: Well, we wanna dig right in to some of your latest work. So, many of our listeners already know you as a leading voice in higher education, but you’ve recently, co-authored another book called the great upheaval higher education’s past present and certain future.
[00:17:38] Higher education is something that we Jordan, I always share stories of the week on this program and we talk a lot about higher education and indeed what it’s going through and, how the future of higher education will look, especially for kids like mine and Gerard. Can you talk to us a little bit about the main findings of your book and the recommendations within
[00:17:58] Arthur Levine: Americans going [00:18:00] through a transition. From a national analog industrial economy to a global digital knowledge economy. We’ve only experienced change on this rapidity, this magnitude, and this acceleration once before, which was the industrial revolution.
[00:18:16] And during that period, American higher is transformed and that’s going to happen again because we’re experiencing change at the degree we are. so there’s all content debate about what form that change will take will be disruption. The whole higher education system will disappear. Will it be adaptation, higher education can fix it to else.
[00:18:37] So we decided to look and see what the story was. And we looked in three directions. One was backward and past history. One was forward looking as a dramatic. Demographic economic and technological changes occurring. And the third is sideways looking at other industries that have been forced to change faster than we were, and those [00:19:00] would be movies and music and newspapers.
[00:19:04] when we finished all that, we found they’re going be four major change in higher education. None of it’s on making the first is there’s gonna be a dramatic expansion of new providers and distributors of higher education content. That’s going to create more competition for higher education. It’s gonna reduce cost and it’s going to increase student choice.
[00:19:26] the second thing we found was, you know, we have near universal access to digital technology. Students are going to ask from colleges and university exactly what they’re getting from Netflix. In Amazon, in terms of research universities, the nation desperately needs scientists and research. So those tools survive, but also in smaller numbers.
[00:19:48] And finally, the rest of my education will be disrupted, will be replaced with all the choice and the cornucopia of new providers, and that’s most likely to happen or the institution’s most [00:20:00] at risk of community colleges and regional universities. Those are the general finding our study.
[00:20:07] Cara: It’s really helpful Dr. Levine to have that laid out so clearly, because I think that. What so often lay people here is, two things about higher education. And the first is that something’s gotta change because nobody’s going to be able to afford it anymore. And the second is that when change occurs, it will just be disruption.
[00:20:27] And so to have you define what dis disruption really means in this context, I think is, pretty useful. The kind of disruption can you help me understand that you mentioned the pandemic and you mentioned the pandemic and COVID relief funds in the context of helping to support. Some of these smaller, at least here where I sit, as you, you mentioned in the Northeast, we’ve seen several closures in recent years of schools that, couldn’t afford to stay open due to declining enrollment among other things.
[00:20:56] And that you mentioned that the pandemic will give some of those institutions [00:21:00] a bump for a little while keep them open. But can you talk a little bit more about the other fault lines that the pandemic has really revealed? Not just about the cost of higher education, but also about the quality of an experience that students are actually getting when they pay in many cases, tens of thousands of dollars a year for their college degree,
[00:21:24] Arthur: the pandemic wasn’t an interruption.
[00:21:28] What it really was, was an accelerator. Of things that would’ve happened in higher education anyway, but over a longer period of time, and examples would be some closures. Examples of the online learning examples would be upskilling and reskilling, which were required by the changing markets and all also the competition in the rise of new providers, all that happened because the pandemic that, the pace that it did, but it would’ve happened anyway.
[00:21:59] [00:22:00] And there are certain events, you know, society that serve as accelerators. The 2008, 2009 recession was an extraordinary accelerator. Millions of jobs disappeared when they came back of the millions that required a high school diploma or less. Only 50,000 were restored. 90% of the new jobs that were created required some higher education that was changing to would’ve happened anyway, as we moved to a digital knowledge age, but it moved them faster. It got rid of the old jobs faster and created the new one faster. The pandemic did the same thing to higher education in every other social institution in America.
[00:22:42] Cara: So I’d like to ask you about another institution that I think, well, not a separate institution, but K to 12 education. Which I think many could argue has experienced some of the disruptions that you are describing [00:23:00] in higher education. So for example, we’ve seen in the past couple years, the pandemic, if you, if I like the term accelerator has accelerated, for example, parent demand for program that allow for learning outside of the classroom, that allow for parents to have more choice in the kind of educational experience their children have, whether that’s within the public system, outside of the public system or some hybrid of public and private providers.
[00:23:27] Now as we talk about higher education, one of the main reasons we, this nation produces teachers, in colleges of education, one of which you used to lead and we’ve been struggling , for decades about. What is actually the right way to prepare the future teachers of this country.
[00:23:49] Can you talk a bit about American teacher preparation programs what they look like, your read on how they’ve been doing to prepare America’s teachers and maybe [00:24:00] give us some insight into what you see coming for colleges of education.
[00:24:04] Arthur: about a decade and a half ago, I did a study of America’s education schools and on their teacher education programs, they weren’t nearly as good as they needed to do low in selectivity. Their standards for graduation weren’t high enough. They were disconnected from the schools. They were preparing students in fields.
[00:24:26] We really didn’t need, we didn’t need elementary school teachers. As much as we needed stem teachers for secondary school and they prepared lots of elementary school teachers, they had a curriculum that prepared students for the industrial age. And they also are, I guess, stands out is that they’re preparing people for a low paid profession, certainly low data profession and what the pandemic did was make all that worse.
[00:24:53] It encouraged retirements from the part of teachers who found the combination of in school, out of school online, [00:25:00] offline, really difficult masks, no masks that, and what it also did was. Make the teaching profession, less appealing. Enrollment had been going down to head school for quite a while.
[00:25:12] Well, they crashed during the pandemic so that we’re going to have to find ways to prepare teachers. I had to tell you about something that the president of M MIT and I did while I was a widow Wilson. We’ve decided to create the education school of the future, which is to say this would be a school that wasn’t time based students to grasp according to competencies, according to outcomes they passed.
[00:25:39] If you could achieve all the outcome, the day you entered, you’ve receiving diploma, the day you entered, by the way that wouldn’t have been possible. We had to assess all that. And that took while however, The notion was let’s have a curriculum that starts where the student is. Let’s have a student move along in this curriculum and [00:26:00] not in the same pace as everybody else.
[00:26:02] None of us learn in the same way as everybody else. None of us learn at the same pace as everybody else. There are things each of us know and don’t know things. Each us do well and don’t do well. But there a program that picks up all of that. So when the student graduates that student has the skills and knowledge, the competencies to be a teacher in a classroom and everything about this was difficult.
[00:26:28] It difficult figuring out how do you create a timeless education school, which doesn’t have semesters. And when students move according to mastery, how to create a curriculum. It’s mastery based. How do you make this affordable economically? How do you give students a skill to live in a world in which everything is changing quickly, profoundly.
[00:26:53] So we gave them an immersion and design thinking. Don’t ask to them the skills to enter a classroom [00:27:00] today. And we gave them the skills and knowledge to be able to move that classroom into the future. As things around them changed. The name of that graduate school is the high meadow graduate school of education at its located in Cambridge.
[00:27:14] GR: Thank you to Dr. Levine. So I had the honor to attend two schools of education, one at Harvard in one of the university of Virginia. At some point in our formal reading package or through conversations we would talk about books such as ed school, Folies uh, teacher wars, you know, other books that uplifted their profession.
[00:27:34] And when I worked in public policy, at some point we would have conversations about teacher preparation, cuz all of us know how important it is to have the right teacher in the right place in time. From your experience both professional and through the academic lens. What can we do to support the teacher in a way to help deliver the type of academic outcomes.
[00:27:54] One for students across the board.
[00:27:56] Arthur: I wanna tell you about a program we created [00:28:00] at the Wilson foundation. We called the Woodrow Wilson state teaching fellowship. And we went into states and we built a coalition, the governor, the chief state school officer, the state higher education executive officer universities, legislators on both sides of the aisle, schools, unions, and funders.
[00:28:20] And what we did was we picked several universities in that state and it ultimately was in Indiana, Ohio, Michigan, Pennsylvania, New Jersey, and Georgia. And we picked five or six universities in the state. And what we would do is offer them money. If they were willing to change their program, to create the kind of program today’s teachers truly need.
[00:28:44] And we offered them $500,000 for taking , on that assignment. And when they successfully completed it here to another $500,000, they had to agree to keep the curriculum. After the funding ended, we did one other thing. [00:29:00] We provided fellowships to students to a attend those schools, and we wanted stem teachers, top stem teachers,
[00:29:08] and we taught them. We got extraordinary people to go become stem teachers in each state. And they performed well in their classrooms. When they became teachers, they waiting their programs and they stayed longer than the average teacher. The bottom line here. It’s that it’s doable. What it is, is an active will.
[00:29:31] If states want to improve what they’re doing in teacher education, they can, it doesn’t come cheaply. The state of Indiana after the program ended funded the program to continue at those universities and Woodrow Wilson happily said goodbye. They created, they built it and they sustained it. And the universities we work with, they too sustained the program.
[00:29:55] Were they everything they could have been? No, of course not. But there was [00:30:00] so much better than what we originally found that those universities.
[00:30:03] GR: Let me just follow up with that wonderful example. You identify great teachers to work in stem, and we know that’s a hard to staff sub field with several subjects under it. How did you define the right type of student? Was it a combination of GPA, GRE other scores? Was it the school, the attended undergraduate major?
[00:30:27] What criteria did you use to identify the right students for this program?
[00:30:31] Arthur: That’s a great question. We were inundated with applications to this program, which was really, really pleasing. So the first cut we took was they wrote an essay. they got a set of recommendations and we looked at their grades and test scores.
[00:30:48] And then what we did was we took who remain and we interviewed them all. and what really mattered was there was certainly a threshold they had to cross in terms of academic quality. It was really [00:31:00] motivation. One of the things that everybody knows is you can’t get anybody to teach and stay in a rural school unless they’ve grown up in a rural area.
[00:31:09] It was those kinds of bodies kind of knowledge that enabled us to pick the right people. We really wanted diversity. That was critical to us. Since we were preparing teachers for the high need schools in each of those states in the most understaff subject stem, we wanted to recruit a group of fellows who looked like the school in which they’d be teaching.
[00:31:32] GR: Absolutely. There’s been a big push over the last 15 years in particular, but even longer to diversify , the teaching force because the student body they’re working with across the border are also changing. So you’ve had a chance to, leave one of the top education schools in the country teach education is one part of it.
[00:31:53] Research is another one of the digs that people make against education schools [00:32:00] is that we don’t have enough rigor in terms of academic research, the number of articles and peer review journals. I don’t buy it cause I know that in fact we do, but what did you do to recruit and retain some of the best and brightest scholars in the country?
[00:32:14] Who’ve dedicated their life to teach in the next generation of teachers
[00:32:18] Arthur: in terms of recruiting faculty. That hasn’t been the difficulty, the research issue that you raised is a real one, but not for the reason that you raised it. When teacher education came to the American university, which was in the late 19th century and early 20th century, what it was made to do was to look like arts sciences, it diminished the emphasis on practice.
[00:32:45] It diminished the emphasis on working with schools and in fact took it, its emphasis, the research focus that arts and science colleges have and what that did was twist what education school were about. Those subjects [00:33:00] that engaged in research rather than practice were the most important. What mattered truly.
[00:33:06] was not connections with the schools, but connections to journals we took and teacher education became the bottom of the heap. What we ended up doing in essence was crowning in the search crowning graduate education and diminishing teacher education. The university made teacher education schools do that, and they followed suit.
[00:33:30] There needs to be a commitment now to prepare teacher educators and teacher education schools that can work with their local school districts. What’s also true. These are too many universities of treated ed schools and teacher education as a catch cow. And I know of several instances in which ed schools were made to lower their admission standards to get their moments out.
[00:33:57] GR: Understandable last [00:34:00] question. And since you mentioned arts and science, I wanna talk about American law and medical schools that enjoy stellar reputations within the higher education establishment. And even in our , wider society. Could you discuss how these professional schools achieve their high academic status?
[00:34:15] does some key lessons from them that we can learn across the boards as relates to, reforming ed schools, but also the whole idea of accreditation and what that means for quality?
[00:34:25] Arthur: Yes. In 1910, the Carnegie foundation for the advance of teaching created something called they did a study of medical schools in the United States.
[00:34:38] Many of which were butcher shops. They were just horrible and. Man named Abraham fluster visited every medical school in the United States and Canada, and then wrote a report for the Carnegie foundation. That report was widely disseminated. That report changed in nature of medical education in the United [00:35:00] States, appoint to two models in 1910 ones with Johns Hopkins.
[00:35:05] And the other was Harvard. We took the ingredients that were necessary to create a good teacher, a good doctor, and said those needed to be requirements in every school. And they got adopted. Now, how could that possibly have happened? And the answer is the study was a set up. It was a prestigious foundation that had been asked by accreditors states.
[00:35:31] In the American medical association to do a real study of what this was like. And we release a report, which was then widely adopted by accreditors states and funders. That combination changed medical education America. And it’s what I talked about earlier. If coalitions and resources that make it possible to change education, any state can do it.
[00:35:59] [00:36:00] I know for example, Wyoming, which has only one teacher education program, one university, one at school is in the midst of doing many of the things we’ve talked about so far, it’s an exciting experiment to watch.
[00:36:14] GR: Well, I appreciate the lessons from history the identification of particular universities and schools of education that have decided to become a pioneer. Thanks also for the entrepreneurial approach that you worked out with. M I T I, in fact, I’m personally gonna look into that more because I’m interested in the future of edge schools.
[00:36:33] If you wouldn’t mind left up to you, we’d love for you to read something from your latest book. I’m sure all of us would glean some good wisdom from it.
[00:36:42] Arthur: Henry Adams sign of a family that produced two presidents attended Harvard and the midnight 19th century. He lamented the fact that he received an 18th century education that failed to prepare him for a world PLS into the 20th century.
[00:36:59] [00:37:00] Adams went to college at a time in which the classical college was dying. And the university of Valent forum, the models that would guide the future had not yet been created. There was a time, much like the present, an age of continuity and experimentation. We know a transformation is to come. The present cannot be sustained.
[00:37:29] GR: Thank you, Dr. Levine for the reading. And we look forward to conversations in the future with you about to not only the future of higher education, but the future of ideas, institutions. And I really like what you said about coalitions. We cannot as silos try to figure all this out. It’s gonna take a lot of helping hands coming together.
[00:37:51] Thank you for joining
[00:37:51] Arthur: Thank you for having me. I really enjoyed talking with you.[00:38:00]
[00:38:15] GR: So Cara, my tweet of the week is from Jason Riley from wall street journal. He’s been a guest here on our show and his tweet is from March 16th 21 2, and it says wealthy New Jersey. Governor Phil Murphy sends his own children to exclusive. Private schools, but wants to force low income black and Hispanic kids to attend some of the worst public schools in the state shame.
[00:38:38] As someone who has supported parental choice, both public and private going all the way back to 1991 I have seen this level of hypocrisy across the board. So Jason, thank you for keeping comments like this on the front burner. And guess what? It’s just not Democrats doing it. It’s Republicans as well.
[00:38:56] So Jason thank you for the tweet.
[00:38:59] Cara: It’s also [00:39:00] your local parents who send their kids to fancy private schools. And then question why anybody else should have a choice. So it’s, it’s systemic. Jason is amazing Gerard and we always thank him for his work. All right, now, Gerard, I’m gonna tell you.
[00:39:14] Who next week’s guest is, but also coming up after this, we have a treat. We’re gonna spend a couple minutes with friend of the show, wonderful human being Sephira Shuttlesworth. And so I know that you’ve got a couple of questions with her, but listeners before that, let me tell you that I hope you do join us again next week.
[00:39:31] And every week, next week on the learning curve, we are gonna be speaking with John Lewis Gaddis. He is professor of military and Naval history at Yale university and the pulitzer prize winning author of George F Kennan, An American Life. So Gerard we are gonna cut to one more treat of a conversation.
[00:39:53] I know you’re looking forward to it as much as I am, but let me say goodbye to you. Now, my friend have a great week. We’ll talk soon.
[00:40:33] GR: Hello listeners. Welcome back to The Learning Curve. Today is March 18th, 2022. It’s just not any day. In fact, it is the 100th anniversary of the birth of Reverend Shuttlesworth. Many of you know him as a civil rights icon. As an educator and as someone who helped change the face of American politics and policy in many unique ways and to talk about his life, [00:41:00] to talk about the role she played in helping do that, but also the work that she’s doing right now to address a different type of trauma in the United States.
[00:41:09] I want to welcome Dr. Sephira Shuttlesworth to the show.
[00:41:13] Sephira Shuttlesworth: Well, hello, good afternoon. And thank you for having me on. And yes, as you said today, would’ve been the 100th birthday of Reverend Fred Shuttlesworth. And if our listeners aren’t familiar with him, I invite you to Google him.
[00:41:28] He was an extraordinary American who to heart for humankind. And he spent the balance of his life trying to leave the world better than he found it. I am sitting here today thinking back over our time together. Fred and I were friends for 20 years, and then we were married for the last five years of his life.
[00:41:51] And, oh my gosh, what uh, ride? That was he was an extraordinary man who had some large ideas about what we could [00:42:00] do as human beings and what. Kind of work we could do together and how we could heal this land together. And the word together itself was huge. In his mind, someone asked me just the other day, what was his purpose?
[00:42:13] What was his motivating factor. And I said, love, it was good, old fashion love. And he would tell you to love the neighbor as you love yourself and do unto others as you would have them do unto you the golden rule. And as a young man, he said, he recognized that there was work that he needed to be doing, that he was called to do a special kind of work, and the Lord prepared him for that work.
[00:42:39] And as you will see, if you look further into his life, you’ll see where he was bombed and beaten and all of that. But at the end of the day he was able to be around to see our first black president to be elected to the United States. And so he got a lot of his just desserts before he transitioned on over to heaven.[00:43:00]
[00:43:00] GR: Well, speaking of the bombing, Cara and I earlier during show, her story of the week was about HBCUs that have had a number of bomb threats over the past several months. And the us department of education is investing money to help address that. And I mentioned, because I know of a story that you shared when we were on a panel together in Boston one time.
[00:43:21] I said, you know, black people have been bombed a lot. Yes. Even, just across the board. Would you mind sharing with our readers who were listening about the story of your husband? Him being bombed and walking out in the words he shared after he had come up from it.
[00:43:39] Sephira: It was his same favorite story to tell, but yes, basically Christmas night of 1957, I believe it was, he had preached, it was a funny, he had preached that day and he was lying in his bed sitting, talking to one of his deacons.
[00:43:55] He was in the bed, the deacon was sitting and talking and A bomb went off [00:44:00] and he said he knew what it was. He knew it was meant for him. And as the dust settled, he found himself lying on the mattress in a hole in the floor. So he was on the ground, the mattress was on the ground. And so he said he emerged, he got up and shook.
[00:44:16] The dynamite dust, blew the dynamite dust out of his nose. And he grabbed his coat, which was hanging on a wall now that it was leaning at a 45 degree angle. And so he got his coat and he put it on. He emerged from the back of the house. And by this time a big group of people had gathered and the front of the house and was trying to get to their pastor.
[00:44:35] And of course the police were there. The police were already there. And they were holding the crowd back. And so when he emerged around from the back of the house, people were gasping and went on. And he said he saw a big police officer standing there. He stood much taller than he did. And he said, the police officer looked at him and he rubbed his eyes as if there was an apparition.
[00:44:55] And he said, as I took one step forward, he’d take two steps back. [00:45:00] He said, so finally I stopped moving. He said, and I was standing there and he said, the police officer said to me Reverend, he says I know these people and I didn’t think they’d go this far, but if you don’t mind, I have some advice for you.
[00:45:13] And that is if I were, I’d get outta town as quickly as possible. And so Fred responded to him, he says, well, you’re not me. And you go back and tell your clan brethren that if the Lord could save me from this right here, I am here for the duration and the war has just begun. It was his favorite story to tell
[00:45:34] GR: well, thank you for telling it to our listeners.
[00:45:37] Absolutely. We are dealing with a lot of trauma today in the United States. A lot of it driven by challenges associated with COVID. It’s impacted students, teachers, families impacted businesses. You, as a leader, you as an educator yourself, you decided not just to talk about, about it, but to do something about it.
[00:45:55] So I’d love for you to share with us. what’s taking place with your new trauma program that you’re affiliated [00:46:00] with.
[00:46:00] Sephira: I will do that. You know, it all started with I had COVID December of 2020, I was diagnosed with COVID along with five other family members, including my 95 year old mother.
[00:46:12] And so of course, you know, when you get that diagnosis, you just, I don’t know, my mind just went into fight, fight. We’re fighting, we’re fighting this. And so fight we did. And we all emerged we lived and that was the thrill of it all. But the young man who was responsible for us getting it, who was a friend of my sisters, he had gone over and they were playing cards.
[00:46:36] And so she and her been got it and passed it off to the rest of us. And he was, gone in like five days. And so in the midst of it, when, , you’ve been diagnosed and the person you got it from is dead. Now that just. Exacerbates the fear and the stress associated with having the disease. And so then you just kick it into as high gear as possible.
[00:46:59] [00:47:00] For us, we started doing all kinds of research and eating things like sea Mo stuff that I don’t even know what it is, but , you know, we found out that those things, what you had to do with build your immune system. And so we worked hard , to build that immune system and to keep each other going and motivate each other.
[00:47:18] I’d go over and stand at my mother’s window, look through , her bedroom window and talk to her through the window because I wanted to make sure that she was fighting also. And so in my downtime, and I was thinking about, you know, what, this is just too much to ask almost of people, and I want to do something.
[00:47:37] I’m gonna make it out of this. And then the question becomes, how can I help others? What can I do? And I thought about the people in my profession, and I said to somebody, you know, Second in line to the first responders who I have the utmost respect for are the educators. I said, you know, I don’t know if anybody’s thinking about the educator.
[00:47:57] School is hard. It was [00:48:00] hard before the pandemic ever showed up. We had our struggles and I used to say, when I was reading schools, John Q, that has no notion of what it is we deal with in a day’s time. And so now add the stress of not knowing if you’re gonna be in school next week or not. You Sunday night, we’re gonna get that phone call.
[00:48:19] We don’t know what we’re doing. I don’t know if I’m supposed to report. If I’ve got little children, who’s gonna watch my child, all of the mountain stress. And then the children, I have a 12 year old grandson and , he’d come home sometimes go gram. So and so wasn’t wearing their mask today and he was standing too close to me.
[00:48:37] I, children are afraid. They don’t even know how to tell you that they’re afraid and they have every right to be afraid and fear and stress. If you carry it long enough, it becomes trauma. So I decided I need to find out who knows something about managing trauma. We need to help people with the trauma [00:49:00] that has been exacerbated by this pandemic.
[00:49:02] So I went in search and I found something called brain stimulated wellness, and it is a protocol whereby we teach the brain to respond before the mind can react to stress. When the mind reacts toque, we can get into all kinds of trouble, all kinds of places we didn’t intend to be. And we’ve got enough evidence of that, but we can teach the brain.
[00:49:25] If we know the different parts of the brain and how they respond, we can teach the brain and give it a set of event to choose from a set of techniques to choose from so that we can take down the stress and the trauma. And the, good thing about this program is there’s even a blood test. If you wanna see whether or not your stress level has been taken down, you can have your blood drawn.
[00:49:50] Have it looked at under a black field and. It will show you that while you’re stressed, your cells are [00:50:00] all different sizes and they’re jumbled up and they’re not moving in the direction they’re supposed to. In any of that, you can just see that they are out of order. And then you use the hand technique, what we call the hand technique, which is simply you take one hand and fold it over the other in a certain way that opens up the channels of your brain.
[00:50:22] So that wellness can get in and then you draw the blood again, look at it under the very scope. And what you’ll see is perfectly round, beautifully red and white cells, one red, one white, one red, one white, where they’re supposed to be doing what they’re supposed to be doing. And so it is fascinating work.
[00:50:44] This program has been in existence for over 20 years, largely in Canada and a few other places around the world. And they’ve won all kinds of Awards because not only is it a program about trauma, but we’re also looking at [00:51:00] how to help communities heal economically because our economics have gotten all skewed throughout this, pandemic also, but we can help businesses to lower their insurance costs.
[00:51:13] We can schools to get some of the things that they’ve always needed and needed more of by having a second income in place. And we can talk all about that as to anybody is interested, but here’s what I wanna close with. We have a program a series of videos called closing the door to suicide. I’m gonna say that again, closing the door to suicide because the trauma and stress by now has mounted in such ways that there are a lot of people who are considering.
[00:51:47] Just because of what we’ve been through. They’re considering making the pain stop but that’s not the best way we want you to think about who you will [00:52:00] harm if you take that. So anybody who is hearing my voice and who knows somebody who needs to hear this www dot, closing the door to suicide.com to date, we’ve had over 283,000 people to log on and to the information that is there, you’ll find videos that speak to teachers.
[00:52:27] And there’s one that speaks to college students and one that speaks to first responders. And so you just click on whichever one resonates with you and listen to that. As many times as you feel like you need to listen to it so that you can breathe to date. We have not had anybody out of 234,000 plus people to commit suicide.
[00:52:54] So basically what I’m here to do is to save lives. I’m more working with [00:53:00] the program that helps you to gain wellness while you’re here and to save your life in the event that you were thinking about not being here.
[00:53:11] GR: Well, Dr. Shuttlesworth, thank you so much. First of all, for your commitment to education across the board.
[00:53:17] Thank you for sharing the great work you’re doing with this program, but also thank you for keeping alive, literally and figuratively through your life, through your words and through your action. At a point in American history, we don’t see enough examples of this. You’re a living example of it. So thank you for being a friend to The Learning Curve.
[00:53:36] Oh,
[00:53:36] Sephira: absolutely. Thank you so much for having me on take care.
Related Content