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Voiceover: You're listening to a Towson University podcast.

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Mark Ginsberg: Welcome to On the Mark, where we have candid conversations about meaningful and consequential work happening here at Towson University. I'm Mark Ginsberg, president of TU, located in Towson, Maryland. And on this podcast, we're introducing you to members of our university community who are engaged in high-impact teaching, research, and student success practices.

Today, I'm pleased to be joined by an internationally recognized scholar whose work examines many of the facets of global health care systems. Dr. Mary Helen McSweeney is an associate professor in our College of Health Professions, where she serves as the director of the Health Sciences Master's Program and the Health Leadership Graduate Certificate Program. Mary Helen is trained as a health economist, and her research focuses on population health management, long-term care, the aging population, and end-of-life care. She holds a Master's in International Affairs from Columbia University, and a second Master's in Population Health Management from Johns Hopkins, as well as her doctoral degree in Health Economics from the Graduate Center of the City University of New York. We're very pleased that she was recently selected as a 2025-2026 Fulbright US Scholar – a very prestigious honor. Mary Helen, thank you for joining with us. It's an honor to have you on On the Mark.

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Dr. Mary Helen McSweeney: Thank you.

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Mark Ginsberg: Well, let's start with some of the key questions, and your work is so wide-ranging and so important to not only the future of all of us who are aging in the country, but for the future of the country itself. So, why don't we just start with the general question about what long-term care is, as well as what some of the emerging issues are, as we think about some of the urgent health care matters focused on the care of not only elderly adults, but those who require long-term and sustained care for the quality of their life.

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Dr. Mary Helen McSweeney: And I would say, Dr. Ginsberg, that's one of the key misnomers. People frequently, when they hear the term "long-term care," they think that that pertains strictly to care of older adults, and that is far from the case. That's one of the things I try to emphasize in my classes, is that long-term care services are not just the health care services, but they're the supportive services, the social services, the mental health services that people need to be able to live independently in the community or to be able to age in place wherever they see that that's the best option for them. But the population is wide ranging. It can range anywhere from veterans that have come back...

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Mark Ginsberg: Sure, sure.

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Dr. Mary Helen McSweeney: ...from various military engagements with disabling conditions. Those tend to be people on the younger spectrum, people with multiple chronic conditions, which can range anywhere from people college age to retirement age, and then older adults. So, I would say any set of services to support that wide-ranging group of people would fall under that particular definition.

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Mark Ginsberg: Yeah, it's a really good point. I think you're right that many of us probably do just associate long-term care with the elderly adults or people near the end of their life, but in fact, maybe some of the biggest challenges are with those who need chronic sustained care over many years.

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Dr. Mary Helen McSweeney: Absolutely. And payment for those services, as we know, has changed dramatically, not just in the United States, but in other places. I think that governments as a whole are waking up to what the cost is of taking care of people, particularly if they choose to live in the community, and it is substantial. Are we really prepared for that? Most likely not. Some people did plan maybe with purchases of long-term care insurance.

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Mark Ginsberg: Right, right.

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Dr. Mary Helen McSweeney: They have sufficient income and assets, but I would say most people have not, and that's where a lot of the governmental systems come in. And those, in terms of their capability to pay for things, that's changed dramatically. Also historically in the past, family members were the people tapped to take care of people as they got older, developed multiple chronic conditions. Now we have sandwich families. We have faculty members, members of our community that are taking care of children and also taking care of older adults and living in multi-generational families. It's a struggle. And where that's going to go, I'm not quite sure. I'll just mention there was a recent article published in one of the UK journals talking about the NHS paying more and more...

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Mark Ginsberg: The National Health Service.

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Dr. Mary Helen McSweeney: Yes, talking about the National Health Service in the UK.

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Mark Ginsberg: Yeah, yeah.

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Dr. Mary Helen McSweeney: And how it's turned into the National Social Service because...

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Mark Ginsberg: Interesting.

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Dr. Mary Helen McSweeney: ...close to 50% of what the NHS is paying for are social programs and social supports, and some people are questioning, is that an appropriate use of resources? Now, with my training in population health, we are trained in the importance of social determinants of health and the impact on people and their ability to live longer and with quality of life within the community, and you do need social supports to do that. If you're by yourself, it's a lot more difficult than if you have a family around you.

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Mark Ginsberg: Yeah.

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Dr. Mary Helen McSweeney: Where is the United States going to go in terms of building those kinds of programs? I'm not quite sure. They are expensive and some people may not see their relevance to health care.

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Mark Ginsberg: Right. It seems like there's a growing body of literature on the impact on families for those who have disability, long-term care needs, chronic illnesses. There's also a growing literature on the challenges that middle-aged children of elderly adults face, which are really very similar.

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Dr. Mary Helen McSweeney: Yes.

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Mark Ginsberg: And that's really what you're saying, I think.

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Dr. Mary Helen McSweeney: Right.

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Mark Ginsberg: Is that the peripheral impact, the direct impact on those who require care is one thing, which is significant and very, very challenging, but the impact on those who care for those, the impact on caregivers, that is, is also very dramatic.

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Dr. Mary Helen McSweeney: Right. Yes, and I can actually speak to that from my personal experience with multiple family members and the challenges in balancing an academic career and research and teaching and having family members that also needed care at home. Your career trajectory becomes a little bit different.

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Mark Ginsberg: And that's not probably the exception, but my guess is that that is, for all of us, I think, certainly I can speak from my own experiences, too, it's ubiquitous that as people live longer, as medical care becomes more sophisticated, the need to care for those who are caring for others becomes even greater. I hadn't thought about this but talk a little bit about the Family Medical Care Act and some of the social supports now that a number of states have built in but is also quite controversial still in many sectors.

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Dr. Mary Helen McSweeney: There are states like Maryland, they're very supportive...

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Mark Ginsberg: Yeah...

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Dr. Mary Helen McSweeney: ...of the social service component.

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Mark Ginsberg: Right.

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Dr. Mary Helen McSweeney: And then there are other states that just don't have the money to do it, okay? So, what does that mean for people that might want to age in place? Well, some may not be able to stay at home, particularly if they're by themselves and they don't have supports and so they may have to go into more of a residential care setting, when in fact that's not necessarily what they would want.

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Mark Ginsberg: Yeah. And they vary so much, too, in terms of their accessibility...

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Dr. Mary Helen McSweeney: Absolutely.

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Mark Ginsberg: ...affordability, and certainly the quality of the care provided.

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Dr. Mary Helen McSweeney: Yes, and we can even see that within Maryland, we have a whole host of different kinds of residential care alternatives, anywhere from small group homes to a very expansive continuing care retirement communities or life plan communities. We have basically everything in this state as far as long-term care services and supports that you could possibly imagine, but again, what people can afford and also even if they could afford it, do they want that? Many people don't want that, and they're perfectly fine with selling homes and moving into high-rise apartment complexes and bringing in home care services, as long as they can ambulate on one floor and they have an elevator and there is security, that's fine. Towson, for example, is very good at having supportive services like that, you know, meal delivery. We have places like our Bykota Senior Center that are supportive of keeping people active within the community and within their homes.

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Mark Ginsberg: So, the need for care is accelerating. The need for quality care is particularly acute. But as I've been reading about some of the challenges of long-term care, it seems like one of the big, significant challenges is the issue of labor...

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Dr. Mary Helen McSweeney: Yes.

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Mark Ginsberg: ...the issue of the workforce, the issue of care providers. Talk a little bit about how you see that really significant matter.

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Dr. Mary Helen McSweeney: Well, I would say that Towson University is uniquely positioned to address those kinds of issues, particularly in the College of Health Professions.

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Mark Ginsberg: Ah-hah. Yeah, tell us about that.

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Dr. Mary Helen McSweeney: Well, we've got in the department that I'm in, Department of Health Sciences, we have a health care management major that will prepare people for the administration path careers, which are important, right? Health care has an administrative component, and it also has a clinical component.

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Mark Ginsberg: Sure.

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Dr. Mary Helen McSweeney: But we also, as our dean points out, we are the number one school that is training people on an undergraduate level for clinical careers, and that's significant. We have robust nursing programs and kinesiology, speech-language pathology. Some of these are five-year or doctoral-level programs, but again, we do a really good job here at addressing the clinical needs. I think what people miss out many times are the administration and even public health needs. We have a robust public health program here on our campus, which is not just training people for public health careers, but we have many people that use it as pre-professional training to go on if they wanted to become an MD or a doctorally trained person within health professions.

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Mark Ginsberg: So, there's definitely, I think, an opportunity, it seems like, for people who seek to enter this field, to be well-trained in the field at our university. Talk a little bit about some of the levels of care...

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Dr. Mary Helen McSweeney: Yes.

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Mark Ginsberg: ...because I've been reading also that the burnout, the churn of the workforce, aides who come into the home, you mentioned those earlier, folks who are nursing care, nursing home aides, the opportunities are great in terms of the need, but it seems like the challenges are great also in terms of those who provide those services.

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Dr. Mary Helen McSweeney: I would say the extent to which that workforce turns or churns, it really depends upon who you work for. There are employers who are extremely supportive of their frontline workers in terms of training and providing support for higher levels of education, flexible schedules, things like that. There are also places that are not. But people, I think, have to understand that you're working long hours and you're working with people, and sometimes, certainly with the frontline workers, the work can be physically exhausting, and people don't always know that when they sign up for that. So, the role of the employer, I think, is to locate people very early, maybe going down to even junior high school level to start to talk about those kinds of opportunities. But yes, there definitely is a lot of problems everywhere, not just in the United States, but I would say globally. Now that we have smaller families, fewer people that are available to do the caregiving piece, it becomes a lot more challenging.

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Mark Ginsberg: Mark Parkinson, the CEO of the American Health Care Association, recently, in something he wrote, was quoted as saying that every sector is dealing with a labor shortage right now, but for long-term care, this crisis is historic, it's persistent, and it's not sustainable.

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Dr. Mary Helen McSweeney: Correct. And I think some of that is related to the training issue, not just to have frontline workers trained and then supported. I would say that a typical clinician doesn't choose a long-term care path as their primary path coming out of school.

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Mark Ginsberg: Yeah, that's a good point.

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Dr. Mary Helen McSweeney: They'll go, and we also see that even in our administrative programs, that going to hospital environment or health care system environment has a lot more appeal than starting your career in long-term care.

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Mark Ginsberg: Yeah.

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Dr. Mary Helen McSweeney: But we do have people that I found in many of our programs that come and they do that kind of work, but they were exposed to long-term care, then they're offered a long-term care job, and the light goes off, and it just becomes a wonderful experience.

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Mark Ginsberg: Mm-hmm. Interesting.

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Dr. Mary Helen McSweeney: We have local employers here where, I'm thinking of one in particular, Marquis Health, that has hired numbers of people out of our programs, and that long-term care was not their first choice for a career, but once they were in it, they realized the value, and they also realized that you can progress quite quickly within organizations if you choose long-term care or senior living as your career path. So, that has really been an opportunity that we try to talk to our students about, but our alums come back and say, "Gee, we should have known about this earlier." But again, we need well-trained administrators, and that's where I see there are some people who feel that they can run nursing homes, assisted living, just with a bachelor's degree. I would say that's no longer the case because of the financial aspect of it, the marketing aspect of it. Just the clinical care piece has become a lot more sophisticated, and now our nursing homes are really looking like step-down units from hospitals.

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Mark Ginsberg: Yeah, for hospitals, acute care facilities. Yeah, yeah.

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Dr. Mary Helen McSweeney: Right. And that they're making, I think, some very legitimate arguments. And I'll just say I am licensed in long-term care administration, so having that NHA license maybe gives me a particular viewpoint, but I would say that there are certain kinds of services that can be delivered within a skilled nursing environment that are definitely delivered at lower cost and equal quality of care to what is being done within hospitals and health care systems.

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Mark Ginsberg: Let's explore that a little bit because I think a number of people who are listening to this might be thinking, I have a member of my family who's in need of care, whether they're a young person with acute chronic illness or whether they're an elderly person with memory issues that may require certain levels of care. As you think about that continuum from home-based care, maybe we're aged coming into the home, to assisted living as you were just describing it, to long-term nursing home care, what advice would you give to a family that's thinking about what's the best place and what's the best level of care for my loved one?

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Dr. Mary Helen McSweeney: The reality nowadays is you really have to look at what you can afford. That is our reality, at least here in more of a market-based economy that we have here within the United States. I would say plan and work with an elder law attorney and financial planners...

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Mark Ginsberg: Mmm, mmm, good advice.

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Dr. Mary Helen McSweeney: ...to look at your income and asset trajectories and make sure that you have estate planning. I always say to people, make sure that family members have powers of attorney put in place to make decisions, but I would basically say you have to plan for that kind of reality. Now, sometimes people have done tremendous amounts of planning and what happens within the family ends up being a very expensive proposition. If you are a family with multiple members, I would say don't be surprised if there'll be an ask for your time and volunteerism to help family members out at some point in the future. I'm a proponent of if people have the income and the assets and if it is appropriate, purchase long-term care insurance if you're able to do it.

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Mark Ginsberg: Yeah, good advice.

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Dr. Mary Helen McSweeney: As I said, look at what assets are there, what income is going to look like at retirement, and even the question of when you want to retire. The traditional age of retirement has been age 65. I think that's gone. I think that more and more people, particularly educated, if they love what they do, they love their work, they're going to be working longer and longer.

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Mark Ginsberg: Yeah. Yeah, that's right.

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Dr. Mary Helen McSweeney: There are people that will be working in retirement age, which has implications for younger people and career opportunities as well, but I even see on the campus that you have people who are in senior positions, administrative positions that are older. You'll see faculty who will be working longer and longer, particularly if they have a loved one at home that needs access to health benefits. Those are some of those kinds of realities. People have to plan for them.

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Mark Ginsberg: So, one of your advice is then is to think clearly and planfully about the right level of care.

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Dr. Mary Helen McSweeney: Yes.

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Mark Ginsberg: And you suggested an attorney to consult with the family.

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Dr. Mary Helen McSweeney: Elder law attorney.

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Mark Ginsberg: Elder law attorney is a specialty in law today...

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Dr. Mary Helen McSweeney: Correct.

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Mark Ginsberg: ...and one that could be really helpful. Most elder care lawyers that I know are as much social worker or social advocate as they are attorney but looking at the psychosocial needs as well as the legal and financial needs. Somebody once said that medical debt has become one of the most common side effects of illness, so what you're suggesting, I think, is trying to prevent that...

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Dr. Mary Helen McSweeney: Yeah.

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Mark Ginsberg: ...because that'll create another level of stress for people.

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Dr. Mary Helen McSweeney: Correct. Again, look at the decision of do you want to age in place in your home? Is your home set up in order to do that, right?

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Mark Ginsberg: That's a really good point. Aging in place has become a more common practice.

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Dr. Mary Helen McSweeney: Correct. People say, "Oh, I can age in place." Well, if your bedroom's on a second floor and you're in an older house that was built with different building codes, it may be a lot more challenging. I'm thinking Baltimore row houses.

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Mark Ginsberg: Yeah, yeah.

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Dr. Mary Helen McSweeney: A lot more challenging to get chairlifts and things like that.

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Mark Ginsberg: That's right. That's right. Things people may not be thinking about but are real life impediments.

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Dr. Mary Helen McSweeney: Correct. If you are able to afford it, that's where the opening is for many of our retirement communities and many of our providers that we have here in this state and in other states, is that they can provide care supports and residential options to people at all different kinds of levels, from people who want to live independently but want to be part of a campus because they don't want to go grocery shopping every week. They want some activities and some social supports. There are vendors and organizations that have been around for years here that provide that anywhere from there to options for memory care and things. Memory care is wonderful. It's a very expensive proposition.

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Mark Ginsberg: I know another one of your interests is global health and having now in the midst of your Fulbright, which is a wonderful opportunity for every faculty member who has that opportunity. Let me ask you to talk a little bit about global health. When you think of global health, which I know is one of your other interests, what do you think about when you think about global health? What does it encompass and what are some of the issues from your perspective?

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Dr. Mary Helen McSweeney: Well, ideally, it would mean countries working together.

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Mark Ginsberg: Ideally.

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Dr. Mary Helen McSweeney: Ideally. Nowadays, I would say that, to quote the Prime Minister of Canada...

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Mark Ginsberg: You're doing your Fulbright in Canada, so you're quite familiar with the Canadian health care.

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Dr. Mary Helen McSweeney: Correct. So, I became much more familiarized with what socialized medicine looks like in the Canadian perspective with all the good points and all of the challenges that they have. But we do have a new world order. That is going to make working together as countries to promote global health and to address diseases and other kinds of challenges a lot more difficult. The US recently withdrew from the World Health Organization, so this is going to make it a lot more difficult to just share data sets. I would say from my experience in Canada, data integrity, data security are huge issues.

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Mark Ginsberg: Hmm. Really big ones.

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Dr. Mary Helen McSweeney: Very, very big ones, and if you want to get access to any kind of federal or even provincial data sets, there's a lot of questions, you know, security protocols and clearances that you have to go through. Very much like accessing Center for Medicare and Medicaid Services data sets, that you would have to go to data centers. It's the same approach in Canada.

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Mark Ginsberg: Yeah, It strikes me that disease and illness doesn't really know national boundaries.

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Dr. Mary Helen McSweeney: No. Not at all.

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Mark Ginsberg: Certainly, we learned that during the pandemic. It was a real important lesson for the world.

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Dr. Mary Helen McSweeney: Yes. Yeah. Yes.

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Mark Ginsberg: So, I'm kind of curious from your experience, having been a Fulbright scholar, having worked in different countries around the world, how interconnected are our health care systems today?

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Dr. Mary Helen McSweeney: Well, I would say the US is an exception to the rule, okay? However, what I find very interesting is that a lot of our health IT, our tech, is used by other countries.

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Mark Ginsberg: Interesting.

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Dr. Mary Helen McSweeney: Specifically electronic health record systems.

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Mark Ginsberg: So, we're probably more advanced in that sector than many other places.

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Dr. Mary Helen McSweeney: Yes.

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Mark Ginsberg: In terms of our systems and our IT structures.

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Dr. Mary Helen McSweeney: Absolutely.

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Mark Ginsberg: Software developed here in the United States.

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Dr. Mary Helen McSweeney: Absolutely, which makes us a country that a lot of other countries are very interested in what we've done. Now, that doesn't necessarily mean they'll use our systems, but they're certainly interested in what we are doing. Just examples in Canada that I'm aware of. We have two major electronic health record systems used here in Maryland.

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Mark Ginsberg: Yeah, yeah.

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Dr. Mary Helen McSweeney: EPIC and Cerner, okay?

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Mark Ginsberg: EPIC is one for sure, right.

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Dr. Mary Helen McSweeney: EPIC is being rolled out in Ottawa hospitals, and that should be, fingers crossed, pretty functional here in 2026.

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Mark Ginsberg: So, that may allow for more data sharing because there'll be more commonality in the systems?

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Dr. Mary Helen McSweeney: Hopefully. But remember, Canada has a very unique way of how it funds health care. There is the Canada Health Act, which basically guarantees health care for every person who's a legal resident or citizen, but every province can go and do their own thing in terms of implementation. So, you do see vast differences between, say, what's done in Ontario or Quebec or Nova Scotia or British Columbia.

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Mark Ginsberg: I'm glad you raised that. I wanted to go there as well and to talk a little bit about the financing systems. In the United States today, I was reading that in, I think, three years ago, somewhere around 7% of the country was uninsured. Looking at 2026, we're looking at 9 to 10%. The number of uninsured is going up. In other countries, we see a more ubiquitous access to health care system, which is really related to the financing systems that undergird it. Talk a little bit about your experience with these distinctions.

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Dr. Mary Helen McSweeney: In a way. In a way.

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Mark Ginsberg: Okay.

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Dr. Mary Helen McSweeney: In theory, and it is true, everybody has a legal right to health care in a country like Canada.

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Mark Ginsberg: Yeah.

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Dr. Mary Helen McSweeney: The key issue is the wait times.

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Mark Ginsberg: Yes.

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Mark Ginsberg: People wait, and people can wait very long periods of time. Sometimes that has deleterious consequences that people don't get diagnosed in time. That's when some people may be looking at my area of research that was up there, which is medical assistance in dying.

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Mark Ginsberg: My understanding is, too, in many of these countries, there are two-tiered systems, those who can pay privately and those who rely on the publicly financed system.

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Dr. Mary Helen McSweeney: And you are starting to see more and more conversations about that in Canada, but it is very controversial.

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Mark Ginsberg: Mmm.

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Dr. Mary Helen McSweeney: There are people who feel that the letter of the Canada Health Act should be required and everybody should get on the queue and wait for their care, and then there are other people who say, "Well, sometimes we don't have enough providers. We should permit more private services as well as public services." So, there are people, and I'll include myself there, have that experience. I went to a concierge doctor to see what it was like, and it was excellent quality of care, but yes, everything is paid out of pocket – any kind of testing, visits, stuff like that – but there are people who are willing to do that. There are also people who have to do it because you're talking about the aging of the health care workforce. Just like here in the United States, many providers are retiring. And so, if your family doctor retires, what happens to a person like that? They go to the bottom of the list to wait for another family doctor, and it could be years. So, there are families that work with older adults who go to these concierge or private physician businesses where they get their family doctors. So, there is a lot of criticism about this, but being an economist, I see that there are gaps in how the system works.

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Mark Ginsberg: Yeah, yeah.

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Dr. Mary Helen McSweeney: And so, I can see the value in certain instances of private options for people, even within a socialized medical system.

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Mark Ginsberg: Yeah, yeah. So, it sounds like there are many things that we can learn from other countries, but there are also many things other countries can learn from the United States experience.

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Dr. Mary Helen McSweeney: Absolutely. I would say what people really focus on in terms of the value of US health care is the technology piece, okay? There are a lot of concerns about health outcomes here, which are legitimate, and that they see changes in the delivery of public health services that they also find challenging. Canada's very good on social programs and social supports, and they're very proud of having those programs in place. I would say that the UK is exactly the same. I think with a socialized medical system, what I saw is that wait times are just the key issue.

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Mark Ginsberg: Yeah, yeah.

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Dr. Mary Helen McSweeney: Here, it's whether you have insurance or a program to cover your care.

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Mark Ginsberg: Well, I was going to say, here in the United States, I think many would say that we have the most high-quality, most sophisticated care that's available anywhere in the country, but access to that care varies widely.

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Dr. Mary Helen McSweeney: Right.

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Mark Ginsberg: So, there are disparities in health, there are disparities in individual health, but there are also disparities in access to health.

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Dr. Mary Helen McSweeney: Yes, absolutely. And again, those access issues I think are going to become more and more challenging with cuts to budgets to our Medicaid financing system, the kinds of social supports that we used to be able to get, funding for basic public health and preventive services. A lot of that kind of stuff is going to go away. However, I think what will happen, let's use Maryland as a good example, that while the federal government has made it clear they're moving in one direction, our governor has made it clear that even if the feds aren't going to pay for things, we are going to mandate certain things here if you're a resident of this state. So, we may see health care evolve here more in terms of states' rights, but I would say the key thing right now is the focus on how can technology help everybody?

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Mark Ginsberg: Yeah, yeah. Well, Jonas Salk, one of the great thinkers in health care, historically once said, "The health of our nation is intertwined with the health of all nations," and he also recently said, which I think is a great quote, that "Public health is a collective responsibility that transcends borders and boundaries."

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Dr. Mary Helen McSweeney: Yeah.

[00:32:14]

Mark Ginsberg: Well, the conversation that we're talking about, about long-term care, about the needs of those with acute and chronic illnesses that sustain over time, the needs of the elderly population in terms of the care that the older persons receive, differentiated from but parallel to those who might have chronic or acute illnesses, are significant. But also the global health challenges that we face internationally, as well as the opportunities to learn from and impart our knowledge to countries around the world are very important. So, let me thank you very much for joining with us today on On the Mark, Mary Helen. Your work is fascinating and important. Thank you for your advice. Thank you for your work. And thank you for being part of the Towson University community.

[00:32:55]

Dr. Mary Helen McSweeney: Well, thank you for inviting me.

[00:32:56]

Mark Ginsberg: Sure. Once again, thank you very much for joining us on On the Mark, and we look forward to hearing more about your work in the future.

[Music]

[00:33:09]

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