scientificamerican--2020-12-08--Biden's Health and Human Services Nominee Has Political Skill but No Frontline Health Experience

Xavier Becerra , President-elect Joe Biden ’ s choice to head the Department of Health and Human Services , is set to be a pandemic-era secretary with no public health experience .
Whether that matters depends on whom you ask .
Becerra built his career in the U.S. House of Representatives before becoming California ’ s attorney general , and some wonder whether his political and legal skills would be the right fit to steer HHS through a health catastrophe that ’ s killing thousands of Americans every day .
Although he would bring years of health politics and policy @ @ @ @ @ @ @ it comes from front-line experience as an executive or administrator running public health programs , managing patient care or controlling the spread of disease .
Yet beyond the immediate COVID-19 crisis , many Democrats see Becerra as an important ally to undo what they view as years of damage from the Trump administration ’ s efforts to undermine the Affordable Care Act ; the Medicaid program , which provides coverage for more than 70 million Americans ; reproductive health ; and more .
As California ’ s attorney general since 2017 , Becerra @ @ @ @ @ @ @ of the Trump administration , filing 107 lawsuits to overturn federal action on the Affordable Care Act , contraception , immigration , workers ’ rights , LGBT rights , education , consumer protection , gun violence and the environment .
“ COVID is the biggest issue on the table , but it is not the only issue on the table , ” said Dr. Georges Benjamin , executive director of the American Public Health Association .
“ If you look at his body of work , he is not your traditional attorney .
@ @ @ @ @ @ @ area is substantial .
And I think that counts.
” On Tuesday , Biden will formally introduce Becerra along with other candidates for top health jobs , many with deep public health experience .
They include Dr. Rochelle Walensky , an infectious disease expert at Harvard Medical School who practices at Massachusetts General Hospital in Boston , as the next director of the Centers for Disease Control and Prevention .
Biden ’ s choice for COVID “ czar ” is Jeffrey Zients , a private equity executive and former Obama administration official who @ @ @ @ @ @ @ White House .
Dr. Vivek Murthy is the nominee for U.S. surgeon general , a position he held in the final Obama years .
Biden has said he will let the federal government ’ s longtime scientists guide his pandemic response , in particular those at the CDC , which is overseen by HHS .
President Donald Trump sidelined the agency , damaging its reputation as the world ’ s most trusted public health institution .
That Becerra ’ s deepest experience is political makes some observers wary .
“ I think there @ @ @ @ @ @ @ that sort of cloud the scientific and medical judgment of how best to do things .
I hope they can manage that well , ” said Jeffrey Morris , a biostatistics professor at the University of Pennsylvania who has worked on COVID issues .
He said he had mixed feelings about the Becerra selection .
“ What is the leadership style , and is there going to be micromanaging from the top down into these organizations ?
To me , that ’ s the key aspect.
” “ A lot of people are @ @ @ @ @ @ @ proud that Biden picked another Californian to join his administration , ” South said .
“ If Republicans are looking to target a few Biden appointees for rejection , you can expect them to make the case that there is no logical nexus between a state attorney general and serving as secretary of Health and Human Services.
” Still , Becerra , who as a member of Congress worked in the House Democratic leadership and was a member of the powerful Ways and Means Committee , has more health policy background and knowledge @ @ @ @ @ @ @ systems than many previous heads of the sprawling HHS , which employs more than 80,000 people and has a $ 1.3 trillion budget .
For three years , Becerra has managed California ’ s Justice Department , with a $ 1.1 billion budget and 4,800 employees .
As attorney general , he ’ s been deeply involved in crafting health policy .
His office has gone after anti-competitive behavior from hospitals .
And he ’ s sponsored legislation to take on drugmakers and pay-for-delay schemes .
“ He ’ s gone after powerful @ @ @ @ @ @ @ Wright , executive director of the nonprofit Health Access California .
Antitrust enforcement is more commonly handled by the U.S. Department of Justice and the Federal Trade Commission .
But Becerra made it a priority as California ’ s top cop .
In May 2018 , he brought an antitrust case against nonprofit health care giant Sutter Health , accusing the system of monopolistic practices that drove up the cost of medical care in Northern California .
“ This is a big ‘ F ’ deal , ” Becerra said at a news @ @ @ @ @ @ @ encompassed years of work by the department and his predecessors and millions of pages of documents—alleged that Sutter had aggressively bought up hospitals and physician practices across the region and illegally exploited that market power for profit .
Health care costs in Northern California , where Sutter dominates with its 24 hospitals , are 20 % to 30 % higher than in Southern California , even after adjusting for Northern California ’ s higher cost of living , according to a 2018 study from the Nicholas C. Petris Center at the University of @ @ @ @ @ @ @ .
In December 2019 , Sutter agreed to pay $ 575 million to settle the case and promised to end a host of practices that Becerra alleged stifled competition .
Becerra channeled lessons learned from the Sutter case into an antitrust bill in the California legislature .
The legislation ultimately failed , but it would have given the attorney general power to review private equity- or hedge fund-led mergers or acquisitions of a health care system or hospital .
“ The Sutter case is a blueprint for a national policy that could start @ @ @ @ @ @ @ system and save American health care consumers billions of dollars right away , ” said Glenn Melnick , a health care economist at the University of Southern California .
He views Becerra as “ a real expert in some of the most important issues facing our health care system , not just in California but nationally.
” If confirmed by the Senate , Becerra supporters say , he will bring to the job a political acumen from his two decades-plus on Capitol Hill that ’ s likely to be an asset for the @ @ @ @ @ @ @ bills and other health legislation with a politically divided Congress .
Former California Democratic member of Congress Henry Waxman worked with nearly a dozen HHS secretaries during his time on the House Energy and Commerce Committee .
He said he ’ s not worried that Becerra lacks experience leading a vast health care bureaucracy .
The HHS secretary job , he said , is one “ where you need political skills to see how far you can get with other people in a political context.
” That ’ s why most HHS secretaries @ @ @ @ @ @ @ political backgrounds .
Becerra “ understands the policies and has a deep commitment to them , ” he said .
“ I think he ’ ll do well.
” Public health officials say the job before Becerra is gigantic .
Dr. Gary Pace , the health officer in rural Lake County , California , said Becerra would be tasked with rebuilding a broken public health system .
“ We want a federal partner who can give us good guidance—we haven ’ t had that , ” Pace said .
“ For him , @ @ @ @ @ @ @ first is starting to get the CDC back into a flagship public health role , with trusted and timely evidence-based guidance.
” Born in Sacramento to Mexican immigrant parents , Becerra would be the first Latino HHS secretary .
He was elected to Congress in his 30s and has been involved in national health legislation during the past two decades , even though he is more widely known for his involvement in immigration and tax issues .
He joined the powerful House Ways and Means Committee , which oversees tax and health legislation @ @ @ @ @ @ @ played a central role in the drafting of what would become the Affordable Care Act in 2010 .
While HHS oversees major federal health agencies , including the CDC , the Centers for Medicare & Medicaid Services , the Food and Drug Administration and the National Institutes of Health , it also has a wide-ranging human services portfolio , including oversight of child care and welfare programs , Head Start , programs for seniors and refugee resettlement .
“ It ’ s not like any one person is going to have everything , @ @ @ @ @ @ @ Clinton administration health official , who called Becerra an “ inspired choice.
” “ I think that the most important point is that this is a leader of a team and not the be-all and end-all.
” California Healthline staff writers Rachel Bluth and Samantha Young contributed to this story .
This story was produced by KHN , which publishes California Healthline , an editorially independent service of the California Health Care Foundation .

Xavier Becerra, President-elect Joe Biden’s choice to head the Department of Health and Human Services, is set to be a pandemic-era secretary with no public health experience. Whether that matters depends on whom you ask.
Becerra built his career in the U.S. House of Representatives before becoming California’s attorney general, and some wonder whether his political and legal skills would be the right fit to steer HHS through a health catastrophe that’s killing thousands of Americans every day.
Although he would bring years of health politics and policy work to the role, none of it comes from front-line experience as an executive or administrator running public health programs, managing patient care or controlling the spread of disease.
Yet beyond the immediate COVID-19 crisis, many Democrats see Becerra as an important ally to undo what they view as years of damage from the Trump administration’s efforts to undermine the Affordable Care Act; the Medicaid program, which provides coverage for more than 70 million Americans; reproductive health; and more.
As California’s attorney general since 2017, Becerra has been a thorn in the side of the Trump administration, filing 107 lawsuits to overturn federal action on the Affordable Care Act, contraception, immigration, workers’ rights, LGBT rights, education, consumer protection, gun violence and the environment.
“COVID is the biggest issue on the table, but it is not the only issue on the table,” said Dr. Georges Benjamin, executive director of the American Public Health Association. “If you look at his body of work, he is not your traditional attorney. His body of work in the health area is substantial. And I think that counts.”
On Tuesday, Biden will formally introduce Becerra along with other candidates for top health jobs, many with deep public health experience.
They include Dr. Rochelle Walensky, an infectious disease expert at Harvard Medical School who practices at Massachusetts General Hospital in Boston, as the next director of the Centers for Disease Control and Prevention. Biden’s choice for COVID “czar” is Jeffrey Zients, a private equity executive and former Obama administration official who will steer the pandemic response from the White House. Dr. Vivek Murthy is the nominee for U.S. surgeon general, a position he held in the final Obama years.
Biden has said he will let the federal government’s longtime scientists guide his pandemic response, in particular those at the CDC, which is overseen by HHS. President Donald Trump sidelined the agency, damaging its reputation as the world’s most trusted public health institution.
That Becerra’s deepest experience is political makes some observers wary.
“I think there’s always a danger of letting that sort of cloud the scientific and medical judgment of how best to do things. I hope they can manage that well,” said Jeffrey Morris, a biostatistics professor at the University of Pennsylvania who has worked on COVID issues. He said he had mixed feelings about the Becerra selection. “What is the leadership style, and is there going to be micromanaging from the top down into these organizations? To me, that’s the key aspect.”
Garry South, a Los Angeles-based Democratic strategist, called Becerra’s appointment “curious.”
“A lot of people are raising eyebrows—even those who are pleased and proud that Biden picked another Californian to join his administration,” South said. “If Republicans are looking to target a few Biden appointees for rejection, you can expect them to make the case that there is no logical nexus between a state attorney general and serving as secretary of Health and Human Services.”
Still, Becerra, who as a member of Congress worked in the House Democratic leadership and was a member of the powerful Ways and Means Committee, has more health policy background and knowledge of U.S. health care finance and delivery systems than many previous heads of the sprawling HHS, which employs more than 80,000 people and has a $1.3 trillion budget.
For three years, Becerra has managed California’s Justice Department, with a $1.1 billion budget and 4,800 employees. As attorney general, he’s been deeply involved in crafting health policy. His office has gone after anti-competitive behavior from hospitals. And he’s sponsored legislation to take on drugmakers and pay-for-delay schemes.
“He’s gone after powerful health care interests,” said Anthony Wright, executive director of the nonprofit Health Access California.
Antitrust enforcement is more commonly handled by the U.S. Department of Justice and the Federal Trade Commission. But Becerra made it a priority as California’s top cop. In May 2018, he brought an antitrust case against nonprofit health care giant Sutter Health, accusing the system of monopolistic practices that drove up the cost of medical care in Northern California.
“This is a big ‘F’ deal,” Becerra said at a news conference unveiling the lawsuit. The case—which encompassed years of work by the department and his predecessors and millions of pages of documents—alleged that Sutter had aggressively bought up hospitals and physician practices across the region and illegally exploited that market power for profit. Health care costs in Northern California, where Sutter dominates with its 24 hospitals, are 20% to 30% higher than in Southern California, even after adjusting for Northern California’s higher cost of living, according to a 2018 study from the Nicholas C. Petris Center at the University of California-Berkeley that was cited in the complaint.
In December 2019, Sutter agreed to pay $575 million to settle the case and promised to end a host of practices that Becerra alleged stifled competition.
Becerra channeled lessons learned from the Sutter case into an antitrust bill in the California legislature. The legislation ultimately failed, but it would have given the attorney general power to review private equity- or hedge fund-led mergers or acquisitions of a health care system or hospital.
“The Sutter case is a blueprint for a national policy that could start to restore competition for the health care system and save American health care consumers billions of dollars right away,” said Glenn Melnick, a health care economist at the University of Southern California. He views Becerra as “a real expert in some of the most important issues facing our health care system, not just in California but nationally.”
If confirmed by the Senate, Becerra supporters say, he will bring to the job a political acumen from his two decades-plus on Capitol Hill that’s likely to be an asset for the Biden administration as it negotiates pandemic relief bills and other health legislation with a politically divided Congress.
Former California Democratic member of Congress Henry Waxman worked with nearly a dozen HHS secretaries during his time on the House Energy and Commerce Committee. He said he’s not worried that Becerra lacks experience leading a vast health care bureaucracy. The HHS secretary job, he said, is one “where you need political skills to see how far you can get with other people in a political context.” That’s why most HHS secretaries, Republicans and Democrats, have had political backgrounds.
Becerra “understands the policies and has a deep commitment to them,” he said. “I think he’ll do well.”
Public health officials say the job before Becerra is gigantic.
Dr. Gary Pace, the health officer in rural Lake County, California, said Becerra would be tasked with rebuilding a broken public health system.
“We want a federal partner who can give us good guidance—we haven’t had that,” Pace said. “For him, I’d say what we need first is starting to get the CDC back into a flagship public health role, with trusted and timely evidence-based guidance.”
Born in Sacramento to Mexican immigrant parents, Becerra would be the first Latino HHS secretary. He was elected to Congress in his 30s and has been involved in national health legislation during the past two decades, even though he is more widely known for his involvement in immigration and tax issues. He joined the powerful House Ways and Means Committee, which oversees tax and health legislation, in the 1990s. The committee played a central role in the drafting of what would become the Affordable Care Act in 2010.
While HHS oversees major federal health agencies, including the CDC, the Centers for Medicare & Medicaid Services, the Food and Drug Administration and the National Institutes of Health, it also has a wide-ranging human services portfolio, including oversight of child care and welfare programs, Head Start, programs for seniors and refugee resettlement.
“It’s not like any one person is going to have everything,” said Dan Mendelson, a former Clinton administration health official, who called Becerra an “inspired choice.” “I think that the most important point is that this is a leader of a team and not the be-all and end-all.”
California Healthline staff writers Rachel Bluth and Samantha Young contributed to this story.
This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.


scientificamerican--2020-12-08--New DIY Contact Tracing App Is Based on the Science of Memory

The following essay is reprinted with permission from The Conversation , an online publication covering the latest research .
Imagine you begin to feel ill on Thursday , a few days after returning from a trip .
You ’ re afraid it ’ s COVID-19 , so you get tested on Friday .
Even under good circumstances , it will probably be at least Monday before a contact tracer calls from the health department .
And then some phone tag may ensue before you speak with anyone—if you get a call at all .
Once a contact tracer does reach @ @ @ @ @ @ @ remember all the people you were in close contact with , starting two days before you began feeling symptoms .
That means recalling all the places you went and the people you saw over the past week .
It isn ’ t easy .
As time passes , memories fade .
Unfortunately , your contacts , unaware they were exposed to the coronavirus , may have already infected others .
Concerned about those delays , three of us and our colleague Ronald Fisher , all psychology professors with expertise in memory , developed @ @ @ @ @ @ @ exposed to COVID-19 to effectively trace their recent contacts on their own .
Self-driven contact tracing shouldn ’ t replace health department efforts .
Professional teams of trained contact tracers are critical for locating the people you came in contact with but don ’ t know , such as at a restaurant or on an airplane , and then tracing the next ring of contacts .
However , jump-starting the effort on your own can improve your chances of remembering and allow you to warn your contacts sooner .
Contact tracing , along @ @ @ @ @ @ @ infected , is considered crucial for controlling the coronavirus ’ s spread until a vaccine becomes widely available .
Health department contact tracers try to notify and interview anyone who was within 6 feet of an infected person for a total of 15 minutes or more .
Studies show that , to be effective , that notification needs to happen within a few days of the person ’ s symptoms appearing .
But case numbers have gotten so high , it ’ s become impossible for many states and counties to keep up @ @ @ @ @ @ @ Missouri and Wisconsin , have urged residents to start notifying contacts on their own .
We created CogTracer as a free online tool to help people start tracing those contacts using best-practice interviewing methods .
With DIY contact tracing , the timetable changes .
For example , while you ’ re waiting for your test , you can be given the link to the website and start walking yourself through a contact tracing interview .
How psychology can help jog your memory CogTracer uses prompts , in words and photos , to spark @ @ @ @ @ @ @ locations visited as possible .
It urges you to look back at places that might have evidence of your movements that week , such as social media posts and credit card records , and it provides scientifically supported interviewing techniques to reduce the chances of forgetting a contact .
Research in investigative interviewing shows that people can effectively remember events on their own when they have scientifically supported methods .
One technique for remembering is known as context reinstatement .
It involves putting yourself back in a specific time and place .
For @ @ @ @ @ @ @ gathering over the holidays , you might mentally recreate the event .
You could think back on how you arrived and departed , what you wore , who was there , what you ate , what you heard and what you saw .
The technique encourages closing your eyes during this process to help you concentrate .
“ Reliving ” this experience should make it easier to remember your close contacts at the event .
Another important way to improve memory is varied retrieval .
When you search your memory only once , @ @ @ @ @ @ @ over , it is likely that something will be forgotten .
What you recall depends on how you cue your memory .
If you prompt your memory in different ways , you ’ ll recall different things .
CogTracer takes advantage of repeated and varied recall by including broad category cues , such as “ people you interact with in homes ” or words such as “ babysitter , ” that may trigger memories of nonroutine activities that may otherwise be forgotten .
Applying these proven methods should result in more complete recall @ @ @ @ @ @ @ for contracting COVID-19 .
Online tools can overcome other barriers , too This DIY approach can also help overcome other barriers to effective and timely contact tracing .
Because many people put a high premium on privacy , some are resistant to providing information to contact tracers .
CogTracer is anonymous and private—you don ’ t enter any information , and you make your own lists .
This provides a way for those who otherwise would not engage in the process to contribute to contact tracing efforts on their own terms .
Additionally @ @ @ @ @ @ @ , further delaying the contact tracing process .
Online interviews can more quickly bridge these language gaps .
As the pandemic rages , public health workers are engaged in Herculean efforts to fight this disease .
By reimagining contact tracing and applying the science of memory , we can leverage the power of individuals to attack the problem from as many fronts as possible .
This article was originally published on The Conversation .
Read the original article .

The following essay is reprinted with permission from The Conversation, an online publication covering the latest research.
Imagine you begin to feel ill on Thursday, a few days after returning from a trip. You’re afraid it’s COVID-19, so you get tested on Friday. Even under good circumstances, it will probably be at least Monday before a contact tracer calls from the health department. And then some phone tag may ensue before you speak with anyone—if you get a call at all.
Once a contact tracer does reach you, you will be asked to remember all the people you were in close contact with, starting two days before you began feeling symptoms. That means recalling all the places you went and the people you saw over the past week.
It isn’t easy. As time passes, memories fade. Unfortunately, your contacts, unaware they were exposed to the coronavirus, may have already infected others.
Concerned about those delays, three of us and our colleague Ronald Fisher, all psychology professors with expertise in memory, developed a way for people who have been exposed to COVID-19 to effectively trace their recent contacts on their own.
Self-driven contact tracing shouldn’t replace health department efforts. Professional teams of trained contact tracers are critical for locating the people you came in contact with but don’t know, such as at a restaurant or on an airplane, and then tracing the next ring of contacts. However, jump-starting the effort on your own can improve your chances of remembering and allow you to warn your contacts sooner.
Notifying contacts faster
Contact tracing, along with testing and isolating people who are infected, is considered crucial for controlling the coronavirus’s spread until a vaccine becomes widely available.
Health department contact tracers try to notify and interview anyone who was within 6 feet of an infected person for a total of 15 minutes or more. Studies show that, to be effective, that notification needs to happen within a few days of the person’s symptoms appearing. But case numbers have gotten so high, it’s become impossible for many states and counties to keep up. Some, including in Alaska, Missouri and Wisconsin, have urged residents to start notifying contacts on their own.
We created CogTracer as a free online tool to help people start tracing those contacts using best-practice interviewing methods.
With DIY contact tracing, the timetable changes. For example, while you’re waiting for your test, you can be given the link to the website and start walking yourself through a contact tracing interview.
How psychology can help jog your memory
CogTracer uses prompts, in words and photos, to spark your memory for as many contacts and locations visited as possible. It urges you to look back at places that might have evidence of your movements that week, such as social media posts and credit card records, and it provides scientifically supported interviewing techniques to reduce the chances of forgetting a contact. Research in investigative interviewing shows that people can effectively remember events on their own when they have scientifically supported methods.
One technique for remembering is known as context reinstatement. It involves putting yourself back in a specific time and place.
For example, if you attended a family gathering over the holidays, you might mentally recreate the event. You could think back on how you arrived and departed, what you wore, who was there, what you ate, what you heard and what you saw. The technique encourages closing your eyes during this process to help you concentrate.
“Reliving” this experience should make it easier to remember your close contacts at the event.
Another important way to improve memory is varied retrieval. When you search your memory only once, or in the same way over and over, it is likely that something will be forgotten. What you recall depends on how you cue your memory. If you prompt your memory in different ways, you’ll recall different things.
CogTracer takes advantage of repeated and varied recall by including broad category cues, such as “people you interact with in homes” or words such as “babysitter,” that may trigger memories of nonroutine activities that may otherwise be forgotten.
Applying these proven methods should result in more complete recall of those who could be at risk for contracting COVID-19.
Online tools can overcome other barriers, too
This DIY approach can also help overcome other barriers to effective and timely contact tracing.
Because many people put a high premium on privacy, some are resistant to providing information to contact tracers. CogTracer is anonymous and private—you don’t enter any information, and you make your own lists. This provides a way for those who otherwise would not engage in the process to contribute to contact tracing efforts on their own terms. Additionally, non-English speakers may require an interpreter, further delaying the contact tracing process. Online interviews can more quickly bridge these language gaps.
As the pandemic rages, public health workers are engaged in Herculean efforts to fight this disease. By reimagining contact tracing and applying the science of memory, we can leverage the power of individuals to attack the problem from as many fronts as possible.
This article was originally published on The Conversation. Read the original article.