Governor's Push for a Sweeping Overhaul of Public Health

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>>> YOU WOULDN'T KNOW OF COURSE LOOKING AT YOU OR ME, BUT WE HOOSIERS ARE STATISTICALLY SPEAKING SOME OF THE UNHEALTHIEST PEOPLE IN AMERICA.

NAME THE METRIC AND CHANCES ARE INDIANA HAS A WOLFE INTERNATIONAL RAN RACKING.

BIRTH WEIGHT, CHRONIC DISEASE AND YES LIFE EXPECTANCY.

SIMPLY PUT WE EAT AND SMOKE TOO MUCH.

WE EXERCISE CAN SALEM TOO LITTLE AND AS A RESULT WE DIE TOO SOON.

FIVE YEARS EARLIER THAN HAWAII.

THIS WEEK OP THE SHOW WE'LL EXAMINE THE GOVERNOR'S PUSH FOR A SWEEPING OVERHAUL OF THE STATE'S PUBLIC HEALTH SYSTEM.

INDIANA LAWMAKERS FROM THE STAYS STATE HOUSE TO YOUR HOUSE.

>>> PAINFULLY AWARE OF INDIANA'S HEALTH THE GOVERNOR WANTS TO TURN OVER A NEW LEAF AND NO I'M NOT TALKING ABOUT KALE, SPINACH, ARUGULA OR SOME OTHER VITAMIN PACKED SUPER FOOD.

- NO AERIER AND A HALF AGO THE GOVERNOR CREATED A 15 MEMBER COMMISSION TO EVALUATE THE STATE'S PUBLIC HEALTH SYSTEM AND RECOMMEND IMPROVEMENTS.

THE GROUP'S FINDS SHAPE A PACKAGE OF REFORMS THE GOVERNOR IS AFTER ADVOCATING.

JOINING ME ARE SENATOR ED CHARBONNEAU OF VALPARAISO, CHAIR OF THE SENATE COMMITTEE ON HEALTH AND PROVIDER SERVICES, REPUBLICAN REPRESENTATIVE OF MARION, VICE CHAIR OF THE HOUSE COMMITTEE ON FAMILY CHILDREN AND HUMAN AFFAIRS, DR. CHRISTMAS TINA BOX INDIANA STATE HEALTH COMMISSIONER AND DR. VIRGINIA CANE, DIRECTOR OF THE MARION COUNTY PUBLIC HEALTH DEPARTMENT.

THANK YOU ALL FOR BEING HERE FOR OUR DISCUSSION OF THIS CRITICALLY IMPORTANT TOPIC.

LET ME START WITH SOME DEFINITIONS BECAUSE I THINK A LOT OF US, HEALTH CARE, PUBLIC HEALTH THEY ALL GET CONFLATED AND DR.

BOX, LET'S START WITH CROW.

WHY SHOULD WE PAY ATTENTION TO THE NUANCE IN IN THIS LEGISLATION WE'RE GOING TO TALK ABOUT FOCUS ON PUBLIC HEALTH AS OPPOSED TO HEALTH CARE.

>> MOST OF PEOPLE CONSIDER THEIR HEALTH TO BE ABOUT THE CLINICAL CARE THEY RECEIVE, THE% TREATMENT THEY GET TO TREAT CHRONICS DISEASE IN THEIR DRAUGHTS CAN THAT'S A SMALL PART OF YOUR HEALTH.

PUBLIC HEALTH ADDRESSES THE PREVENTIVE THINGS, SO WE PERIOD OF TIME INJURY, PREVENT CHRONIC DISEASE.

REALLY THE BEST WAY TO LOOK AT THIS IS THOSE TWO THINGS NEED THE TO BE MARRIED AND JOINED TOGETHER WORKING TOGETHER.

>>> AND TRADITIONALLY IN THIS SEDATE AND 49 OTHER STATE ACROSS COUNTRY WE SEE THAT IT'S THE HEALTH CARE THAT GETS THE BULK OF FUNDING.

HOW DO WE GET PEOPLE TO UNDERSTAND THAT MAYBE IF YOU SPEND A LITTLE EFFORT ON THE FRONT WE COULD SAVE ON THE BACK END.

>> WHAT'S INCREDIBLE IS INDIANA RANKS FOR THE NATIONAL PRIVY OF PUBLIC HEALTH FUNDING TO 25 PERCENT LOWER RANKING, SO WE'RE THE LOWEST -- >> FOUR OUGHT, RIGHT?

SO IF I HAD A -- IT WOULD SAY 48 -- >> ACTUALLY 45TH BUT THAT'S NOT A GREAT SLATE TO BE PROUD OF, FOR IMPORTANT THAT THAT IF YOU LOOK AT THE PER CAPITA FUNDING WE SEE IN OUR COUNTIES SOME OF THE COUNTIES AS LOW AS $1.25 IS JUST INCREDIBLE.

IT'S -- I'M SORRY, SCOTT COUNTY BUT THAT'S INCREDIBLY LOW, HOW ARE YOU ABLE TO PROTECT YOUR RESIDENTS AND CITIZENS?

>> LET'S PUT IT INTO DETENTION, CONTEXT.

>> MY COUNTY IS ACTUALLY $83 BUT THE INCREDIBLE ADVANTAGE THAT I HAVE IS THAT I DO A LOT OF GOING AFTER A LOT OF FEDERAL GRANTS THAT A LOT OF THESE SMALL COUNTIES, THEY ARE NOT ELIGIBLE NOR DO THIS HAVE THE PROPER INFRASTRUCTURE TO BRING THAT TYPE OF FUNDING INTO THEIR COUNTY.

70 PERCENT OF OUR FUNDING COMES FROM PROPERTY TAXES AND MOST PLACES.

>> SO GEOGRAPHY REAL IS THAT KEY ALONG WITH GENETICS AND ENVIRONMENTAL FACTORS BUT CERTAINLY GEOGRAPHY.

>> FIRST OF ALL MY HAT IS OFF TO THE GOVERNOR TO BRING THIS TO THE FRONT, BECAUSE I THINK IF NOTHING ELSE, THE REPORT THAT WAS DONE BRINGS TO LIGHT DATA.

DATA THAT QUITE POSSIBLY WE HAVEN'T BEEN PAYING ATTENTION TO AT THE STATE LEVEL, AND BECAUSE IT'S FUNDED AT THE LOCAL LEVEL, BUT WHAT WE'RE SEEING HERE AND WHAT I BELIEVE HAS GOT TO HAPPEN IS A MESHING OF -- AND IT'S A TRANSFORMATIONAL FROM PAYING ATTENTION TO VERY EXPENSIVE TREATMENT THAT WE'RE VERY GOOD AT AND FLIPPING BACK AND PAYING ATTENTION TO PREVENTION.

AND IT IS GOING TO AFFECT THE WORKFORCE, IT IS GOING TO AFFECT EVERY PART OF OUR ECONOMY.

THE ISSUE IS THE RESULTS DON'T SHOW IMMEDIATELY OR EVEN SEMI-IMMEDIATELY, A LOT OF THEM ARE LONG-TERM, SO ONE OF THE THINGS WE HAVE TO DO IS IDENTIFY HOW ARE WE GOING TO MEASURE -- >> NO, AND WE DEFINITELY WANT TO JUMP INTO THAT BUT I WANT TO SETTLE SETTLE THE STAGE, HOW DIRE OUR POLITE PLIGHT IS, THE HEALTH CARE COSTS, WE CAN TALK ABOUT RANKS, WHAT'S ONE THING IF YOU HAD TO BUTTONHOLE A COLLEAGUE, GIVE ME THE TEN SECOND ONE FACTOID THEY WOULD GET MY ATTENTION?

>> ONE THING I WANT TO SAY IS WE SPEND A LOT OF TIME EVALUATING PERSONALIZED HEALTH CARE, THAT'S WHAT I GET WHEN I GO TO THE DOCTOR.

THIS IS PUBLIC HEFT SO THIS IS THE TOTALITY OF ALL OF US GETTING OUR PERSONALIZED HEALTH CARE, WHICH WE GO AND CHECK OUR OWN -- OUR CHOLESTEROL AND EVERYTHING EL IN OUR LIVES, THE TOTALITY OF THE PUBLIC.

SO I DO TELL MY LEGISLATORS THAT HE NEED TO BE SETTING THE INFRASTRUCTURE ON ALL THE TOTALITY OF OUR PERSONALIZED HEALTH CARE WHICH SOME OF US IN INDIANA ARE LACKING AND VINYLIZE OUR PERSONAL HEALTH CARE AS A PYRETY.

SO I THINK FOR ME I COME FROM A RURAL COMMUNITY, YOU ARE MORE LIKELY THE DIE IN MY AREA THAN YOU ARE IN MY DISTRICT THAN YOU MAY BE IN MARION COUNTY.

AND I AGREE WITH SENATOR CHARBONNEAU, THAT IS A PUBLIC HEALTH INFRASTRUCTURE THAT THEY'RE RECOMMENDING, SO I THINK THE DATA IS STARK, AND THAT'S SOMETHING THAT I THINK WE DEFINITELY HAVE TO PAY ATTENTION TO, BUT IT MAKES A BIG DIFFERENCE -- WE SPEND A LOT OF TIME IN THE LEGISLATURE TALKING ABOUT MEDICAID AND THE COST OF HEALTH CARE.

>> THE SECOND LARGEST BUDGETARY LINE ITEM NEXT TO EDUCATION.

>> BUT IT IS THE DIFFERENCE BETWEEN THE PUBLIC HEALTH AND PERSONALIZED HEALTH.

>> FOR MOST PEOPLE, WHAT DO YOU MEAN BY PUBLIC HEALTH?

I'M NOT SURE WHAT YOU MEAN BY THAT.

SO FOR EXAMPLE RECENTLY WE HAD SOMEBODY DIAGNOSED WITH MENINGITIS, WHAT WOULD HAVE PREVENTED THAT?

IMMUNIZATIONS; VACCINATIONS, BUT MIGHT HAVE GONE TO THE RESTAURANT LAST NIGHT, YOU KNOW AND LOCALLY IF THINGS ARE NOT TAKING PROPERLY, INSPECTIONS AND THOSE RESTAURANTS YOU CAN HAVE SOME ADVERSE OUTCOMES.

PEOPLE GETTING SICK, FOOD, NAUSEA AND VOMITING, FOOD POISONING, BUT YOU WANT TO TALK ABOUT HEALTH CARE COSTS?

WHEN YOU HAVE POOR HEALTH OUTCOMES, WHAT HAPPENS?

YOU HAVE A HIGHER UTILIZATION OF SERVICES, YOU HAVE A LOT OF PEOPLE HAVE TO FREQUENT THOSE SERVICES MORE FREQUENTLY THAN IF YOU PREVENTED IT.

AND I THINK EVERYBODY IS CONCERNED ABOUT THE HEALTH CARE COSTS IN A COMMUNITY.

>> THERE'S THE LITERAL COST AND THE IN TANGIBLE COST, YOU TALK ABOUT THE LIVE LOOK DISPARITY AND I DON'T MEAN TO PICK ON SCOTT COUNTY BUT HAMILTON COUNTY WHICH IS ON THE HIGH END TO SCOTT COUNTY.

THERE ARE STATS -- LET'S DO THIS, LET'S STIPULATE THAT WE'RE NOT KEEPING PACE FOR MUCH OF THE COUNTRY AND WE NEED TO DO BETTER FOR HOOSIERS.

WE HAVE THE LARGESTEN ROLLMENTS MIDDLE SCHOOL IN THE COUNTRY, OUR FLAGSHIP INSTITUTION, INDIANA UNIVERSITY AS TWO PUBLIC HEALTH SCHOOLS, AND SEPARATE DEGREE GRANTING SCHOOL OF PUBLIC HEALTH IN BLOOMINGTON, AND A LOT OF OTHER INSTITUTIONS PUBLIC AND PRIVATE ARE TRAINING PEOPLE FOR THE WORKFORCE.

EXPLAIN HOW WE CAN HAVE THAT INFRASTRUCTURE IN TERMS OF EDUCATION AND A PIPELINE FOR THE WORK FORCE AND YET HAVE THESE HORRIBLE WOEFUL NUMBERS?

>> I THINK WHAT WE SEE IS A LOT OF PEOPLE COME TO INDIANA TO TRAIN BUT THEY DON'T STAY IN INDIANA TO PRACTICE AND THAT'S A HUGE PROBLEM.

IF YOU'RE IN PUBLIC HEALTH AND YOU'RE LOOKING AT A PUBLIC HEALTH SYSTEM THAT IS NOT WELL RESOURCED THEN YOU MAY CHOOSED TO GO TO TO ANOTHER STATE AND PRACTICE BECAUSE YOU KNOW YOU HAVE THE RESOURCES AND TOOLS YOU NEED TO PROVIDE THE SERVICES, THE CORE SERVICES THAT EVERYONE SHOULD HAVE ACCESS TO, AND I GIVE SENATOR CHARBONNEAU, I AGREE WITH HIM, THE GOVERNOR TOOK THIS ON AND THIS IS HUGE.

GRANTED WE HAD A PANDEMIC AND IT SHOWED THE LIGHT ON THOSE GAPS AND ISSUED THAT WE HAD AND IF WE HADN'T HAD OUR NATIONAL GUARD AND OUR HOSPITAL OPTION AND EMS STEP UP WE WOULD HAVE STRUGGLED, MANY WERE NOT ABLE TO DO THAT, SO THE GOVERNOR TAKE THIS ON AS SHOWN A LIGHT ON IT AND WE HAVE WORKED VERY HARD TO DEVELOP A TRUE PROGRAM AROUND THIS.

THIS IS NOT JUST WE NEED FUNDING TO IT, GIVE IT TORSIONS AND WE'RE GOING TO PROVIDE YOU WITH SOMETHING, THIS IS THE PROGRAM AND HOW TO FUND IT.

>>> NO MATTER WHAT SECTOR THE ECONOMY YOU TALK TO THE NUMBER ONE ISSUE IS PEOPLE, IS WORKFORCE.

YOU TALK ABOUT THE PIPELINE, WE HAVE SOME GREAT MEDICAL SCHOOLS IN INDIANA, WE GRADUATE ROUGHLY 500 MEDICAL SCHOOL GRADUATES EVERY YEAR, WE ONLY HAVE 150 RESIDENT DEN SISES WHICH WE'RE TALKING ABOUT 150 DOCTORS THAT ARE GOING TO END UP SOMEPLACE ELSE BECAUSE I THINK THE STATISTICS SHOW THAT WHERE DOCTORS DO THEIR RESIDENCY IS WHERE THEY'RE MOST LIKELY TO STAY.

>> AGAIN THERE ARE A LOT OF CULPRITS -- WE SAID HOW DO WE GET WHERE WE ARE AND THERE ARE A LOT OF FACTORS, ENVIRONMENTAL FACTORS, WE TALK ABOUT SOCIAL BEHAVIORS AND LIFESTYLE CHOICES AND THE FACT WE HAVE MEAGER FUNDING FOR -- >> WE HAVE PRIORITIZED OTHER THINGS AND WE'VE MOVED THE NEEDLE.

>> AND MONEY ISSUE OR IS IT SOMETHING DEEPER?

AND I BRING THIS UP BECAUSE COVID I THOUGHT REALLY PUT A BRIGHT LIGHT ON SOMETHING.

IT SEEMS TO ME TO THE MAKE OF COVID YOU WOULD CELEBRATE PUBLIC HEALTH AND SAY THESE MEN AND WOMEN SAVED OUR BACON BUT YOU HAVE THIS DISTAIN OR ANIMOSITY THAT IT'S HARDER TO GET THINGS ENACTED NOW THAN IT WAS BEFORE COVID.

AM I MISREADING THE SENTIMENTS?

>> I THINK THAT ESPECIALLY WITH THE COMMISSION'S PROPOSAL WE ARE ASKING OUR COUNTY COMMISSIONERS AND LOCATED OFFICIALS AND COUNTY COUNCIL TO PUT SKIN IN THE GAME.

AND THAT HASN'T HAPPENED, THE PUBLIC HEALTH FUNDING IS THE LOWEST BUDGET ITEM, BUT I ALSO WANT TO GIVE TO MY LOCAL LOCATE COLLEAGUES THERE, THIS ARE NO DIFFERENT THAN WE ARE, THEY HAVE BUDGETS AND THEY HAVE DEPARTMENTS THAT ARE ASKING FOR INFRASTRUCTURE AND PERSONNEL AND IT SEEMS TO ME THAT PUBLIC HEALTH LINE ITEM ON EACH OF THOSE COUNTIES HAS BEEN SO LOWER ON THE LADDER THAN MOST OF THE OTHER DEPARTMENTS.

WHAT I LOVE ABOUT THE IN ADDITION AND OUR OPPORTUNITY TODAY IS TO EDUCATE OUR COUNTY COUNCIL OP WHAT DOES IT MEAN TO HAVE A FLUID PUBLIC HEALTH DEPARTMENT WHERE WE ARE SPEAKING WITH EACH OTHER, AND LIKE YOU SAID COVID OPENED -- IT'S A MAGNIFYING GLASS OF WHAT WAS BROKEN BETWEEN COUNTIES, TEEN THE STATE DEPARTMENT OF HEALTH AND IT ALSO KIND OF ELEVATED JUST THE PERSONNEL ISSUES.

THERE'S TOO MANY STATUTORY REQUIREMENTS THAT THEY HAVE TO GET DONE, BUT ALSO WHAT WE WOULD LOVE FOR THEM TO DO TO BRING UP THE PUBLIC HEALTH NUMBERS.

THERE'S JUST NOT ENOUGH AND IT'S A HARD DECISION WHEN YOU DO OUTCOMES WITH MONEY.

>> JUST TAKEN THE SIMPLE THING THAT WE'RE REQUIRED TO DO VISION SCREENING CHECKS FOR OUR CHILDREN AND THINK ABOUT THAT CHILD THIS THIRD GRADE YOU WONDER WHY THEY'RE NOT PERFORMING LIKE THEY SHOULD, THEY CAN'T SEE THE BLACK BACKYARD, THEY COMPLAINT READ AND UNLESS THIS PROGRAM IS IN PLACE THAT PROBLEM WOULD NOT HAVE BEEN IDENTIFIED UNTIL MAY BE THEY MAD MADE IT TO HIGH SCHOOL BUT THEN YOU HAVE A SCIENTIFIC NUMBER OF YOUR POPULATION -- YOU'RE NOT GETTING THE BRIGHTEST AND THE BEST BUT WE HAVE TO BE I BELIEVE TO PROVIDE THE SOURCE RESOURCES BECAUSE WE NEED A GOOD WELL SKILLED WORK FORCE IN ORDER TO FILL OUT THE JOBs HERE IN THE STATE OF INDIANA.

>> IS THAT THE WAY SENATOR THAT THIS COULD BE PACKAGED FOR -- SERGE THE WAY THE GOVERNOR FRAMED I WOULD WHO THINK THAT PUBLIC HEALTH MAYBE SHOULD BE UNDER FUNDED BECAUSE YOU'RE TALKING ABOUT THE NANNY STATE AND PEOPLE NEED TO BE SELF RELIABILITY AND YOU'RE HEARING ABOUT SOCIAL MEDICINE, PEOPLE SAY THE ONLY PERSON THAT MATTERS IN HEALTH CARE IS ME WHICH IS I GUESS ANOTHER ISSUE FOR ANOTHER DAY.

BUT IN TERMS OF TRYING SELL THIS IS IT JUST ABOUT MONEY OR IS IT AGAIN, THE ATTITUDE, IS THERE A NOTION THIS IS AN ARM OF BIG BROTHER THAT'S GETTING IN THE WAY OF PERSONAL FREEDOM?

>> THE TIMING OF THIS COMES AFTER A PANDEMIC, WHERE THERE WERE A NUMBER OF ISSUE THAT WERE RAISED AND MANY PEOPLE WERE NOT HAPPY, NOT COMFORTABLE, BUT TO ME THE REPORT -- FIRST OF ALL HAS PRESENTED DATA.

THERE SHOULDN'T -- AS LONG AS WE CAN EDUCATE EVERYONE, THERE SHOULDN'T BE ANY QUESTIONS ABOUT THE FACT AT A THAT WE NEED TO DO SOMETHING.

THE GOVERNOR'S RECOMMENDATION CAME OUT WITH $240 MILLION, I THINK THE YEAR -- THE.

>> THE COMMISSION IRK NEW MONEY, 240 -- >> AND THE GOVERNOR SCALED IT BACK IN HIS BUDGET.

>> KEEPING SCORE 120 MILLION THIS THE FIRST YEAR AND TO 27 IN THE SECOND YEAR.

>> THE THIRD PIECE IS WHERE WE GET INTO THE DEBATE OR THE -- YOU KNOW, WHAT'S GOING TO BE DIFFERENT?

WHAT IS -- ARE WE JUST GOING TO BE SENDING MORE MONEY INTO THE LOCALS TO DO THE SAME THINGS THAT HAVE ALWAYS BEEN DONE?

AND WE HAVE HAD A LOT OF TALK ABOUT THAT, A LOT OF DISCUSSIONS ABOUT IT AND THERE ARE SOME SIGNIFICANT CHANGES FROM AN ORIGINAL STANDPOINT, ONE IS THE FACT WE HAVE TALKED ABOUT THE COLLABORATION BETWEEN OR AMONG COUNTIES AND ALSO THAT REGIONAL -- >> SORT SUPPORT SYSTEM.

>> SUPPORT SYSTEM, AND AGAIN WE HAVE TO BE CAREFUL ON HOW WE PRESENT THAT BECAUSE THE FOLKS THAT ARE ADAMANT ABOUT THE IT'S STATE GOVERNMENT NOT TAKING OVER LOCAL GOVERNMENT ARE GOING TO POINT TO THAT AND SAY IT'S -- AND IT'S NOT, THERE'S TO HELP THE LOBE HEALTH DEPARTMENTS TO AGAIN COLLABORATE AND MAYBE USE SOMEONE AMONG THREE COUNTIES RATHER THAN EACH COUNTY HAVING THEIR OWN.

>> AND IT'S NOT SO MUCH -- MY PERCEPTION IS NOT BIG FOOTING LOBE ELECTED OFFICIALS IT'S MORE AS WE SAW IN THE LAST SESSION A CONCERN ABOUT HEALTH AUTHORITIES.

PEOPLE WHO ARE TRANEED AND NOW THEY'VE LOST THE ABILITY TO FOR INSTANCE DECLARE EMERGENCIES, NOW THAT HAS BEEN THANKS TO YOUR AND YOUR COLLEAGUES -- I DON'T KNOW HOW YOU VOTED BUT THE MALE TO LOCAL HEALTH OFFICIALS IS YOU MAY HAVE THE DEGREE, YOU MAY HAVE THE EXPERTISE BUT WE'RE GOING TOES MAYBE THE DECISION.

>> WE DID IN THE BILL AND I WANT TO PICK UP ON WHAT SENATOR CHARBONNEAU, WE ENSURE THIS REMAINS UNDER LOCAL CONTROL, THE COUNTY COMMISSIONERS OPT IN -- AND ALSO OUR COUNTY COUNCIL MEMBERS WILL CONTINUE TO HAVE TO SIGN OFF ON WHATEVER BUDGET THE COUNTY COMMISSIONERS DECIDE ON, BUT MORE IMPORTANTLY WHAT THIS IS REALLY ESTABLISHING AND THIS IS WHAT WORKED REALLY WELL IN SOME COMMUNITIES IS BRINGING EVERYBODY TO THE TEENAGE, AND THERE ARE REALLY GOOD STUDIES THAT SHOW WHEN YOU BRING YOUR NOT FOR PROFITS TOGETHER AND YOUR HOSPITAL AND HAD BEEN SYSTEMS AND YOUR ELECTED OFFICIALS AND YOUR PUBLIC HEALTH PEOPLE AND MAYBE YOUR END COLLEGES AND UNIVERSITIES TO ADDRESS A PROBLEM YOU HAVE BEER DELIVERY OF THOSE CORE PUBLIC HEALTH SERVICES.

>>> AND WE SHOULD POINT OUT THAT URN AMONG THE MEMBERS OF THAT PASSENGER, AND YOU HAVE A BENJAMIN FRANKLIN QUOTE, HEY I DON'T HAVE TO GO TO MEDICAL SCHOOL TO UNDERSTAND AN OUTAGES OF PREVENTION IS POUND OF CURE >>> THE ECONOMY FOR THE STATE OF INDIANA AND YOU SAY WE'RE FINE WHERE WE ARE NOW BUT YOU KNOW WHAT IN ANNAPOLIS WE WERE NUMBER ONE CAN IT'S NOT THAT OUR RATE EVER CHANGED BUT ALL OF THE SURROUNDING CITIES AND -- >> NUMBER ONE -- >> SO WE BECAME NUMBER ONE, SO IF WE STAY THE SAME I'M A BUSINESS AND I WANTS TO COME INTO YOUR STATE CAN BRING MY BUSINESS I'M LOOKING AT YOUR COSTS.

>> THE DECREASING LIVE LOOK IS IN OUR 25 TO 64 CRITERIAS, THAT'S OUR WORKFORCE THE.

>>> HEADLINES HAVE FOCUSED OVER THE PAST FEW WEEK SINCE THE SESSION BEGAN ON THE DOLLARS ASPECT OF THIS AND WE HAVE DEVOTED A GOODS CHUNK OF THIS DISCUSSION DISCUSSION TO THIS, BUT 600 TOPICS ABOUT DATA COLLECTION AND USE OF THAT DATA AND CHILD DEVELOPMENT, THE WORKFORCE CAN HOW TO ENSURE THERE'S NOT SHORTAGES, CAN I GO ON CAN ON.

WHEN THE DOCTOR WRITES THE PRESCRIPTION AND SAYS TAKEN THIS PILL AND PEOPLE THINK I'M GOING TO TAKE HALF AND I'LL STILL GET BETTER QUICKER.

IS THERE A WAY TO BREAK THIS TABLET IN HALF?

IS IT ALL OR NOTHING?

THERE ENOUGH IN THERE THAT CAN MAKE A SIGNIFICANT DIFFERENCE?

>> I THINK THAT'S THE JOURNEY FOR ALL OF US, THE ADVOCATES AND I THINK FOR WHAT WE'RE DOING WE'RE TRYING TO WORK THAT IN AND HOW DOES THAT WORK -- >> THE OVERSIGHT AND MORE EXPERTISE.

>>> I THINK IF YOU LOOK AT THE LINE ITEMS OF WHAT'S RECOMMENDED IN YEAR ONE AND YEAR TWO ITING WHAT THAT MEANS TO LAY THE FOUNDATION, ASSEMBLY I'LL ALWAYS TEASE THE HOUSE HAS BEEN VERY COMMITTED TO PASSING A TOBACCO TAX AND WE'VE ALWAYS BEEN STUCK IN THE SENATE TO SAY -- IF WE'RE GOING TO MOVE INTO THAT VENTURE BECAUSE WE ARE ONE OF THE LOWEST TAX RATES WE NEED TO A DOT DOT DOT ARROW TO WHAT WOULD THAT FUND.

THERE'S BEEN NEVER A TAKEN IN THIS INDIANA GENERAL ASSEMBLY THAT WE HAVE TWO RECOMMENDATIONS, IS THAT THAT WE WOULD PRAGMATICALLY SEE HOW US HAVING THE LOWEST TAX RATE ON TOBACCO PRODUCTS COULD ACTUALLY ANNUALLY FUND WHERE WE NEED TO SETTLE PUBLIC HEALTH FUNDING.

>> AND THAT'S WHAT@CATS WANT AND THE BUDGET SURPLUS IS SUCH THE GOVERNOR WOULD ARGUE THERE ARE DOLLARS TO DO THIS.

LET ME ASK YOU THE SAME QUESTION, IS IT ALL OR NOTHING?

THERE'S A RECESSION LOOMING AND WE HAVE TO BE CAREFUL THIS SHEPHERDING OUR RESOURCES, DO WE QUIT AND GO HOME OR IS THERE SOMETHING ELSE THAT CAN BE DONE THAT MOVES US UP THE LADDER?

>> THIS IS GOING TO GO THROUGH A LONG PROCESS FOR SURE AND IN SENATE BILL FOUR IS THE IMPLEMENTATION AND THE MONEY IS IN THE BUDGET.

I THINK THERE ARE A NUMBER OF THINGS THAT WERE INTHE RECOMMENDATIONS THAT AREN'T IN THE SENATE BILL FOUR BECAUSE THERE ARE THINGS THAT COULD BE IMPLEMENTED WITHOUT EDUCATION -- >> THERE'S NO OMNIBUS BILL THAT HAS EVERY ASPECT OF ALL 32 RECOMMENDATIONS IN IT.

>> RIGHT.

>> AND AS A PRACTICAL MATTER WE WON'T KNOW THE BUDGET PHYSICAL APRIL -- A LOT OF THIS IS POSTURE OR PICK YOUR WORD UNTIL WE GET TO THAT APPOINTMENT, SO YOU'RE SAYING YOU DON'T KNOW.

SO AS WHERE HE WE MOVE ORPHAN CLEARLY THERE ARE TWO SIDES FORMING IN THIS, THOSE WHO SAY TOO MUCH MONEY OR MAYBE FILL PHILOSOPHICALLY THIS ISN'T THE PLACE THE GOVERNMENT CAN STICK THEIR NOSE IN.

>>> LOOK AT OUR WORK PORTION AND THE NUMBER OF EMPLOYEES WE HAVE THIS PUBLIC HEALTH AND LOOK AT THE NATIONAL AVERAGE, WE'RE ABOUT AT LEAST TWO EMPLOYEES LESS EASILY IN THE SMALLEST HEALTH DEPARTMENTS COMPARED TO ILLINOIS, OHIO CAN KENTUCKY.

I DON'T KNOW ABOUT YOU BUT I'M A HOOSIER, PROUD OF BEING A HOOSIER.

DO WE WANT OHIO, ILLINOIS, KENTUCKY BEATING US OUT?

HOW'S THAT POSSIBLE?

WE HAVE TO HAVE SOME KIND OF PRIDE HIRE BUT WE ALSO NEED TO LOOK AT AND SEE WHAT ARE THE STANDARDS WE NEED TO HAVE AND WE NEED TO MEET THE STANDARDS BECAUSE I'M NOT PROUD THAT WE'RE FORTY-FIFTH IN TERMS OF TOBACCO, IN THE SAME LEVEL -- SIXTH WITH OBESE OBESITY.

TOBACCO, THAT CREATES CANCER.

>> WE COULD GO DOWN THE LIST AND DO BUT -- WE'RE ALMOST OUT OF TIME, BUT LET ME ASK YOU THIS, AS WE MOVE TOWARD TRYING TO GET CRITICAL MAGAZINE BEHIND THE MEASURE ASKS THE CERTAINLY THE COMMITTEE PROCESSES MOVING FORWARD YOU TESTIFIED IN FRONT OF THIS GENTLEMAN'S COMMITTEE THIS WEEK, THE GOVERNOR DECLARED ONE DAY NEXT WEEK AS PUBLIC HEALTH DAY.

WHAT ELSE CAN AND SHOWN SHOULD BE DONE, WHAT DO YOU THINK LEVERAGE THERE IS TO PERSUADE SOME LAWMAKERS WHO THINK THIS IS NOT A PRIORITY?

>> I THINK THIS IS SO FOREIGN TO MANY PEOPLE, TO HELP THEM UNDERSTAND THE THINGS WE'VE COMMUNICATED HERE CAN THE ABOUT THE THAT WE HAVE ESTABLISHED THE CORE SERVICES THAT WE BELIEVE SHOULD BE ABLE TO EVERY HOOSIER AND WE HAVE DEVELOPED STATE KEY QUALITY IMPROVEMENT MEASURES AROUND EACH OF THOSE AND THEY WILL BE LOCAL MEASURES THAT FOR THE FIRST TIME IN THE STATE OF INDIANA MEASURING AND REPORTING ON, REPORTING TO OUR LEGISLATURES EVERY YEAR.

>> ACCOUNTABILITY, ACCOUNTABILITY, ACCOUNTABILITY.

>> WE SHOULD HAVE BOOKED A FOUR HOUR SESSION ON THIS.

AGAIN MY GUSTSHAVE BEEN REPUBLICAN SENATOR ED CHARBONNEAU OF VALPARAISO , REPUBLICAN REPRESENTATIVE OF MARION AND DR. VIRGINIA CANE OF THE PUBLIC HEALTH DEPARTMENT.

CAN TIME NOW FOR OUR WEEKLY CONVERSATION WITH ED FEIGENBAUM.

ED WE COVERED A LOT OF GROUND, WHAT'S THE PROGNOSIS.

>>> THE GOVERNOR IS EXPENDING A LOT OF HIS POLITICAL CAPITOL OP THIS AND HERE'S BROUGHT IN THE HEAVY HITTERS AS YOU'VE HARD THIS MORNING.

THE INTERESTING THING IS GOING TO BE THE ASK, THE BIG BUDGET REQUEST.

OBVIOUSLY HE WANTED A LOT MORE, THE COMMISSION WANTED A LOT MORE, IT'S GOING TO BE PAIRED DOWN AND YOU'VE GOT THE FORMER SENATE OF BROKERS COMMITTEE GOING OUT CAN ASKING FOR THE MONEY.

HE'S FINDING THAT THE PEOPLE HE SAID NO ARE SMILING BACK NOW BUT THERE ARE BIGGER PHILOSOPHICAL ISSUES HERE AND ONE IS SOME LEGISLATORS ARE SUSPICIOUS ABOUT EVERYTHING IN THE PUBLIC HEALTH REALM AFTER COVID AND AT THE LOBE LOCAL LEVEL YOU'VE GOT THE COUNTY COMMISSIONER CONCERNED ABOUT POSSIBLE THE STATE COMING IN AND SAYING THIS IS THE WAY YOU MUST GOES DO IT AND AS YOU HEARD IN THE ROUND TABLE THAT'S NOT THE WAY THIS FRAMEWORK IS SET UP.

SO THERE ARE A LOT OF MOVING PARKING LOTS TO THIS AND IT'S A DIFFICULT PACKAGE TO PUT TOGETHER.

>>> IF YOU DETAKE OUT A SIGNIFICANT AMOUNT OF THE MONEY, DOES THAT PRETTY MUCH PULL THE PLUG ON EVERYTHING OR THE SAME QUESTION I ASKED THE OTHER GISS IS THERE SOMETHING THAT COULD MAYBE A DIFFERENCE?

>> ABSOLUTELY, WE HAVE GOT PEOPLE TALKING ABOUT HOW REGIONALISM AND INTERCOUNTY COOPERATION IS IMPORTANT YOU, YOU DON'T NEED TEN FOOD SERVICE OFFERSES IN EVERY COUNTY OF.

>>> YOU TALK ABOUT POLITICAL CAPITOL BEING EXPENDED, WHAT IS GOING TO MAKE A BIGGER DIFFERENCE, THAT SOMETHING OR WHAT IS HAPPENING BEHIND CLOSEs DOORS?

I THINK THE GOVERNOR AND THE OR PUBLIC OFFICIALS WILL HELP FOCUS THE STATE TOWARD IT BUT THE OTHER IS MUCH MORE IMPORTANT.

>> WE'LL WATCH AND SEE WHAT HAPPENS.

SHOULD INDIANA JUDGES BE ABLE TO HOLD VIOLENT OFFENDERS WITHOUT BAIL?

WE'LL LOOK AT THE BALANCE BETWEEN PUBLIC SAFETY AND CIVIL LIBERTIES ON THE NEXT INDIANA LAWMAKERS.

ON BEHALF OF COMMENTATOR ED FEIGENBAUM AND INDIANA'S OTHER PUBLIC BROADCASTING STATIONS I THANK YOU FOR JOINING US.

UNTIL IN THE CASE WEEK, TAKE CARE.