2020 Vs. 2025: What's Different and the Same in Health Policy - Our 200th Episode!

Let us know what you think about Health Affairs podcasts at [e-mail]. If you have 30 minutes to spare, let us know and we'll set up a 30-minute chat for the first 20 listeners that reach out. Coffee will be on us.

Health Affairs' Jeff Byers welcomes Deputy Editor Jessica Bylander to the program to celebrate the 200th episode of Health Affairs This Week and take a look back at the health care world of 2020 and see what has changed in terms of COVID-19, vaccinations, telehealth, and more.  

Health Affairs published an ahead-of-print article this week from Yashaswini Singh and coauthors exploring explore how the expansion of private equity-owned physician practices has led to a decrease in access for certain eye conditions such as retinal detachment.
 
Yasahswini Singh also appeared as a guest on a live episode of A Health Podyssey discussing private equity's effect on health care staff turnover.

Health Affairs is hosting an Insider exclusive event on May 29 focusing on the FDA's first 100 days under the second Trump administration featuring moderator Rachel Sachs alongside panelists Richard Hughes IV and Arti Rai.

Related Links:

• The Many Ways Kennedy Is Already Undermining Vaccines (The New York Times)
• Health secretary RFK Jr. endorses the MMR vaccine — stoking fury among his supporters (NPR)
• Measles tracker: Follow cases, outbreaks and vaccination rates across the U.S. (NBC News)
• Fact Sheet: Telehealth (American Hospital Association)

Episode Transcript

Jeff Byers (00:39):
Hello and welcome to Health Affairs This Week. I am
your host, Jeff Beyers. We'rerecording on 04/24/2025. This
week, we published an ahead ofprint article by Yasha Sweeney
Singh titled private equityowned physician practices
decreased access to retinaldetachment surgery twenty
fourteen to 2022. Check thatout.

(01:00):
She also wrote another paper onprivate equity that was
published in the March issue aswell, and Rob Lot spoke with her
on a health policy podcast. Soif you're interested in how
private equity affects healthcare, check out the AOP, which
you can find in the show notesand check out that podcast. On
May 29, we are hosting aninsider event on the FDA's first

(01:23):
a hundred days under the secondTrump administration. This is
moderated by Rachel Sacks, andthe panel will include Richard
Hughes the fourth and Arty Rye.Check it out.
Become an insider today. Todaymarks the publication of our two
hundredth episode of healthaffairs this week, so really
excited about that. Thank youfor listening to us over the

(01:44):
years. We launched this podcastin December 2020, which truly
feels like yesterdays in a lotof ways, but also feels like an
eternity. A lot has changed inthe last four and a half years.
To talk about what's changed andwhat remains the same, I'm
joined by Health Affairs ownJessica Bylander. Jessica,
welcome to the program.

Jessica Bylander (02:03):
Hi. It's been a little while.

Jeff Byers (02:05):
Yeah. Yeah. So four and a half years, you know, to
put some context to that, Ijoined health affairs in August
2020. So five years ago, Iwasn't even here yet. Also,
welcomed the birth of adaughter.
What's, you know, big change foryou since we started this
podcast?

Jessica Bylander (02:23):
Wow. Yeah. Well, I've I mean, I've I feel
like I've been at health affairsforever, like, thirteen years.
So over time, the years, like,kind of squished together a
little bit more. I I was shockedto learn that this was the two
hundredth episode and that we'vebeen doing this for nearly five
years.
I thought that couldn't beright. Yeah. I guess since 2020,
I had a second child and

Jeff Byers (02:45):
Congrats.

Jessica Bylander (02:45):
Kept working here and have had a lot of
adventures and couple couplebouts of COVID nineteen. Yeah.

Jeff Byers (02:54):
Yeah. So, Jess, do you consider health care fun? Is
this a fun world?

Jessica Bylander (03:01):
Is it a fun world? I think it's a I think
it's a fun world. I think it's avery dynamic world. I think
things are often changing, andthere's always something new to
learn about and to kind of catchup on. It is also hard to be an
expert to me at least becausethings move so much, and there
are so many different facets ofhealthcare to stay on top of,

(03:22):
but I'm never bored, that's forsure.

Jeff Byers (03:25):
Yeah. That's true. Never a boring day in
healthcare. So one of the thingswe thought we would do today to
celebrate our two hundredthepisode would be to talk about
what's changed since the programstarted. So this started in
December 2020, as mentioned.
You can remember, 2020 was notan awesome time in American

(03:46):
history. I think that's safe tosay due to the COVID nineteen
pandemic, which really grippedThe United States, I believe,
around March 2020. And we didn'thave vaccines until April, maybe
March of twenty twenty one. SoDecember 2020 was locked in. The
COVID nineteen pandemic wasstill gripping the world with
uncertainty in this time.

(04:07):
Largely since then, lockdownmeasures have been lifted and
people have gone on mostly tolive their lives for the most
part. What's happening todaywith COVID nineteen, Jessica?

Jessica Bylander (04:17):
Yeah. I mean, it feels so different about five
years later. You know, the thestate of panic we were all
gripped with and uncertainty. Iremember the relief of getting
my own vaccine in April 2021 andjust what a difference that
made. And, I mean, I I think wecan all agree that that that
period was, like, collectivelytraumatic of of just reading

(04:38):
about deaths every day and justbeing so uncertain and not being
able to kind of see family or orgo where you wanted to go.
So, obviously, you know, fiveyears in, that's not the
feeling. That's sort of not thevibe. And COVID nineteen doesn't
really feel like this dailythread. It doesn't feel like
something that's kind of top ofmind at all times. Yeah.

(05:00):
As I said, I know I've had it acouple times and, effects have
been minimal. So, yeah, I mean,the data show that, you know,
the deaths from COVID nineteen,have dropped from their sort of
peak at more than five thousanddeaths per day in 2021 to around
two hundred eighty reporteddeaths per day at the February.
So it's, you know, it's notdropped to nothing. It's not not

(05:21):
a risk for everyone. I think itis worth knowing that it's still
out there.
There are still, you know,variants evolving. There are
still, you know, a handful ofpercent of cases, you know,
testing positive every week,both in US and and globally.
But, yeah, we have vaccines. Wehave boosters that people get
some sort of annually like theflu shot, and we have antiviral

(05:42):
treatments for folks who do getsick from it. But, yeah, there
are still people beinghospitalized.
There are still people dying.And as before, I think the
people most at risk of of thatare older folks, people who are
immunocompromised, and who haveunderlying comorbidities. But
yeah, so I think one interestingthing while COVID has gotten a
lot less attention, there are,you know, growing reports of

(06:05):
long COVID, which is when youhave kind of lingering symptoms
for weeks afterwards or monthsafterwards. So I think
researchers say about eightpercent of Americans have ever
experienced long COVID. Butactually a new study in BMJ
Public Health recently foundthat among healthcare workers,
the prevalence of long COVIDcould be like forty percent
globally.

(06:26):
So I thought that was reallyinteresting that sort of how
it's evolved into this long termpossibly chronic condition and
also how it's just become, youknow, kind of a daily part of
our lives, but not somethingfolks are acutely concerned
about all the time.

Jeff Byers (06:41):
Yeah. As you as you were bringing us up to speed on
what's happened in the last fiveyears, I was just doing a quick
Google search of, top headlinesfrom the New York Times on
Friday, 04/24/2020. BesidesCOVID, can you do you think you
can guess what a what a topheadline was?

Jessica Bylander (06:58):
Oh my gosh.

Jeff Byers (07:01):
I'm putting you on the spot, so my apologies.

Jessica Bylander (07:03):
Yeah. I'm like, was it basketball? I'm not
sure.

Jeff Byers (07:10):
No. It from a one, jobless numbers are eye
watering, but understate thecrisis, which made me
immediately look up what theunemployment rate in March 2020
was. The unemployment rate wasin March 2020 was 4.4%. The
unemployment rate today in March2025, '4 point '2. Just to give

(07:35):
some context there.
And another headline was one infive New Yorkers may have had
COVID nineteen antibody testssuggest. Again, that was on
Friday, 04/24/2020, which now Ialso have experienced a bout of
COVID nineteen. Minimal symptomson my end as well, and I believe
most of us have known someone,if we have not experienced COVID

(07:58):
nineteen, to experience it. But2020 still hadn't benefited from
the mRNA vaccine technology. TheCOVID nineteen was arguably,
vaccine the COVID nineteenvaccine was a game changer, had
a lot of people feel morecomfortable to lead.
You know, Jessica, you mentionedthe relief that you felt getting
in. I know I felt relief gettingthe COVID nineteen vaccine at

(08:20):
the time in 2021. How might weview vaccine policy from 2020
versus today?

Jessica Bylander (08:28):
Yeah. I mean, it's a complicated question. I
think, you know, on the one handin 2021, probably vaccines were
more in the news than everbefore and more people were
actually excited to getvaccinated than ever before. But
also, I mean, it it it didbecome extremely political and
extremely sort of, polarizing insome ways. So the CDC's

(08:50):
morbidity and mortality weeklyreport, found that, childhood
vaccines for one, rates werelower among children in 2020
born in 2020 and 2021 comparedto those born before the
pandemic.
And, you know, the implicationsfor that are obviously wide.
And, yeah, it looks like underthe Trump administration,

(09:12):
vaccine policy will be reviewed,it may look a little bit
different. So what we know isthat the administration has
taken some steps, according tothe New York Times, halting
funding for researchers who werewho were studying vaccine
hesitancy and how to overcome itand canceling, programs intended
to discover new vaccines toprevent future pandemics. And

(09:34):
HHS secretary Robert F. Kennedyhas made some comments
indicating concerns aboutvaccine safety.
But on the other hand, you know,in the face of rising deaths
from measles and, the currentoutbreaks, RFK recently endorsed
the measles vaccine on socialmedia, calling it the most
effective way to prevent thespread of the disease.

Jeff Byers (09:53):
Yeah. So not that there's a pandemic du jour per
se, but we are hearing moreabout measles as a potential
pandemic versus COVID nineteenthese days. What is the state of
measles and a potential outbreakin The United States currently?

Jessica Bylander (10:09):
Yeah. So so as of, I think, last week, eight
hundred measles cases werereported by 25 jurisdictions in
The US, and most of those caseswere in Texas. And three
children have have died ofmeasles according to the CDC. So
just to put that in perspective,in 2024, there were only two

(10:30):
hundred eighty five cases ofmeasles reported in all of all
of 2024 and no deaths reported.So this is something the CDC
seems to actively tracking.
I think they said they would beupdating their website weekly
with with new information on oncases and hospitalizations,
deaths, and they even, includeon that website that tracks it

(10:51):
the percent of of cases who werevaccinated.

Jeff Byers (10:55):
So during the COVID nineteen pandemic in 2020, Joe
Biden had been elected inNovember but hadn't taken office
until January 2021. So the firstTrump administration did have
that public health tracking ofthe COVID nineteen outbreak at
that time. And then eventually,I think that was updated daily
for a long time and then movedto weekly sometime after the the

(11:18):
vaccine came out under the Bidenadministration. Are there any
parallels to the COVID nineteenand measles outbreak?

Jessica Bylander (11:24):
I think, you know, just trying to keep the
information up to date. As Isaid, updating the CDC website
every Friday, they said, andjust ensuring, that folks have
the most up to date informationabout that. I know in in 2023,
the CDC launched a public healthdata strategy to address gaps in
public health data and modernizeUS public health data systems.

(11:47):
There was a lot of, criticism ofthe US government and and,
agencies about our data 2020 andand its ability to, keep up with
what's going on in, diseasesurveillance and to keep the
public apprised of, like, thelatest data. So efforts began
around then and and reallyramped up over the years to

(12:09):
improve our ability to detectthreats and to intervene
quickly.
And and there were someinvestments from congress in in
that effort in 2020 as well. So,you know, CDC has said it's made
good progress on updating itsdata infrastructure and, you
know, exchanging some dataautomatically and covering more
of the population. So I think itremains to be seen, like, our

(12:30):
our data systems better able toidentify new threats and respond
to them.

Jeff Byers (12:37):
Well, time will tell. Finally, telehealth got a
bump in use as people didn'tleave their homes as much in
2020. What does the telehealthmarket look like today?

Jessica Bylander (12:48):
Yeah. So, you know, recent data from the
Kaiser Family Foundation doesshow that telehealth use has
declined since 2020, but it isstill higher than pre pandemic
levels. In the last quarter oftwenty twenty three, more than
12.6% of Medicare beneficiariesreceived telehealth service. So
it's definitely become more of ahousehold practice, especially

(13:10):
for people in remote areas orfor people who are accessing
specialists such as therapistsand others. But yeah, so efforts
now, I think, are kind offocusing on ensuring that
telehealth flexibilities thatwere put into place during the
pandemic are made permanent orcontinued.
Groups such as the AmericanHospital Association are urging

(13:32):
Congress to make thoseflexibilities such as, you know,
eliminating geographicrestrictions and allowing
telehealth visits to occuranywhere that a patient is
located and eliminating inperson visit requirements for
behavioral health that weregranted during the pandemic
permanent to avoid sort oflosing momentum, that we've
gained in telehealth over theyears.

Jeff Byers (13:51):
Well, Jessica, thanks for joining us again back
on the program here at HealthAffairs this week. If you, the
listener, enjoyed this episode,send it to the time traveler in
your life, and we will see younext week. Thanks all. Thanks.