- [Narrator] Funding for this edition of State of Affairs with Steve Adubato has been provided by The Turrell Fund, supporting Reimagine Childcare.

PNC, Grow Up Great.

Delta Dental of New Jersey.

Everyone deserves a healthy smile.

Hackensack Meridian Health.

Keep getting better.

MD Advantage Insurance Company.

The New Jersey Education Association.

The Robert Wood Johnson Foundation.

NJM Insurance Group.

Serving New Jersey'’s drivers, homeowners and business owners for more than 100 years.

And by The Healthcare Foundation of New Jersey.

Promotional support provided by NJ.Com, keeping communities informed and connected.

And by The New Jersey Business & Industry Association.

[INSPRATIONAL MUSIC] - Hi, I'm Steve Adubato.

Welcome to our new studio.

Hopefully, it looks good on the other end.

And we're joined by Dr. Bryan Pilkington, Associate Professor at Seton Hall University and at the Hackensack Meridian School of Medicine.

Good to see you Bryan.

- Good to be with you Steve.

- You and I had a great conversation on the MDAdvantage podcast and we wanna have you on here as well.

First of all, define this for us.

Bioethics is...

Finish the sentence.

- Bioethics is an interdisciplinary field of study which brings folks from a variety of perspectives in, to think about and critically evaluate health practices, health professions.

It's sort of a continuation of what had been called 30, 40, 50 years ago.

Medical ethics or nursing ethics.

- And again, this is a heavy... An important area of research for you, the connection between bioethics and COVID-19.

Describe it.

- It is, yeah.

What lots of bioethicists do, especially in light of COVID-19 is think through particular ethical challenges and the situations that everyone in our diverse communities are facing.

So there are host of issues.

If you think about things, if viewers of your show have run into considerations about resource allocation, vaccination, hesitancy or compliance, what to do in light of COVID-19 where research dollars go.

There's a host of different issues, all focused on the health of members of our community and the ethical reflections in the work through those considerations is really what bioethicists do.

- So, when it comes to the vaccine or the vaccines, plural, that are out there and vaccine resistance and vaccine awareness and education, there's a critical role for science to play or scientists and clinicians, medical professionals.

What is the role of ethics, slash, morality when it comes to the vaccine?

- That's a great question.

Each of the groups that you mentioned, the scientists have a particular role in putting out the best kind of research that will effectuate positive change among members of our communities, right?

Avoiding the jargon, you want a good vaccine that works, right?

Clinicians have a role of educating, in addition to treating patients, right?

They have a responsibility to educate folks about what the vaccines are just like they would any other kind of intervention or therapy.

The ethicists will think through possible challenges and considerations that often engage values or sort of broader systems of beliefs and considerations.

So one thing we might talk about, if we had some educators, some clinicians and scientists on, if there are members of our communities who are hesitant to take the vaccine, who are resistant to the vaccine, one ethical issue that might arise is the notion of free riders, right?

So if you have a member of a community who thinks, "Well, look, I'm just gonna eventually benefit from herd immunity."

And is resistant to taking the vaccine.

The ethical consideration is, why do you get to gain those benefits without bearing any costs?

So that's sort of one example and one framing, the way a bioethicist might think through this or lend particular kinds of questions to narrow our focus in these sorts of discussions.

- So, I'm gonna complicate it even more for you in a good way because you raise these issues and it's for all of us to think about because if we don't, they're not going away.

Is it an ethical issue, slash, moral issue from a political leadership point of view when President Trump took the vaccine and we're taping this late March 2021.

When President Trump took the vaccine, he and his wife, the First Lady at the time, did they have a moral/ethical responsibility to take that vaccine in public and say why, and say that it was safe or they would not be taking it given how many people follow President Trump and what he does or doesn't do.

Is that ethical, moral issue?

Or is it, "Hey, I didn't wanna tell anybody."

- Steve, another great question.

- I only have the questions.

I have zero answers.

I'm gonna qualify this.

Go ahead.

- No, this is great.

When we chatted before, you know my background is in philosophy, so I've been on the other end of folks saying, "Hey look, there's just too many questions here."

It's a great question.

The way I approached bioethics and lots of bioethicists do this but not all, you get the best answers even if they're not full answers but the best approach to bioethical questions is to get a bunch of folks in the room to think through these complicated issues.

So for this kind of question, to really get an answer, it would be great to have some political theorists, members of communities and folks who have been influenced more or less by what the president does, past president has done.

That said, it's especially helpful.

One of sort of a...

This value using good bioethical thinking, again, from a philosophical background, is clarity, and given the claims that have come out, that had come out of President Trump's office and a lot of the confusion, and the claims just turned out not to be true.

I think it would have been of great benefit for the president, the past president, sorry, I keep doing that, to serve as a model, and say, "Look, I messed this one up.

I got this one wrong and here's why this is important."

- But real quick on this and I'll get off it.

Is it just as important with President Biden?

If President Biden is having health issues, if those health issues are somehow connected hypothetically to his age and his condition, if there are cognitive issues, is there an ethical, slash, moral responsibility to share that with the American public?

- Steve, another great question.

It raises...

Interesting... Well, it raises challenging considerations about the roles that one inhabits, right?

Because we have a strong view in this country generally about privacy and we saw this with all sorts of issues in COVID in-- - For the leader of the free world?

- So sorry, so the role challenge?

- Is there the same question of privacy for the leader of the free world?

- So yeah, so that's the other part, right?

So, President Biden in his personal life has this privacy.

Once you have so many folks depending on you then it would be beneficial for him to share, right?

If there's anything that's relevant and what you'd want to do, again, just being an ethicist, not a political theorist.

What I would wanna do if I were in that position is to ensure that there were folks around me to make sure that that was happening.

The long answer to your very good question.

The short answer is yes.

If there are health issues which are affecting decisions impinging on the office, then yes, sharing it with the public, I think is important.

- Dr. Pilkington, before I let you go, I'm wanna ask you a question that I wanna use for our lessons in leadership program that I do with my terrific colleague, Mary Gamba.

And here's the question.

I was recently doing a leadership seminar.

I do that in the other part of my life and one of the...

It was a criticism that I got from one of our students with, "Steve, you don't talk about the role of morality in leadership, and that's missing in your leadership seminars," and I responded, "I appreciate the feedback but I wouldn't even know how I would quote, teach, morality and leadership as a leadership competency."

Is it a leadership competency, doctor?

- Leadership conferences are more your area than mine but I would be very happy to see it.

Ethics, morality.

I don't distinguish between the two, some folks do but I would like to see it as a leadership competency.

When we... And the folks who I think would do this best and you're among them, Steve, are the best practitioners of a particular profession, right?

When I teach medical students, when I teach nursing students, we talk through different kinds of ethical approaches and at the end of the day, I tell them, "Look, what you wanna do, especially if you're a fan of virtue ethics which I am, is find a really good practitioner of a certain sort."

And when you see them doing things, when you see how they make decisions, yes I don't think we can just pull ethics and morality out of this.

Otherwise it's too bureaucratic.

The thinking is too robotic and it can alleviate within leadership, some important features of responsibility.

- Well said, Dr. Bryan Pilkington.

Challenging questions but more importantly, more thoughtful answers.

Associate Professor at Seton Hall University, one of our higher Ed partners, is also at the Hackensack Meridian School of Medicine where I've done some teaching as well.

Hey, thank you, Dr. Pilkington.

We appreciate it all the best.

- Thanks Steve, good to see you again.

- I'm Steve Adubato, we'll be right back.

(grand music) - [Announcer] To watch more State of Affairs with Steve Adubato, find us online and follow us on social media.

- We have in the house Cecilia Zalkind, who is President and CEO of Advocates for Children of New Jersey.

Ceil, great to have you back as always.

- Thank you, always nice to be here.

Thank you.

- We're taping this at the end of March.

By the way, our re-imagined childcare website, you'll see it, check it out.

You just said before we got on the air, it's a quote great year for children.

We're talking about childcare, the importance of those years.

Why is it a great year for childcare?

- Well, I think it's a great year on two levels: one, what's happening in the state and this year's proposed state budget, which has some great advances for children, including childcare, and then what's happening to the American Rescue Plan.

Again, supporting many issues related to children, but a particular support for childcare.

The biggest federal investment in childcare since the New Deal.

- You just triggered something.

Are you talking about the New Deal, by the way, check out the PBS documentary on Franklin Roosevelt, the New Deal, which has nothing to do with childcare, but that being said, how much do you believe, Ceil,the focus on childcare, The importance of childcare, is a product of policymakers beginning to truly understand, acknowledge and do something about the connection between COVID, childcare, and dare I say, people working in the economy?

- Absolutely.

I think that there's no denying that childcare has certainly been elevated because of COVID not only in terms of its importance for families but also the importance for our state and our state's economy.

I think that this is a great time to take advantage of not only the interests in childcare, the recognition of its importance, but some policies that we can use to create, rebuild, reimagine a new system of childcare.

- By the way, we should make it clear that Reimagine Childcare is an ongoing series we've been involved in with Cecilia and folks at the Turrell Fund and others who care deeply about childcare.

But do you actually believe, when we use the term reimagine childcare, that childcare will look significantly different in the next three to five years?

And if so, what would that look like?

- Well, I think it would look different in terms of the level of support and some of the policies that support accessibility to childcare.

I think if you look at what New Jersey has done with the first round of federal money, the Cares Act Fund, it has been instrumental in helping childcare survive during this incredibly challenging time, and also helping parents who suddenly are confronted with childcare needs because of school closures they haven't faced.

If you look at the policies the state's implemented, actually they really define what a high quality system would be; an accessible, a new, stronger system, greater support for childcare programs, new payment policies and in greater eligibility for parents to get tuition assistance.

- Let's get a little more into the weeds here.

The childcare credit, okay, tied directly to the American Rescue Plan, the $1.9 trillion COVID package put out by President Biden, now law.

What are the changes specifically as it relates to the child tax credit?

What is it, and what are those changes?

- Well, the child tax credit is a little different than the childcare tax credit, both of-- - Explain the difference.

- Well, the childcare tax credit, and there's a federal tax credit and a New Jersey tax credit, which Governor Murphy just increased in this year's budget.

That enables parents to file their childcare expenses off their taxes.

And this year in New Jersey, it's a refundable credit.

So parents can get money back for taxes because of their childcare expenses.

The child tax credit is something new and significant because it gives families assistance, gives them direct funding based on their income and the number of children in their family.

The details of how this is going to work are still being developed by the IRS.

But families up to a certain income level can receive up to $3,000 a year per child, for children and their families.

It has been described as the biggest impact on reducing child poverty that we've ever seen.

- Reducing child poverty.

- Yes.

- To those who might say, "Well, that's a one-off, "that's fine.

", but you're saying immediate and long-term impact on child poverty.

If so, make that case Ceil.

- To your point, it is a one-year initiative under the American Rescue Plan.

It starts immediately.

There's no filing for it.

It's based on a parent's tax filing, but this is time for advocates to act and make sure that this becomes permanent.

Our own Senator Booker has advocated for this for many years.

I think we're gonna see an immediate, significant impact on families.

So when you think about families who are really devastated by COVID, families who've lost their jobs, reduced employment, this is a lifesaver.

And I think to all of us who advocate in this space, we need to make sure that this becomes permanent.

It's a significant policy development.

- So you understand this from a perspective that not many others would actually understand it, and it's this.

For actual childcare centers, for those actually hands-on frontline childcare professionals, COVID has been incredibly devastating to them and their organizations, A.

B, have we lost many of them for good?

- Well, you're absolutely right.

This has had a devastating impact on childcare, the pandemic has.

And as we've heard from many of our childcare partners this was a problem long before the pandemic.

But what the pandemic highlighted is these programs exist on a shoestring.

They don't have the reserves to support them when programs have to close, or as we see now, when the number of children they can serve are reduced by new COVID guidelines.

So I think they have been struggling, but again, to the credit of our policy makers, we used the first round of federal funds the Cares Act, very well.

We supported childcare programs even while closed, based on who they had enrolled as of March 1st.

Sounds like a small issue but it was huge in helping childcare survive.

There was assistance in accessing PPE here, in helping programs with increased costs due to cleaning, with helping programs supply for the Payroll Protection Act loans, and then, in supporting childcare with additional funding, recognizing the reduced class size because of COVID guidelines.

We would not have a childcare system without those steps that New Jersey took.

- Before I let you go, 30 seconds Ceil.

The impact for children when they do have quality childcare as opposed to not having it.

On their lives.

- Well I think that we've discussed childcare in the context of working parents.

It's even more important as the early education opportunity for our youngest children when they are thriving, when their development, their brain development is accelerating.

This is a time to have a high quality setting to help support that development.

- Yeah.

Folks, continue to follow our series Reimagine Childcare done in cooperation with Advocates for Children of New Jersey.

Ceil, thank you for being a wonderful partner in doing the work that you and your colleagues do every day.

Thank you.

- And thank you.

- I'm Steve Adubato, we'll be right back.

(grand music) - [Announcer] To watch more State of Affairs with Steve Adubato, find us online and follow us on social media.

- We're now joined by Dr. Jeffrey Le Benger, who is Board Chair and CEO of Summit Health.

Good to see you Jeff.

- Thank you for having me today Steve.

- You got it.

By the way Summit Health is in fact an underwriter of the healthcare programming that we produce and broadcast.

But Summit Health is a new brand, new name.

Talk about that Jeff.

- Right.

So 18 months ago, the Summit Medical Group merged with CityMD, and we are trying to bring our integrated health care model to the entire New York Metropolitan Area.

And after 18 months, we are rebranding the name to Summit Health.

CityMD will still be branded as CityMD, but we'll be a Summit Health company.

And as you and your viewers know, that we are a fully integrated company in Northern New Jersey.

We have every ancillary.

We have every specialty.

We just don't own a hospital, but we believe in healthcare outside of the hospital to the ambulatory sector.

We partner with hospitals.

Our doctors go there for Tertiary Quaternary Care, but for us it all has to do with the gaps of care that a patient has, the transitions of care that a patient needs, and care managing that patient to the best quality and outcome they could have.

- Doctor, you were actually on Governor Murphy's Healthcare Affordability Advisory Group.

You and a whole range of other healthcare leaders.

A, what is that advisory group's mission?

And B, the longer-term impact of COVID on "Affordability" and we'll get into access as well.

What is that advisory group all about?

- Well, I think they're going to look at how healthcare is fragmented and very costly.

And they're going to look how to increase the integration and the care management of patients within the New Jersey marketplace.

And as you know, that's what we do.

We really are integrated health care models, Summit Health that manages those patients really well.

And I think we are going to have our first advisory meeting, I think it is tomorrow, and we are going to get our mission, our vision and what do we stand for and what we are going to try to achieve in this state.

But what I am told, that we are gonna be part of trying to assimilate a culture within the state to have an integrated health care model to have high qualities at a lower cost point.

- You know, doctor it's interesting... By the way 700,000 patients in the Northern New Jersey area that Summit Health is responsible for.

But I wanna understand this, COVID has impacted the world of healthcare on so many levels as you well know.

And you are by the way a practicing physician, I wanna make that clear.

- Yes.

- But telehealth, I coach and teach communication skills to a whole range of physician leaders.

And one of the issues that keeps coming up is the question of telehealth and the ability to communicate and connect physicians to their patients.

A, do you believe telehealth will be even bigger moving forward?

And B, what needs to be done to get physicians ready to be the best they need to be via telehealth?

I know it's a complicated question, but if it's there's going to be more of it, how do we get our physicians to be better at it?

- Okay.

So let me take the economic side of it first.

Before, telehealth was never reimbursed.

Now the state is reimbursing a telehealth visit as par with a visit within the physician's office.

- And that's new.

- That's new.

That's new, that happened with COVID and it's going to continue.

With us at Summit Medical Group we went during COVID from maybe doing 10 or 12 a day of telehealth visits to over 4,000 in one day.

So it was an unbelievable beta about how to handle a patient.

And now we are very comfortable in doing telehealth visits.

And I think there is going to be a need for telehealth to be part of the access of healthcare.

That's why with us, why we merged with CityMD is all about access points for health care for psychosocial, socio-economic, physicality whatever the issue might be.

You go to a CityMD, you have a virtual healthcare visit.

Or you come see an integrated healthcare model.

We are now coming out within a month or two with a digital app that will have virtual health on it that you can just plug in and do a virtual visit right then and there on your phone.

It's a great app.

So I think that doctors learned during COVID how to do telehealth.

And I think it's going to be a great addition to their model of healthcare delivery throughout the entire country because not every patient needs to come in for a sore throat or an ear ache, right.

- But some things they do need to come in for, correct.

- Correct.

Well, during COVID we found a lot of patients were afraid to come in and we have to get healthcare back where it was.

- Our whole mission is obviously to provide credible information about important medical clinical healthcare issues.

And let's talk about the vaccine.

So I know you've been out there.

You've been speaking on this, you talk to your patients all the time about it.

There is still a degree Dr Le Benger of resistance pockets of it.

What would you say to those watching right now?

Who say this?

"Listen, they don't need me.

I'm not sure I want to get the vaccine.

There'll be herd immunity.

They don't, by then we'll be fine".

What would you say to those folks who are just hanging back?

- So me being a physician, not to be tough about this but that's part about being a human being is to have a safety net for other human beings.

And if you could help that, okay and get a vaccine to prevent the disease to prevent the spread of the disease.

You may not be worried about yourself but worry about others.

You might come in contact with who they might come in contact with.

And then it's an elderly maybe an overweight diabetic that has an increased incidents or a black or brown or Hispanic person who for some reason has a higher incidence with and they get it and they go to the hospital or they unfortunately pass away.

That's what herd immunity is about.

You live in civilization, you live in a community.

You are also there to help protect others.

That's what we're all about.

That's why a vaccine is so important.

- You've been listening to a Dr. Jeffrey La Benger Board Chair and CEO of Summit Health.

Dr. La Benger I want to thank you so much for joining us and continue to educate folks every day.

Thank you doctor.

- Thank you I really appreciate it.

Have a great day.

- We appreciate you.

I'm Steve Adubato that's Jeff Le Benger Thanks for watching.

We'll see you next time.

- [Narrator] State of Affairs with Steve Adubato Is a production of the Caucus Educational Corporation.

Funding has been provided by The Turrell Fund, supporting Reimagine Childcare.

PNC, Grow Up Great.

Delta Dental of New Jersey.

Hackensack Meridian Health.

MD Advantage Insurance Company.

The New Jersey Education Association.

The Robert Wood Johnson Foundation.

NJM Insurance Group.

And by The Healthcare Foundation of New Jersey.

Promotional support provided by NJ.Com, And by The New Jersey Business & Industry Association.

- [Announcer] Right now, six feet can feel like a long ways away, but from six feet, we can still smile at each other, from our doorways and our stairways, from opposite sides of the street and opposite sides of the country.

Through fear and frustrations, we can remind each other that we're still here for each other, because we can still smile at each other.

And we're not going anywhere.

(gentle music)