Public Health Gag Order, Ochsner Health, We're all invested!

David Caldwell

Hey there folks, welcome to the podcast! Today, we’re kickin' things off with something a little different. Sofia and I thought it might be fun to share what we’re reading, listening to, and honestly, just thinking about lately. Sound good?

Sofia Ramirez

Absolutely. And I think it’s the perfect way to set the tone—no pun intended—for today’s discussion. But before we dive in, a quick reminder for listeners: we’re both digital hosts collaborating closely with Dr. Chad Swanson, who's behind this project and deeply engaged with every aspect of it.

David Caldwell

Yeah, Chad’s the real deal, folks. He’s literally making all of this happen. Okay, Sofia, what’s been your go-to book recently?

Sofia Ramirez

Well, I’ve been working my way through Marty Makary's "Blind Spots." It’s thought-provoking, particularly this story about William Harvey. You know, he was the first to describe the blood’s circulation process in the 17th century, but his medical practice took a massive hit because of it.

David Caldwell

Wait, people turned on him? For figuring out how blood moves through the body? I mean, what?

Sofia Ramirez

Exactly, and it’s a stark reminder of what’s at stake when we challenge convention. It also makes me so grateful for those trailblazers—scientists, physicians—who risked their livelihoods for progress. This stuff matters, and it always comes at a price.

David Caldwell

Whoa, okay. That's heavy. But also kinda inspiring, right? Speaking of inspiration, I finished Uché Blackstock’s memoir a while back. It’s out in paperback today, by the way!

Sofia Ramirez

Oh, I’ve been meaning to pick it up. What did you think?

David Caldwell

It’s... moving. She dives into how racism is baked into our healthcare system, but not in this preachy way. It’s more like—here’s her life, her story—and you see how unfair our entire health system can be.

Sofia Ramirez

And it reinforces a simple truth: healthcare should prioritize health and fairness. It’s not supposed to uphold elitism, not perpetuate the status quo. That doesn’t serve anyone, really, except maybe the privileged few.

David Caldwell

Right. And like, ideally, this podcast becomes a go-to for tackling those issues. I know Chad’s vision is to make us that “one-stop shop” for daily discussions on current events and healthcare transformation.

Sofia Ramirez

Exactly—contextualizing everything we talk about, integrating historical and systemic perspectives with a willingness to address listener questions and comments. It’s all about moving forward together, creating that resource people can rely on, whether they’re concerned citizens, premed students, hospital administrators, or, I don’t know, community activists?

David Caldwell

Yeah, pretty much anyone who wants the health system to… not suck, basically.

Sofia Ramirez

Well put, David.

David Caldwell

Speaking of making the health system better for everyone, there’s this wild story about Ochsner Health. They managed to save $56 million in healthcare costs across half a million patients. Am I getting that right, Sofia?

Sofia Ramirez

That’s right, David. We learned about this story on Dr. Eric Bricker's ahealthcarez video, published a couple of weeks ago. Ochsner managed to lower costs while actually improving patient outcomes, which is almost unheard of in the healthcare system. And it gets even better—they took $45 million of those savings and reinvested it directly back into their doctors and other healthcare providers. It’s just... it’s the sort of win-win approach we don’t see enough of in medicine.

David Caldwell

Okay, wait. Back up for a second. How did they pull this off? I mean, isn't the system usually geared toward doing the opposite?

Sofia Ramirez

Exactly. Most healthcare systems are still stuck in a fee-for-service model, where the focus is on treating illness reactively instead of preventing it. But Ochsner flipped this script. They focused on improving outpatient primary care—keeping people out of the ER and hospitals—and took on financial risk for the total cost of care for their patient population. Oh and, they attacked chronic disease management head-on.

David Caldwell

Alright, but what does "taking on financial risk for the total cost of care" even mean? I mean, I think I get it, but spell it out for me here.

Sofia Ramirez

Good question! So, in traditional models, hospitals get paid more when people are sicker, right? Billing for every test, procedure, or hospital stay. But Ochsner switched to a value-based care model. This means they committed to a fixed payment for managing their patients’ healthcare needs. If they keep costs down while improving health outcomes, they get to keep the savings. If not, they bear the financial burden. It’s a huge shift in accountability.

David Caldwell

Oh, so it’s like they’ve got actual skin in the game. No more “the sicker, the better,” huh?

Sofia Ramirez

Exactly. And here’s where their chronic disease prevention efforts paid off big time. For instance, Ochsner reported that 88 percent of their diabetes patients had their condition well controlled. Compare that to the national average of, what, 50 to 60 percent? And with hypertension, 85 percent of their patients had blood pressure under control versus a shockingly low 20 percent nationally. Those numbers are staggering.

David Caldwell

Seriously, how is everyone else just okay with those national averages? Like, 20 percent? That’s not just bad, it’s... scary.

Sofia Ramirez

It is. But here’s the thing—this isn’t just about better medicine. It’s about their environment and incentives. Ochsner is based in a region with fewer high-paying commercial insurance plans through employers. Most of their patients are on Medicare or Medicaid, which reimburses at much lower rates. Unlike many systems propped up by lucrative employer-sponsored plans, Ochsner had to innovate just to survive.

David Caldwell

So let me get this straight. Other hospitals don’t follow Ochsner's lead because… they don’t need to? They're swimming in insurance cash?

Sofia Ramirez

Precisely. In most systems, high employer reimbursements mask inefficiencies and discourage change. But when those high reimbursements aren’t there—like in the Gulf South—hospitals are forced to rethink their strategies. That’s why Ochsner’s story is so compelling. They’ve shown what’s possible when financial incentives align with better health outcomes.

David Caldwell

It’s like necessity really is the mother of invention here. I mean, this is fascinating, but also kinda frustrating—

Sofia Ramirez

Frustrating but eye-opening. It shows us what's possible, David. The change is there—we just need the vision and the right incentives to make it happen.

David Caldwell

Sofia, after hearing about Ochsner’s impressive strategies, it’s disheartening to pivot to a very different challenge in public health. Dr. Jeremy Faust wrote about something that's, uh, pretty concerning—a federal gag order on public health agencies, just 2 days ago, January 21. Can you, like, walk me through what this actually means?

Sofia Ramirez

Of course. So, in the new Trump administration, there was a directive just issued that limited how public health agencies could communicate externally. It wasn’t just about regulating press releases or public statements—it restricts data sharing, scientific reports, real-time updates—

David Caldwell

Wait, like actual health advisories? The kind of stuff people need to stay safe?

Sofia Ramirez

Exactly, David. Now agencies like the CDC aren't able to publish things like the Morbidity and Mortality Weekly Report without scrutiny. And that report is foundational—it’s where public health officials, researchers, and even doctors get real-time updates about disease outbreaks and health trends.

David Caldwell

Okay, that’s... terrifying. Why would they, I mean, why even do this?

Sofia Ramirez

Well, it comes down to political interference. The reasoning given was often framed around “protecting public confidence,” but in reality, it silences experts during critical moments. And we will likely feel the impact especially hard during respiratory virus peaks. Vaccine updates? Delayed. Data about hospitalizations? Limited or even missing altogether.

David Caldwell

Wait, what about flu season—or even COVID— will policymakers be just, like, blind? No real data?

Sofia Ramirez

Unfortunately, yes. And without that data, decisions around resource allocation, public advisories, and even individual behaviors could become guesswork. It undermines trust, too. If people can’t access reliable info, it feeds misinformation and conspiracy theories.

David Caldwell

Right, it’s like creating a perfect storm for, I don’t know, chaos? I mean, this impacts everyone, not just the government.

Sofia Ramirez

It does. Public health is all about transparency. If we can’t trust agencies to deliver timely, accurate information, it cripples the entire system. And it leaves vulnerable populations—those who need real-time guidance the most—completely unprotected.

David Caldwell

So, not to overreact here, but this feels like a foundational betrayal. Like, healthcare depends on trust, doesn’t it?

Sofia Ramirez

It does, David. And without restoring that trust, we’re... well, we’re setting ourselves up for even deeper public health crises down the line. Things are changing very quickly, however, so we'll keep you updated on this podcast.

David Caldwell

Sofia, after talking about how trust plays such a pivotal role in public health, it really puts this statistic into perspective for me—only five to twenty percent of our health is actually controlled by healthcare services? That just blows my mind every time I hear it.

Sofia Ramirez

That’s right, David. It’s a sobering reminder that while doctors, hospitals, and treatments are vital, most of what keeps us healthy happens outside of clinical settings. In fact, factors like diet, exercise, social connections, and even sleep have an outsized influence on our overall well-being.

David Caldwell

It’s crazy, though. I mean, when we think about health, we tend to focus on, you know, medical treatments, insurance policies, stuff like that. So, you're saying that’s not where most of the action is happening?

Sofia Ramirez

Exactly. Those things matter—don’t get me wrong—but they’re only part of the picture. Let’s take diet, for example. What you eat has a long-term impact on health conditions like diabetes or heart disease. And it’s not just about avoiding the bad stuff—it’s about consistently getting the nutrients your body needs.

David Caldwell

Okay, so... give us the cheat sheet here. Like, if someone’s listening and wants to improve their diet, where should they even start?

Sofia Ramirez

I’d say focus on whole foods as much as possible. Incorporate lots of fruits, vegetables, lean proteins, and whole grains. Minimize processed foods and sugary drinks as much as you can. It doesn’t have to be perfect—small, sustainable changes are more important than a specific diet that you don't keep.

David Caldwell

Alright, so diet’s a big piece of the puzzle. What about exercise? How much are we actually supposed to be moving—because, you know, I could probably use a reality check here.

Sofia Ramirez

Well, for adults, the general recommendation is at least 150 minutes of moderate aerobic activity per week, like brisk walking or cycling. That boils down to about 30 minutes, five days a week. But even small bursts of physical activity add up—they’re better than nothing. And strength training twice a week is a great bonus.

David Caldwell

So basically, the key is just getting up and moving, right? You don’t have to start training for a marathon or anything?

Sofia Ramirez

Exactly. It’s all about integrating movement into your day in a way that’s sustainable and enjoyable. Consistency beats intensity for most people.

David Caldwell

Got it. Let’s talk about social connections, then, because that one kinda stands out to me. Like, how do relationships actually affect our health?

Sofia Ramirez

Oh, in so many ways. Strong social connections reduce stress and even lower the risk of chronic diseases like heart disease. People who feel supported by their community are more likely to engage in healthy behaviors and less likely to report feelings of loneliness, which is a huge predictor of poor health outcomes. It’s really powerful.

David Caldwell

So it’s not just touchy-feely stuff—it has real, measurable impacts on physical health, too. That’s kinda wild.

Sofia Ramirez

It absolutely does. And lastly, there’s sleep. Sleep affects nearly every aspect of our health, from our immune system to our mental health to how well we can think and focus during the day. The sweet spot for most adults is seven to nine hours per night.

David Caldwell

Okay, confession time—I’m pretty sure I’ve been consistently missing that sweet spot for years. What about you?

Sofia Ramirez

I probably could do better—I won’t lie. But prioritizing sleep is critical. Things like keeping a regular sleep schedule, reducing screen time before bed, and creating a calming environment can really help.

David Caldwell

So... to sum it all up, focusing on what we eat, staying active, building strong relationships, and getting enough sleep could make a bigger difference than anything a doctor can do?

Sofia Ramirez

Pretty much, David. And that’s not to say healthcare isn’t important—it is. We should and will continue considering policies and insurance coverage. But we need to realize that so much of our health "system" is shaped by the choices we make every day and the environments we live in.

David Caldwell

That’s... a lot to think about. But also kinda empowering in a way. We have more control than we, I guess, realize.

Sofia Ramirez

Exactly—these are things we can all work on incrementally. And honestly, we’ll keep coming back to this idea throughout the podcast because it’s just that crucial to understanding how to improve public health as a whole.

Sofia Ramirez

So, David, as we’ve explored, our personal choices, like what we eat or how much we exercise, play a critical role in our health. But here’s the thing—these choices don’t happen in a vacuum. All of us are tied into a larger system of health—politics, policies, hospitals, public health—and whether we realize it or not, we’re all invested in it.

David Caldwell

Right, and by “invested,” you don’t mean, like, financially, right? You're talking more… structurally, I guess?

Sofia Ramirez

Yes, actually both. Take politicians, for example. Sure, we criticize them—and we absolutely should hold them accountable—but at the end of the day, we’re the ones who voted them into office. And just like that, we’ve shaped the policies that guide this system.

David Caldwell

Ah, so... it's kind of like we're, I don’t know, holding the pen as they write these rules?

Sofia Ramirez

Exactly. And it doesn’t stop there. We see it with insurance companies, too. They operate within the laws and regulations our society created. It’s easy to point fingers, but we have to remember that these systems don’t exist in a vacuum. They’re a reflection of our collective choices—good, bad, or otherwise.

David Caldwell

Okay, but hang on—what about the people inside the system? Like doctors or public health workers? They’re not calling the shots, right?

Sofia Ramirez

Not entirely, but they’re still tied into the system in major ways. Look at Dr. Swanson—

David Caldwell

Hey, shout-out to Chad!

Sofia Ramirez

Yes, always a shout-out to Chad. So, as an ER physician, he works primarily within a fee-for-service system, which rewards volume over health outcomes. That’s the structure he’s forced to operate in. And health academics? They’re pressured to publish research and meet institutional standards, sometimes at the expense of innovation.

David Caldwell

And public health professionals—you mentioned them earlier, right? They’re dealing with, what, project-based pressures?

Sofia Ramirez

Exactly. Many public health workers feel like they’re running on a hamster wheel. They’re expected to deliver specific programs or meet short-term goals, even when the real impact of their work won’t be seen for years—sometimes decades. The system doesn’t reward long-term thinking, despite how necessary it is.

David Caldwell

Alright, so we’re saying everyone’s kind of stuck in these roles that, uh, perpetuate a system that’s not working optimally?

Sofia Ramirez

That’s pretty much it. But here’s the thing—we can be hard on the system while still being gentle with most of the individuals within it. A lot of people are just trying to make the best out of a flawed structure. Recognizing that shared humanity is key if we’re ever going to fix this.

David Caldwell

You know, that’s... really powerful. And it kinda reframes the way we should think about accountability. It’s not just about pointing fingers; it’s about figuring out how to change the system without crushing the people inside it.

Sofia Ramirez

Exactly. Because the truth is, everyone—politicians, doctors, public health workers, even us as everyday citizens—plays a role. If we focus on collaboration, instead of just blame, we might actually get somewhere.

David Caldwell

Well, on that note, Sofia, I think my brain needs to digest all of this. You’ve laid out a lot today.

Sofia Ramirez

It’s a lot, but it’s also the beginning of a conversation we all need to have. And hey, we’ll keep tackling it, one piece at a time.

David Caldwell

For sure. So, to everyone listening, thanks for sticking with us. Let’s keep pushing for that healthcare system we all deserve.

Sofia Ramirez

Yes—and that’s a wrap for today! Stay curious, stay engaged, and we’ll see you next time.