Comment on State of New Jersey’s Health: Healthcare Hotspots by Tweetybird0   
I watched this program about health care and it was very informative but I still am very worried I had no choice but to retire on disability I pay out of my fix income pension for my health insurance I have alot of heath problems and am unable to afford my co pays, I feel terrible I can not being able to pay most times for procedures, I also wait until the last min to go get examine, I applied for Affordable heath and its been very confusing. Its terrible I cant even see a dentist I have dental insurance but once again unable to afford co pay I need 4 root canals and my co pay is out rages. This is American
          Second Best   

CLEVELAND—Is John Kerry finally winning? His campaign, which only a week ago was defensive about the candidate's standing in the polls, is now more confidently asserting that he's pulled ahead. Before Friday, the Kerry campaign hadn't been willing to make that claim. Typically, the Bush campaign would argue that the president was leading in the race, and the Kerry campaign would respond by saying, no, it's a tie. But in a Friday afternoon conference call, Kerry's people finally started pointing to the scoreboard.

Here are the numbers outlined by Democratic pollster Stan Greenberg on the latest Democracy Corps poll. The numbers are consistent with the latest polls from news organizations, most of which are in keeping with what the Kerry people have been saying all along, that the race is a toss-up. In Greenberg's poll, the horse race is a statistical tie, with Kerry at 49 and Bush at 47. The president's approval rating is 48 percent, "which is just at the edge of electability," Greenberg noted.

So why the confidence? Greenberg cited two internal numbers from the part of the poll that focused on "persuadable" voters. That group includes undecided voters, Bush and Kerry supporters who say their minds remain open, and a third group, Bush voters who say they want the country to go in a significantly different direction. The first number Greenberg cited was this: Fifty-seven percent of the persuadable voters in the Democracy Corps poll said they want to know how a candidate will "make the economy and health care better for people," while only 32 percent want to know "how you'll make us safe." The other number Greenberg highlighted: Given a choice between "I'm comfortable with changing to a new person if he has the right priorities" and "Bush has made us safer and I'm reluctant to change," 54 percent of persuadable voters said they were comfortable with changing, and 45 percent said they were reluctant. The responses to those two questions, Greenberg said, show that Kerry has "an audience" ready to listen to his message. He just has to "seal the deal."

With 11 days to go, that puts Kerry in the exact same place he was with more than three months to go, before the Democratic convention. He had a willing and persuadable audience then, and he proved unable to win them over. People preferred the "generic Democrat" to Bush, but they soured on the specific Democrat. Fortunately for Kerry, in the first debate, Bush reminded voters of what they don't like about him, and now we're back to square one again.

That dynamic is in keeping with the "spotlight" theory of the election being peddled by Ron Brownstein of the Los Angeles Times. The theory goes something like this: Given that a slight majority of the electorate doesn't want Bush, and that a different but similarly slight majority doesn't want Kerry, the winning candidate will be the one who manages to keep the spotlight on his opponent's flaws, rather than his own.

Up to now, I've rejected Brownstein's theory and argued that Kerry has to do more than just watch Bush lose. He has to win the separate "referendum on the challenger" by persuading Americans that he's an acceptable replacement for the president. But if Brownstein is right, neither candidate should get too optimistic by polling data that shows him ahead. Because every time for the past few months that this race has been one man's race to lose, that man hasn't had any trouble finding a way to lose it.


          Kerry vs. His Script   

WATERLOO, Iowa—Since the final presidential debate, John Kerry has traveled around the country delivering a series of speeches that his campaign calls his "closing argument." The topics vary, but the theme is always the same, the "Fresh Start for America": Friday in Milwaukee, a "fresh start" for jobs; Monday in Tampa, a "fresh start" for health care; Tuesday in Wilkes-Barre, Pa., a "fresh start" for fiscal responsibility and Social Security. The speeches are supposed to convince Americans of Kerry's fitness for the presidency, but a side effect has been to demonstrate how inept he is at delivering prepared remarks.

The campaign gives reporters the text of each of Kerry's speeches "as prepared for delivery," apparently to show how much Kerry diverges from them. During his stump speeches and town halls, Kerry makes the occasional Bush-style error, such as the time I saw him tell a blind man in St. Louis that he would "look you in the eye." Tuesday night in Dayton, Ohio, Kerry tried to thank teachers for spending money out of their own pockets on students, but instead it came out as a thank-you to Mary Kay Letourneau as he said, "And they're putting out for our kids." His pronunciation of "idear" grates on my ears far more than Bush's "nucular." But the authentic Kerryism emerges only when he gives a formal address.

Kerry proves incapable of reading simple declarative sentences. He inserts dependent clauses and prepositional phrases until every sentence is a watery mess. Kerry couldn't read a Dick and Jane book to schoolchildren without transforming its sentences into complex run-ons worthy of David Foster Wallace. Kerry's speechwriters routinely insert the line "We can bring back that mighty dream," near the conclusion of his speeches, presumably as an echo of Ted Kennedy's Shrum-penned "the dream will never die" speech from the 1980 Democratic convention. Kerry saps the line of its power. Here's his version from Monday's speech in Tampa: "We can bring back the mighty dream of this country, that's what's at stake in these next two weeks."

Kerry flubs his punch lines, sprinkles in irrelevant anecdotes, and talks himself into holes that he has trouble improvising his way out of. He steps on his applause lines by uttering them prematurely, and then when they roll up on his TelePrompTer later, he's forced to pirouette and throat-clear until he figures out how not to repeat himself. He piles adjective upon adjective until it's like listening to a speech delivered by Roget.

Kerry's health-care speech Monday in Tampa was a classic of the form. The written text contained a little more than 2,500 words. By the time he was finished, Kerry had spoken nearly 5,300 words—not including his introductory remarks and thank-yous to local politicians—more than doubling the verbiage. Pity his speechwriters when you read the highlights below. It's not their fault.

Kerry's Script: Most of all, I will always level with the American people. 

Actual Kerry: Most of all, my fellow Americans, I pledge to you that I will always level with the American people, because it's only by leveling and telling the truth that you build the legitimacy and gain the consent of the people who ultimately we are accountable to. I will level with the American people.

Kerry's Script: I will work with Republicans and Democrats on this health care plan, and we will pass it.

Actual Kerry: I will work with Republicans and Democrats across the aisle, openly, not with an ideological, driven, fixed, rigid concept, but much like Franklin Roosevelt said, I don't care whether a good idea is a Republican idea or a Democrat idea. I just care whether or not it's gonna work for Americans and help make our country stronger. And we will pass this bill. I'll tell you a little bit about it in a minute, and I'll tell you why we'll pass it, because it's different from anything we've ever done before, despite what the Republicans want to try to tell you.

Kerry's Script: These worries are real, and they're happening all across America.

Actual Kerry: These worries are real. They're not made up. These stories aren't something that's part of a Democrat plan or a Republican plan. These are American stories. These are the stories of American citizens. And it's not just individual citizens who are feeling the pressure of health care costs. It's businesses across America. It's CEOs all across America. This is an American problem.

Kerry's Script: That's wrong, and we have to change it.

Actual Kerry: Well, that's wrong, my friends. We shouldn't be just hoping and praying. We need leadership that acts and responds and leads and makes things happen.     

Kerry's Script: That's wrong, and we have to change it.

Actual Kerry: Well, that's wrong. We had a chance to change it in the Congress of the United States. They chose otherwise. And I'll talk about that in a minute.

Kerry's Script: It's wrong to make it illegal for Medicare to negotiate with the drug companies for lower prices.

Actual Kerry: But not satisfied to hold onto the drug company's profit there, they went further. Medicare belongs to you. Medicare is paid by the taxpayer. Medicare is a taxpayer-funded program to keep seniors out of poverty. And we want to lower the cost to seniors, right? It's common sense. But when given the opportunity to do that, this president made it illegal for Medicare to do what the VA does, which is go out and bulk purchase drugs so we could lower the taxpayers' bill and lower the cost to seniors. It is wrong to make it illegal to lower the cost of tax and lower the cost to seniors. 

Kerry's Script: And if there was any doubt before, his response to the shortage of flu vaccines put it to rest.

Actual Kerry: Now, if you had any doubts at all about anything that I've just said to you, anybody who's listening can go to johnkerry.com or you can go to other independent sources and you can track down the truth of what I've just said. But if you had any doubts about it at all, his response to the shortage of the flu vaccine ought to put them all to rest.

Kerry's Script: I believe we need a fresh start on health care in America. I believe we need a President who will fight for the great middle class and those struggling to join it. And with your help, I will be that kind of President.

Actual Kerry: I believe so deeply—and as I go around, Bob and Bill and I were talking about this coming over here from other places—that the hope that we're seeing in the eyes of our fellow Americans, folks like you who have come here today who know what's at stake in this race. This isn't about Democrat and Republican or ideology. This is about solving problems, real problems that make our country strong and help build community and take care of other human beings. I believe we need a fresh start on health care in America. I believe we need a President who's going to fight for the great middle class and those who really are struggling, even below minimum wage now. And they won't even raise it. With your help, ladies and gentlemen, I intend to be that kind of President who stands up and fights for the people who need the help.

Kerry's Script: Families will be able to choose from dozens of different private insurance plans.

Actual Kerry: Now George Bush is trying to scare America. And he's running around telling everybody—I saw this ad the other night. I said, "What is that about? That's not my plan. That may be some 20 years ago they pulled out of the old thing." But here's what they do, they are trying to tell you that there is some big government deal. Ladies and gentlemen, we choose. I happen to choose Blue Cross/Blue Shield. I could choose Kaiser. I could choose Pilgrim. I could choose Phelan. I could choose any number of different choices. That's what we get. And we look through all the different choices and make our choice. You ought to have that same choice. The government doesn't tell what you to do. The government doesn't run it. It gives you the choice.

Kerry's Script: Ladies and Gentlemen, here's the Bush Health Care Plan: Don't get a flu shot, don't import less-expensive drugs, don't negotiate for lower prices, and most of all, don't get sick.

Actual Kerry: So, Ladies and Gentlemen, if you had doubts about it at all, here's the Bush Health Care Plan: Don't get a flu shot, don't import less-expensive drugs from Canada, don't negotiate for lower prices on prescription drugs. And don't get sick. Just pray, stand up and hope, wait—whatever. We are all left wondering and hoping. That's it.


          Unanswered Questions   

SCOTTSDALE, ARIZ.—There are lots of questions going into the third and final presidential debate of the 2004 campaign: Will President Bush find his inside voice? After two debate victories, will the overconfident, coasting "Bad Kerry" return? Will Bush wire himself with an earpiece so he can listen to the baseball playoffs? What bad Red Sox joke will Kerry make? Most important, wouldn't the nation be better off if this were another foreign-policy debate?

If you've paid any attention at all to the presidential campaign for the past seven months, you know the basic differences between Bush and Kerry on taxes, health care, education, abortion, same-sex marriage, Social Security, outsourcing, or whatever your favorite domestic issue is. There are no unanswered questions for the two men that I can think of. Instead, Wednesday night's debate will be a shallow exercise in political point-scoring, with each candidate trying to highlight the embarrassing parts of his opponent's record.

Normally, I'd think such an event would be both great fun and worthwhile. But on foreign policy, the central issue of this election, there's still a great deal of confusion as to where each candidate stands, despite a presidential debate and a half, and a vice presidential debate, on the subject. Do you know, for example, what John Kerry's position is on how the nation should deal with state sponsors of terrorism? Does he agree with Bush that those who harbor terrorists are as guilty as the terrorists themselves? What's his opinion of the Bush Doctrine? Would he amend it? If so, how? Does he think the nation should adhere to a foreign-policy doctrine, or should we just take an ad hoc approach to terrorism and other global problems?

None of those questions were addressed in the first three debates. The campaign's focus on unilateralism vs. internationalism has obscured the more fundamental foreign-policy difference between Bush and Kerry: their views on the role of states, and state sponsors, in the war on terror. Matt Bai's New York Times Magazine piece on John Kerry's view of the war on terror elucidates this difference between the two men more clearly than any article yet written on Kerry's foreign policy, including manful attempts by the Atlantic and TheNew Yorker.

Bush's war on terror assumes that states are the main actors in international affairs. After 9/11, Bush expressed skepticism that a mere "network" could have pulled off such a feat. Bush, Bai writes, does not believe that terrorists "can ultimately survive and operate independently of states." The Bush National Security Strategy calls terrorists "clients" of rogue states. The Bush war on terror is remarkably state-centric. After the fall of Afghanistan, the administration immediately began looking for the next state to topple.

Kerry focuses on nonstate actors, international networks that operate outside of state control. "Kerry's view, on the other hand, suggests that it is the very premise of civilized states ... that is under attack," Bai writes. Kerry's internationalism stems from his view of the war on terror, rather than vice versa: "And no one state, acting alone, can possibly have much impact on the threat, because terrorists will always be able to move around, shelter their money and connect in cyberspace; there are no capitals for a superpower like the United States to bomb, no ambassadors to recall, no economies to sanction."

The clear implication of Bai's article is not, as the Bush campaign would have it, that Kerry wants only to reduce terrorism to a "nuisance" while Bush wants to eliminate it. It's that Bush would seek to topple more regimes in his second term, while Kerry wouldn't. Perhaps everyone already knew that. But don't you want to know more about it? I've already proposed several questions for Kerry. Here are some for Bush: Mr. President, you say John Kerry has a "fundamental misunderstanding" of the war on terror when he says it is only a war against al-Qaida. Does this mean that you are likely to try to change other regimes by force in the Middle East in your second term—those that harbor, say, Hezbollah, Hamas, Islamic Jihad? You say those who harbor terrorists are as guilty as the terrorists themselves. What countries in the world are harboring terrorists, and how do you plan to punish them for their guilt? When you mock Sen. Kerry for saying the war on terror is in large part a "law enforcement operation," are you saying that breaking up terrorist cells is insufficient for victory in the war? What is sufficient for victory? Other than Iraq and Afghanistan, where do you see the next battleground in the war on terror?

If you want to know about the candidates' health-care plans, you can read about them on their Web sites and in newspaper articles. We're a nation at war. Don't you wish the two candidates had to answer some more questions about who exactly we're at war with?


          Cheney Drops the Ball   

CLEVELAND—Does Dick Cheney know that he told voters watching the vice presidential debate to go to GeorgeSoros.com? In response to a series of attacks from John Edwards on Cheney's tenure as CEO of Halliburton, the vice president said that Kerry and Edwards "know the charges are false. They know that if you go, for example, to factcheck.com, an independent Web site sponsored by the University of Pennsylvania, you can get the specific details with respect to Halliburton." One problem with Cheney's rebuttal: He misspoke. He meant to say "factcheck.org," rather than ".com." According to the Wall Street Journal, the company that owns factcheck.com, Name Administration Inc., took advantage of Cheney's error to redirect traffic to a page titled, "Why we must not re-elect President Bush: a personal message from George Soros."*

But maybe Cheney was lucky to have misspoken, because there was a larger problem with his response: It isn't true. Well, it is true that factcheck.org provides "specific details with respect to Halliburton," but those details have nothing to do with the charges Edwards made. The Democratic running mate said that Halliburton, while Cheney was CEO, "did business with sworn enemies of the United States, paid millions of dollars in fines for providing false financial information, it's under investigation for bribing foreign officials." All factcheck.org rebuts is a different charge, that Cheney collected $2 million from Halliburton "as vice president." It turns out that Cheney collected a good chunk of that money as vice president-elect, including nearly $1.5 million on Jan. 18, 2001, two days before his inauguration.

After the debate, Bush campaign communications director Nicole Devenish repeats Cheney's statement and directs reporters to factcheck.org for the details. I've already been to factcheck.org, I tell her, and it says nothing about what Edwards said, about trading with the enemy, about bribing foreign officials, about providing false financial information. She tells me to go to debatefacts.com, the Bush-Cheney rapid-response Web site. The answers are all there.

Except they're not. "The Facts" page at the Bush-Cheney debate site doesn't get Edwards' claims correctly either: "Edwards' Claim: The Department Of Defense's Contracting Process In Iraq Is Rife With Cronyism And Secrecy," it says. Did Edwards claim that? I thought he said Cheney traded with the enemy, bribed foreign officials, and provided false financial information. On those charges, the Bush-Cheney campaign has no answers, at least not tonight.

The exchange on "factcheck.com" was the debate writ small in many ways: Edwards would make a charge, and Cheney would have no answer for it. In debate, that's called a "dropped argument." Cheney left arguments all over the floor. Three times, when offered a chance to respond to something Edwards had said, Cheney declined, leaving Edwards' critique to stand on its own. Edwards went through a long list of votes that Cheney made as a congressman: against Head Start, against banning plastic weapons that can pass through metal detectors, against Meals on Wheels, against the Department of Education, against Martin Luther King Day, against the release of Nelson Mandela. What else was he against, longer recess? Cheney declined to defend or explain a single one of his votes. On gay marriage, Edwards said the constitutional amendment proposed by the president was unnecessary, divisive, and an attempt to distract the country from important issues such as health care, jobs, and Iraq. Cheney declined to refute any of Edwards' points, and instead thanked him for his kind words about his family. On homeland security, Edwards said the administration has failed to create a unified terrorist watch list, and it foolishly screens the passengers on airplanes but not their cargo. We need to be not just "strong and aggressive" but also "smart," he said. Cheney's response: to decline a chance to respond, which is the same as ceding the point.

When Cheney did have an answer, it was often a misleading one, just like factcheck.com. On one occasion, Cheney said the Kerry-Edwards tax plan would raise taxes on 900,000 small businesses, and he said that was a bad idea because small businesses create 7 out of 10 jobs in America. But the two statements have nothing to do with each other. Those 900,000 small businesses—double the real number that would be affected, according to CNN—don't create 70 percent of the nation's jobs. On another occasion, Cheney criticized Kerry for supporting defense cuts that Cheney supported as secretary of defense during the first Bush administration. Other statements were simply false, rather than merely deceptive or misleading. For example, Cheney said he had never asserted a connection between 9/11 and Iraq. That's not true. Cheney said he had never met Edwards before. That's not true.

Edwards didn't have a perfect debate. Cheney defended himself and the administration capably during the opening questions about Iraq and the war on terror, and I was disappointed when Edwards failed to give an answer to Cheney's criticism that he and Kerry have no plan to deal with state sponsors of terror. And Edwards got mauled when Cheney said Edwards, by saying that 90 percent of the casualties in Iraq were American, was saying that the deaths of Iraqi soldiers fighting with the U.S. "shouldn't count."

We're halfway through the debates, and I think that each side still has one big question that it hasn't answered. Kerry and Edwards haven't given an adequate explanation of how they would approach states that sponsor terrorism and harbor terrorism. If Iraq was the wrong country to focus on, what was the right country? Just Afghanistan? Or do they support a broader Bob Graham-style war against Hamas, Hezbollah, and other terrorist organizations? If regime change isn't the right policy for dealing with state sponsors of terror, what is? Would a Kerry-Edwards administration wage a "war on terror," or just a war on al-Qaida?

The question for Bush and Cheney is the same, but from the opposite side. Where does their war stop? When does it end? How do we measure victory? Most important, what is their answer to a question that Edwards posed and Cheney ignored: "There are 60 countries who have members of al-Qaida in them. How many of those countries are we going to invade?"

Correction, Oct. 7, 2004: The article originally claimed that George Soros bought the factcheck.com URL after Cheney referred to it and redirected its traffic to GeorgeSoros.com. In fact, the company that already owned the URL, Name Administration Inc., redirected the traffic to the Soros page. (Return to corrected sentence.)


          Daydreaming About Dean   

MIAMI—Can we change horses in midstream? Democrats wanted Republicans and independent voters to be asking themselves that question at this stage in the presidential campaign, but with little more than a month to go before Election Day, some Democrats are asking it of themselves. It's the seven-month itch: The long general-election campaign has led the voters who settled down with Mr. Stability to wonder what would have happened if they had pursued their crushes on riskier but more exciting candidates. What if dreamy John Edwards were the nominee instead of John Kerry? Would he be better able to explain his votes for war and against the $87 billion to fund the war? Would his campaign have been leaner and more effective than Kerry's multitudes? Or what about Democrats' first love, Howard Dean? Remember him? Would his straightforward opposition to the war in Iraq look more prescient now than it did during the Iowa caucuses, which were held shortly after Saddam Hussein was captured?

The most surprising Democrat to engage in this daydreaming is one who never dated Dean in the first place: Peter Beinart, editor of the New Republic. Writing in Time, Beinart says, "[T]here's reason to believe [Democratic primary voters] guessed wrong—that Dean would be doing better against Bush than Kerry is." Deaniacs can be forgiven for being a little bit piqued at the timing of Beinart's conversion. After all, most Dean supporters thought Beinart's magazine did its best to torpedo the Dean candidacy for much of 2003, including an online "Diary of a Dean-o-Phobe." But TNR also ran glowing profiles of Dean and his campaign manager, Joe Trippi, and it never married Kerry, either. Although the magazine ultimately endorsed Joe Lieberman, its endorsement issue contained an article praising every other major Democratic contender—Dean, Edwards, Dick Gephardt—except John Kerry. So, it's understandable why Beinart would be one of the first to fantasize about divorce.

Beinart argues that Dean's clarity on the war, his straight-talking authenticity, and his lack of a Senate voting record would have forced President Bush to focus on the issue of Iraq, rather than the character of John Kerry. Not everyone who worked for Howard Dean during the primaries agrees that the Vermont governor would have been a stronger nominee—in fact, some say just the opposite or even burst into laughter at the notion—but one senior Dean adviser that I talked to Wednesday agrees strongly. "If Howard Dean were the nominee right now, nobody would be wondering where he stands on Iraq, nobody would be accusing us of not fighting back, and we wouldn't be fighting to hold on to our base," said the adviser, who asked that his name not be used. Kerry's "thoughtful and nuanced positions" might be an admirable quality in a president, but they're difficult to defend during a campaign.

A Dean general-election campaign would have contrasted Dean's record with Bush's in three ways: Dean being against the war versus Bush being for it; Dean's record of balancing the Vermont budget while providing health care versus Bush's largest deficits in history with no health care; and a new wrinkle that was only hinted at during the primaries, Dean's mysterious, infrequently mentioned "tax reform" vs. Bush's irresponsible tax cuts. Yes, Dean would have repealed the entire Bush tax cut, the senior adviser said, but he would have proposed replacing it with some Dean tax cuts, including the elimination of payroll taxes on the first $20,000 of income. The message: Bush cuts taxes from the top down, but Dean cuts them from the bottom up. Why didn't Dean introduce this during the primaries, when his tax-hiking ways made some Democrats think he would be an electoral disaster, the second coming of Walter Mondale, in the fall? He wanted to wait until after the Feb. 3 primaries because "he didn't want people to think he was pandering," the adviser said.

The Dean adviser did go out of his way to insist that he was not criticizing the Kerry campaign. The Republicans "might have destroyed Howard Dean," too, he said, but "I just think Howard would have matched up differently and better." The Dean adviser praised Kerry's maligned convention, which made voters believe that Kerry was a viable commander in chief who was as good as Bush or better on the issues of terrorism and homeland security. "They were in perfect position after the convention to win this thing," he said, quickly adding that he's not saying they've lost it. But then he added, "They basically are hoping that Bush shits the bed in the debates."

Of course, it's pretty obvious that the Republicans would have run a different campaign against Howard Dean than they did against John Kerry. But that doesn't mean it would have been any less effective. And if Dean couldn't beat Kerry, what exactly would have made him so formidable against President Bush? Would Dean's support for civil unions in Vermont have made gay marriage a much bigger issue in the fall? Was there something in his past that we didn't learn about? Would the aggressive campaign he would have waged in the spring and summer—leaping instantly on every bit of bad news from Iraq, from Abu Ghraib to Fallujah—have backfired? Would Dean have been able to build a campaign that brought together his divided Vermont and D.C. factions? It's impossible to know, though divining that impossibility is exactly what Democratic primary voters charged themselves with this time around.

Falling in love with Dean all over again ignores what made Democrats fall out of love with him in the first place. An incomplete list: his infuriating stubbornness and refusal to admit mistakes; his lousy white-background TV ad in Iowa; and his shift from a straight-talking, budget-balancing, health-care-providing Vermont governor to the shrieking leader of a cult movement. In Iowa, Dean's poor showing was exacerbated by the fact that he was the second choice of no one. He and Kerry found out that in American democracy, it's better to have a large number of people barely tolerate you than to have a smaller number like you a lot. By the weekend, it will be clear whether Kerry managed to rally a nose-holding majority to his side at Thursday's debate. If not, expect to hear a lot more conversations like this over the next 33 days.


          Great Expectations   

PHILADELPHIA—On the Kerry plane Thursday, reporters asked Mike McCurry why the campaign agreed to make the foreign-policy debate first, as the Bush campaign wanted, instead of third, as the Commission on Presidential Debates had scheduled it. "You know, we have to take anything like that and turn it into an opportunity," McCurry said. So, you see it as an opportunity? Not quite: "I'm supposed to lower expectations, not raise them."

Maybe McCurry should tell the candidate. I counted six times this week that Kerry raised his debate expectations by disparaging President Bush's intelligence or knowledge, seven if you count a comment made by Sen. Joe Biden during a Friday rally here. During his Monday night appearance on David Letterman, Kerry said that during the debates, "George Bush is gonna sit on Dick Cheney's lap," an apparent reference to the widespread Democratic belief that the vice president is the ventriloquist/puppeteer and Bush is the dummy. (At least, I hope that was the reference.) On Tuesday's Live With Regis & Kelly, Kerry said of the just-concluded debate negotiations, "The big hang-up was George Bush wanted a lifeline where he could call," an allusion to Regis Philbin's Who Wants To Be a Millionaire? game show. That night in Orlando, Kerry said that President Bush says he would have gone to war "even if he knew there was no connection of al-Qaida and Sept. 11 and Iraq—which we knew, but even if he knew that." In Columbus on Thursday, Kerry mocked Bush's claim that the CIA was "just guessing" about Iraq in its National Intelligence Estimate by implying that the president didn't understand the nature of the report and hadn't looked at it: "It's called an analysis. And the president ought to read it, and he ought to study it, and he ought to respond to it." On Friday on the campus of the University of Pennsylvania *, Biden compared the two candidates for president by saying, "John Kerry understands and has actually read history." Earlier that morning, during Kerry's war-on-terror speech at Temple University, Kerry noted that the president agreed to testify before the 9/11 commission "only with Vice President Cheney at his side," and he ridiculed Republican claims that a new president wouldn't be able to get more allies involved in Iraq and the war on terror by saying, "I have news for President Bush: Just because you can't do something doesn't mean it can't be done."

Good lines all—well, except the sitting-in-Cheney's lap one. But was this the week to trot out the Bush-is-an-idiot-controlled-by-Cheney meme? I thought the campaigns were supposed to talk up their opponents before the debates, not deride them. Kerry is Cicero and Bush is Rocky Marciano, the man who has never lost.

Other than this minor misstep in the expectations game, however, Kerry set himself up well this week for Thursday's debate, which will be the most decisive event in the presidential campaign so far. The foreign-policy debate deserves to go first, because this is a foreign-policy election. At Kerry's town halls, even the ones that are supposed to be about health care or Social Security or the economy, the majority of voters ask him questions about Iraq. Here's one way to think about next week's face-off: Bush and Kerry are running for leader of the free world, not just president of the United States, and both candidates want to cast themselves as a global Abraham Lincoln while defining their opponent as an international version of John C. Calhoun.

Bush lays claim to the mantle of Lincoln the Emancipator: Like the 16th president, Bush believes that individual liberty trumps state sovereignty (the international version of states' rights). Sure, Saddam Hussein was sovereign, but he was a tyrant and a menace to his people, Bush says, so America's invasion was a just one. Kofi Annan says Bush's invasion of Iraq was a violation of international law, but Bush appeals to a higher law that says that some laws and some rulers are illegitimate. Bush laid out his Lincolnesque doctrine of liberty over sovereignty in his acceptance speech at the Republican convention: "Our nation's founding commitment is still our deepest commitment: In our world, and here at home, we will extend the frontiers of freedom." Bush wants to paint Kerry as a global Calhoun, a man who prefers French sovereignty to Iraqi freedom.

Kerry, on the other hand, casts himself as Lincoln the preserver of the Union (while at the same time questioning Bush's competence and highlighting the disparity between the president's "fantasy world" ideals and the "world of reality" on the ground). I don't want to overstate this, because the Republican caricature of Kerry as a one-worlder who would let France exert a veto over American security is inaccurate. But Kerry clearly believes in the international structures and institutions that have been created since World War II, and he sees Bush, shall we say, nullifying them. In this version of the story, it's Bush who is Calhoun, the man who would elevate the shortsighted rights of his state over the compact that every state has entered to promote the greater good.

This analogy, like all historical analogies, is flawed in many ways. It may be particularly unfair to Kerry, who on the stump talks about relying on allies out of pragmatism rather than idealism. But it gets at the factor that I think will determine the winner of next week's debate: Which candidate will be able to present himself as the internationalist and his opponent as the isolationist? Bush says Kerry would turn his back on the people of the world who suffer under tyranny. Kerry says Bush has already turned his back on the world and has replaced dictatorship in Iraq with chaos, not the freedom he claims.

It will be an uphill battle for Kerry. So far, he's been successful at pointing out the flaws in Bush's policies, but he hasn't convinced enough people that President Kerry's policies would be any better. And Bush's bounce out of the Republican convention showed how attractive the president's principles, if not his policies, are.

In July, voters seemed to have decided that they'd like to get rid of Bush. But when they turned their attention to his potential replacement, they were disappointed by what they discovered. The Republican convention exploited that disappointment, and now there are more undecided voters than ever—because voters found out they don't like either guy.

Bush lost the incumbent's referendum, then Kerry lost the one on the challenger. Now we don't know what we want. That's why Thursday will be so critical. For Kerry to win, he needs to argue successfully that liberty and the international order, like strength and wisdom, are not opposing values.

Correction, Sept. 27, 2004: This article originally said that Biden spoke at the University of Philadelphia. He spoke at the University of Pennsylvania. (Return to corrected sentence.)


          Shrum Strikes Back?   

ALLENTOWN, PA.—The Washington Post's Mark Leibovich profiled Kerry adviser Bob Shrum in a piece Friday that focused on the so-called "Shrum Curse," the idea that Shrum is the losingest great political strategist of modern times. Leibovich didn't bring up William Jennings Bryan or the Buffalo Bills, but he does compare Shrum to Kerry's favorite baseball team, the Boston Red Sox. Ten speechwriters at the Democratic convention, Leibovich writes, considered wearing "Reverse the Curse" T-shirts emblazoned with a picture of Shrum. The article's headline: "Loss Leader: At 0-7, Adviser Bob Shrum Is Well Acquainted With the Concession Speech."

Ouch. It gets worse. Here are some of the piece's highlights: "Shrum's career-long slump in presidential campaigns, a well-catalogued losing streak that runs from George McGovern to Al Gore. … the ["Reverse the Curse"] slogan endures as a joke among Kerry staffers. … Shrum's 0-7 win-loss record in presidential elections has become ensconced in the psyches of the campaigns he orchestrates. …. Kerry is sputtering … His campaign has been called listless and unfocused, words that were also applied to Shrum's last presidential enterprise, the Gore campaign (a forbidden comparison within Kerry headquarters). … But curses sometimes have prosaic explanations. … critics started to rehash old complaints about Shrum. They say he relies too heavily on populist rhetoric, … that his aggressiveness led to backbiting within the campaign. ... James Carville harpooned Shrum relentlessly to reporters at the Republican convention last week. Clinton himself was critical of the campaign's reluctance to attack Bush—a position Shrum had advocated—in a phone call to Kerry … Shrum's brand of old-style liberalism—steeped in the tradition of his political patron, Ted Kennedy—is anathema to the centrist, New Democrat ethic that got Clinton elected twice. … 'You tend to listen extra hard to Clinton people,' says a mid-level Kerry aide who didn't want to be identified because he's not an official spokesman. 'They've actually won one of these.' "

The one thing Leibovich couldn't nail down was Shrum's role in the Kerry campaign after the elevation of John Sasso and Michael Whouley and the infusion of Clinton operatives like Joe Lockhart. How much power does Shrum have now? Does he still have the candidate's ear? "Shrum is either in Kerry's doghouse, or his influence has been diffused by the high-level additions. Ultimately, though, campaign sources say, Shrum is a survivor" who has "worked strenuously to cultivate Lockhart." Leibovich also writes that Kerry feels loyal to Shrum for helping him to defeat William Weld in 1996.

So, Shrumologists take note: During a rally here on Friday, the same day Leibovich's critical profile appeared, Kerry inserted a Shrumian flourish into his standard stump speech. For a few minutes, Kerry sounded an awful lot like Al Gore during his much-criticized—and Shrum-penned—"people vs. the powerful" acceptance speech at the 2000 Democratic convention. The business-friendly Kerry  of Labor Day vanished, replaced by a Wall Street-bashing economic populist.

Kerry spokeswoman Stephanie Cutter said Kerry's remarks weren't significant. "It didn't strike me as anything unusual," she said. "It's not a 'people vs. the powerful.' " Judge for yourself: There's a theme that runs through "everything I just talked about," Kerry explained. "Why aren't we importing drugs from Canada? Why did they take that out? Why did we refuse to allow Medicare to be able to negotiate [bulk drug prices] so you would lower your taxes? Why has the tax burden of the average American family gone up while the tax burden of the richest people in America has gone down? Why is it that when we're fighting to have alternative and renewable energy, we wind up with an energy bill that's written for the oil and gas companies? Why is it that when American citizens are losing their health care by the millions, it's the HMOs and the companies that keep getting fed?" Kerry mentions all of these things frequently on the stump, but this time he punctuated his critique with an allusion to the rhetoric of Al Gore's "forbidden" campaign: "I'll tell you why: because this administration exists for the purpose of serving the powerful and the moneyed, and we need to restore … the voices of America, the real Americans who built this country and make it strong. We need to step up and fight."

Was Kerry paying a final tribute to the dear, departed Shrum? Or was Shrum serving notice to the Clinton faction that he won't disappear without a fight? Both? Neither? Was it just a coincidence? What is the sound of one hand clapping? If a Shrum falls in the forest, does it make a sound?


          Kerry Returns to Form   

DES MOINES—The most interesting thing to happen with the Kerry campaign Wednesday was an exchange between Stephanie Cutter, a Kerry spokeswoman, and CNN's Candy Crowley. Disgruntled reporters gathered around Cutter after Kerry's anticipated but disappointing speech in Cincinnati that criticized President Bush's handling of the war in Iraq. The speech had two memorable moments, both of which occurred before it really began: the announcement beforehand that Peter Frampton was on hand, and the shouts of a protester—"You said you committed atrocities. You said you burned villages"—who was silenced when the man standing next to him put him in a headlock. After the speech, Kerry spokesman David Wade said the protester was a man named Mike Russell, who Wade said was the Bush-Cheney chairman in Bracken County, Ky., during the 2000 election. "He is now, coincidentally, with the Swift Boat Veterans," Wade added.

Nothing Kerry said in Cincinnati could compensate for the blunder he made the day before when he stood before cameras on the tarmac of the Cincinnati airport and expressed his sorrow for the 1,000th American casualty in Iraq. "More than 1,000 of America's sons and daughters have now given their lives on behalf of their country, on behalf of freedom, in the war on terror," Kerry said. The war on terror? Oops. The mistake was part of the natural reversion to the mean of the Kerry candidacy. After the successful day and a half of campaigning that followed his conversation with President Clinton, the usual Kerry—the New Old Kerry—was back. Kerry took no questions after making his mystifying "war on terror" comment. Crowley called out, "Senator, you've been saying that it's 'wrong war, wrong place, wrong time.' What does that mean about these deaths?" but Kerry, in a typical maneuver, just walked away. It's been more than five weeks since Kerry last took questions at a press conference, or an "avail," as it's called.

So, Crowley asked Cutter if she could explain what Kerry meant. Short answer: No. Long answer: Cutter said Kerry was referring to something Donald Rumsfeld said Tuesday about the increase in terrorists in Iraq after the war. "There were not terrorists in Iraq before we went," Cutter explained (incorrectly), but there are now. Kerry was just "repeating what Rumsfeld said," Cutter continued. So, Crowley asked, Iraq is now part of the war on terror? "No. That's not what I'm saying," Cutter said. "Should he have clarified it, said it differently? Maybe. But the point remains the same. There was no terrorism before we went to war. There is now terrorism there." But Democratic orthodoxy is that the war on terror and the war in Iraq are distinct, Crowley said. Cutter replied, "And he agrees with that." Crowley: "Had he stayed for questions, we could have clarified that."

Kerry should have said, hey, I misspoke, I was trying to express my sympathy for all the Americans who have lost their lives in the broader war on terror, not just the 1,000-plus who have died in the war in Iraq. But instead the campaign has concocted this preposterously complicated explanation, saying yes he meant to say it, but no, he thinks Iraq is not part of the war on terror. What?

The other head-scratcher uttered by Kerry in the past two days came Wednesday in Greensboro, N.C. There, in response to a question from a woman about the health problems caused by mold and indoor air contamination—and her complaint, "There's not one agency in this government that has come forward" to deal with the problem—Kerry endorsed the creation of a new federal department. "What I want to do, what I'm determined to do, and it's in my health-care plan, is refocus America on something that can reduce the cost of health care significantly for all Americans, which is wellness and prevention," Kerry said. So far, so good. But then, "And I intend to have not just a Department of Health and Human Services, but a Department of Wellness." Again, what? Apparently this idea comes from Teresa Heinz Kerry, who told the Boston Herald in January 2003 that she would, in the Herald's words, "be an activist first lady, lobbying for a Department of Wellness that would stress preventive health." Oh, boy. Preventive health is a fine idea, but do we need a new agency—I assume it's not Cabinet-level—to handle it?

Kerry ended his day in Iowa, the state that launched him to the nomination of the Democratic Party. The traveling press headed to the Hotel Fort Des Moines to spend the night. At the hotel, I came across an inauspicious if ultimately meaningless piece of trivia on an information sheet given to hotel guests. Three presidential candidates, according to the hotel, celebrated their victories in the Iowa caucuses at the Hotel Fort Des Moines. Two of them, Walter Mondale in 1984 and Bob Dole in 1996, went on to win the nominations of their parties (the third was George Bush in 1980). In their general-election match-ups, Mondale won one state and the District of Columbia, while Dole won 41 percent of the popular vote. John Kerry? He too celebrated caucus night at the Hotel Fort Des Moines this January, but the hotel hasn't added him to its list yet. Maybe it's afraid of being a three-time loser.


          Kerry's Deathbed Conversion   

CLEVELAND—Everything you need to know about Bill Clinton's 1992 presidential run—and therefore, everything a Democrat needs to know about taking the White House from an incumbent—is supposed to have been scrawled on a wipeboard in Little Rock 12 years ago by James Carville. "It's the economy, stupid," the phrase that has become holy writ, was only one-third of Carville's message. The other two tenets of the Clinton war room were "Change vs. more of the same" and "Don't forget health care." John Kerry has been running on two of those three planks, the economy and health care. But one day after talking with President Clinton on his deathbed—Kerry's, not Clinton's—the candidate has finally embraced the third: change.

Kerry offered a taste of his new message Monday morning at one of his "front porch" campaign stops in Canonsburg, Penn., but he waited until the afternoon in Racine, W.V., to unveil his new stump speech in full. The new message: Go vote for Bush if you want four more years of falling wages, of Social Security surpluses being transferred to wealthy Americans in the form of tax cuts, of underfunded schools and lost jobs. But if you want a new direction, he said, vote for Kerry and Edwards.

It's a simple and obvious message, but Kerry hasn't used it before. There were other new, even more Clintonesque wrinkles, too. Kerry talked about the same issues—jobs, health care, Social Security, education—that he's talked about in the past, but he had a new context for them: how Bush's policies were taking money out of taxpayers' pockets. The deficit, the Medicare prescription drug plan that forbids bulk-price negotiation and the importation of drugs from Canada, and the "$200 billion and counting" Iraq war all "cost you money," Kerry said, by increasing the cost of government. Kerry even pushed his health-care plan as a selfish device to put more money in voters' wallets (rather than an altruistic plan to cover the uninsured), in the form of lower health-insurance premiums ($1,000, he says). He also talked about a Clinton favorite, putting 100,000 new cops on the street during the 1990s, and he said he wanted to cut taxes for corporations by 5 percent to lower the cost of doing business in the United States. Talking about corporate tax cuts on Labor Day—if that's not a New Democrat, I don't know what is.

In West Virginia and later Cleveland, Kerry framed most of the new message around a mantra: "W stands for wrong. Wrong choices, wrong judgment, wrong priorities, wrong direction for our country." If you like those wrong choices, the lost jobs, "raiding Social Security," rising health-care costs, and "a go-it-alone foreign policy that abandons America," then vote for George W. Bush, Kerry said. If not, vote for me. The cost of the Iraq war is coming out of your pocket, he said, and it's taking away from money that could be used for homeland security. "That's W.; that's wrong," he said. With each issue Kerry raised—from Iraq to rising Medicare premiums to Social Security to jobs—he concluded his criticism of the president's policy by repeating, "That's W.; that's wrong."

It's not a perfect speech, nor is it delivered all that well. Kerry will never win an oratory contest with Bush, and he is fond of bizarre extemporizing. For example, he said, after being given a shotgun by a union leader to emphasize his support for hunting, "I'm thankful for the gift, but I can't take it to the debate with me." Still, even with Kerry's shaggy delivery, the speech—and more important, the message, if he sticks with it—should be good enough to get his campaign out of its latest sinkhole.

Sometimes, Kerry even improvises well. During the event in Canonsburg, Kerry was heckled by a small but noisy group of Bush supporters. But he managed to pull something out of Clinton's bag of tricks. When Kerry began talking about how the average family's tax burden has risen during the past four years, a man shouted, "Yeah, you're average, Kerry!" In response, Kerry adopted the tactic that Clinton used at the Democratic Convention in Boston: He embraced his affluence. "Just to answer that guy, 'cause he's right," Kerry said. "I'm privileged," just like President Bush. As a result, "My tax burden went down," Kerry said. "And I don't think that's right. I think your tax burden ought to go down."

Before today, Kerry's public image was starting to resemble that of a different Democratic candidate of recent vintage: the Republican caricature of Al Gore, a self-promoting braggart with a weakness for resume-inflating exaggerations. When Kerry was so angered by a Washington Post headline last week that he decided to speak directly after Bush's acceptance speech at the Republican Convention, he appeared to be imitating Gore's unfortunate tendency to let his campaign strategy be driven by the whims of the political media. Some Democrats feared that, by shaking up his campaign over the weekend and bringing in John Sasso and Michael Whouley, Kerry was overreacting in Gore-like fashion to some bad August press. On Monday, anyway, those fears seem overstated. The revamped Kerry campaign looks more like the Democrat who beat a president named Bush than the Democrat who lost to one.


          John Edwards' To-Do List   

OKLAHOMA CITY—Does John Edwards talk about stuff besides the Swift Boat Veterans for Truth ads? As he says to the people who ask him a question at his town-hall meetings, "The answer is yes." But once you've been following a candidate for a few days, his stump speech starts to get a little tedious. OK, more than a little tedious. The press corps (and the campaign staff and the Secret Service) entertains itself by playing "Wheel-o," a betting game where we guess which of the 16 numbers scrawled in chalk on the back wheel of the plane will rest on the ground after landing. Or we roll Jack Edwards' toy ball up the aisle of the plane during takeoff and cheer if it gets into the front cabin. Or we take pictures of ourselves in front of the "world's largest six-pack," six brewing tanks painted like beer cans in front of the brewery in La Crosse, Wis. Or we dream of driving to Juarez, Mexico, during tonight's stay in Las Cruces, N.M.

Reporters listen when the candidate speaks, but we don't hear him. My ears perk up only when Edwards says something new or different, and after a while, I start to hear nuances that aren't there. On Monday in La Crosse, Edwards dropped his exaggerated claim that Kerry volunteered for dangerous combat duty in Vietnam. Aha! I thought. The campaign is finally abandoning its mild, needless puffery about Kerry's war record to head off nitpicking from the Swift Boat Veterans and others. Well, nope, actually. The next day Edwards made the claim again.

So, instead of reporting on whatever contrived bit of newness I heard in Edwards' speech today, here's a list of the things he's said over and over again during the past two and a half days. I've stripped out the bromides—"hope over despair, possibilities over problems, optimism over cynicism"—and focused solely on policy proposals. These aren't all the promises or proposals Edwards has made this week, just the ones he makes most often. For best results, crank up Tina Turner's "Simply the Best," Van Hagar's "Right Now," or anything by Bruce Springsteen or John Cougar Mellencamp while reading:

  • raise the minimum wage;
  • spend more money on: early education, public schools, child care, afterschool programs, and salaries for teachers in the communities where they're needed;
  • raise taxes on: companies that take jobs overseas; individuals who make more than $200,000 a year;
  • reduce taxes for: small businesses that create jobs in communities with high unemployment; individuals through a $1,000 tax credit for health care and a $4,000 tax credit for college tuition (in addition to promising four years of tuition to individuals who perform two years of public service);
  • improve health care by: making the congressional health-care plan available for purchase by all Americans; covering all children; allowing prescription drugs to be imported from Canada; and allowing the government to use its bulk-purchasing power to negotiate lower drug prices from pharmaceutical companies;
  • reform labor laws by: swiftly and severely punishing employers that violate labor laws; banning the hiring of permanent replacements for strikers; "make card-check neutrality the law of the land";
  • fight the war on terror by: strengthening alliances to help "get terrorists before they get us";
  • improve the situation in Iraq by: improving our relations with allies so that NATO will agree to get involved; keeping Iran and Syria from interfering; and getting "others involved in reconstruction besides Halliburton."

Though the real message is the one-point plan of getting a new president.

Refer to this list often. Read it three or four times each day while grooving to Van Halen. Pretty soon, when John Edwards asks, "Are we going to have a president and a vice president who actually understands what's going on in your lives? Who presents an optimistic, positive, hopeful, uplifting vision of America? Or are we going to have a campaign based on fear and lies?" you'll be praying for more fear and lies, too.


          Looking Backward   

MANKATO, Minn.—After watching President Bush speak for only a couple of hours on the 2004 stump, it's easy to see the main tenets of his re-election campaign: My opponent is un-American, or at least less American than me and you. My opponent, much like Al Gore, doesn't know who he is. My opponent is a tax-hiking, big-government liberal. Worse, he wants to ask other countries for permission for America to defend itself against its enemies. Last, and most important, my wife is better than his wife.

What you don't hear from President Bush's stump speech, or from his surrogates, is what he plans to do were he given another four years as president. The problem is particularly glaring on matters of foreign policy. There are glimmers of a domestic agenda in the president's two campaign events Wednesday: He wants to reform America's high schools, increase math and science education, and increase the use of the Internet in schools. He wants more ethanol subsidies. He wants to make health care more available and affordable. He wants less regulation. He likes community colleges. He wants workers to be able to acquire flex time and comp time in lieu of overtime pay.

Bush also gives his audiences a rehash of the greatest hits from his 2000 campaign mantras. He likes tort reform and dislikes "frivolous lawsuits." (A favorite line of Bush crowds: "You cannot be pro-patient and pro-doctor and pro-trial lawyer at the same time. You have to choose. My opponent made his choice, and he put him on the ticket.") He wants private Social Security accounts for younger workers. He likes marriage and the family, which always gets him a big cheer, because what it really means is he's against gay marriage. He's for a "culture of life," "judges who faithfully interpret the law instead of legislating from the bench," and a "culture of responsibility." Not to mention the responsibility society and the ownership society. He's still against the soft bigotry of low expectations. And of course, he wants everyone to love their neighbor just like you'd like to be loved yourself.

Bush doesn't talk much about the future. He talks about the past. The biggest portions of Bush's speech are spent mounting a vigorous defense of his presidency. When Bush's campaign foundered in New Hampshire four years ago, he retooled his strategy in response to John McCain and began billing himself as a "reformer with results." He's not using that slogan yet, but the rhetoric is similar. "It's not enough to advocate reform," he says. "You have to be able to get it done." The closing section of his speech ends with the mantra, "Results matter." On education, health care, the economy, farms, and security, Bush concludes by saying, "Results matter." Of his Medicare prescription drug benefit, Bush says, "Leaders in both political parties had promised prescription drug coverage for years. We got the job done."

Bush spends the longest amount of time defending his policies after Sept. 11. He takes credit for the creation of the Homeland Security Department (one of those things that Bush voted against before he voted for it), and he takes pride in the Patriot Act. Afghanistan has gone from being the "home base of al-Qaida" to being a "rising democracy." Pakistan, once a "safe transit point for terrorists," is now an ally. Saudi Arabia, he says, "is taking the fight to al-Qaida." Libya has given up its quest for weapons of mass destruction.

Most of all, Bush defends the war in Iraq. He repeats the litany of reasons for going to war: Saddam was defying the will of the United Nations, he harbored terrorists, he funded suicide bombers, he used weapons of mass destruction against his own people. "In other words, we saw a threat," Bush says. "Members of the United States Congress from both political parties, including my opponent, looked at the intelligence and came to the same conclusion."

What Bush doesn't acknowledge is what went wrong: The WMD were never found. We weren't welcomed as liberators. Oil revenues haven't paid for the war. It wasn't a cakewalk. What went wrong? Why? Given four more years, what does Bush plan to do about it? He hasn't told us yet, other than suggesting "more of the same."

"Every incumbent who asks for your vote has got to answer one central question, and that's 'Why?'" Bush says. "Why should the American people give me the high privilege of serving as your president for four more years?" The answer Bush gives to that question is his record. He says he deserves re-election because of what he has already done. At Wednesday's first event, in Davenport, Iowa, U.S. Rep. Jim Nussle embodies this attitude when he introduces Bush to the crowd. "There is no one I would have wanted to be at the helm of this country these last four years than you," Nussle says.

Bush and Nussle are asking the wrong question. The real question an incumbent faces is, what now? What's next? So far, Bush isn't telling. A president's record matters, but the reason it matters is because it has predictive value. Bush's defenders say he is a transformational figure, that he's willing to take on big problems and challenges. Wouldn't you like to know what Bush believes those big problems and challenges would be in foreign policy over the next four years? Are there gathering threats that, like Iraq, he thinks need to be tackled "before they materialize"? The president says that is the lesson of Sept. 11, that the nation must confront its security problems pre-emptively. Where else does he plan to apply that lesson? Does he plan to tell us?

After the 2002 midterm elections, when Treasury Secretary Paul O'Neill objected to another round of tax cuts for the rich, Vice President Cheney told O'Neill to discard his worries. We won the midterm elections, Cheney said. "This is our due." As much as liberals dislike President Bush's record over the past four years, it's the prospect of another four years that terrifies them. What they want to know—what keeps them awake at night—is what President Bush hasn't answered yet: What are you going to do next? This time, what will be your due?


          I'm a War Vice President   

BOSTON—I admit it. I don't get it. John Edwards is a perfectly fine public speaker, and compared to the likes of Bob Graham, he's Cicero, but I've never understood the press corps' crush on him. Of all the Democratic presidential candidates with whom I shared a small one-on-one encounter—even a handshake and a quick question—I found Edwards the least personally charming. Wesley Clark was a stiff shouter in speeches, but he had a likable way of engaging in locker-room razzing with the media. Howard Dean, the candidate whose stump persona (at least until he began messianic chanting) most closely resembled the one he put forth to the press, had a regular-guy air. Even John Kerry was hands-on, a guy who would put his arm around you to bring you into his circle. The awkward forcedness of the moment was part of its A-for-effort appeal.

Edwards, on the other hand, was guarded, bland, and impenetrable when I sat down for a 30-minute interview with him last September in a supporter's home in Sioux City, Iowa. He had nothing to say beyond the confines of his scripted talking points, even on the subject of his home state of North Carolina's recent pilfering of Roy Williams from my beloved Kansas Jayhawks (beyond conceding, "I wanted Roy baaaaad"). He showed no interest in small talk or idle conversation, just question, response, stop. Question, response, stop. The candidate Edwards most resembled was Dick Gephardt, who was similarly suspicious during my 10-minute encounter with him, but at least Gephardt displayed a deep knowledge of policy. And I didn't mind because, hey, you don't expect to be charmed by Dick Gephardt.

But Edwards' great strength as a candidate is supposed to be his ability to melt people with his winning smile. I was initially impressed by his public charm, particularly the first time I saw him deliver his revamped "Two Americas" stump speech in January. But that quickly wore thin, too. His delivery appears artful at first, but with repetition I saw it as rote and mechanical, so practiced that it's a little bit creepy. I find him as inscrutable as I did in that Iowa living room 10 months ago. As the campaign continued and Edwards kept drawing rave reviews, even from Republicans, I started asking myself: What's wrong with me?

With those doubts in mind, like everyone else I waited for Edwards' moment to arrive Wednesday night with anticipation. I wanted to see him deliver a new speech, a piece of oratory worthy of a presidential nominating convention. Edwards delivered that speech, a captivating declaration of the ways a Kerry-Edwards administration would wage the war on terror. Edwards was sure and forceful, and he outlined a powerful alternative to the Bush administration's war. Unfortunately, he took until the fifth page of the transcript of his seven-page speech to get to that play-within-the-play, and the minispeech was finished by the middle of the sixth page. The speech I wanted to see was bookended by disappointment.

The opening wasn't awful, but it wasn't particularly good, either. I was touched to hear Edwards mention his son Wade, who died in a car accident eight years ago and whom he writes about with grace in his book Four Trials. I don't recall hearing Edwards ever say the word "Wade" in public before. I once saw him tell a voter that he had four children, and then he named only three: Cate, Emma Claire, and Jack.

After that moving—perhaps only to me—moment, Edwards transitioned into the John-Kerry-served-in-Vietnam portion of his address. Maybe it's nitpicky, but some of the assertions he made, and has made before, aren't exactly accurate. He said that Kerry's decision to beach his Swift boat while under fire was made "in a split-second," which isn't right. It was a decision Kerry had talked about and hashed out with his crew in advance. That doesn't make it less brave or less brilliant, but the story ought to be told the right way.

Likewise, Edwards implied that Kerry knew that captaining a Swift boat was a dangerous duty when he volunteered for it, which isn't true. When Kerry asked for Swift duty, he wasn't asking for a combat job. It was only later that the Swifts' role in the war changed. Again, that fact doesn't detract from John Kerry's valor. In fact, it makes Kerry more understandable, more human. It shows how Kerry, an opponent of the Vietnam War before he enlisted, ended up unhappily—but with distinction—participating in it. Without that element of his story, Kerry becomes a thoughtful and serious young man, skeptical about Vietnam, who enthusiastically asks to be allowed to ship out and kill people he thinks of as innocents. I prefer the story of a man who got put in a situation he didn't ask for but did his duty anyway.

After Kerry-in-Vietnam, Edwards shifted into son-of-a-mill-worker mode, followed by Two Americas. He was, however, more substantive than usual, listing off specific policies a Kerry administration would seek to enact: tax credits for health care, child care, and college tuition, paid for by an increase in taxes on the wealthiest 2 percent of Americans. I think rolling back the high end of the tax cuts is a good idea, but if a lot of Americans thought they were in the top 1 percent four years ago, how many think they are in the top 2 percent? He should have given us a salary figure.

But whatever flaws marred the portions of the speech about domestic policy, they were erased by the masterful section on foreign policy and the war on terrorism. About 20 minutes into his speech, Edwards painted the images of Sept. 11—"the towers falling, the Pentagon in flames, and the smoldering field in Pennsylvania"—and he mourned the nearly 3,000 who died. Unlike many of the speakers during the convention's first three days, Edwards didn't refer to 9/11 as a lost opportunity or a nostalgic period of national unity. He noted it as a tragedy that plunged the nation into war.

Edwards criticized the Bush administration for dragging its feet on intelligence reform, and he promised better homeland security, safer ports, and more money for first responders—firefighters, cops, and emergency medical technicians. He also promised more dead terrorists. "And we will have one clear unmistakable message for al-Qaida and the rest of these terrorists," he said. "You cannot run. You cannot hide. And we will destroy you." And on the subject of Iraq, Edwards declared that America would win. He promised more special forces, a modernized military, stronger alliances, and he even said the magic words I didn't expect to hear: "a democratic Iraq."

Not long after that, he went back to heart-tugging and platitudes, and I was again wondering why I don't get it. But one moment moved me, though you had to have watched Edwards closely for the last year to catch it: He adapted the conclusion of Four Trials, the book in which he talks most freely about Wade, for the speech. The last lines of the book are nearly the same as the ones Edwards said, near the very end of the speech, when he talked about the lessons he has learned during his sometimes tragic life. One lesson, Edwards said, is that "there will always be heartache and struggle—you can't make it go away. But the other is that people of good and strong will can make a difference. One is a sad lesson and the other's inspiring. We are Americans and we choose to be inspired."

I saw it as a second mention of his son, this one a more private one, to pay tribute to the one member of the family who couldn't share this night with his dad.


          Closing Arguments   

NASHUA, N.H.—I'm feeling sorry for Dennis Kucinich. And the feeling just makes me feel even sorrier, because pity isn't the emotion he's trying to evoke. Kucinich is standing in front of more than 1,000 Democrats at a fund-raiser Saturday night for the New Hampshire Democratic Party, at which every candidate in the New Hampshire primary except Al Sharpton is scheduled to speak. Kucinich must know that he's not going to win Tuesday night, but at the same time he surely fantasizes that this is his moment, this is his chance to make a winning, last-ditch appeal for his unlikely candidacy.

I am the only candidate who voted against the Iraq war and the Patriot Act, Kucinich proclaims to fervent applause. I am the only candidate "who insists on an immediate end to the occupation." Imagine a presidential debate between President Bush and my opponents (other than Al Sharpton), he says. They supported the war, they voted for the invasion, or they support the occupation. "Where's the debate with President Bush?" he asks.

And it's not just the war. Kucinich wants not-for-profit single-payer health care, and his opponents don't. "This is the time," Kucinich is saying, but I can't hear the rest. He's being drowned out, at least in the back of the room where I stand, by cries of "How-ard! How-ard! How-ard! How-ard!" coming from the hallway, where Howard Dean must have just arrived. Nearly a year of campaigning by the Ohio congressman for the highest office in the land is summed up in this moment. What must it be like to imagine yourself as the leader of an incipient movement for progressivism and then to have that movement led by another man, one that you view as a charlatan?

The night's other tragic figure is Joe Lieberman. He's begging for scraps of support by appealing to state pride, the last refuge of a second-tier candidate. "Hey, let me tell you this, I love New Hampshire," he says. "Did you see me at the debate the other day? I swore to God to fight to the death to protect the first-in-the-nation status of the New Hampshire Democratic primary." Lieberman knows he's not popular, but he's hoping against hope, too. "Looking around this room, I see there are some people supporting some other candidates for president, and I respect that diversity," he says.

See, Lieberman's not a conservative Democrat. He's diverse! "I have never wavered for a moment" on the need to remove Saddam Hussein, he says, and it sounds like three people clap. I'm more electable than the others, he says, because there are "a surprising number of Republicans who are disappointed with George W. Bush and ready to go for an acceptable alternative." There's a winning Democratic primary message: The candidate whom Republicans kinda like!

Lieberman can't get it right even when he's shoring up his liberal bona fides by talking about his plan to fight poverty. "Is it right for George W. Bush to have turned his back on 35 Americans in poverty?" he asks, omitting the crucial word, "million." But he's not discouraged. "I feel something happening in this campaign for me," he says. "My staff says that in New Hampshire today, there is an outbreak of 'Joe-mentum,' and I hope so." That's only the latest painful "Joe" pun in a Lieberman campaign list that includes the "Joe-vember to remember" and the campaign vehicle, the "WinnebaJoe."

As he's wrapping up, thanking "the people of New Hampshire for the warmth and respect" they have given him, Lieberman's speech has the feeling of a farewell, very much like a speech I saw Dick Gephardt give the night before the Iowa caucuses. Miracles do happen, and the Lieberman campaign is circulating a poll that shows him in a fight for third place (most polls show him mired in fifth), but inside this room it feels as if Lieberman, like Kucinich, is clinging to a fantasy.

Of the other candidates, Wesley Clark comes across the worst. "I haven't been a member of this party for very long," he says, and the crowd grumbles. "I know," shouts one man, while another calls out, "No shit!" Now that Dean has turned down his volume, Clark is the race's screamer, and he sounds a little unhinged. "We Democrats have got to take out that president," he says, in an unfortunate turn of phrase for one of the two candidates that has actually killed people. The crowd's applause is polite but tepid, and the race feels like it's slipping away from Clark, too.

The chair of the Democratic Party, Kathy Sullivan, introduces Dean as if he's a figure from the distant past, praising him for energizing the party "at a time when we were tired and unsure of ourselves." Dean draws big cheers, but they mostly come from the people in the back rows and in standing-room-only. A woman calls out to him, "Howard, don't ever give up." A man yells, "Give 'em hope, Howard!" Dean's eyebrows rise as he smiles his wicked grin. "I'm going to resist the temptation," he says.

Nearly a year ago, Dean appeared before the Democratic National Committee's winter meeting and declared, "What I want to know is why in the world the Democratic Party leadership is supporting the president's unilateral attack on Iraq." He pricked the post-9/11 bubble surrounding Bush and in the process transformed himself from a curiosity into a contender. But his speech Saturday barely touches on Iraq. He also says something I don't think I've ever heard him say before: "I ask for your vote."

John Edwards captivates the crowd. Edwards doesn't transfix me the way he does other members of the press. His way of merely describing his message as "positive" and "optimistic" and "uplifting" rather than, you know, actually having a message that embodies those qualities grates on me. What's the difference between Edwards' rhetoric and the awkward "Message: I care" rhetoric of George H.W. Bush? Edwards also has this new gesture he's using, where he puts a finger to his lips to appear thoughtful, that makes him look like Austin Powers.

But his message undoubtedly connects. He enters to enthusiastic applause, though it's not Dean-level. His speech about two Americas, about the importance of fighting poverty, and the borrowed Deanisms about restoring American democracy and taking it away from "that crowd of insiders in Washington, D.C.," and the "I believe in you" conclusion wins nearly everyone over. Edwards has become Howard Dean in the body of a good-looking, smooth-talking Southerner, and as he did in Iowa, he feels hot, hot, hot.

Of course, they're all Dean now. (Or, as The Nation'sDavid Corn put it, they're "the Angry Populist, the Calm Populist, the Polite Populist, the Executive Populist, and the Radical Populist.") John Kerry, who I think has the support of the majority of the crowd, says he wants to "break the grip of the powerful interests in this country and put the people in charge."

If Kerry, or whoever is the party's nominee, becomes president in 2005, he'll have Howard Dean to thank. Dean won. That's why he's losing.


          Is He Still Here?   

MANCHESTER, N.H.—I knew John Kerry was the man of the hour, but what made the feeling more than an abstraction was the Baltimore-Washington airport bookstore. It stocked a display of Kerry's campaign book, A Call to Service, above the latest books by Bill O'Reilly and Ann Coulter. Yes, it's the Washington area, but still—it's an airport bookstore.

Kerry continued his winning streak at tonight's debate, the final one among the seven remaining Democrats before the New Hampshire primary. Debates have been Kerry's best format during this campaign. He's a TV candidate, cool and authoritative, and the time-cramped medium comes to his aid by forcibly restricting his long-winded oratorical perambulations. But until tonight's context, Kerry's debate performances seemed as irrelevant as Al Sharpton's zingers.

The moment when Kerry won the debate, I thought, was when he answered Manchester Union-Leader reporter John DiStaso's question about his decision to throw his medals (or was it his ribbons?) away in protest during the Vietnam War. "I could not be more proud of the fact that when I came back from that war, having learned what I learned, that I led thousands of veterans to Washington, we camped on the Mall underneath the Congress, underneath Richard Nixon's visibility," Kerry said. "He tried to kick us off. And we stood our ground and said to him, 'Mr. President, you sent us 8,000 miles away to fight, die and sleep in the jungles of Vietnam. We've earned the right to sleep on this Mall and talk to our senators and congressmen.'" Kerry used the occasion to cast himself as both pro-veteran and antiwar, surely the sweet spot he hoped to squeeze his candidacy into before he got bogged down over the meaning of his vote in favor of the Iraq war resolution.

I'm beginning to suspect that Kerry's lack of clarity on the Iraq war actually benefits his candidacy. One, because voters from a wide spectrum can find ways to square his position with theirs, and two, because his muddled ambivalence best captures the way I suspect the great majority of Democrats feel. (Kerry may have best explained his stance in October 2002 when he said, "My vote was cast in a way that made it very clear, Mr. President, I'm voting for you to do what you said you're going to do, which is to go through the U.N. and do this through an international process. If you go unilaterally, without having exhausted these remedies, I'm not supporting you. And if you decide that this is just a matter of straight pre-emptive doctrine for regime-change purposes without regard to the imminence of the threat, I'm not going to support you." The quote is taken from Walter Shapiro's One-Car Caravan.)

But wouldn't Kerry know it? Even during his rosy post-caucus glow, he can't escape the man he once exasperatedly referred to as "Dean, Dean, Dean, Dean." Whether the Vermont governor is riding high in the polls or flaming out, he's the candidate the media fixate on. The local ABC affiliate in Manchester trumpeted its Nightline broadcast of the debate by mentioning only one candidate, Dean, by name. And if Dean's last-ditch effort to save his candidacy wasn't already the story of the day, his campaign ensured that it would be by sending their candidate on a televised triple play: the debate, his (and his wife's) interview with Diane Sawyer on ABC's Primetime Live, and his appearance on the Late Show With David Letterman. I watched all three from the comfort of my hotel room.

There are advantages to watching political events on television rather than attending them in person. For one, you get to see them as the viewers do. I was on the scene in Iowa during this campaign's defining moment, the Dean Scream, and I didn't even notice it. The crowd was so noisy during what appeared to be typical Dean behavior during a stump speech, not unlike his listing off of the industrialized countries with universal health care ("the British and the French and the Germans," on and on to "the Danes, the Swedes, the Japanese, even the Costa Ricans have health care!"), that no one in the room seemed to hear the "part growl, part yodel," as the Boston Globe put it. Second, when you attend a political debate, all you really do is watch it on TV anyway, except you watch it in on TV in a room filled with other journalists. Third, I had no idea that Ernie Hudson, aka "the fourth Ghostbuster," had his own show on ABC.

A couple things struck me from the Primetime interview. Dean said he was "speaking to 3,500 kids" on caucus night. I didn't formally survey the demographics of Dean's volunteers in Iowa, obviously, but his reference to the "under-30 generation" during his post-caucus speech elicited mild boos from the crowd. When I followed three Dean volunteers as they canvassed for votes in Des Moines, one was 33, one was 55, and one was 58. They weren't atypical. From my experience, nothing tweaks Dean supporters more than the idea that they are angry children, and they're right that the widespread belief that Dean is the kiddie candidate gives voters a reason not to take him seriously.

The second thing that occurred to me was something from Howard Dean: A Citizen's Guide to the Man Who Would Be President, the book by a team of Vermont reporters. In it, one journalist notes that as Vermont governor, Dean never quite grasped that he was something other than an ordinary person, and that his words had unusual power. Sure, he had an uncommon job, but other than that, Dean thought he was just a regular guy. To a great extent, Dean has behaved on the campaign trail as if he still feels the same way.

Dean's regular-guy status is one of the most appealing things about his candidacy, and it's one of the most fun things about covering him. He's willing to let himself be a normal person to a reporter in a way that most politicians won't. But in another way, a presidential candidate, and especially a president, isn't a regular guy. Presidents can't do or say the things that even senators and governors can. Neither can first ladies. That may not be fair, but that's the way it is.

It looks as if Howard and Judy Dean have decided that if they can't remain "just ordinary folks," they don't want to be president and first lady. That's admirable. But I also suspect that that decision, and not some pirate yell, is the biggest obstacle that would keep them from the White House.


          Howard Dean's Very Bad Night   

DES MOINES, Iowa—"Prove it or not," Howard Dean told his supporters at a rally Sunday in Davenport. "Now is the time to see if this works," to see if the unorthodox, Internet-fueled campaign assembled by Dean and his campaign manager, Joe Trippi, translates into votes. "Tomorrow, at 6:30 p.m., you can prove it or not." The answer Iowans gave him was a raspberry: Or not.

I attended a West Des Moines caucus Monday night with Dean's Iowa press secretary, Sarah Leonard, and her feeling about the race was that it would be close, so close perhaps that they wouldn't be able to call it that night. She felt it was a three-way race, between Dean, Kerry, and Gephardt. "Edwards, I just don't think you can build an organization in 48 hours," she said. But it wasn't close. Momentum beat organization, both Dean's digital one and Gephardt's analog one. (Leonard did say before the caucus, however, that the rumor that Dean had a hard count of 50,000 was preposterous. "If we had a hard count of 50,000, I'd probably be at the Val Air," she joked, referring to the ballroom site of Dean's caucus night party.)

The results from our caucus reflected the results of the 1,992 other caucuses in the state in one respect: Kerry got twice as many delegates as Howard Dean, four to two (with John Edwards picking up four as well). There were lots of new and first-time caucus participants, so many that the organizers ran out of forms to register them. But they weren't the new voters the Dean campaign wanted. George Davey, the precinct captain for the Dean campaign, said he was hoping for 25 to 50 Dean voters between the ages of 18 and 25, but only one showed up. "I think if we could blame [Dean's loss] on anyone, blame it on the 18- to 25-year-olds, because they were nonexistent," he said.

Davey, who is 37, also said Dean needed to be less negative toward his opponents. And another Dean volunteer, Toby Sackton, a 57-year-old from Boston, complained that Dean's television ads weren't any good. "We saw three ads, one by Kerry, one by Edwards, and one by Dean. Dean's was by far the worst," he said. "It was an ad aimed at getting the supporters out," not appealing to voters who didn't already like Dean.

I think there's something to Sackton's complaint. I heard four or five Dean radio ads on my drive to the caucus, all with the same message: Dean had the courage to stand up to President Bush on the war while the other major candidates folded. Dean's saturation TV ads focused on nefarious "corporations" and "special interests" and "Washington insiders," rather than the things I'd seen Dean use on the stump (in addition to his stance on the war) to appeal to voters who hadn't heard of him already: his Vermont record of balanced budgets, health care, and the state's "Success by Six" program for children.

In his final days in Iowa, Dean's campaign was about his campaign. To the extent issues were at stake at all, Dean's message focused on the past—Do you want a candidate who was against the war, as Dean put it in Davenport, "not now, but then"?—while John Kerry focused on a future consideration—Do you want a candidate who will raise your taxes? Beyond the war, Dean hit three notes: What his opponents said and did in 2002 and 2001, the fact that he's raised lots of money in small donations over the Internet, and tiresome bromides about the special interests/corporations/Washington insiders. It's a high-tech version of Al Gore's "people vs. the powerful" campaign. That's not good enough.

Four years ago, George W. Bush rebounded from a surprisingly large defeat in New Hampshire by co-opting his opponent's message and recasting himself as a "reformer with results." Dean might do the same. If he's got a tax cut in his back pocket, it's time to bring it out. And he needs to do a better job of introducing himself and his record to voters who haven't been paying attention to the campaign for six months or a year.

The early signs of that happening aren't auspicious. Rather than reaching out to the unconverted, Dean fired up his base of supporters at the Val Air. He grinned, ripped off his jacket, rolled up his sleeves, and flung an orange "Perfect Storm" hat into the crowd. Then he started waving an American flag. Walter Shapiro's metaphor of Dean as an "aging rock star reduced to reprising his greatest hits in smaller and smaller clubs" never felt more apt.

At the Hotel Fort Des Moines bar on Saturday night, the New Republic's Ryan Lizza told Dean strategist Steve McMahon that his campaign needed a new message. McMahon shook his head. You and I are in different businesses, he said. The press is bored with our message, but we need to dance with the girl that brung us. I think McMahon's wrong. I think Dean's campaign became much more anti-business and much less moderate than it was six months ago, and it became a campaign about a messianic figure and his movement rather than a blunt, moderate Democrat and his policies. But even if McMahon is right, he must know by now that it's time to find another girl.


          Mystery Candidate   

MASON CITY, IOWA—Whatever John Kerry is doing right in this campaign, he isn't doing it on the stump. At least, that's my impression after watching him last night. Granted, it was the end of a long day for the senator, who spent much of it flying around Iowa by helicopter, and Kerry is a notoriously erratic speaker. The speech I watched him give had the quality of a rambling answering-machine message—Where is he going? What is he talking about? Will it ever end? But Kerry is the candidate that I've seen the least of in person, so I'm willing to give him the benefit of the doubt. Maybe I've just never seen him on a good day. If his momentum in the polls is for real, he must be doing something right.

There's a nugget of a theme in the middle of the speech, where Kerry uses President Bush's aircraft-carrier "Mission Accomplished" banner (derision of which is a surefire applause-getter in Iowa and New Hampshire alike) as a device to critique President Bush's domestic policy. "What mission?" Kerry asks. What about the mission to provide jobs for the unemployed, or to alleviate the high cost of prescription drugs, or to help family farmers, or to decrease the number of uninsured, or to clean up the environment? On those counts, "It's not even mission attempted," Kerry hollers. "It's mission deserted! Mission abandoned! Mission not even tried!" (Kerry returns to this theme at the conclusion, when he says Democrats will hang their own "Mission Accomplished" banner when they send President Bush back to Texas.)

In his first 100 days as president, Kerry says, he would issue an executive order that prohibits government officials from working as lobbyists for five years after they leave public life. He vows that every meeting between an official and a lobbyist in his administration would be public record. He makes an eloquent case for providing health care for the uninsured, saying, "Health care is not a privilege for the powerful and the wealthy. It is a right for all Americans." And he gets the automatic cheers any Democratic candidate gets when he refers to John Ashcroft by promising to "appoint an attorney general who is outside politics" and who will "not pursue a political and a religious agenda."

The audience doesn't seem wowed by Kerry, and he isn't bum-rushed by supporters the way I've seen crowds swarm around Howard Dean, Wesley Clark, and to a lesser extent on Thursday afternoon, John Edwards. What am I missing? I wonder. But driving between Dean events today, I hear a radio ad that might provide part of the answer. It supports Ryan Lizza's theory that Kerry is gaining ground by pushing an anti-tax message. Unlike unnamed other candidates, "John Kerry is not going to raise taxes on the middle class," the announcer says.

Kerry didn't directly criticize Howard Dean or Dick Gephardt on Thursday (though the veteran who introduced him did criticize Dean when he compared Kerry's Vietnam experience to "another candidate" who "asked for a deferment" and then went skiing). But he emphasized tax reform, not just the repeal of the Bush tax cuts. "I'm not looking for some great redistribution" or a "confiscatory" tax scheme, he says. "I'm looking for fairness." He also promises to "scour" the tax code for provisions that benefit "Benedict Arnold" companies and CEOs who move their assets offshore to escape taxes. Fifteen years ago, Kerry says, U.S. businesses had $250 billion in offshore assets. Today, it's $5 trillion. "This system is rigged against the average American," he says. "America is losing its democracy to a dollar-ocracy."

If Kerry's lead in the polls is accurate, and if it's attributable to his message on tax cuts (two pretty big ifs, in my opinion), Dean's decision to withhold his tax-reform plan until after the Iowa caucuses will be considered a major miscalculation. Instead of betting everything on Iowa and New Hampshire in an attempt to end the campaign before it began, Dean overconfidently decided to keep part of his platform in his quiver, presumably hoping it would have greater impact during a later stage of the campaign.

But what's bad news for Dean could be good news for the rest of the country. For years, pundits have complained that Iowa and New Hampshire have too much control over the presidential nominating process. This year, most people thought Iowa and New Hampshire would be even more important, because the condensed primary schedule would create unstoppable momentum for the winning candidates. But it looks like Terry McAuliffe's plan is having the opposite effect: By cramming so many primaries and caucuses into a small part of the calendar, McAuliffe created something much closer to a national primary than ever existed before. Joe Lieberman and Wesley Clark are taking advantage of the new game by staking their candidacies on the states after Iowa and New Hampshire. And if John Zogby is right about John Kerry, Howard Dean may be forced to do the same thing.


          A Browser's Guide to Campaign 2004   

Here's a quick guide to the good parts of Winning Back America, Howard Dean's campaign book to be published Dec. 3 (complete with a cover picture of the candidate trying his damnedest to look sunny):

Chapter 1: "I'm a Regular Guy." Dean touches on his family's roots and his childhood in New York City, and he makes passing mention of his Rhode Island prep school, but he says he "really grew up in East Hampton on eastern Long Island." His "idyllic childhood" involved being outdoors, riding bikes, a duck pond, fishing, sailing, and baseball. His dad wouldn't buy him a uniform for his baseball team because he thought it was a waste of money. The chapter concludes, "At heart, I'm a country person."

Chapter 2: Howard Dean, Farmer. Devoted to Dean's summer jobs as a teenager. Dean writes two sentences about working as a sailing-camp counselor but an entire page about his work on a cattle ranch in Florida. There he earned "agricultural minimum wage," cleared land, dusted crops, and in a yearning-macho voice worthy of Apocalypse Now's Col. Kilgore, he remembers "feeling the cool mist of the herbicide on my bare chest as the plane went over."

Chapter 3: "Unlike George W. Bush, I Had Black Roommates at Yale." Bush went to Yale, too, but his senior year was Dean's freshman year, 1968. "The gulf between our experiences was much larger, though; it was as if we were a generation apart," Dean writes, referring to the changes wreaked both by "the phenomenon of the sixties" and the increasing diversity of the Yale student body, including more Jews, more public school students, and in 1969, women.

Chapter 4: Howard Dean, Ski Bum. Dean's post-college years before medical school. He skis in Colorado (living in a cabin "in a little place called Ashcroft"), where he pours concrete and washes dishes to pay the bills. He becomes a teacher by virtue of a strange snap judgment after missing a plane to Bogotá, Colombia: "I've taken many hundreds of flights in my life, and this is the only time that's ever happened. I realized that there was a reason I missed the plane. I cut short my intended trip, went home, and decided to get to work." After teaching for a year, he takes a job on Wall Street. He decides he's too careful with other people's money to be a good broker, and that he doesn't really like New York City.

Chapter 5: Med School and Judy. Contains one of the more intriguing sentences in the book: "I didn't really get to be a happy person until I went to medical school." Dean's explanation for this is that he didn't work hard enough at Yale, and "If I'm directionless and coasting, I'm not happy." He meets his future wife, Judy Steinberg. He doesn't get into any of his top three choices for his medical residency. The University of Vermont was choice No. 4, and he moves to Burlington in May 1978.

Chapter 6: Dean Enters Politics. Is Dean a moderate Republican in disguise? He compares himself to his Republican father, a "fiscal conservative" who was "not particularly liberal on social issues, but he wasn't particularly conservative either. Today he would be considered a moderate, business-oriented Republican; he wanted the budget run properly. In that way, I am very much my father's son." Dean on why he's a "pragmatic Democrat": "I was friendly with the younger, more liberal Democrats because they were my age, but I didn't vote with them. I didn't relate to their political sensibilities."

Chapter 7: The Vermont Statehouse. A woman tells him, "You're going to do really well here, but you've got to get over this chip on your shoulder that tells you to fix somebody's wagon if they cross you."

Chapter 8: Governor. "Our telephone number remained in the book." Dean cuts marginal tax rates to improve Vermont's economy, but he insists he didn't engage in the "outrageous tax cutting that went on in some of the states." He also cuts spending programs over the objections of liberal Democrats. On one occasion, he visits Congress to talk about health care: "Bob Michel, the House minority leader, was there. He was a wonderful person. Newt Gingrich was there. He's not a wonderful person."

Chapter 9: More of the Vermont Miracle. Here's Dean's illustration of the "striking difference" between Republicans and Democrats: "When the Democrats controlled the National Governors Association (I was chair of the NGA from 1994 to 1995), we used to fight against our own party when it passed legislation that harmed the states. When the Republicans took over, however, they took orders from the G.O.P. in Washington, with few standing up for the people they represented. … Most Republican governors caved to the right-wing Republican White House because they were fearful; the folks in the White House are more than willing to threaten them."

Chapter 10: Pre-President Dean. He defends the Bush daughters: "I know that several thousand kids every year get caught with fake IDs." And he defends his wife's decision not to participate in his presidential campaign: "The notion that the wife is going to be dragged along in the wake of her husband's career is something that should have been left behind decades ago." Six sentences on religion, including "I'm a fairly religious person though I don't regularly attend church or temple," "I pray just about every day," and "I also believe that good and evil exist in the world, and I thoroughly disapprove of people who use religion to inflict pain on others."

Dean's favorite books: All the King's Men, To Kill a Mockingbird, and Ken Kesey's Sometimes a Great Notion; also Barbara Ehrenreich's Nickel and Dimed and David McCullough's Truman ("It is one of the books that has had the most impact on me in the last ten years").

Dean ranks the presidents: 1) Washington; 2) Lincoln; 3) FDR; 4) a four-way tie between Jefferson, Truman, TR, and LBJ, despite Vietnam. We also learn Dean's weight, about 167 pounds. And don't tell Arianna, but he drives a Ford Explorer.

Chapter 11: The Chapter Most Worth Reading. Dean on the execution of his brother Charlie by communists in Laos in 1975 and on the death of his father in 2001. His parents thought Charlie was CIA: "There was speculation that Charlie was in Laos because he was working for the CIA and I think my parents believed that to be the case. Personally, I don't think he was employed by the U.S. government in any capacity, but we'll probably never know the answer to that question." Dean admits that he has spoken to counselors about his brother's death, and the chapter ends, "I'm sure that, had he lived, he'd be the one running for president and not me."

The second half of the book is campaign boilerplate: True believers will nod in approval, but you've heard this stuff before.


          Notes From New Hampshire   

MANCHESTER, N.H.—Notes on a day in New Hampshire:

The first Wednesday of every month is Meetup day for Howard Dean supporters, so they're gathered in a cramped restaurant called Merrimack, waiting for the candidate to arrive. It's close to a Holiday Inn where Dean and the other candidates will participate in a "women's issues" debate sponsored by Planned Parenthood. Merrimack is packed with media, including Joe Klein ("Hi, Joe," Dean says when he gets there) and George Stephanopoulos, who appears to be dressed in the same black turtleneck Wesley Clark and Dennis Kucinich wore Tuesday night.

Once Dean arrives, he stands atop a chair to address the crowd. "It's not true that I'm the shortest candidate in the campaign," he says. "In fact, I may be in the top half." This isn't as preposterous as it sounds. There are nine candidates, and only John Kerry, John Edwards, and Dick Gephardt are indisputably taller than Dean. Dennis Kucinich and Carol Moseley Braun are shorter. That leaves a fierce battle for the vital center among Dean, Wesley Clark, Al Sharpton, and Joe Lieberman. Maybe at the next debate they should all line up in their stocking feet.

During his speech, Dean clearly urges his supporters (who are voting this week on whether the campaign should turn down federal matching funds) to let him bust the federal spending caps: "It's a gamble, and there's good things to be said for both sides. But I fundamentally do not believe we can compete with George Bush if we limit our spending to $45 million."

Earlier in the day, Dean delivered a speech in New York (which I watch from the comfort of my Manchester hotel room, on www.howarddean.tv) to announce the vote. What catches my eye: While criticizing President Bush's "powerful money-bundlers," Dean said, "They are people like Walden O'Dell, a 2004 Pioneer, who is also manufacturing electronic voting machines to count our votes, and has said that he is, quote, 'committed to helping Ohio deliver its electoral votes to the president next year.' " Does Dean believe that the Republican Party is going to manipulate electronic voting machines to steal the 2004 election? At Merrimack, I ask him. He admits that he doesn't know much about the subject, but he sounds open to the possibility. "I think it's a serious issue," he says.

A line Dean says to a supporter that he might want to consider dropping: "The only difference between me and McGovern is we're going to be in the White House."

Things of interest during the Planned Parenthood debate:

The candidates are asked to grade themselves on their parenting, and Dean and Clark give the most interesting answers. "I will not pretend for a moment that I did 50 percent of the work, but I did a lot," Dean says. Clark is even more honest. "I don't give myself a very good grade, but I had an A-plus wife," he says. "Sometimes you get better than you deserve in life, and I've been lucky."

They are also asked, "Do you practice a faith, and would you invoke the name of God when discussing a policy?" Nearly every one of them gives the safe answer, that their faith is important to them, but that they respect the separation of church and state. "I pray every night, but don't go to church very often," says Dean. "My religion does not inform my public policy, but it does inform my values," is Edwards's answer, and he adds, "The president of the United States should not be setting policy for the country based on his or her faith."

Only Kucinich dissents. (Along with Clark, Kerry, and Braun, he's one of four Catholics at the debate. Although Braun and Clark self-identify as Catholics, Braun attends an Episcopal church and Clark attends a Presbyterian one.) He says that within the context of a pluralistic society, religious values can and should influence public policy. "We must live our spiritual values in our public policy," such as full employment, health care, and education, he says. "A government that stands for peace reflects spiritual values." After the debate, I try to ask Kucinich about the relationship between his faith and his public policy, but I get off on the wrong foot by saying that he changed his abortion position to pro-choice "right before" he started running for president. "Wrong," Kucinich says, it was spring 2002. The discussion goes nowhere from there.

Since the topic came up, after the debate I also ask Clark why he converted to Catholicism as a young man, and why he no longer practices.

"When I was in England during the Vietnam War, the Nonconformist churches over there were just extraordinarily political. And I just couldn't go to service and have them condemn the armed forces that I was serving in. I mean, they were my West Point classmates there, and they were being accused of terrible crimes, and it wasn't so," he says.

"I believed in the structure, and the balance, and the long-term durability of the Catholic Church, and that's why I converted to Catholicism. But over the years as we went from location to location and saw the church, we found that our spiritual needs were better met by attendance at Protestant services. The services were richer in their spiritual meaning. And of course I still consider myself a Catholic. But I enjoy the singing, I enjoy the sermon, I enjoy the fellowship in the Protestant services. It's just a much deeper spiritual experience. That's for me."

Back to the debate. Three of the candidates say 18-year-old women should be required to register for Selective Service, just like 18-year-old men. "If you have different standards, that begins the path toward discrimination," Dean says. Clark and Kerry say yes, too. Edwards says no, and Braun says it would be OK if it weren't for the fact that one in four women at the Air Force Academy are victims of sexual assault or rape. Kucinich gives my favorite answer, an attempt to have it both ways: "No, not that they can't, if they want to."

What role would a "first lady, first man, or first friend" play in their administrations? There are three interesting answers. Dean confirms that "I'd very much like to be the first president who has a working wife in the White House" who does not participate in his career. Braun, who is divorced, says, "This is an impossible question. There has never been a First Man or First Gentleman." Like Dean, but with more flair, she concludes, "You'll get me, but you'll get no one for free."

But it's Kucinich, who also is divorced, who steals the show. "As a bachelor, I get a chance to fantasize about my first lady. Maybe Fox wants to sponsor a national contest or something," he says. He adds that he wants "someone who would not want to just be by my side," but would be a "dynamic outspoken women who was fearless" in her support for peace in the world and universal, single-payer health care. So, "If you're out there, call me."


          See Dick Run   

SIOUX CITY, Iowa—Dean season! Gephardt season! Dean season! Gephardt season! If any lingering debate remained over which presidential candidate is currently enjoying his media moment, my two days with Dick Gephardt settled it. The 20 national reporters who follow Gephardt for all or part of his campaign swing from Des Moines to Sioux City are the latest sign that not only have the leaves turned in late October, but so have the media.

I came along to witness firsthand the evidence for something I wrote earlier this month after the Phoenix debate, that Gephardt's hard-nosed and well-organized Iowa campaign presents, at the moment, the biggest obstacle to President Dean (or, to be fairer, Democratic Nominee Dean). But I missed the media conspiracy memo that told everyone else to show up, too. During Gephardt's weekend swing in Iowa two days before, only three national reporters trailed the candidate. But now, David Brooks is here. So are Mara Liasson of NPR and Carl Cameron of Fox News. Throw in reporters from ABC, MSNBC, Knight Ridder, the Atlanta Journal-Constitution, the Christian Science Monitor, Newsweek, and the New York Times. (Counting Brooks, on Wednesday there are two New York Times writers following Gephardt.) Just for the sake of overkill, there are reporters from the British press and from Japanese television along for the ride. At one event in Pocahontas, Iowa—a town with an absolutely gigantic statue of the Indian princess outside her teepee welcoming visitors from the highway—the number of journalists nearly matches the number of prospective caucus-goers.

The Gephardt campaign pushes its slow-and-steady-wins-the-race angle (or is it a plea for votes from Maryland Terrapins alums?) by emblazoning "Fear the Turtle!" on the front of the press itinerary, complete with a little clip-art turtle on every page. The packet includes the latest Iowa poll results, which show Gephardt and Dean in a statistical tie for the lead, with Kerry and Edwards lagging behind. For good measure, the campaign throws in last week's favorable press clippings, including Des Moines Register wise man David Yepsen's assertion that Gephardt is the Iowa front-runner and that Dean has "plateaued" in the state. Also enclosed is a much-discussed Washington Post report—distributed, in truncated form, to voters at campaign events—that Gephardt is the candidate "many prominent Republicans fear the most." Not included is a delicious metaphor for Gephardt supporters to latch onto: While hurtling from campaign stop to campaign stop in Iowa over the past few months, the Dean van has been pulled over multiple times for speeding.

At his first stop, a senior center in Des Moines (the first of three consecutive senior centers visited by the campaign), Gephardt is supposed to deliver a "health policy address," but it turns out to be a rehash of old Howard Dean quotes about Medicare. (Later, while being ribbed by reporters about the false advertising, Gephardt's Iowa press secretary, Bill Burton, protests that he never called it a "major" policy address.) The newest wrinkle: Gephardt wants to paint the 1997 balanced budget accord—generally thought to be one of President Clinton's major accomplishments, and one supported by Dean—as a "deep, devastating cut" in Medicare.

While Gephardt speaks in front of a sign that reads "Protect Social Security" and "Protect Medicare" over and over, like computer-desktop wallpaper, I wonder: Does he really want to play this game? Dredging up old quotes and votes about Gephardt's onetime conservatism is what helped to derail his '88 campaign. He voted against the establishment of the Department of Education. He voted for a constitutional amendment to ban abortion. He voted to means-test Social Security and to eliminate cost-of-living adjustments from the program. He voted for Reagan's 1981 tax cuts. He opposed an increase in the minimum wage. Does a man with a legislative record this long and varied really want to ostentatiously declare, "There are life-and-death consequences to every position taken and every vote cast"? If that's so, how many times was Dick Gephardt on the side of death?

For now, however, it's a more recent House vote that's preventing Gephardt from running away with the Iowa race. At nearly every campaign event I attend, Gephardt is forced to deliver, in effect, two separate stump speeches. The first is the one he would like the campaign to be about: universal health care, jobs, and the immorality of rapacious multinational corporations. Gephardt's not anticapitalist: "Capitalism is the best system," he says in Pocahontas. "But capitalism has to have rules, so the capitalists don't destroy the very system" they benefit from.

He describes his visits to Mexico, China, and India, where workers live in the cardboard boxes used to ship the products they make. "I smelled where they live," he says. They live without electricity, without running water, with raw sewage running down the streets and next to "drainage ditches filled with human waste." "They live in worse conditions than farm animals in Iowa," he continues. "This is nothing short of human exploitation, that's what it is, for the profit of some special interests in the world." I'm not sure I agree with Gephardt's proposed solutions—though I'm intrigued by his notion of a variable international minimum wage—but there's no denying that he's a powerful critic of global capitalism's excesses.

Then, once Gephardt has finished and the applause has subsided, almost invariably a voter raises his hand to ask: What about Iraq? Was this war about oil? How can we recover the world's respect? How can we pay for all your programs with a war on?

At this point, Gephardt is forced to unveil stump speech No. 2. Sept. 11 changed everything, he says. Government's highest obligation is to protect American lives. In a Gephardt administration, the highest priority would be to prevent a nuclear device—"dirty or clean"—from going off in New York, Los Angeles, or Des Moines. That's why he decided Saddam Hussein needed to be removed. He supported the war because he believed the estimates of the CIA and the warnings of former Clinton administration officials, not because he listened to President Bush ("I would never do that").

Slowly, Gephardt's defense of his vote for the congressional war resolution transitions into a critique of the president. Though in an interview he insisted that the president was smart, on the stump he's not shy about insinuating that the president (whom he often refers to as "Dubya") is stupid. "He's incompetent," "He frightens me," "He's hard to help," I told him America founded the United Nations because "I wasn't sure he knew the history," and "If you'd been meeting with him every week since 9/11, you'd be running for president," too. Because Bush refused to negotiate with Kim Jong Il, North Korea is now "weeks away" from producing nuclear bombs. Bush abandoned the peace negotiations between Israel and Palestine, saying, "It's not our problem." He's arrogant. He doesn't play well with others. By the end, people are satisfied enough with Gephardt's explanation, and maybe even a little terrified, but you get the sense that they're not enthused by it.

But Gephardt isn't counting on enthusiasm. He has a couple edges on Dean, in addition to his obvious union support. For one, a surprising number of Iowa Democrats just don't like the former Vermont governor. The opposition to Gephardt tends to be substantive, based on his support for the war or his failure as Democratic leader to enact a more Democratic agenda. But the opposition to Dean is stylistic, or maybe even cultural. In socially conservative Iowa, sometimes you hear it whispered: Where's Dean's wife? Before Gephardt arrives at an event in the town of Ida Grove, I overhear a woman grumble about Judith Steinberg's refusal to campaign for her husband. "I can't get used to that," she tells her companion. "It's supposed to be a family thing."

By the same token, Gephardt never fails to mention the "church loans" and "church scholarships" that allowed him to attend Northwestern and then Michigan law school. He also refers to his son, Matt, who survived prostate cancer as an infant, as a "gift of God." I don't think I've ever heard Howard Dean say the word "God" in reference to anything.

Just before the last stop in Sioux City, I'm granted a 10-minute ride-along interview with Gephardt. I've got a number of questions, but the one I really want an answer to is this: If balanced budgets and free trade—two things that don't get a lot of emphasis in the Gephardt platform—weren't the secrets of the Clinton economy, what were? Higher taxes for the rich? Gephardt explains that the '97 budget accord wasn't needed to balance the budget, and then he tries to explain why Bush's steel tariffs—which Gephardt supported, and which made the United States lose manufacturing jobs—aren't analogous to the retaliatory tariffs Gephardt wants to be able to impose on foreign products or factories that don't comply with minimal labor and environmental standards. Soon enough, we're so sidetracked that I've forgotten entirely what we were talking about.

But afterward, when I'm once again following Gephardt in my rental car, I'm left with my question: Clinton balanced the budget and promoted free trade, and the economy boomed. President Bush ran up enormous deficits and put new restrictions on trade, and the economy sputtered. Isn't Dick Gephardt's plan closer to President Bush's?


          The Republicans’ Secret Health Care Bill   
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          Trump-Supporting Doctor On MSNBC Says The NRA Is The Solution To Health Care   
Dr. Alieta Eck drew ridicule from MSNBC host Stephanie Ruhle on Wednesday by suggesting that the way to give Americans better health care was to allow people to buy insurance through the National Rifle Association . During a discussion with a panel of doctors who support President Donald Trump's effort to "repeal and replace Obamacare," Ruhle asked Eck how legislation could improve the health care system.
          People divided   
By the time you read this, perhaps the latest round of fighting over the American Health Care Act will be over — for now.
          Avalon - Unit Manager - RN - Woodland Park Care Center - Salt Lake City, UT   
Previous experience in a hospital, long term care facility, or other healthcare related facility; Previous experience in a hospital, long term care facility, or...
From Avalon Health Care Group - Fri, 23 Jun 2017 16:45:49 GMT - View all Salt Lake City, UT jobs
          Analysis: GOP Health Bill Could Cost California $114B   
CHICAGO, IL - JUNE 28: Demonstrators protest changes to the Affordable Care Act on June 28, 2017 in Chicago, Illinois. After more senators said they would not offer support, senate Republican's yesterday announced they would delay a vote on their revised health-care bill. (Photo by Scott Olson/Getty Images)California officials say the state's budget could take a $30 billion annual hit if health care legislation proposed by U.S. Senate Republicans is passed.
          Part Time Support Analyst - Cerner Corporation - Kansas City, MO   
Cerner is transforming health care by developing tools and technologies that make it easier and more efficient for care providers and patients to navigate the...
From Cerner Corporation - Tue, 11 Apr 2017 17:23:09 GMT - View all Kansas City, MO jobs
          Case Manager (LTACH) - Select Specialty Hospital - Atlanta, GA   
Registered Nurse is preferred with other health care professions considered. Long-Term Acute Care Hospital....
From Select Medical Corporation - Thu, 04 May 2017 15:08:37 GMT - View all Atlanta, GA jobs
          LOOP: Senate GOP delays health care vote for a week   
HEALTH CARE // Lacking the 50 votes need to pass health care, Senate Majority Leader delayed a vote on the GOP plan for a week. Senate Republicans then visited with President Trump at the White House where he warned them of the ‘cost of failure.’ http://cvote.it/2skdgl3 HEALTH CARE // A pro-Trump group decides to pull ads slamming a Republican Senator who attacked [...]
          The Senate plan means 22 million uninsured? Let’s take a honest look at that number   
Senate Republicans have announced that they are delaying a vote on their health care plan by at least a week. The news comes after several Senators had second thoughts because a report from the Congressional Budget Office suggested that under the GOP plan 22 million people would not have health insurance. The U.S. Bishops cited the [...]
          6-28-17 Chad Hartman Show 2p: Rep. Keith Ellison   

In this hour Chad talked to Congressman Keith Ellison about health care and more...


          Republicans Aren’t Sure President Trump Is the Best Person to Sell Health Care   
"Add some money to it!" he said
          ‘Let’s Talk Together.’ Schumer Challenges Trump on Health Care Plan   
"Either Republicans will agree and change the status quo, or markets will continue to collapse and we’ll have to sit down with Sen. Schumer”
          Cohort Profile: The Kiang West Longitudinal Population Study (KWLPS)—a platform for integrated research and health care provision in rural Gambia   
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          Veterans’ groups voice concerns over GOP health care bill   
Major veterans' organizations are voicing concerns about a Senate GOP bill to repeal the nation's health care law, fearing the impact of rising insurance costs and worried the underfunded Department of Veterans Affairs won't be able to fill the coverage gap.
          Almost 100 Veterans Died Waiting For Health Care At Los Angeles VA Hospital   
President Donald J. Trump signed into law a Veterans Affairs reform bill that will streamline the firing process for bad employees and shield whistleblowers.
          Avalon - Unit Manager - RN - Woodland Park Care Center - Salt Lake City, UT   
Candidates should have a current nursing license as well as a positive attitude! The Unit Manager will direct the day to day functions of the Nursing Unit in...
From Avalon Health Care Group - Fri, 23 Jun 2017 16:45:49 GMT - View all Salt Lake City, UT jobs
          Medication Assistant Certified (MA-C) / Medication Aide - Woodland Park Care Center - Salt Lake City, UT   
Administer legend drugs, with the exception of chemotherapeutic agents and experimental drugs. Previous experience as a Medication Assistant - Certified....
From Avalon Health Care Group - Fri, 05 May 2017 20:29:40 GMT - View all Salt Lake City, UT jobs
          US Health Care   
Health care: In a recent posting one of the commenters  suggested that I was being a bit over the top regarding issue of health care.  As I noted there all the information I provided was based either...

[Summary only. Full text at site.]
          Sen. Pat Roberts still defends GOP health plan; health care advocates say it's terrible for Kansas    
U.S. Sen. Pat Roberts said the bill would have been good for Kansas and that the Senate needs to act soon, "to prepare for Obamacare's inevitable collapse." Health care advocates in Kansas strongly disagreed with his statement.
          Health Care Consultant - Health Land Clinic - Vancouver, BC   
Collect, compile and analyze information from clients, health care institutions and organizations and produce proposals for the development of the company, such... $34 an hour
From Indeed - Fri, 10 Mar 2017 21:41:29 GMT - View all Vancouver, BC jobs
          Beeler cartoon: Trumpcare    
Nate Beeler cartoon on the GOP's health care plan.
          Beeler cartoon: Trumpcare    
Nate Beeler cartoon on the GOP’s health care plan.
          Granlund cartoon: Health care push    
Dave Granlund cartoon on the GOP’s health care push.
          Mark L. Hopkins: Here we go again on health care    
The Republican Health Care Plan is now before Congress. We have been told since the passage of The Affordable Healthcare Act back in 2009 that the Republicans intended to replace that legislation with something much better. All of us, Republicans and Democrats, would appreciate having a comprehensive health care plan that meets the needs of our citizens. The experts tell us that the current plan has not solved the two big health care issues which are access to services and containing costs. The [...]
          Beeler cartoon: Health care reform    
Nate Beeler cartoon on health care reform being in progress.
          As Affordable Care Act Repeal Teeters, Prospects for Bipartisanship Build   

While he presses Republicans to get behind his bill for undoing Obamacare, Senator Mitch McConnell is also raising the specter of bringing Democrats into Senate health care talks. Source link

link: As Affordable Care Act Repeal Teeters, Prospects for Bipartisanship Build


          Republicans Repeat A Shockingly Dishonest Argument To Sell Their Health Care Plan   

Their professed concern over the uninsured rings untrue. Source link

link: Republicans Repeat A Shockingly Dishonest Argument To Sell Their Health Care Plan


          What's Next For the Senate GOP Health Care Bill?   

Senate Republicans are regrouping on health care legislation. Here’s what you need to know about what comes next. Source link

link: What's Next For the Senate GOP Health Care Bill?


          W.Va. Sen. Capito’s difficult journey to ‘no’   

Sen. Shelley Moore Capito, R-W.Va., announced Tuesday she was against the current version of the Senate GOP health care bill. In an exchange that was filmed by someone else in the room and later posted on Facebook , where it has been viewed more than 5 million times, Hill showed the senator photos of Amy…

link: W.Va. Sen. Capito’s difficult journey to ‘no’


          Dent: GOP Should Not Make Mistake Dems Did on Healthcare   
Republicans will make the same mistake as Democrats if they pass healthcare reform legislation on a strictly partisan basis, Rep. Charlie Dent, one of the few Republicans to vote against the House's American Health Care Act, said Wednesday.
          Expanded mental health service set to help patients with long-term conditions   
SPECIALIST mental health care is being offered to people with long term physical health conditions, thanks to a new service that could reduce GP and hospital visits.
          Registered Nurse - RN - Part Time Wound Nurse - Woodland Park Care Center - Salt Lake City, UT   
Ability to plan, organize, develop, implement, and interpret the programs, goals, objectives, policies and procedures that are necessary for providing quality...
From Avalon Health Care Group - Tue, 27 Jun 2017 16:28:24 GMT - View all Salt Lake City, UT jobs
          Director of Nursing - DON - Woodland Park Care Center - Salt Lake City, UT   
Must be knowledgeable of general, rehabilitative and restorative nursing and medical practices and procedures and laws, regulations and guidelines governing...
From Avalon Health Care Group - Fri, 23 Jun 2017 16:45:53 GMT - View all Salt Lake City, UT jobs
          Avalon - Unit Manager - RN - Woodland Park Care Center - Salt Lake City, UT   
Must be at least 18 years of age; Must be knowledgeable of general, rehabilitative and restorative nursing and medical practices and procedures and laws,...
From Avalon Health Care Group - Fri, 23 Jun 2017 16:45:49 GMT - View all Salt Lake City, UT jobs
          Selling the GOP health care bill: Does Trump help or hurt?   
WASHINGTON (AP) -- It was a platform most politicians can only hope for: A captivated, 6,000-person crowd and more than an hour of live, prime-time television coverage to hype the Republican vision for a new health care system....
          Protesters Stage ‘Die-In’ At Sen. Gardner’s Office In Health Care Bill Opposition   
Disability rights activists with the group ADAPT, spent Tuesday gathering both inside and outside of Sen. Cory Gardner's office to show their opposition to the Republican health care bill.
          Continuing the Case for Health Care Reform   

Fareed Zakaria is one of the most balanced, sensible reporters and commentators on international affairs going today. Because of this, he brings a global perspective to American domestic issues that many of the pundits lack. In this week's Time Magazine, he has a commentary entitled, “Health Insurance Is for Everyone” (CNN shows about half the article, the entire piece is on Time’s website that is accessed by subscribers).  In it he writes,

The centerpiece of the case against Obamacare is the requirement that everyone buy some kind of health insurance or face stiff penalties--the so-called individual mandate. It is a way of moving toward universal coverage without a government-run or single-payer system. It might surprise Americans to learn that another advanced industrial country, one with a totally private health care system, made precisely the same choice nearly 20 years ago: Switzerland.

Switzerland is not your typical European welfare-state society. It is extremely business-friendly and has always gone its own way, shunning the euro and charting its own course on health care. The country ranks higher than the U.S. on the Heritage Foundation's Index of Economic Freedom.

Twenty years ago, Switzerland had a system very similar to America's--private insurers, private providers--with very similar problems. People didn't buy insurance but ended up in emergency rooms, insurers screened out people with pre-existing conditions, and costs were rising fast. The country came to the conclusion that to make health care work, everyone had to buy insurance. So the Swiss passed an individual mandate and reformed their system along lines very similar to Obamacare. The reform law passed by referendum, narrowly. The result two decades later: quality of care remains very high, everyone has access, and costs have moderated. Switzerland spends 11% of its GDP on health care, compared with 17% in the U.S. Its 8 million people have health care that is not tied to their employers, they can choose among many plans, and they can switch plans every year. Overall satisfaction with the system is high.

Zakaria continues,

The most striking aspect of America's medical system remains how much of an outlier it is in the advanced industrial world. No other nation spends more than 12% of its total economy on health care. We do worse than most other countries on almost every measure of health outcomes: healthy-life expectancy, infant mortality and--crucially--patient satisfaction. Put simply, we have the most expensive, least efficient system of any rich country on the planet. Costs remain high on every level. Recently, the International Federation of Health Plans released a report comparing the prices in various countries of 23 medical services, from a routine checkup to an MRI to a dose of Lipitor. The U.S. had the highest costs in 22 of the 23 cases. An MRI costs $1,080 here; it costs $281 in France.

In 1963, Nobel Prize--winning economist Kenneth Arrow wrote an academic paper explaining why markets don't work well in health care. He argued that unlike with most goods and services, people don't know when they will need health care. And when they do need it--say, in the case of heart failure--the cost is often prohibitive. That means you need some kind of insurance or government-run system.

Now, we could decide as a society that it is O.K. for people who suddenly need health care to get it only if they can pay for it. The market would work just as it works for BMWs: anyone who can afford one can buy one. That would mean that the vast majority of Americans wouldn't be able to pay for a triple bypass or a hip replacement when they needed it. But every rich country in the world--and many not-so-rich ones--has decided that its people should have access to basic health care. Given that value, a pure free-market model simply cannot work.

In the campaigns for president, it seems that the conservatives have changed their tunes on requiring mandate for everyone to be included in health insurance. Zakaria observes,

Catastrophic insurance--covering trauma and serious illnesses--isn't a solution, because it's chronically ill patients, just 5% of the total, who account for 50% of American health care costs. That's why the Heritage Foundation, a conservative think tank, came up with the idea of an individual mandate in the 1980s, proposing that people buy health insurance in exactly the same way that people are required to buy car insurance. That's why Mitt Romney chose this model as a market-friendly system for Massachusetts when he was governor. And that's why Newt Gingrich praised the Massachusetts model as the most important step forward in health care in years. They have all changed their minds, but that is about politics, not economics.

He concludes,

When listening to the debate about American health care, I find that many of the most fervent critics of government involvement argue almost entirely from abstract theoretical propositions about free markets. One can and should reason from principles. But one must also reason from reality, from facts on the ground. And the fact is that about 20 foreign countries provide health care for their citizens in some way or other. All of them--including free-market havens like Switzerland and Taiwan--have found that they need to use an insurance or government-sponsored model. All of them provide universal health care at much, much lower costs than we do and with better results.


          Things the Government Has Done Quite Well   

We’ve heard the suspicions, especially lately with the health care debate. People do not trust that the government can do anything well. I’ve heard a number of people use the United States Postal Service as the ultimate example. We stand in long lines at the Post Office. UPS and FedEx delivers packages more efficiently and at a better cost. Okay.

But I still think that the government has actually done some things quite well.

  1. Building the interstate highway system: We boast the best auto and truck transportation system in the world.
  2. Public Libraries: Most nations don't even have these.
  3. National Park Service: Our National Parks are amazingly preserved and managed.
  4. NASA: Not only are we the only nation to step foot on the moon, but because of the space program, our nation has developed amazing advances in materials, electronics, communications, and medicine.
  5. The Food and Drug Administration: We can actually trust that the medicine we take is what's on the label because of the government, unlike most of the world.
  6. The Centers for Disease Control: This agency has shown to be exceptional in combating emerging diseases and health risks, including birth defects, West Nile virus, avian, swine, and pandemic flu, E. coli, and bioterrorism.
  7. The Federal Deposit Insurance Corporation: Because of the FDIC, we can bank with confidence that our money will always be our money. Before the FDIC, if a bank lent more than it could support, people would lose their life savings.

So, contrary to what the pundits want us to believe, government is not always evil.

In fact, government is "God’s servant to do you good" (Romans 13:4).


          GOP touts lower premiums, but other insurance costs to rise   
WASHINGTON (AP) -- Republicans are touting lower premiums under their health care legislation, but that reflects insurance that would cover a smaller share of the cost of medical bills....
          Selling the GOP health care bill: Does Trump help or hurt?   
WASHINGTON (AP) -- It was a platform most politicians can only hope for: A captivated, 6,000-person crowd and more than an hour of live, prime-time television coverage to hype the Republican vision for a new health care system....
          The Latest: Trump promises 'big surprise' on health care   
WASHINGTON (AP) -- The Latest on Republican legislation to repeal and replace the Obama health care law (all times local):...
          Program Aide - St. Christoper Adult Day Health Care Center - Corona, CA   
Provide individual participant support in meeting a planned schedule of medical and social activities that meet each participant's care plan.... $10 an hour
From Indeed - Thu, 22 Jun 2017 18:13:29 GMT - View all Corona, CA jobs
          Registration Clerk - McLaren Central Michigan - Mount Pleasant, MI   
Physicians, Chaplains and Patient Communicators. In accordance to specified procedures, operates a console switchboard in order to relay incoming, outgoing and...
From McLaren Health Care - Thu, 13 Apr 2017 16:37:12 GMT - View all Mount Pleasant, MI jobs
          Leading Health Care Firm, Fischer Health, to Become a Part of Porter Novelli   
Porter Novelli announced that it will acquire Fischer Health.
          GOP touts lower premiums, but other insurance costs to rise   
WASHINGTON (AP) -- Republicans are touting lower premiums under their health care legislation, but that reflects insurance that would cover a smaller share of the cost of medical bills....
           Exploring safety, quality and resilience in health care    
Hutchinson, Allen (2014) Exploring safety, quality and resilience in health care. PhD thesis, University of Sheffield.
           Health System Actors’ Participation in Primary Health Care in Nepal    
Karki, Jiban Kumar (2016) Health System Actors’ Participation in Primary Health Care in Nepal. PhD thesis, University of Sheffield.
          Health Care Assistant £8.30 to £16.25 - Greenleaf Healthcare - Saltash PL12   
Enhanced rates of pay for evenings, weekends and public holidays. Full Job Description*.... £8.30 - £16.25 an hour
From Indeed - Thu, 20 Apr 2017 10:24:41 GMT - View all Saltash PL12 jobs
          What Do the Grenfell Tower Fire and Hurricane Katrina Have in Common? Disaster Capitalism   
Both catastrophes are case studies in the workings of the shock doctrine.

At first glance, Hurricane Katrina in New Orleans and the devastating blaze at Grenfell Tower in London last week may not seem too similar. But a closer inspection of the circumstances leading to the two tragedies shows a deep connection to the same capitalist theory: the shock doctrine.

The term shock doctrine, also called disaster capitalism, was coined and researched by Naomi Klein in her 2007 book The Shock Doctrine. The theory describes the rampant corporatization of the public sector, whether it's schools or housing, in the aftermath of a “shock,” which could come in the form of an economic recession, a terrorist attack or even a natural disaster. Pro-corporate politicians take advantage of the shock and trauma the public experiences when a disaster hits to ram through free market-inspired ideas that strip away the safety net and public services in exchange for corporatization and privatization.

In The Shock Doctrine, Klein uses Hurricane Katrina’s devastation of New Orleans as a case study in disaster capitalism. Just weeks after the hurricane hit, a group of lobbyists (including Vice President Mike Pence) joined together to formulate a package of privatization and corporate policies that would transform the city’s landscape for the worse. Some of these policies included the rise of charter schools and school vouchers for families at the expense of the city’s public school system as well as the handing off of rebuilding destroyed houses to private contractors who caused more harm than good.

This same pattern could occur following the Grenfell Tower fire, which killed at least 79 people and was the deadliest fire in Britain in a century.

In the days following the blaze, British media outlets revealed that the fire was exacerbated by external material that easily catches fire and facilitated the quick and deadly spread of the flames. A report from the New York Times shows that wrapping the flammable material around apartment buildings like the 24-story Grenfell Tower is actually banned in the U.S. and several European countries. Yet builders still applied the cladding around Grenfell because of a cost-cutting deal made with British politicians; it was determined at the time that the cost concerns outweighed the safety risks posed by the hazardous material.

But the scaffolding was not the only factor contributing to the fire. Grenfell Tower also lacked basic precautionary measures, such as fire alarms, sprinklers and fire escapes. The building contained only a single staircase for its residents. For years, residents of the tower complained and warned authorities about the potential catastrophe awaiting the public housing building. Many residents also charge that the new flammable scaffolding was installed to beautify the building for adjacent, wealthier neighbors.

This failure to care for Grenfell residents, most of whom are among the area’s poorest, resembles the U.S. government's neglect of New Orleans, which multiplied the disaster caused by Hurricane Katrina.

Katrina was classified as a Category 3 hurricane once it hit the Gulf Coast, bringing winds up to 100-140 mph. Because New Orleans lies below sea level, it faced particular risks from the hurricane. A system of levees built over the course of the 20th century was supposed to protect the city from mass flooding. However, the levees built to protect neighborhoods from Lake Pontchartrain, Lake Borgne and nearby swamps and marshes were less reliable and weaker than other levees along the Mississippi River. These areas also housed the city’s poorest residents, a majority of whom were black.

For many years, public officials warned about the weakness of the levees and the potential for catastrophic damage if they could not sustain a powerful storm. But the levees were never fixed. The combination of the strength of the storm and the weakened fortification ultimately caused billions of dollars in devastation and the displacement of hundreds of thousands of people following the storm.

The buildup to both the Grenfell Tower and Hurricane Katrina disasters poses striking similarities. Gross government oversight and a lack of urgency for protecting poor residents and people of color resulted in devastating disasters that killed many and displaced many more. With Grenfell Tower now in charred ruins, private contractors and money-hungry lobbyists and public officials may see the tragedy the same way Pence and his team of lobbyists viewed the aftermath of Katrina: a grand opportunity for capitalist privatization for the benefit of the rich and at the expense of the poor.

 

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           How Privatization Could Spell the End of Democracy   
Between Trump and tech, never before have so many powerful people been so intent on transforming government into a business.

It’s a hot day in New York City. You’re thirsty, but your water bottle is empty. So you walk into a store and place your bottle in a machine. You activate the machine with an app on your phone, and it fills your bottle with tap water. Now you are no longer thirsty.

This is the future envisioned by the founders of a startup called Reefill. If the premise sounds oddly familiar, that’s because it is: Reefill has reinvented the water fountain as a Bluetooth-enabled subscription service. Customers pay $1.99 a month for the privilege of using its machines, located at participating businesses around Manhattan.

Predictably, the company has already come in for its fair share of ridicule. In Slate, Henry Grabar called it “tap water in a suit”. But while Reefill is a particularly cartoonish example, its basic business model is a popular one within tech. The playbook is simple: take a public service and build a private, app-powered version of it.

he most obvious examples are Uber and Lyft, which aspire not merely to eliminate the taxi industry, but to replace public transportation. They’re slowly succeeding: municipalities around America are now subsidizing ride-hailing fares instead of running public buses. And earlier this year, Lyft began offering a fixed-route, flat-rate service called Lyft Shuttle in Chicago and San Francisco – an aggressive bid to poach more riders from public transit.

These companies wouldn’t have customers if better public alternatives existed. It can be hard to find a water fountain in Manhattan, and public transit in American cities ranges from mediocre to nonexistent. But solving these problems by ceding them to the private sector ensures that public services will continue to deteriorate until they disappear.

Decades of defunding and outsourcing have already pushed public services to the brink. Now, fortified with piles of investor cash and the smartphone, tech companies are trying to finish them off.

Proponents of privatization believe this is a good thing. For years, they have advanced the argument that business will always perform a given task better than government, whether it’s running buses or schools, supplying healthcare or housing. The public sector is sclerotic, wasteful and undisciplined by the profit motive. The private sector is dynamic, innovative and, above all, efficient.

This belief has become common sense in political life. It is widely shared by the country’s elite, and has guided much policymaking over the past several decades. But like most of our governing myths, it collapses on closer inspection.

No word is invoked more frequently or more fervently by apostles of privatization than efficiency. Yet this is a strange basis on which to build their case, given the fact that public services are often more efficient than private ones. Take healthcare. The United States has one of the least efficient systems on the planet: we spend more money on healthcare than anyone else, and in return we receive some of the worst health outcomes in the west. Not coincidentally, we also have the most privatized healthcare system in the advanced world. By contrast, the UK spends a fraction of what we do and achieves far better results. It also happens to provision healthcare as a public service. Somehow, the absence of the profit motive has not produced an epidemic of inefficiency in British healthcare. Meanwhile, we pay nearly $10,000 per capita and a staggering 17% of our GDP to achieve a life expectancy somewhere between that of Costa Rica and Cuba.

A profit-driven system doesn’t mean we get more for our money – it means someone gets to make more money off of us. The healthcare industry posts record profits and rewards its chief executives with the highest salaries in the country. It takes a peculiar frame of mind to see this arrangement as anything resembling efficient.

Attacking public services on the grounds of efficiency isn’t just incorrect, however – it’s beside the point. Decades of neoliberalism have corroded our capacity to think in non-economic terms. We’ve been taught that all fields of human life should be organized as markets, and that government should be run like a business. This ideology has found its perverse culmination in the figure of Donald Trump, a celebrity billionaire with no prior political experience who catapulted himself into the White House by invoking his expertise as an businessman. The premise of Trump’s campaign was that America didn’t need a president – it needed a CEO.

Nowhere is the neoliberal faith embodied by Trump more deeply felt than in Silicon Valley. Tech entrepreneurs work tirelessly to turn more of our lives into markets and devote enormous resources towards “disrupting” government by privatizing its functions. Perhaps this is why, despite Silicon Valley’s veneer of liberal cosmopolitanism, it has a certain affinity for the president. On Monday, Trump met with top executives from Apple, Amazon, Google and other major tech firms to explore how to “unleash the creativity of the private sector to provide citizen services”, in the words of Jared Kushner. Between Trump and tech, never before have so many powerful people been so intent on transforming government into a business.

But government isn’t a business; it’s a different kind of machine. At its worst, it can be repressive and corrupt and autocratic. At its best, it can be an invaluable tool for developing and sustaining a democratic society. Among other things, this includes ensuring that everyone receives the resources they need to exercise the freedoms on which democracy depends. When we privatize public services, we don’t just risk replacing them with less efficient alternatives – we risk damaging democracy itself.

If this seems like a stretch, that’s because pundits and politicians have spent decades defining the idea of democracy downwards. It has come to mean little more than holding elections every few years. But this is the absolute minimum of democracy’s meaning. Its Greek root translates to “rule of the people” – not rule by certain people, such as the rich (plutocracy) or the priests (theocracy), but by all people. Democracy describes a way of organizing society in which the whole of the people determine how society should be organized.

What does this have to do with buses or schools or hospitals or houses? In a democracy, everyone gets to participate in the decisions that affect their lives. But that’s impossible if people don’t have access to the goods they need to survive – if they’re hungry or homeless or sick. And the reality is that when goods are rationed by the market, fewer people have access to them. Markets are places of winners and losers. You don’t get what you need – you get what you can afford.

By contrast, public services offer a more equitable way to satisfy basic needs. By taking things off the market, government can democratize access to the resources that people rely on to lead reasonably dignified lives. Those resources can be offered cheap or free, funded by progressive taxation. They can also be managed by publicly accountable institutions led by elected officials, or subject to more direct mechanisms of popular control.

These ideas are considered wildly radical in American politics. Yet other places around the world have implemented them with great success. When Oxfam surveyed more than 100 countries, they discovered that public services significantly reduce economic inequality. They shrink the distance between rich and poor by lowering the cost of living. They empower working people by making their survival less dependent on their bosses and landlords and creditors. Perhaps most importantly, they entitle citizens to a share of society’s wealth and a say over how it’s used.

But where will the money come from? This is the perennial question, posed whenever someone suggests raising the welfare state above a whisper. Fortunately, it has a simple answer. The United States is the richest country in the history of the world. It is so rich, in fact, that its richest people can afford to pour billions of dollars into a company such as Uber, which loses billions of dollars each year, in the hopes of getting just a little bit richer. In the face of such extravagance, diverting a modest portion of the prosperity we produce in common toward services that benefit everyone shouldn’t be controversial. It’s a small price to pay for making democracy mean more than a hollow slogan, or a sick joke.

 

 

 

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          Why It Makes No Sense to Separate the White Working Class from the Black Working Class    
The media consistently radicalizes the white working class as noble; meanwhile the money is going to the top 1%.

This article appears in the Summer 2017 issue of The American Prospect magazine. Subscribe here

“After all, if every economic issue is framed as a struggle between a hard-working white middle class and undeserving minorities, then workers of all shades will be left fighting for scraps while the wealthy withdraw further into their private enclaves.”  —Barack Obama, Farewell Address, Chicago, January 2017

After three losses to Ronald Reagan and George H.W. Bush, a trifecta last accomplished by Presidents Harding, Coolidge, and Hoover, there was much hand-wringing among Democrats about the loss of the South and the vanishing loyalty of Southern whites. William Galston and Elaine Kamarck at the Progressive Policy Institute argued that the electoral math made the South the true presidential battleground; that Democrats could not win by being more liberal or hoping to motivate black and poor voters to increase their voter participation. Thomas Edsall and Mary Edsall similarly warned in the pages of The Atlantic that the South was key, and it was lost because the liberal orthodoxy was too tied to race, and out of touch with white working-class voters.

“Liberal” candidates like Tom Harkin, Dick Gephardt, and Michael Dukakis were out. Their message was deemed too Northern, elite, and alien to the needed Southern white voter. In was a candidate who could rebrand the Democratic Party and break liberal orthodoxy, proving the party could be tough on crime and defense, and reinvent welfare and the social state. This turned out to be Bill Clinton. Now, the defeat of Hillary Clinton has once again caused Democrats to argue about what is needed to win the white vote.

Countless articles have focused on what Democrats have done wrong. And much of the theme remains the same as in 1989—that there is a noble white worker who has been betrayed. Here is how the Edsalls portrayed one such voter back in 1989:

“You could classify me as a working-class Democrat, a card-carrying union member,” says Dan Donahue, a Chicago carpenter who became active in the campaign of a Republican state senator in 1988. “I’m not a card-carrying Republican—yet. We have four or five generations of welfare mothers. And they [Democrats] say the answer to that is we need more programs. Come on. It’s well and good we should have compassion for these people, but your compassion goes only so far. I don’t mind helping, but somebody has got to help themselves, you’ve got to pull. When you try to pick somebody up, they have to help. Unfortunately, most of the people who need help in this situation are black and most of the people who are doing the helping are white. We [white Cook County voters] are tired of paying for the Chicago Housing Authority, and for public housing and public transportation that we don’t use. They [taxpayers] hate it [the school-board tax] because they are paying for black schools that aren’t even educating kids, and the money is just going into the Board of Education and the teachers’ union.”

As President Barack Obama warned in his farewell address, this depiction of whites as hard-working, noble, and beset (compared with whom?) is nowhere to start a dialogue about an economy in which the real problem is that all economic gains have gone to the top 1 percent. The language presumes that there are not black workers who lost out to trade deals that sent thousands of auto-parts jobs from Flint, Michigan, to Mexico or shut steel mills in Baltimore, Maryland. Richard Trumka, president of the AFL-CIO, echoed Obama on the risks of reinforcing Trump’s cynical manipulation of race and the white working class:

Anyone who talks about dividing people in the country as a solution is a threat to the country, to democracy, the economy, and to working people, and we take every one of those seriously.

Oddly, much of the hand-wringing comes after victories by Presidents Clinton and Obama, each of whom demonstrated both the complexity of the white vote and the fact that the black vote matters. A core challenge is that many voters misunderstand basic economics, leading them to vote against the interests of working America as a whole. Many Americans still hold the view articulated by the Edsalls’ late-1980s white voter that government is not the solution. And their misunderstanding has been reinforced by actions of recent presidents.

One of those was Bill Clinton. The pursuit of white voters by Clinton led to attacks on the Social Security Act, first on the premise that budget discipline was more important, and second on the assumption that Social Security’s aid to the poor was too generous and too much of a handout to black women. Clinton supported partial privatization of Social Security pensions. Even Obama, pursuing deficit cuts, flirted with cuts in the cost-of-living formula.

The Social Security Act, let’s recall, was intended to protect the income of working-class American families. Yes, it was an entitlement, and proudly so. Social Security was first denied to most black Americans, but then extended. Aid to Families with Dependent Children (AFDC) was a core part of Social Security. Clinton’s view that single mothers should be written out of the act—for that is what the end of “welfare as we know it” meant—was not viewed as an attack on working people. But it was. Black women, who have historically had the largest labor force participation rate among all racial groups, and who work more hours than any racial group among women, were stigmatized as being made lazy because they finally had access to that part of the Social Security Act which had initially been denied them when it was passed.

Temporary Assistance for Needy Families, the feeble successor to AFDC, removed a class of workers from Social Security protection. Because of the “Nannygate” scandal surrounding Clinton’s attorney general nominee, protections for domestic workers within the Social Security Act were watered down. Despite the ravaging effect of the Reagan-era downturn on unemployment insurance, the Clinton administration offered little to repair a state-based system that had gone bankrupt and then refinanced itself by cutting access to benefits and benefit levels.

THE HARD REALITY OF TODAY'S level of inequality is this: For an increasing share of the population—black and white—the market no longer works to serve basic needs like housing, health insurance, child care, or college education. As the share of income held by the middle 60 percent declines, the top 10 percent’s share continues to grow, and within that, the top 1 percent.

The effect of heavy concentrations of money in fewer hands means that market-based allocations of resources are dictated by a smaller set of decision-makers. Businesspeople react to where the money is, whether they are home-builders, college presidents, or day-care providers. In the market, price is used as the rationing device, and prices follow where the money is.

When the middle class dominated the economy, it meant that prices for key personal investments followed increases in the incomes of the middle class. The government stepped in with housing, health, and education policies to subsidize those in the bottom 20 percent whose incomes were not keeping pace, and who would be rationed out of housing, health, and education by a market outcome. Worsening income inequality meant rising demands on government programs to ensure fair access to health and education, as prices rose faster than low income. Through the 1990s, the effect of discrimination made blacks synonymous with the bottom 20 percent, as they were overrepresented in the bottom income group.

What has happened to more whites now is that the market has moved past them as well. Pricing for child care and college education, essentials for their children, are outstripping their income growth; instead, prices are tied to the growth in income for the top 1 percent in the case of college tuition. And whites in the bottom 20 percent of income, who hold considerably more wealth than blacks in any part of the income distribution, can no longer self-insure themselves against the bumps in the economy.

As it took almost 40 years to get to this point, in the near term no recipe of policy fixes will sufficiently remedy the effects. Democrats need to focus on reversing those long-term trends, but also must have something to offer workers now. But every year that Trump is in office, that goal becomes more difficult.

Union representation, a key element in reversing those trends, continues to fall. More states are likely to adopt “right to work” laws. It will be increasingly difficult to rebuild workers’ voice in deciding how corporate output will be divided between wages and profits. That is the greatest source of the rising inequality. The hollowing out of the middle is not the result of automation. Rather, it reflects the relative advantage of those workers more closely tied to management, who squeeze down the income share for the middle and below.

What Reagan achieved in the 1980s was the illusion that by letting the floor fall, the middle could be protected. Unfortunately, too many white workers still have a view of the economy fed by the Reagan framework of government’s role. The unabated concentration of income will make after-tax methods of redistribution more vital so that Americans can have access to housing, education, and health. The Affordable Care Act, a market-based approach to health access, is one example where the fix is inadequate to rising income inequality, and made worse because it naïvely assumed that states would expand public access to address the gap in affordability.

UNDER TRUMP, RACE WILL complicate the effort to devise palliatives to rising inequality until more effective remedies can take effect. His dismantling of anti--discrimination offices within the federal government will create new downward pressures on an already stressed black working class. And the decline in union membership is more dangerous to black workers, who have higher union density than white workers and who rely far more than whites on union bargaining power to get higher wages. Further, black union density is more heavily reliant on public-sector bargaining than is true for whites, and public-sector unions are a target of Trump, who will abet the attack on public-sector unions taking place at the state level.

Under Trump, the gap between the experience of black and white workers will grow. Trump has already changed the political discourse. He has revived a strain of Southern populism that allows for asserting white privilege.

For Democrats, the problem with language that emphasizes the white working class as a separate problem from rising inequality of income and wealth is that it will racialize the debate rather than emphasizing the common assault on all who are not rich. It evokes the negative part of Bill Clinton’s presidency. Hillary Clinton had a hard time convincing young black workers that welfare reform and mass incarceration weren’t key to the Clinton legacy. The lack of black enthusiasm for Clinton is as much a part of the story of 2016 as the enthusiasm of white voters for Trump.

Further, progressive forces in the Democratic Party have been too uncritical of Bernie Sanders’s inability to lay the proper foundation with the party’s African American base ahead of the primary season. It was curious during the 2016 primary season to see Republicans all hopped up about the “SEC primary” (so-called because the Southern states involved have flagship universities in the Southeastern Conference), but no mention among the Democrats of the SWAC primary (the Southwestern Athletic Conference, a complementary athletic conference of public historically black universities).

So, while in the fall of 2015 Republicans fawned over attending games between the University of Alabama and Auburn, not a peep was heard on the need for Democrats to be at a game between Alabama State and Alabama A&M. Black voters often determine the victor in the Southern Democratic primaries, but spending time in Iowa and New Hampshire would be a likely outcome of a party worried about white working voters.

Democrats need to spend more time developing a frame to combat inequality. They need to do a better job of explaining that income inequality is a threat to economic growth. They need to be spending time helping Americans take the blinders off and see that workers, of all races, are being given the shaft by a system where corporate greed has become an elite “entitlement.” They need to pull the Band-Aid off a false sense there is some white privilege that can spare some workers the wrath of America’s war on working people. They must fess up to their quiet, and sometimes vocal, support of an agenda that attacked America’s workers. They need to stop believing the problem confronting American workers is that they are uneducated or unskilled. They need to stop defining the white working class as the less-educated. Those are the perennial excuses meted out to black workers. Young black workers reacted angrily in 2016 to a perception that their pain was being ignored. They didn’t vote for Trump, but Clinton lost as much because they didn’t vote for her either as Trump won because white voters voted for him.

The Democrats won’t solve their electability issues repeating the debate about white voters that they had in the late 1980s. They need to focus on the urgency of the effect of income inequality on American democracy. They need to sound the alarm. And they need to wake up and see who they are in bed with. The power elite of the party think they have freed themselves of a dependency on union support. But the Wall Street vision of the economy is poison for workers of all races and for Democrats.

When the Republican Party of the 19th century cut its deal to end Reconstruction and concentrate on winning the white vote, it launched the Gilded Age and the unremittent growth of inequality that collapsed in the Great Depression. It was accompanied by a Southern populism that entrenched a harsh racial code. Trump’s victory puts us within reach of repeating that mistake in history. Democrats need to be wary, and shrewd. How they handle this could entrench the dystopia of more Trumps—or create a new multiracial coalition of class uplift.

 

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          Health Care Aide - Prairie Mountain Health - Virden, MB   
Health Care Aide Certificate from a recognized program. Demonstrated flexibility to facilitate changes in techniques and procedures....
From Prairie Mountain Health - Tue, 27 Jun 2017 21:03:17 GMT - View all Virden, MB jobs
          #Republicans Repeat A Shockingly Dishonest Argument To Sell Their #Health Care Plan   
Republicans have made some pretty dishonest statements about their plan to repeal and replace the Affordable Care Act in recent days, including that it would not cut Medicaid (it would) and that it would lower premiums (it would not). What might take the ...
          The Fool On The Hill   
Twenty four hour news formats have most people believing the reason for higher gas prices is due to rising global demands of crude oil and American’s dependence of imported oil – especially from OPEC nations.

Demand for fuel in China is the best smoke-screen. It’s easy to visualize masses of people on bicycles now driving Cadillac’s with 2 car garages – thus Americans can conclude “it’s out of our control” so just pay the price.

For those just awaking ….there is a small square bock of real estate in Manhattan called Wall Street, the buildings there (and in similar markets throughout the globe especailly London); control the world’s financial conditions good, bad or indifferent.

The Street forecasts
The Street invests
The Street controls

Pay $5.00 for a gallon of gas … The Street wins.

I’ll explain.

Let’s say a group of investors concocted a strategy where it buys future stockpiles of medical equipment to price levels where the average American or Health Care provider couldn’t pay the cost any longer. One day the price of an x-ray is $100 the next day $800 and the next day $1500 – Americans would be outraged!

Over the past 25 years the price of oil and the price of a gallon of gas were paired, both rising, but matched in even parallels. Since 2002 the price of oil disconnected itself from the price of gas like a run-a-way train, the spread is alarming, if it were a cardiogram the patient would have already died.

Index Speculators claimed their territory post September 11, fueled by Institutional Investors, Mutual funds and University endowments… Index Speculators have become as critical to world oil markets as China, both place equal amounts of pressures to continue the rise in oil prices. The key difference is Index Speculators buy “oil indexes” and China buys the “actual commodity”.

As more Oil Index Speculators…”speculate”… the sheer mass of long positions assure higher prices.. the unsupervised frenzy feeds itself.

Could the oil bubble burst? Possibly.. however traditional supply and demand models are paralyzed – eight fold price increases in any commodity over an 8 year period doesn’t increase demand it reduces it (yes even with China consuming more oil). Thus increasing oil production won’t work because we already have an oil surplus.

The only remedy is to eliminate Index Speculation on all commodities. Without Index Speculation investor risk is tied into an obligation to cover short positions by buying the actual commodity, thus placing the focus on real supply and demand swings. Till then Index Speculators remain the core reason Oil and Food prices continue to increase.

The fool on the hill sits alone but has the ability to see the big picture.
          Avalon - Unit Manager - RN - Woodland Park Care Center - Salt Lake City, UT   
The Unit Manager will direct the day to day functions of the Nursing Unit in accordance with current federal, state and local standards governing long term care...
From Avalon Health Care Group - Fri, 23 Jun 2017 16:45:49 GMT - View all Salt Lake City, UT jobs
          RELEASE TOUR FOR STORM WATCH   




STORM WATCH
Unfinished Business series, book 3
by Carole Ann Moleti

Genre: Light Paranormal Romance





Mike and Liz thought they'd gotten control of the specters haunting the Barrett Inn. But things get very complicated when they're the ghosts from your past life. The Category Five Hurricane bearing down on Cape Cod appears to be headed directly for them--or has it been spawned from inside them? Knowing it’s their last chance to end the hauntings, Mike and Liz must decide whether to run or to defy evacuation orders. Will they survive the storm?




EXCERPT #1

The engine whined and strained. The boat spun in the eddy, and Liz’s knuckles went white trying to prevent the steering wheel from spinning. Sandra looked like she was going to puke. Harley looked like he wanted to jump overboard.

“Liz, move over to the next seat but keep your hands on the wheel until I get there. Sandra, you and Harley get underneath the cabin into the berths, one on each side, and keep your heads down. We’ve got to stay balanced. This is going to be a rough ride.”

Mike got his ass in the seat, turned catty corner into the waves, and gunned the engine. The Whaler, made for stability in the surf, cut through it but crashed and rocked wildly between the swells. An air horn rolled back and forth across the deck, adding the effect of a ticking clock to an already nauseating ride.

The cuddy cabin kept the worst of the spray off them, but Mike had to unzip his roof panel and stand up to see over the salt encrusted windshield. A wave lifted the entire boat out of the water.

“Hang on!” He crouched and braced for impact. I hope everyone is where they’re supposed to be or we’ll flip. His lungs were about to burst.

The door thudded from side to side in knee-deep water. The motor bobbled and threatened to stall as the propeller came out of the water. He’d been out in weather this bad, but his two-way radio had been on and someone knew where he was.

EXCERPT #2

He passed the living room where the flashback of an emaciated Mary, in a hospital bed, being tended to by a hospice nurse, wiped all the good feelings away. He pushed past it, into the kitchen.
Mary stood at the stove, stirring and filling bowls with noodles and dumplings and gravy. He smelled lily of the valley, her favorite perfume. Wine-tinged bile rose into his throat. The light dimmed, and all the other voices in the room went silent as she hummed some catchy 80’s tune. The glass fell from his hand and shattered, but he didn’t hear the glass breaking or feel the blood-red wine soaking his feet.

“Dad! You okay?” Allison ran toward him.

The room brightened. “Yeah, my hands were still wet.” He eased himself down to the floor to pick up the glass shards.

“Careful, don’t cut yourself.” Mary knelt beside him. Her hair smelled like lily of the valley as it brushed his cheek.

Mike reached for her, and tumbled into the void when she vanished. He landed on the heel of his hand, miraculously avoiding the splintered glass, coughed, and shook it off. “Get me a paper towel. Damn. Waste of good wine.”

Jay stared. Dana brought a roll of paper towels.

Allison mopped up the spill. Concern etched her face. “Dad, you’re exhausted!”

His cheeks burned, and his hear raced. Mike tried to act nonchalant and hauled himself up. “Yeah, I’m tired. And hungry. Let’s eat.”









Liz Levine is convinced her recently deceased husband is engineering the sequence of events that propels her into a new life. But it’s sea captain Edward Barrett, the husband that died over a century ago, who has returned to complete their unfinished business. Edward’s lingering presence complicates all her plans and jeopardizes a new relationship that reawakens her passion for life and love. What are Captain Barrett’s plans for his wife, and for the man who is the new object of her affections?





Mike and Liz Keeny are newlyweds, new parents, and the proprietors of the Barrett Inn, an 1875 Victorian on Cape Cod, which just happens to be haunted— by their own ghosts from past lives. The Barrett Inn had become an annex of Purgatory, putting Liz and their infant son in danger. Selling the historic seaside bed and breakfast was the only answer, one that Liz and her own tortured specter refused to consider. Were Mike and Liz doomed to follow the same path that led to disaster in their previous lives? Was getting out, getting away, enough?







Carole Ann Moleti lives and works as a nurse-midwife in New York City, thus explaining her fascination with all things paranormal, urban fantasy, and space opera. Her nonfiction focuses on health care, politics, and women's issues. But her first love is writing science fiction and fantasy because walking through walls is less painful than running into them.

Books One and Two in the Unfinished Business series, Carole's Cape Cod paranormal romance novels, Breakwater Beach and The Widow's Walk, were published by Soulmate. Book Three, Storm Watch, is due out June 28,2017. 

Urban fantasies set in the world of Carole's novels have been featured in Haunted: Ten Tales of Ghosts, Seers: Ten Tales of Clairvoyance, Beltane: Ten Tales of Witchcraft, and Bites: Ten Tales of Vampires.

Carole also writes nonfiction that ranges from sweet and sentimental in This Path and Thanksgiving to Christmas to edgy and irreverent in the Not Your Mother's Books: On Being a Mother and On Being a Parent.

Facebook ✯ Website ✯ Twitter ✯ Goodreads ✯ Amazon ✯ Blog ✯ Pinterest ✯ G+


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          COVER REVEAL FOR STORM WATCH   


STORM WATCH
Unfinished Business series, book 3
by Carole Ann Moleti

Genre: Light Paranormal Romance
Cover Designer: Wren Taylor




Mike and Liz thought they'd gotten control of the specters haunting the Barrett Inn. But things get very complicated when they're the ghosts from your past life. The Category Five Hurricane bearing down on Cape Cod appears to be headed directly for them--or has it been spawned from inside them? This may be their only chance to vanquish the specters--if they survive the storm.



Mike and Liz had survived the first round, and they’d remained hopeful the specters would settle down. But there was enough unfinished business for any cosmic disturbance to rile them up again. This storm watch was more than just a minor blip on the radar—or a coincidence. 

Noisy seagulls hunted as the storm with enough power to blow them to Rhode Island threatened. Mike rolled his shoulders, flexing the stiff muscles in his back, trying to imagine he could shed his wife and his son to escape the gaping jaws of Captain Edward Barrett’s legacy. Normally a lingering vague threat, it rubbed him raw at moments like this when he had nothing to do but wait for the bay to come in around him so he could go out and make a living. 

He rinsed his hands in a tide pool. The shadow sent hermit crabs scurrying. Brine stung his knuckles but stopped the oozing with that invisible layer of stickiness every saltwater fisherman learns to love. An incoming tide rolled across the flats as the storm clouds amassed.

The boat teeter-tottered on its keel as Mike climbed aboard and settled into a seat. Reassured by the glimmering water rippling in to release him from bondage, he readied his fishing gear. Chants of “ohmmmmm” from morning beach yoga carried in the breeze. At least that was connection with living spirits, as opposed to the dead, stale vestiges of lives ended too soon who were unable to give up and let go. 

A woman out for an early morning walk grew larger and larger. Her broad brimmed hat dipped so low over her eyes he couldn’t see her face, though her skinny legs, matchstick arms, and pigeon chest were unmistakable once she’d emerged from the glare. That, the jangling earrings, and the purple and pink broomstick skirt hitched up and secured with a silver belt. 

“Good morning, Mike.” Always oppositional, Sandra was headed out when everyone was on their way back. 

“Where’re you going, Sandra? Tide’s coming in.”

She flipped up the floppy brim and grinned. “I’m headed over to check on Harley.” 

The Whaler rocked in the surf. “Should be ready to roll in about twenty minutes. I’ll give you a ride over.” 

Sandra didn’t break stride. “That’s okay. I’ll be sitting on the beach with the old buzzard before you even pull up anchor.” 

They were both oddballs: He, wearing a Red Sox cap, a scruffy beard, a black tee shirt showing a bit of belly, while sitting like a bum in a beached boat. Sandra, like an escapee from a Harry Potter novel, headed over to check on a ninety-six-year-old hermit who lived on a dune that was cut off from the mainland at high tide.










Liz Levine is convinced her recently deceased husband is engineering the sequence of events that propels her into a new life. But it’s sea captain Edward Barrett, the husband that died over a century ago, who has returned to complete their unfinished business. Edward’s lingering presence complicates all her plans and jeopardizes a new relationship that reawakens her passion for life and love. What are Captain Barrett’s plans for his wife, and for the man who is the new object of her affections?





Mike and Liz Keeny are newlyweds, new parents, and the proprietors of the Barrett Inn, an 1875 Victorian on Cape Cod, which just happens to be haunted— by their own ghosts from past lives. The Barrett Inn had become an annex of Purgatory, putting Liz and their infant son in danger. Selling the historic seaside bed and breakfast was the only answer, one that Liz and her own tortured specter refused to consider. Were Mike and Liz doomed to follow the same path that led to disaster in their previous lives? Was getting out, getting away, enough?







Carole Ann Moleti lives and works as a nurse-midwife in New York City, thus explaining her fascination with all things paranormal, urban fantasy, and space opera. Her nonfiction focuses on health care, politics, and women's issues. But her first love is writing science fiction and fantasy because walking through walls is less painful than running into them.

Books One and Two in the Unfinished Business series, Carole's Cape Cod paranormal romance novels, Breakwater Beach and The Widow's Walk, were published by Soulmate. Book Three, Storm Watch, is due out June 28,2017. 

Urban fantasies set in the world of Carole's novels have been featured in Haunted: Ten Tales of Ghosts, Seers: Ten Tales of Clairvoyance, Beltane: Ten Tales of Witchcraft, and Bites: Ten Tales of Vampires.

Carole also writes nonfiction that ranges from sweet and sentimental in This Path and Thanksgiving to Christmas to edgy and irreverent in the Not Your Mother's Books: On Being a Mother and On Being a Parent.

Facebook ✯ Website ✯ Twitter ✯ Goodreads ✯ Amazon ✯ Blog ✯ Pinterest ✯ G+


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          Concierge Medicine, Research Round-Up, Whooping Cough - PediaCast 207   
Join Dr Mike this week in the PediaCast Studio as we add to our popular research round-up by shedding new light on old asthma and dehydration recommendations. Plus, tips for reducing the spread of MRSA in your home, concierge health care, and a new strain of whooping cough infecting thousands of kids in Australia.
          Health Care Aide PPT Main North 7-15 - The Good Samaritan Society - Salmon Arm, BC   
Hillside Village, Salmon Arm, BC HEU CLOSING DATE Jun-28-2017 at 1500 hours HOURS OF WORK 0700-1500 Main North but not exclusive to. EMPLOYMENT TYPE... $18.25 - $21.86 an hour
From The Good Samaritan Society - Wed, 21 Jun 2017 19:49:12 GMT - View all Salmon Arm, BC jobs
          GOP touts lower premiums, but other insurance costs to rise   
WASHINGTON (AP) -- Republicans are touting lower premiums under their health care legislation, but that reflects insurance that would cover a smaller share of the cost of medical bills....
          Selling the GOP health care bill: Does Trump help or hurt?   
WASHINGTON (AP) -- It was a platform most politicians can only hope for: A captivated, 6,000-person crowd and more than an hour of live, prime-time television coverage to hype the Republican vision for a new health care system....
          The Latest: Trump promises 'big surprise' on health care   
WASHINGTON (AP) -- The Latest on Republican legislation to repeal and replace the Obama health care law (all times local):...
          A Bunch of Acronyms and Some Trade Politics   
Last February Sarah and I* speculated in a short National Interest article that a EU-US trade deal (Transatlantic Trade and Investment Partnership, or TTIP) could put pressure on the recent prevalence of investor-state dispute clauses (ISDs):
While ISD clauses are widespread, they usually exist within the context of treaties between states characterized by economic asymmetries. For instance, of the more than 2000 bilateral investment treaties (BITs) worldwide, none exist between two advanced industrial countries. The United States generally embraces investor-state dispute clauses; both their model free-trade agreement (FTA) and BIT contain such language. However, it is far from certain that a US-EU treaty would include an ISD clause. Generally, advanced industrial countries have shown they are more interested in promoting legal regimes that protect "their" multinationals while they are less willing to cede jurisdiction over investment disputes in which they might be defendants.
Today, via Simon Lester, we see that the EU is not super-thrilled with the idea of having an ISD in TTIP that is typical of US ISDs, although it's tough to know from the formal language exactly what the EU is after. Or as Lester puts it: 

What are the authors saying here? Are they saying: 
1. Investment protection and investor-state will only be included if high EU standards for investment protection, as opposed to the weaker U.S./Canadian standards, are met? 
or are they saying: 
2. Investment protection and investor-state will only be included if the usual provisions are weakened so as to ensure that public policy objectives can be pursued? 

I don't know the answer (perhaps Sarah could chime in?), but it seems clear that any ISD in TTIP will have to be different than that in the model US bilateral investment treaty. So far our article is holding up pretty well.

Meanwhile, Eyes on Trade doesn't like Obama's secrecy on another potential trade deal, the Trans-Pacific Partnership (TPP)**. They also nail the reason for the secrecy:
So why keep it a secret? Because Mr. Obama wants the agreement to be given fast-track treatment on Capitol Hill. Under this extraordinary and rarely used procedure, he could sign the agreement before Congress voted on it. And Congress’s post-facto vote would be under rules limiting debate, banning all amendments and forcing a quick vote.
Eyes on Trade think all of this is severely crippling democracy. In a way it is, it by "democracy" you mean legislators favoring parochial interests over the good of the nation as a whole. The Congress has often given the President fast-track authority. Clinton had it for part of his terms. George W Bush had it for most of his. The reason for this is so that individual Congresspeople can't fiddle with the deal in order to privilege local constituencies after its been agreed to by the negotiators of both sides. It's basically a legal way to curtail rent-seeking exceptions and other Congressional shenanigans. These are generally questionable on welfare grounds when things like tax bills are being debated, but when negotiating a trade deal they can be deadly: each new Congressional exception has to be approved by the foreign party, which will likely demand further concessions in exchange, which would have to be approved by Congress in turn, etc. Each iteration of this lowers the chance of any deal being reached. Fast track authority cuts that process out. Interested groups can still lobby the US Trade Representative, and Congress still has to approve any deal, so it's not exactly undemocratic. But fast track makes the policy process more efficient.

Obama hasn't been given fast track authority. Democrats have typically been skeptical of trade deals -- remember that renegotiating NAFTA was a big issue during the 2008 Democratic primary -- and Republicans seem intent on blocking anything Obama chooses to do on grounds of principle. It doesn't seem to have been a major priority for Obama until now, as he's preferred to focus on health care, immigration, and other issues first. But without fast track trade deals are much more difficult to complete. So much so that foreign countries often prefer not to negotiate at all because they know that whatever agreement they reach will end up being altered by Congress. Given that, what's the point of negotiating in the first place?

Although they are fairly obscure these issues are quite important. I continue to think there's a decent chance that Obama gets fast track, and if he does that some deals will get done. The business community is very interested in seeing agreements made, so they will likely push the GOP to give in to Obama. Democrats are a bit less enthusiastic, but are more likely to give Obama authority than they would be to lengthen Romney's leash. And if Sarah and my article is correct, there are not many important interest groups that oppose a EU-US deal. The TPP makes sense in a number of ways as well.

All of this remains to be seen of course, but I'm still pretty optimistic that we'll see some movement on trade during Obama's second term.

*Really Sarah. She knows much more about ISDs than me and wrote that part of the article more or less on her own.

**Yes I know. TPP and TTIP and ISDs, oh my.
          Pfizer & Allergan Combining In $160 Billion Deal   
Pfizer and Allergan will join in a $160 billion deal to create the world's largest drugmaker. It's the biggest health care deal ever and the largest so-called inversion in history.
          Pfizer, Allergan In Deal Talks To Create Drug Giant   
Pfizer and Botox maker Allergan are discussing a potential deal that could be the biggest of 2015, a year marked by a rapid-fire pace of megadeals, particularly in health care.
          President Obama Health Care XXX Parody   
Watch President Obama Health Care XXX Parody at XXXPorn.rs - best free online XXXPorn videos for you to enjoy.
          Montana Special Election Shows What Is Wrong With Early Voting   
I have never been a fan of early voting, but after last night's debacle in Montana I am dead set against it.

For those who haven't been paying attention, on the eve of a special election Montana GOP congressional candidate Greg Gianforte, "body slammed" Guardian reporter Ben Jacobs who dared to try to ask the candidate about the CBO scoring of the Republican health care plan.  Then to compound matters Gianforte's campaign issued a press release blaming the incident on the reporter. NPR reports:
Gianforte's campaign spokesman claimed in a statement that Jacobs interrupted an interview "without permission, aggressively shoved a recorder in Greg's face, and began
asking badgering questions.

"After asking Jacobs to lower the recorder, Jacobs declined. Greg then attempted to grab the phone that was pushed in his face. Jacobs grabbed Greg's wrist, and spun away from Greg, pushing them both to the ground," Gianforte spokesperson Shane Scanlon said. "It's unfortunate that this aggressive behavior from a liberal journalist created this scene at our campaign volunteer BBQ."
Unfortunately for Gianforte, Jacobs had an audio recording of the altercation and Fox News reporters were nearby waiting to interview Gianforte.  The recording and the Fox reporters contradicted Gianforte's "alternative facts" his campaign tried to spin, namely that Jacobs and not Gianforte instigated the incident.  Gianforte has been charged with misdemeanor assault.

As a result of the attack, several Montana newspapers immediately revoked their endorsement of Gianforte.  But the wannabe thug will probably get elected to Congress despite widespread negative publicity the day before the election.  Why?  Because close to 70% of Montanans have already cast their ballot due to the state's liberal early voting laws.

I am not against making voting easier.  In fact, I am a strong supporter of vote centers, which would allow voters to cast ballots at any county voting location on Election Day.  As far as early voting, that reform has not been shown to increase participation, but only changes when people who are going to vote cast their ballots.  But the negative is that early voting results in people casting ballots long before the campaign narrative has played out  It is like allowing jurors to cast votes in a trial before all the evidence is in.  Well, in politics, all the evidence is not in until Election Day.  Sadly 70% of Montana voters are stuck with a choice many of them now regret.

Hopefully, the Gianforte experience will help put the brakes on early voting.
          Indiana's Government Ranks Best in the Nation   
The Indianapolis Star reports:
Indiana's government is the best in the nation, according to a new U.S. News & World Report list of "Best States." 
The survey ranked the 50 states in seven key categories. Massachusetts' No. 2 ranking in health care and No. 1 ranking in education were key reasons why it's at the top of the list. Indiana ranked No. 22, just behind Delaware and Rhode Island. 
Indiana didn't do as well in health care (41) and education (27), but two areas where Hoosiers shone, according to the web-based media company, were in government (No. 1) and opportunity (No. 4). 
Indiana's excellent credit rating, low pension fund liability, budget transparency, use of digital technology and overall fiscal stability were key to its success in the government category. The opportunity category included areas such as economic opportunity, equality and affordability.
I've long had to listen to the nonsense from Hoosier critics that Indiana has the "worst legislature," a description often attributed to the late Nuvo editor Harrison Ullmann. As someone who worked at the Indiana General Assembly and taught about how state legislatures across the country operate, I have always known that what happens at our General Assembly is not unique to this state. The operational and substantive issues that arise in the Indiana General Assembly aren't any different from those dealt with by other state legislatures. Indiana's legislature and executive branches, for all their flaws, operate remarkably well when compared to other states. It is good to see the U.S. News and World Report set the record straight.
          In McConnell’s home state, fear and confusion over health care bill   
Dewey Gorman, a 59-year-old banker who has struggled with opioid addiction, had just gotten out of the hospital in this tiny central Appalachian city when he heard the word from … Click to Continue »
          Director of Nursing - DON - Woodland Park Care Center - Salt Lake City, UT   
Avalon Health Care is seeking a dependable, organized and dedicated Registered Nurse with great leadership skills to join our outstanding team as a Director of...
From Avalon Health Care Group - Fri, 23 Jun 2017 16:45:53 GMT - View all Salt Lake City, UT jobs
          Avalon - Unit Manager - RN - Woodland Park Care Center - Salt Lake City, UT   
Avalon Health Care is seeking a dependable, organized and dedicated Registered Nurse (RN) to join our outstanding team as a Unit Manager!...
From Avalon Health Care Group - Fri, 23 Jun 2017 16:45:49 GMT - View all Salt Lake City, UT jobs
          Respiratory Therapist - Full Time - Woodland Park Care Center - Salt Lake City, UT   
Avalon Health Care is seeking a dependable, organized and dedicated Respiratory Therapist to join our outstanding team!...
From Avalon Health Care Group - Wed, 14 Jun 2017 17:27:09 GMT - View all Salt Lake City, UT jobs
          Governors, Mayors Come Out Against Senate Health Care Bill   
It’s hard to find much of anyone on board with the Senate’s health care bill. Senate Majority Leader Mitch McConnell announced this afternoon that he...
       

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          Administrative Clinical Assistant - Health Care - NetHire Recruiting - Toronto, ON   
Administrative Clinical Assistant - Health Care Toronto, Ontario About Us : Our health care office in Toronto. Our facility is equipped with the newest
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          Communicative Disorders Assistant For Audiology - NetHire Recruiting - Toronto, ON   
This position is located in Yorkville- Toronto This position will involve 4 days per week and approximately 30 hours per week. About Us : Our health care
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          Director of Nursing - DON - Woodland Park Care Center - Salt Lake City, UT   
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          Avalon - Unit Manager - RN - Woodland Park Care Center - Salt Lake City, UT   
Must be a Registered Nurse (RN) in good standing and currently licensed by the State; Avalon Health Care is seeking a dependable, organized and dedicated...
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          Intake Therapist - Full Time Graves - Salt Lake Behavioral Health - Salt Lake City, UT   
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          Psychiatrist - Salt Lake Behavioral Health - Salt Lake City, UT   
Universal Health Services, Inc. (UHS) is one of the nation's largest and most respected health care management companies, operating through its subsidiaries...
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          Medical Director -Psychiatrist - Salt Lake Behavioral Health - Salt Lake City, UT   
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          Trump Optimistic on Health Care Overhaul, But Concedes It Will Be 'Very Tough'   
President Donald Trump voiced optimism Wednesday that fractious Republican senators would be able to reach agreement to overhaul national health care policies, but he concedes it will be "very tough." "I think we’re going to get at least very close, and I think we’re gonna get it over the line," Trump said. He offered his assessment the day after Senate Republican leader Mitch McConnell dropped plans to vote this week on a Republican proposal to dismantle much of the...
          GOP touts lower premiums, but other insurance costs to rise   
WASHINGTON (AP) -- Republicans are touting lower premiums under their health care legislation, but that reflects insurance that would cover a smaller share of the cost of medical bills....
          Louisiana Appeals Court Affirms Class Certification In Reimbursement Dispute   
LAKE CHARLES, La. - A Louisiana appeals court panel on Feb. 1 affirmed the grant of class certification in a case alleging that a health care provider impermissibly demanded and/or collected sums in excess of the discounted rates negotiated with the plaintiffs' health insurers (Keisha Desselle, et al. v. Acadian Ambulance Service Inc., No. 11-742, La. App., 3rd. Cir.; 1012 La. App. LEXIS 101).
          Staff Nurse (RN / LPN) - BAYADA Home Health Care - Saylorsburg, PA   
Contact for more information:. If you are a Registered Nurse - RN or a Licensed Practical Nurse - LPN looking for an opportunity to work in home care, join...
From BAYADA Home Health Care - Sat, 15 Apr 2017 08:22:02 GMT - View all Saylorsburg, PA jobs
          Let's Pretend: A Civil Health Care Discussion   

I should probably accept that corporate and deeply entrenched political interests would not allow a comprehensive health care system to gain traction in the United States. Yet I can’t let go. One of the things that hurt me deeply is the lack of civil public discourse. It could have been different. Come with me to the set of the imaginary Vixen News Network as Becky Glenne shows us how it could have been possible for pundits to peacefully share differing opinions on health care reform.
Stethoscope on Indian banknotes of different denominations

Becky Glenne/VNN: Thank you H.C. Andersen for that follow-up report on the tragic situation the nation has come to know as “The Little Match Stick Girl.” Her identity is still unknown at this time. I have been joined by a panel of bloggers who have strong opinions and, at times, the facts to back them up.

Each of the panelists has been given the question “How does the death of The Little Match Stick Girl relate to the health care debate in the United States?" The order of the panelists has been selected by random draw to prevent accusations of favoritism.

VNN: Fulvia Tiberius, how does this tragic incident relate to the health care debate?

Fulvia: Well, Becky, as far as I can see it has nothing to do with it. It does speak to a higher natural law of survival of the fittest. It is indeed a shame a life has been lost, but I nor should anyone else feel that they have a so-called moral obligation to help, aid or assist another human being unless it is in that specific person’s vested interest to do so.

I reject the intervention of the government into private matters. I oppose the use of any federal state or local taxes to help or prolong the existence of vulnerable or unproductive members of the society. Let the market and environmental forces regulate the health care needs and wishes of the nation. Allow the forces of nature to adjust the population accordingly.

VNN: Germana Servius, your response to the relationship between The Little Match Stick Girl and health care reform, please.

Germana: When compassion is measured in dollars and cents terms, I am deeply saddened. It is not that we are incapable of designing a fair and equitable heath care system, it is that we are profoundly selfish and unwilling to provide the quality of services that members of Congress have currently enjoyed for years. I believe that no child or adult for that matter should be denied affordable health care.

If we seriously looked at waste and fraud within the federal budget, we could have the kind of coverage we could be proud to have as citizens. Stopping an illegal war would go a long way to providing health care funding.

VNN: I wish to remind the panel that the subject is health care, and to the extent possible please confine your responses to that topic. The next name to be drawn is Sabina Aculeo.

Sabina: Socialism! The victim mentality will destroy the nation. Give me my country back!

VNN: That is it? That is your entire response?

Sabina: Yes.

VNN: Moving on, up next is Claudia Laterensis.

Claudia: Glad to be here, Becky. Look,  there is a finite amount of money. We as a nation cannot fund every well meaning but financially unrealistic desire each citizen might want to have in terms of governmental services. Just as in our personal lives, we have to be fiscally prudent in our national spending.

However, there does need to be some form of a health support system. It would be unrealistic and in fact dangerous not to have a base level of health care resources as the incident with The Little Match Stick Girl illustrates.

Is this the time to implement a full-scale health delivery system? I don’t think so, but it might be a time of public/private option that does not require the full engagement of government support.

VNN: Finally we have Marcella Plauta to give her response to the topic.

Marcella: Thank you, Becky. It is the gift of passion and concern that has engaged the nation in this debate. Quite honestly, it has been a challenge to hear authentic and not politicized voices. I want no less than what the majority of industrialized nations have, an equable and accessible health care system.

It does not make me disloyal to my country to want to be able to obtain health treatment without losing my home, my stability or my piece of mind. It should not be a reflection of my character if I believe the interference for profit of the health insurance companies is not the best way to administer health treatment in this country.

I am profoundly disappointed that Congress and both political parties could not create a cohesive workable solution for the nation. There is only one approach at this time; a single-payer plan that does not involve the health insurance industry. This will happen, maybe not in my lifetime, but it will happen.

And so another dream of an engaged population rising above partisanship is once again deferred. Perhaps the next time.

Blogs to Consider If You Are Looking for Alternate Views:

Objectivists

Liberal/Progressive Blogs on Health Care

Conservative/Libertarian

Gena Haskett is a BlogHer CE. Blogs:Out On The Stoop and Create Video Notebook


          HHA - Home Health Aide & CNA - Certified Home Health Aide - Infinity health Care Services, LLC - Morrisville, PA   
Home Health Aides also assist the patient with activities of daily living which include light housekeeping and meal preparation, dressing, eating, bathing,...
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          Certified Nurse Assistant CNA **$1,000 Sign On Bonus** Day Shift - Woodland Park Care Center - Salt Lake City, UT   
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          Certified Nurse Assistant CNA **$1,000 Sign On Bonus** EVENING 2pm-10pm - Woodland Park Care Center - Salt Lake City, UT   
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          Sen. Rand Paul calls Republicans ‘their own worst enemy’ on health care bill   
"We’re splitting the difference with Republicans who want to keep Obamacare."
          Rev. Al Sharpton Covers The Latest On The Healthcare Bill   
06/28/17 – Reverend Al Sharpton encourages people to remain steadfast in the fight against the Senate health care bill despite its latest hiccup. Like BlackAmericaWeb.com on Facebook. Follow us on Twitter and Instagram Sign Up For Our Newsletter!
          Voices of Women with Host Kris Steinnes: Dr. Barb DePree's Recipe for Lifelong Intimacy   
EpisodeAn essential guide to sexual health at midlife and beyond for women and the men who love them, Yes You Can: Dr. Barb’s Recipe for Lifelong Intimacy offers sound medical advice that will empower women to remain as sexually active as they wish for as long as they choose. Reflecting Dr. Barb DePree's decades of experiences providing health care for women, this collection from her “MiddlesexMD” blog posts covers the entire recipe for sexual health.  She provides sound, rea ...
          STNA/Home Health Aide - Algart Health Care - Cleveland, OH   
Required license or certification:. Please email me your present place of employment and past employers. Algart is located on Cleveland's West side.... $12.50 an hour
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          Voices of Women with Host Kris Steinnes: Energy Medicine with author Donna Eden   
GuestEnergy medicine is a powerful approach that is easy to learn. It works with energy as a vital, living, moving force that is at the foundation of our well-being. In energy medicine, you heal the body by activating its natural healing energies and also by restoring energies that have become weak, disturbed, or out of balance. Its applications extend far beyond the health care setting, into business, education, government, spiritual development, and family life everywhere that people wish to b ...
          Yaampi born, the social network of health professionals   

www.Yaampi.com, is an online platform which aims, firstly to offer a unique online community environment and aimed at health professionals, where they can share health medical knowledge, engage in dialogue, debate and research with colleagues around the environment Hispanic and other directory or guide health professionals segmented by specialty and geographic area where professionals get network presence in order to be able to offer their services to the market and patients will with the possibility of finding professional character and health centers.

Yaampi.com after only a few weeks of its release and has several thousands of Latin American professionals in the directory, has the support of a group of major companies and institutions in Latin America and Spain and is geared to meet the needs of communication, management knowledge, socialization and promotion of Latin American health professionals and contacting a coordinated manner to professionals and patients.

The Health Latin American environment is characterized by high fragmentation, coexisting various agents, health care providers, government, financial, professional and objective of a mission Yaampi is centralizing all these agents and optimizándoles enabling communication and relationship between them, in addition to functioning as a medical knowledge base which a party may be made available to patients, such as tips and healthy habits, self-care, awareness campaigns or online diagnostic system.

Yaampi named Quetchua expression "jampi or jampix" which means "the healer"


          Ten tips to enjoy the sun safely   

It is a disturbing fact because if it is true that the sun has beneficial effects on our mood, our health ..., you can also have serious adverse effects, and it is essential to apply a series of measures to protect us against them.

The medical adviser Cinfa, Aurora Garre, said that "the sun can cause irreversible damage to expose our skin if he does not take appropriate protective steps." The most frequent and visible injuries are burns and photoaging, caused by ultraviolet radiation (UVB) and UVA radiation, but Dr. Garre explained that "our skin can also suffer long-term injuries potentiated by radiation which does not feel The Infrared A (IR-A), which is about 20% of the solar radiation. It is a dry heat, as the temperature increases skin surface, not feel. Yet radiation plus ultraviolet very detrimental, because penetrate deeper layers of the skin, our cells attacking compounding the effects of UV radiation, causing premature aging and damage cellular DNA precursor of precancerous lesions of the skin such melanoma. "

Therefore, it is absolutely necessary fotoprotegerse in a correct and complete, since, as Cinfa ensures expert, "the skin has memory and sun damage accumulates over time. Well today means health care for tomorrow."

Decalogue for proper sun protection tips:
1. Prepare our defenses with a diet rich in antioxidants.
Antioxidants reinforce our skin's natural defenses against the aggressions of the sun. A diet rich in fruits and vegetables with vitamin E and vitamin C can help as well as an extra supply of these vitamins in the form of nutritional supplements. You can consult your pharmacist.

Two. Use sunscreens scientifically supported that protect against UVA, UVB and IR-A.
Depending on skin type, apply a sunscreen with SPF 30 or more. Only some sunscreens also include assets that fight the harmful effects of infrared radiation A.

Three. Using sunscreens correctly.
It is necessary to extend 30 minutes before sun and reapply every two hours and after bathing or drying them with the towel. Once opened, should be used in the given period to avoid losing their effectiveness.

April. View ultraviolet and infrared indices.
Before sun exposure, it is recommended that these levels information through channels such as the Spanish Meteorological Agency (AEMT). Help plan outdoor activities and avoid exposure in the days when radiation levels are more harmful.

May. Avoid sun exposure in the middle of the day.
The sun's rays are strongest between 12 am and 4 pm and therefore more damaging.

June. Protecting the body and head with loose clothing and a hat.
Protect other areas of the body that are often neglected and they also suffer the harmful effects of solar radiation, such as feet and ears.

July. Wear sunglasses to prevent eye damage.
It is necessary that the glasses have 100% protection against UV rays, as well as the certificate of having passed all European Union controls.

August. The shade, a good ally.
Make use of the shade in the open is a good measure photoresist. Remember that umbrellas, awnings and trees do not fully protect against solar radiation, so it will be necessary to apply protection.

9. Extreme caution in any outdoor activity.
The reflected solar radiation in case of snow (80%), sand (25%) and water or grass (10%) making them add their effects to impact directly on the skin. In these cases should be used with higher factors photoresists.

10. Protect all year.
Even in summer there are more daylight hours and increased levels of solar radiation, the sun's effects are present 365 days a year, even in winter when there is less sunlight or when it is cloudy, so it is necessary to protect forever.


          Cristiano Ronaldo Healthier Player Award of Real Madrid   

The Real Madrid's Portuguese striker Cristiano Ronaldo, has been chosen by the club's fans as the team player Healthier white 2012-2013 season. Thus, fans have chosen the player, which they consider deserving of this award given Sanitas, through their votes on the Facebook profile of the company.

The ceremony will take place tomorrow at the Santiago Bernabeu during the previous match between Real Madrid and Osasuna in the last game of the season. Iñaki Peralta, CEO of Sanitas Hospitals will be who will present this award to the Real Madrid player.

Sanitas, as official medical provider of Real Madrid since 2008, has provided the club its commitment to healthy sport, their medical knowledge as well as major technological advances and health care that puts the company at the forefront of sports medicine.


Photograph by Addesolen (Own work) [CC0], via Wikimedia Commons


          Individualized glycemic control in diabetic elderly patient   

 Zaragoza, May 27, 2013 - The prevalence of type 2 diabetes increases with age and it is estimated that, worldwide, over the next two decades the epidemic of this disease will be particularly significant in the population over 65 years .

 
In Spain, according to Di @ betes1 study, the prevalence of diabetes in elderly patients over 75 years is about 30% of the population and is almost 40% older than 85 years.
 
Given this situation and the XX Congress of General and Family Medicine, held in Zaragoza, organized the meeting Novartis 'therapeutic targets in the elderly diabetic patient' in order to discuss the main challenges in addressing elderly patient with type 2 diabetes.
 
According to Dr. Carlos Miranda Fernandez-Santos, Family Medical Health Center Buenavista Toledo, coordinator of the Spanish Diabetes Society of General Practitioners and Family (SEMG) and moderator of the meeting: "The aim of This meeting focuses on addressing diabetes and other cardiovascular risk factors in the context of the elderly patient. "
 
The elderly diabetic patient has specific as the presence of comorbidities, a high clinical heterogeneity geriatric symptoms (cognitive impairment, depression or falls) and an increased risk of morbidity and mortality, among others, that necessitate a specific approach of the pathology. In this sense, says Dr. Miranda Fernandez-Santos "when treating a patient with these characteristics is necessary to individualize each case, since as stated Consensus Document on the treatment of elderly diabetic patient, which has participated and endorsed the SEMG, therapeutic goals in diabetic elderly patients vary with age and the patient's own situation. "
 
Among the topics covered in the panel discussion included the reflection on the importance of glycemic control targets to achieve a correct approach to the elderly diabetic patient. According to Dr. Francesc Formiga, program director of Geriatrics, Internal Medicine Hospital of Bellvitge in Barcelona, ​​"the goals of glycemic control of elderly patient should be individualized and always take into account the patient's opinion and involve you in the whole process . Although therapeutic options are the same as for the young, the elderly, these options will have to be adapted to various aspects such as kidney function, frailty, decreased visual acuity, the presence or absence of a qualified, among others, always depending on the patient's profile. "
 
The duration of diabetes and total life expectancy and active patient are of great importance to the planning of therapeutic goals. So says Dr. Formiga "in deciding the therapeutic goals should be considered two different scenarios: first, in the elderly with functional and cognitive capabilities preserved without major complications or comorbidities and good life expectancy, are recommends a target HbA1c of 7% -7.5%. Moreover, in the group of frail elderly with disabilities (physical and / or cognitive) and major complications and / or comorbidities, and a short life expectancy, the control objectives should be less stringent (HbA1c 7.6 % -8.5%). Clearly, the low life expectancy disappear from view very strict control objectives that provide benefits in the medium to long term. "
 
Another issue discussed at the meeting refers to the use of dipeptidyl peptidase 4 (IDPP4) compared with sulfonylurea-based treatments in the elderly with diabetes. In the words of Dr. Concepcion Vidal, Deputy Department of Endocrinology and Nutrition, Hospital Royo Villanova Zaragoza: "The drugs IDPP4 are easy to handle in a single daily dose or in two doses in combination with metformin, with similar reductions in HbA1c and little risk of hypoglycemia. Meta-analyzes with IDPP4 in large population samples seem to show that their use reduces the risk of cardiovascular events, particularly myocardial infarction and mortality from all causes in people with type 2 diabetes, this treatment caused positioned as the optimum in all phases of the disease. In this sense, his qualification is suited to situations of renal failure and its use is becoming widespread in both elderly and in patients debutantes more evolved ".
 
Finally, experts have debated the factors that limit the elderly diabetic patient management in primary care. According to Dr. Francisco Key, Medical Primary Care Service Hospital High Resolution The Toyo Almeria, "the elderly patient with type 2 diabetes has a number of characteristics and constraints that must be considered when using or most suitable drugs: on one hand, the quality of life, to be good or acceptable in some cases, while in others there will be a significant reduction in patients instrumental abilities and high comorbidity, and secondly, chronic complications, for some patients present micro and macrovascular complications, while in others, the newly diagnosed, it will be little or no ".
 
Dr. Francisco Key has also stated that neither "can forget the major geriatric syndromes that, by themselves, can condition treatment and reduce life expectancy, such as cognitive impairment, depression, accidental falls, polypharmacy, urinary incontinence or chronic pain, to name the most common. "
 
About Novartis
Novartis AG (NYSE: NVS) provides solutions for health care consistent with the needs of patients and societies. Focused exclusively to the area of ​​healthcare, Novartis offers a diversified portfolio of products respoder these needs: innovative medicines, eye care, high quality generic drugs that help save cost, preventive vaccines and diagnostic tools, OTC; and Animal Health. Novartis is the only company that has achieved a leadership position in these areas. In 2012, the Group achieved net sales of 56,700 million USD and invested approximately U.S. $ 9,300 million (9,100 million excluding asset impairment depreciation and amortization) in R & D. Headquartered in Basel, Switzerland, the Novartis Group companies employ approximately 129,000 associates and operate in more than 140 countries worldwide. For more information, please visit http://www.novartis.com and http://www.novartis.es sites.
 
 
References:
 
1. Soriguer F, Goday A, Bosch-Comas A, Bordiú E, Calle-Pascual A, Carmena R, Casamitjana R, Brown L, Castell C, Catala M, Delgado E, Franch J, Gaztambide S, Girbés J, Gomis R, Gutiérrez G, López-Alba A, Martínez-Larrad M. T, Menéndez E, Mora-Peces I, Ortega E, Pascual-Mannich G, Rojo-Martínez G, Serrano-Rios M, Valdés S, Vázquez J. A Vendrell J. Prevalence of diabetes mellitus and impaired glucose regulation in Spain: the Di@bet.es Study. 2011

 


Image By IntDiabetesFed [Public domain], via Wikimedia Commons


          Increases eficiacia assisted reproduction treatments in Spain   

Subject matter experts will present the latest updates on treatments and reproduction techniques, in the context of fertility experts today symposium organized by MSD, held in Malaga on 10 and 11 May.

 "This symposium is an opportunity to bring together most professionals working in human reproduction to discuss current issues related to our specialty," said Dr. Buenaventura Coroleu, Head of Reproductive Medicine Dexeus University Institute and one of the speakers at the meeting. Among the novelties, Dr. Coroleu highlights "the analysis of the new options for preservation of fertility, both medical cause as the patient voluntary desire, as well as developments in diagnostic and therapeutic options for patients with poor response to Assisted reproductive cycle or ovarian stimulation treatments oocyte donors. "

As part of the symposium, Dr. Buenaventura Coroleu, Head of Reproductive Medicine Dexeus University Institute, explained that "evolution in assisted reproduction techniques in the last ten years has been very positive. Mainly by the simplicity of the treatment of ovulation stimulators, where stands for example the use of alpha coriflolitropina, which reduces the need punctures seven day to one week, a reduction in adverse effects such as ovarian hyperstimulation and multiple pregnancies. Finally, is the increase of efficiency, with a significant increase in pregnancy rates. "

Efficacy, safety profile and convenience considerations for choosing treatment

The Symposium also analyzed aspects to consider when choosing the right treatment for each patient. Dr. Coroleu notes that "the efficacy, safety profile and convenience are the most important keys to the choice of treatment. Of course, we must take into account the age of the patient, her Body Mass Index (BMI), hormone profile and ovarian reserve ". Whether the patient must be involved in the choice of treatment, Dr. Coroleu believes that "the most important is choosing the best technique and drugs for each patient. Considering this aspect, patients are concerned about the comfort of the treatment, and in these cases we have alternatives to conventional shots mean less patient. This is the case of alpha Corifollitropin. One treatment that has demonstrated efficacy and good safety profile for women who are going to be subjected to a cycle of in vitro fertilization ".

Corifollitropin alpha (ELONVA ®) is a subcutaneous injection for ovarian stimulation the patient is applied once a week1, achieving, with a single injection, the same efficiency as a daily injection of recombinant follitropin for seven days1, 2.
 
The couples come with misinformation to the first consultation

Dr. Buenaventura Coroleu noted the importance of the information given to the patient before starting any treatment: "More and more couples who come to see for reproductive problems more familiar with the different techniques. But, many times, we must clarify doubts arising from an excess of information is not always true. " Dr. Coroleu has pointed to the important work done by the scientific societies in this field "spend much of their efforts to disseminate scientifically correct".
 
About MSD

Today's MSD is a global healthcare leader working to contribute to global health. MSD is known as Merck & Co., Inc. in the U.S. and Canada. Through our medicines, vaccines, biologic therapies, and consumer products veterinarians we work with customers and operate in more than 140 countries to deliver innovative health solutions. We also demonstrate our commitment to increasing access to healthcare through far-reaching policies, programs and partnerships. For more information visit www.msd.es and follow us on Twitter, Facebook and YouTube.

Forward-Looking Statements

This press release contains "forward-looking statements" as that term is defined in the Reform Act Private Securities Litigation United States (1995). These statements are based on current beliefs and expectations of Merck's management and are subject to significant risks and uncertainties. If underlying assumptions prove incorrect or risks and uncertainties materialize, actual results may differ from those discussed in the forward-looking statements.

The risks and uncertainties include, among others, general industry conditions and competition, general economic factors such as interest rate or currency exchange rate fluctuations, the impact of pharmaceutical industry regulation and legislation health care in the United States and internationally, the global trend towards restricting pharmaceutical expenditure, advances in technology and new products and patents attained by competitors; challenges inherent in new product development, including obtaining the approval of regulatory agencies, the ability of MSD to accurately predict future market conditions, difficulties and delays in the manufacturing process, the financial instability of international economies and sovereign risk, the dependence of the effectiveness of patents and other protections for innovative products from MSD, and the exposure to litigation (including those relating to patents) and / or regulatory actions.

Merck undertakes no obligation to publicly update any forward-looking statement, whether as a result of new information, future events or otherwise. Additional factors that could cause actual results to differ materially from those described in the forward-looking statements may be found in Merck's Annual Report 2012 on Form 10-K, and other documents of the Company filed with the Commission Stock Exchange and Securities and Exchange (SEC) which are available on the website of the SEC (www.sec.gov).
 
References:

    ELONVA datasheet
    Devroey P, Boostanfar R, Koper NP, Mannaerts BM, PC Ijzerman-Boon, Fauser BC. A double-blind, non-inferiority RCT Comparing alfa and recombinant FSH Corifollitropin During the first seven days of ovarian stimulation using a GnRH antagonist protocol. Hum Reprod. 2009, 24: 3063-3072.


Fotografía: See page for author [Public domain], <a href="http://commons.wikimedia.org/wiki/File%3ASperm-egg.jpg">via Wikimedia Commons</a>


          Early antibiotic treatment of severe sepsis   

Infectious disease specialists have advocated the early use of highly active antibacterial antibiotics to reduce the number of deaths caused by severe sepsis in the scientific session entitled "Facing the dilemma of mortality and resistance in Gram-positive infections" organized by Novartis under XXIII European Congress of the European Society for Microbiology and Infectious Diseases (ESCMID). This disease, which is often confused with 'blood poisoning', is one of the leading causes of mortality in the world 4, which could be significantly reduced with the use of drugs active against Gram + from Time 0 in which active sepsis5 code.

Sepsis or sepsis is the body's response to infection, either extra-or hospital, more frequent due to the immune status of patients and increased invasive techniques, intravenous catheters, prostheses and implants intravasculares1, 6. It is a disease whose incidence increases 2% annually and that records 18 million cases per year worldwide. Only in Spain are detected daily one to two new cases of severe sepsis per 100,000 inhabitants. Has a mortality rate of 50% 2 in case of septic shock, being superior to that of prostate cancer, breast cancer and HIV / AIDS juntos3.

To reduce these numbers, Dr Alex Soriano, Infectious Diseases Unit of the Hospital Clinic of Barcelona, ​​argued in his paper "Saving your patient: the importance of early treatment" the importance of early antibiotic therapy in the treatment of serious infections "to reduce mortality, length of hospitalization and possible relapse."

Although this is an increasingly common protocol, the usual tendency is to start with a classic less potent antibiotic and increase it if necessary. The consumption of antibiotics has been linked to the selection of resistant organisms, but for Dr. Soriano "the problem is not that you use a strong antibiotic from the beginning, but that the patient take for many days as necessary. The initiation of treatment should not be delayed unnecessarily and discontinued or adjusted according to the results of the microbiology laboratory. "

In your opinion, was suspected severe sepsis is better not to take risks, as it is in the patient's life threatening. "It is true that following this protocol is possible that people who do not need treatment so strong end up getting it but it does not pose a risk to the patient," said the doctor.

Area Director Integrated Hospital Care at Novartis, Begoña Gómez, highlights the importance of efforts devoted to R & D to address issues such as sepsis. "The health and quality of life of patients is our top concern, so that our work is focused on the development of drugs that allow us to care for and heal people, not forgetting to publicize the progress made in this regard between the medical community. " Sample this commitment, Novartis has held in the Congress of the symposium on ESCMID positive infections.

This release contains certain forward-looking statements relating to the business of the Company. There are factors that could modify the current results.

About Novartis

Novartis AG (NYSE: NVS) provides solutions for health care consistent with the needs of patients and societies. Focused exclusively to the area of ​​healthcare, Novartis offers a diversified portfolio to best meet these needs: innovative medicines, eye care, high quality generic drugs that help save cost, preventive vaccines and diagnostic tools, OTC; and Animal Health. Novartis is the only company that has achieved a leadership position in these areas. In 2012, the Group achieved net sales of 56,700 million USD and invested approximately U.S. $ 9,300 million (9,100 million excluding asset impairment depreciation and amortization) in R & D. Headquartered in Basel, Switzerland, the Novartis Group companies employ approximately 129,000 associates and operate in more than 140 countries worldwide. For more information, please visit the websites http://www.novartis.com y http://www.novartis.es.

 

Referencias
1 http://www.news-medical.net/health/What-is-Sepsis-%28Spanish%29.aspx
2 http://www.intramed.net/sitios/librovirtual1/pdf/librovirtual1_52.pdf
3 http://www.cec.health.nsw.gov.au/__documents/programs/sepsis/world-sepsis-day/1_2_wsd_factsheet_english.pdf
4 http://www.biomerieux.com.mx/upload/SPANISH_Fact_Sheet_Sepsis-1.pdf
5 http://www.juntadeandalucia.es/salud/export/sites/csalud/galerias/documentos/p_3_p_3_procesos_asistenciales_integrados/sepsis_grave/sepsis_grave.pdf
6 http://www.intramed.net/sitios/librovirtual1/pdf/librovirtual1_52.pdf


Fotografía By Credit: Rocky Mountain Laboratories, NIAID, NIH [Public domain], via Wikimedia Commons


          Reviewed by pulmonologists and patients about the impact of asth   

The agreement between the view that a patient has of their illness and its treatment and your doctor plays an important role in the evolution of it. However, a study by the Asthma Research Program of separ (Spanish Society of Pneumology and Thoracic Surgery) shows a high level of disagreement both in the evaluation of the impact of asthma on daily life and in treatment satisfaction between pulmonologist and asthma patient.

Analyzing the valuations of 1160 patients and 300 pulmonologists, stands first in 53.6% of cases are found well-controlled asthma. Regarding the impact of the disease on the patient's daily life, the degree of agreement between the patient's opinion and his pulmonologist was only 57% and in 26% of cases, physicians (relative to patients) underestimated the impact. The lower degree of concordance in the clinical impact of the disease was observed in the development of sporadic recreational activities (57.1%) and daily routine (57.6%), and quality of life related to health (61, 5%).

The concordance in the degree of satisfaction with treatment was 56% and in 21% of cases, physicians (in relation to their patients) that grade desatisfacción underestimated. The lower agreement was observed in the assessment of symptom improvement (62.8%), in reducing the frequency of exacerbations (64.1%) and lifestyle changes recommended assumable (64.3%) .

In general, patients with well controlled asthma showed significant levels under sick-patient discrepancy (29% and 32.1%) compared with those of uncontrolled asthma (73.7% and 73.1%). This seems to indicate that the lack of agreement could contribute to reduced compliance and consequently to poorly controlled asthma.

In conclusion, the degree of concordance between patients and pneumologists in the perception of the magnitude of asthma is low, particularly in patients with uncontrolled asthma. VISA Study researchers believe there are several factors that adversely affect the patient-physician concordance appropriate, for example, increased demand for health care, limited medical visit time and false expectations about what patients expect their medical professionals.

The study VISA defined as the degree of understanding agreement between physician and patient, which both understand what the other expects of treatment, positive or negative and what are the expectations regarding the disease and its impact on daily life . "It's important to know by the patient the risks and benefits asthma treatment and at the same time, the physician must know the expectations and fears of the patient to be able to help," says Dr. Vincent Square, pulmonologist and director of Asthma Research Program of separ.

As a recommendation, Dr. Place notes that "very little agreement should be considered in asthma education programs administered to patients with poorly controlled asthma and include specific strategies to improve it. At the same time, health professionals should consider the perspective of their patients for the identification of specific therapeutic targets, individualized and achievable ".


          Share Health Information on the Internet   

This pattern, eventually, could bias the collective wisdom about doctors, hospitals or treatment options.

It is estimated that 60 percent of people seek health information on the Internet and social networks are part of that search. Social networks are not limited to big as Facebook or Twitter, but discussion forums or specific areas of health as PortalesMedicos.com.

The study analyzed data from the Health Monitoring Survey 2010, belonging to the Pew Internet & American Life Project. They conducted a telephone survey of 1745 adults who reported searching online health information and answered questions about the type of information sought and the degree of participation in social networking forums or health.


The results of the study revealed that 41% consulted about doctors, hospitals and treatments, 32% used social networks as part of their investigation. However, only 10% published opinions and 15% own comments in response to questions from others. People look generally more information than it provides.

Women are more likely than men to seek health information on the Internet, which is not surprising, since women tend to be in charge of health decisions within the family.

People with higher incomes, younger people or the city were more likely to access on the Internet that people with low income, elderly or rural areas. People with private health insurance were also more likely to seek health information online, probably because they have more health care options.

Finally, people with chronic diseases are twice as likely than those who do not have to look for health information online.

Source: Benefits To Sharing Personal Health Info Via Social Media


          Control of hypertension in diabetic patients   

About 50% of the complications of diabetes are the direct responsibility of hypertension (HT) [1], as in the case of kidney disease.

The relationship between diabetes and hypertension is very narrow: the presence of diabetes causes an increase in blood pressure, and hypertension is a risk factor for diabetes [1]. In this regard, Dr. Javier Salvador, Head, Department of Endocrinology and Nutrition, University Hospital of Navarra, stresses that "between 40 and 80% of diabetics have hypertension. However, if we tried to detect variations in blood pressure chronobiological possibly discover that the prevalence of abnormalities is higher. The frequent association of obesity and metabolic syndrome in type 2 diabetes itself facilitates the development of hypertension. "

The purpose of blood pressure control in diabetic patients is lower than in the nondiabetic population, and is set at odds of 130/80 mmHg [2], due to increased cardiovascular risk of these patients. Dr. Salvador considers that "there is still much room for improvement in this area": ​​although cross sections, measuring blood pressure "reaches at least 85% of patients, only 32% of people with type 2 diabetes show values ​​below 130/80 ".

If levels are altered, should be advised imposition of a change in lifestyle that includes healthy eating, exercise and systematic neglect of smoking, although it will be necessary to consider whether treatment can not be maintained levels within normal voltage.

Hypertension, responsible for the complications of diabetes
The endocrinologist considers that "both the blood pressure, and lipid profile and glycosylated hemoglobin values ​​are cornerstones to control in patients with diabetes" in order to reduce the development of micro and macrovascular complications and cardiovascular risk in general. And is that about 50% of the complications of diabetes are the direct responsibility of hypertension (HT) [1], including renal disease.

Dr. Salvador has stressed the importance of the kidneys in the treatment of patients with diabetes and has been referred to the art DPP4 inhibitors, which "represents an excellent alternative second step" for the treatment of diabetes because "do not produce hypoglycemia, its neutrality on body weight and easy to support combinations with other antidiabetic agents, including insulin."

Among iDPP4, the expert stressed due to the elimination of linagliptin biliary and fecal preferably "renal clearance is minimal, less than 5%, which can be used without dose adjustments in patients with any degree of renal impairment, in contrast with other DPP-4 inhibitors. "

Dr. Javier Salvador has moderated, with Dr. Jose Luis Llisterri, president of the Spanish Society of Primary Care Physicians (SEMERGEN), the plenary session "The new generation of iDPP4, why patient profiles are shown ", held as part of the 18th Annual Meeting of the Spanish Society of Hypertension - Spanish League for the Fight Against Hypertension. The session was conducted jointly by the SEH-LELHA, SEMERGEN and the Spanish Society of Endocrinology and Nutrition (SEEN), sponsored by the Boehringer Ingelheim and Lilly Partnership in Diabetes.


On diabetes
An estimated 371 million people suffer from diabetes type 1 and type 2 worldwide [3]. Type 2 diabetes is the most common type, and is estimated to represent 90% of all cases of diabetes [4]. Diabetes is a chronic disease that occurs when the body does not produce or properly use the hormone insulin [5].


Boehringer Ingelheim and Eli Lilly and Company
In January 2011, Boehringer Ingelheim and Eli Lilly and Company announced an alliance in the field of diabetes that centers on four compounds representing developing several kinds of treatments. The partnership builds on the successes of both companies, which are two of the world's leading pharmaceutical companies, combining Boehringer Ingelheim's solid track record in innovation and research-based Lilly's innovative research, as well as his experience and history pioneered the field of diabetes. By joining forces, the companies demonstrate commitment to the care of patients with diabetes and are held together to focus on patient needs. Learn more about the alliance at www.boehringer-ingelheim.com or www.lilly.com.


Boehringer Ingelheim "Value through Innovation"
The Boehringer Ingelheim group is one of the top 20 pharmaceutical companies in the world. Headquartered in Ingelheim, Germany, it operates globally with 145 affiliates and has over 44,000 employees / as. Since its founding in 1885, the family-owned company has been committed to researching, developing, manufacturing and marketing novel products of high therapeutic value for human and veterinary medicine.

A central element of the corporate culture, Boehringer Ingelheim is committed to socially responsible behavior. Therefore, the company is involved in social projects and takes care of its employees / as and families, offering equal opportunities to all. Respect, equal opportunity and the reconciliation of work and family life form the basis of mutual cooperation. Just as, environmental protection and sustainability are always present in any activity of Boehringer Ingelheim.

Boehringer Ingelheim was installed in Spain in 1952, and over the past 60 years has evolved to be in position # 10 of the pharmaceutical sector in our country. The company is based in Spain in Sant Cugat del Vallès (Barcelona), and currently has two international centers of production in Sant Cugat del Vallès and Malgrat de Mar. For more company information visit www.boehringer-Ingelheim. this is


About Lilly Diabetes
In its continued commitment to diabetes care, Lilly provides patients with breakthrough treatments that enable them to live longer, healthier and fuller lives. Since 1923, Lilly has been the industry leader in pioneering therapies to help health care professionals improve the lives of people with diabetes, and further research on innovative medicines to respond to the unmet needs of patients. For more information about Lilly's current products on diabetes visit www.lillydiabetes.es


About Lilly
Lilly, a leading innovation-driven corporation, is developing a growing portfolio of leaders in their field, applying the latest research in their laboratories around the world and from collaborations with eminent scientific organizations. Headquartered in Indianapolis, Indiana (USA), Lilly provides answers-through medicines and information-for some of the most urgent medical needs of the world today. For more information visit www.lilly.es

REFERENCES

1. Spanish Diabetes Society. Does it affect diabetes in my blood pressure?. Available

2. In the Sierra, Alejandro et.al. Evaluation and treatment of hypertension in Spain. Consensus document. Med Clin (Barc). 2008, 131 (3) :104-16

3. International Diabetes Federation. IDF Diabetes Atlas Poster. 2012 Update. 2012 (5th Edition).

4. World Health Organization: Fact Sheet No. 312 What is Diabetes? 2010

5. International Diabetes Federation. What is Diabetes?. IDF Diabetes Atlas. 2011 (5th Edition


          Alvita expands its range of oral hygiene   

To do this, Alvita, the trademark for hygiene and patient care developed by Alliance Healthcare exclusively for the pharmacy, the market offers a new range of oral hygiene products that meet the needs of each patient. The new line launches Alvita mouth include:

· Whitening Toothpaste 75 ml. Specially formulated to help maintain the natural whiteness of your teeth and protect them from staining. Its pleasant fresh mint taste freshens the mouth and keeps breath fresh during and after brushing. Also effectively protects teeth against cavities and strengthens the enamel, achieving a healthy smile and fresh.

· Sensitive Toothpaste 75 ml. Specially formulated to protect teeth and gums suffering sensitivity to cold, heat or certain everyday situations such as eating, drinking or brushing your teeth. Besides minimizing discomfort and calm, everyday use contributes to proper oral hygiene.

· Calcium and Fluoride Toothpaste duplo 2x75 ml. With advanced formula, Calcium and Fluoride Toothpaste AlvitaÒrefuerza enamel and effectively protects against cavities, keeping teeth healthy and strong. Daily use helps to proper oral hygiene by providing a pleasant feeling of freshness of mint.

· Fresh Mint Mouthwash 500 ml. Contains fluoride salt which helps protect teeth against cavities and increases the resistance of enamel, and allantoin, which acts as a healing agent and tissue regenerator. Furthermore, to enhance the action of brushing his pleasant mint flavor provides a comfortable feeling of freshness.


With these new releases, Alvita continues in an effort to collaborate with the pharmacy savings with quality, not to mention the health care and quality of life of patients.


          Cherry Picked - Professor: Health care fight reflects role of federalism in disputes   
Tuesday, October 8, 2013
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          Costo Del Flomax 0.4 mg :: Safe & Secure Order Processing :: Canadian Health Care Pharmacy   
Costo Del Flomax 0.4 mg Generic Flomax Best Place To Purchase Flomax Cheapest. Flomax (Tamsulosin) is an alpha blocker used to treat symptoms of benign prostatic hypertrophy (BPH). Flomax is used in the treatment of benign prostatic hyperplasia Rating 4.1 stars, based on 84 comments Price start from $0.81 Per pill Follow this link to […]
          1 in 5 Californians uninsured under GOP bill, study says   
Because California moved more aggressively than most other states to implement the Affordable Care Act — accepting increased federal dollars to expand the Medi-Cal insurance program for the poor, and creating the state insurance exchange Covered California — the potential loss in coverage in the state would be more dramatic than in many other states, according to the report. “California has been as aggressive as any state in getting more people insured under the Affordable Care Act,” said Larry Levitt, senior vice president at the Kaiser Family Foundation, which analyzes health care policy. Since the ACA was implemented in 2014, California reduced the rate of its uninsured residents from 17 percent to a record low 7 percent, according to recent estimates by the U.S. Centers for Disease Control and Prevention. The Senate measure would also change eligibility requirements to receive federal subsidies to buy insurance plans on Covered California, leading to tens of thousands fewer people receiving the financial assistance.
          Stock market makes biggest gain in 2 months   
The U.S. stock market notched its biggest gain in two months Wednesday, bouncing back from losses a day earlier. Banks and other financial companies led the rally as investors bet on interest rates climbing further. Energy stocks also rose as the price of crude oil closed higher for the fifth straight day. “These equity markets are perhaps in more of a relief rally, with investors coming back in after being away a bit here,” said Chris Gaffney, president of World Markets at EverBank. Traders bid up shares in financial sector companies amid heightened expectations that interest rates could be headed higher. Investors also bid up shares in companies that reported improved quarterly results. Homebuilder KB Home climbed $1.24 to $24.06, while wireless communications company CalAmp gained $1.19 to $20.44. Spectranetics surged 26.2 percent after Dutch electronics and health care technology company Philips said it agreed to buy the medical device company for $38.50 a share, or $2.2 billion. FedEx shares temporarily halted trading before the package delivery giant disclosed that an information system virus significantly affected the global operations of its TNT Express subsidiary.
          CBO: Senate health bill would lead to 22 million fewer insured   
The Senate health care bill introduced last week would lead to 22 million fewer Americans having health insurance by 2026, while reducing the federal deficit by $321 billion, according to an analysis released Monday by the nonpartisan Congressional Budget Office. Like the House bill, it would eliminate the requirement for individuals to buy insurance and repeal the taxes on corporations and wealthy Americans that paid for the expansion of coverage to millions of people since the law took effect in 2014. On Monday, GOP Senate leaders added a so-called “continuous coverage” provision that would require people who had gaps in insurance coverage of at least 63 days the previous year to wait six months, after signing up for insurance, before their new coverage kicks in. The Senate bill, called the Better Care Reconciliation Act, would end the increased federal funding to state Medicaid programs that began under the ACA. [...] it would change the way Medicaid — called Medi-Cal in California — gets funded in the long run by capping the amount of money the federal government provides states each year, and tying that number to a growth rate that is slower than the growth rate of health care costs. The subsidies under the Senate proposal would be linked to a less generous insurance plan with a higher deductible — meaning even those who would continue to receive assistance would probably shoulder higher out-of-pocket costs. Older Americans, regardless of whether they receive subsidies, could pay much higher premiums under the GOP plan because both the House and Senate bills would allow insurance companies to charge older people up to five times more than what they charge younger people. Changes to the Senate bill are anticipated this week, as several GOP senators — from both the moderate and conservative wings of the party — have expressed reservations about the measure and could lobby for amendments.
          Registered Nurse - RN Pediatric Days / Nights - BAYADA Home Health Care - Greenville, SC   
Expand your nursing future through career advancement programs like the BAYADA Presidential Scholarship and our ASPIRE training program....
From BAYADA Home Health Care - Wed, 31 May 2017 17:09:20 GMT - View all Greenville, SC jobs
          Better Care Reconciliation Act of 2017   
The Senate delayed its vote on the Better Care Reconciliation Act in light of widespread negative reactions for a variety of reasons from both sides of the aisle. So what makes this different from the American Health Care Act? Or the Affordable Care Act?
          Did Sen. McConnell Choose the “BCRA” Name for His Health Care Law to Stick It to McCain-Feingold Supporters?   
A reader emails with an interesting theory: Plenty of pundits (presumably non-ELB readers) have recently puzzled aloud about the title that Majority Leader McConnell gave to the Senate substitute to the American Health Care Act (“weirdly named,” said Ryan Grim). … Continue reading
          Peoria transit workers vote 104-0 to authorize strike   
PEORIA, Ill. (AP) - Transit workers in the Peoria area have voted to authorize a strike but their officials with their union say they're hoping to avoid a walkout. Amalgamated Transit Union Workers Local 416 members voted 104-0 Sunday for strike authorization. Union president Ron Cox says the union is negotiating with CityLink over health care and contract length. The current contract with about 140 workers expires at midnight Wednesday. CityLink is the Greater Peoria Mass Transit District . It serves Peoria, Peoria Heights and West Peoria. It also has contracts with Pekin and East Peoria.
          A Closer Look as Deadline for Chicago Teachers Strike Nears   
Teachers in the country's third-largest city have cranked up the heat in contract talks, threatening to go on strike in less than two weeks. The Chicago Teachers Union and school district officials are clashing over cost-of-living raises, pension contributions and health care costs in negotiations that have stretched into a second year.
          Respiratory Therapist - Full Time - Woodland Park Care Center - Salt Lake City, UT   
The Respiratory Care Practitioner (RCP) administers respiratory therapy care and life support to patients with deficiencies and abnormalities of the...
From Avalon Health Care Group - Wed, 14 Jun 2017 17:27:09 GMT - View all Salt Lake City, UT jobs
          Staff Nurse (RN / LPN) - BAYADA Home Health Care - Saylorsburg, PA   
Overview If you are a Registered Nurse - RN or a Licensed Practical Nurse - LPN looking for an opportunity to work in home care, join BAYADA Pediatrics! Our
From BAYADA Home Health Care - Sat, 15 Apr 2017 08:22:02 GMT - View all Saylorsburg, PA jobs
          Nutrition and weight loss how important is it?   
Nutrition and weight loss how important is it? It is critical because it leads to all kinds of health issues with one of them being obesity. There are millions of people that need to lose weight and because of that they are putting themselves at risk.

Nutrition and Weight Loss is so important it is a matter of life and death is that important enough? In this country we do not have a health care system but a sick care system. What do I mean by that? Our system of taking care of people’s health does not start until they become sick or are hospitalized. A health care system should take care of one’s health that is help people maintain their health or keep them healthy. Which do you think we have? Let me say this before I sign off here today. I am not against doctors, nurses or hospitals but do we believe we have the cart before the horse. One of the most important things a person can do for their health is to not be overweight. It is at epidemic numbers and increasing on a daily basis. It leads to so many other diseases and just overall health problems.

It is now impacting school age children. That is a very difficult situation because if as a child they are having weight concerns then they could have a lifetime of health issues ahead of them. Not necessary and preventable.
          Why is it such a challenge to get the nutrition we need?   
Why is it such a challenge to get the nutrition we need? Everywhere we look now days there is something about nutrition, supplements and health awareness is at an all time high. You turn on the television and those wanting to be the next President were talking about health care in this country. We simply do not get the proper nutrition in our foods anymore and that leads to a lot of health problems with one of them being people who are overweight.

Do you realize how big of a problem weight is for millions of Americans? Half of all people in North America make New Year’s resolutions – and the most common resolution is to lose weight. Isn't that amazing? This is something that can no longer be ignored. There are ways to lose weight but one of the things it takes is discipline and the willingness to deny yourself.

There are a lot of other factors to be considered but for someone that wants to change their life by losing weight can do it. Do you want to be there to watch your son or daughter be married? How about enjoying your grandchildren? Being overweight can and actually cuts short people's lives everyday. If you are looking for something that works it is out there.
          Registered Nurse - RN - Part Time Wound Nurse - Woodland Park Care Center - Salt Lake City, UT   
At least one year of experience in Long Term Care is preferred. Demonstrate clinical assessment skills at the level necessary to meet the job requirements....
From Avalon Health Care Group - Tue, 27 Jun 2017 16:28:24 GMT - View all Salt Lake City, UT jobs
          Director of Nursing - DON - Woodland Park Care Center - Salt Lake City, UT   
The ideal candidate will have current nursing license as well as at least three years of Long Term Care experience, preferably in a DON role....
From Avalon Health Care Group - Fri, 23 Jun 2017 16:45:53 GMT - View all Salt Lake City, UT jobs
          Avalon - Unit Manager - RN - Woodland Park Care Center - Salt Lake City, UT   
Must be at least 18 years of age; Today’s aging population means there’s a growing demand for healthcare professionals in post-acute care, and a wave of career...
From Avalon Health Care Group - Fri, 23 Jun 2017 16:45:49 GMT - View all Salt Lake City, UT jobs
          Respiratory Therapist - Full Time - Woodland Park Care Center - Salt Lake City, UT   
Today’s aging population means there’s a growing demand for healthcare professionals in post-acute care, and a wave of career opportunities available at Avalon...
From Avalon Health Care Group - Wed, 14 Jun 2017 17:27:09 GMT - View all Salt Lake City, UT jobs
          Cruising the Web   
I never thought that Trump's travel order was necessary, but I didn't doubt that he had the power to issue that order. Given that he first issued the order about five months ago and it was only temporary while the administration figured out new vetting procedures for issuing visas. Well, that original time has now just about elapsed and there are going to be three to four months until the Supreme Court hears the case. So, the whole question may become moot by then if the administration actually does what it said it was going to do.

Jonathan Turley chastises the legal pundits and appellate judges who thought that the order wasn't within the president's executive authority.
For those of us who have long argued that the legal authority supported Trump, the order was belated but not surprising. However, the order does offer a brief respite for some self-examination for both legal commentators, and frankly, the courts. At times the analysis surrounding the immigration order seemed to drop any pretense of objectivity and took on the character of open Trump bashing.
Turley argues quite accurately that Trump's persona and his own attacks on the media have driven the media so crazy is that they've dropped their supposed standards and ethics. The same appeared to be happening with the lower courts.
For those of us who have long argued that the legal authority supported Trump, the order was belated but not surprising. However, the order does offer a brief respite for some self-examination for both legal commentators, and frankly, the courts. At times the analysis surrounding the immigration order seemed to drop any pretense of objectivity and took on the character of open Trump bashing....

The court ruled “when it comes to refugees who lack any such connection to the United States, for the reasons we have set out, the balance tips in favor of the Government’s compelling need to provide for the Nation’s security.” The preliminary ruling on this type of stay indicates that, when the final merits are decided, a majority of the court is likely to make the changes permanent and binding.

Indeed, three justices — Clarence Thomas, Samuel Alito, and Neil Gorsuch — did not want any limitation on lifting the injunction and dissented from that part of the opinion. To use Johnson’s rhetoric, the date of the hanging is set for the October term absent a dramatic shift on the court. That gives us some time to contemplate how this controversy has impacted our core institutions.

I previously wrote that Trump seems at times to bring out the worst of people — supporters and opponents alike. Yet, his signature attacks often cause people to fulfill the very stereotypes that he paints, particularly among some reporters and judges. Ironically, Trump’s attacks on the media as biased may not have been true at the outset but they are true now. Mainstream media have become openly hostile to Trump.

There is often little distinction on some cable networks between the hosts and their guests in attacking Trump, who brings much of this criticism on himself in ill-considered and often insulting attacks. However, the media is trained to resist such personal emotions and retain objectivity. Throughout much of its history, it has done precisely that ... until Donald Trump.

He seems like the itch that reporters and commentators just have to scratch and frankly sometimes it seems like a few are enjoying it too much. With ratings soaring, hosts and legal experts have shown little interest or patience in the legal arguments supporting his case, even though the Obama administration advanced similar arguments in court.

The hostile (and often distorted) analysis in the media was disconcerting but predictable, given the trend toward greater opinion-infused coverage. Networks are fighting for greater audience shares based on formulaic coverage — offering echo-chamber analysis to fit the ideological preferences of viewers. For the anti-Trump networks, the legal analysis is tellingly parallel with the political analysis. These cable shows offer clarity to viewers in a world without nuance. The law, however, often draws subtle distinctions and balancing tests. In this way, viewers are being given a false notion of the underlying legal issues in these controversies.

What has been more concerning is the impact of Trump on the courts. Trump shocked many in both parties by his personal attacks on judges as well as general disrespect shown to our courts. These were highly inappropriate and inaccurate statements from a president. However, once again, courts seemed to immediately become the very stereotype that Trump was painting.

Of course, the White House gave the courts a target-rich environment in the first travel order, which was poorly drafted, poorly executed and poorly defended. Yet, the courts did not just strike those portions that were problematic. Where existing case law requires courts to use a scalpel in striking down provisions, judges pulled out a meat ax. They enjoined the entirety of the order while lashing out at Trump’s most sensational campaign rhetoric....

In the Fourth and Ninth Circuits, judges brushed over the obvious improvements and again relied on Trump’s own comments and tweets. It seemed like sensational tweets were more important than long-standing precedent or official statements from the administration.

The level of reliance on campaign statements by the courts was wrong in my view, as I have repeatedly stated. The record had conflicting statements from Trump and his associates but courts seemed to cherry-pick statements, relying on those that fulfilled their narrative while ignoring those that did not. The analysis of the order should have turned largely on the face of the document. While such political statements can be relevant to analysis (particularly in areas like racial discrimination), the court has always minimized such reliance in favor of more objective textual analysis.
That doesn't mean that the order was good policy. But the basis on which the lower courts decided was to stretch the law just to deliver a blow to Trump.
Courts that once gave President Obama sweeping discretion in the immigration field seemed categorically opposed to considering the same accommodation for President Trump. For commentators, viewers were given a highly distorted view of the existing law — brushing aside decades of cases while supporting the notion that a major federal policy could live or die by the tweet.
The Supreme Court notably didn't pay any attention to Trump's statements. If all you knew about the executive order was what you heard in the MSM, you would be amazed that the Supreme Court struck down most of the injunctions against the implementation of the order. The media will have to search out

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Andrew McCarthy explains why the Supreme Court order on the travel order is not as big a deal as perhaps President Trump would like to brag.
This ruling is unworkable and actually doesn’t much narrow the lower-court stays.

Let’s try to keep it simple here. The lower courts granted standing to challenge the travel ban to American persons and entities that had special relationships with aliens outside the United States. Ostensibly, the lower courts claimed that the rights of these Americans were harmed by the travel ban’s exclusion of aliens — specifically, aliens who a) are close relatives whose exclusion would deny family reunification to an American; or b) are scholars whose exclusion would deprive their contributions to American universities that had extended offers to them. In effect, however, the lower courts were vicariously granting American legal rights to aliens outside the United States, despite the judges’ grudging admission that the aliens technically had no such rights.

In its order this morning, the Supreme Court did not disturb this arrangement.

To be sure, the justices rejected the lower courts’ extension of vicarious rights to aliens who did not have such special “bona fide relationships” with American persons or entities. The lower courts’ reasoning for that extension heavily relied on the imputation to Trump of anti-Muslim bias — that’s part of why we can infer that most of the justices are not persuaded by that rationale. Nevertheless, six of the nine justices, at least for now, appear inclined to rule that Americans in these “bona fide relationships” with aliens have not only standing but legal interests sufficiently compelling to block enforcement of presidential orders that address national-security threats.
Read the rest of his post for the evidence he marshals to criticize the Supreme Court's Monday ruling.

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Rich Lowry refutes the idea that the GOP health care bills are doing anything all that radical in reforming Medicaid. What was radical is how the program expanded on Obama.
The Democrats now make it sound as if the Obama expansion is part of the warp and woof of Medicaid. In fact, it was a departure from the norm in the program, which since its inception has been, quite reasonably, limited to poor children, pregnant women, the disabled and the ailing elderly. ObamaCare changed it to make a priority of covering able-bodied adults.

ObamaCare originally required states to enroll able-bodied adults with incomes less than 138 percent of the federal poverty line starting in 2014. The Supreme Court re-wrote the law to make the expansion voluntary, and 31 states and the District of Columbia took it up.

Traditionally, the federal government had paid more to poor than rich states, with a match ranging from 75 percent for the poorest state, Mississippi, to 50 percent for the rich states. ObamaCare created an entirely new formula for the Medicaid expansion population. It offered a 100 percent federal match for the new enrollees, gradually declining to a 90 percent match — supposedly, forever.

So, perversely, ObamaCare had a larger federal match for the able-bodied enrollees in Medicaid than for its more vulnerable populations.

“This higher federal matching rate,” writes health-care analyst Doug Badger, “allows states to leverage more federal money per state dollar spent on a non-disabled adult with $15,000 in earnings than on a part-time minimum-wage worker with developmental disabilities, who earns barely half that amount.”

According to Badger, West Virginia received seven times as much federal money for spending $1 on an able-bodied adult than for spending $1 on a disabled person.

This obviously makes no sense, and the Senate health-care bill phases out the enhanced funding over four years. But it doesn’t end the expanded Medicaid eligibility for the able-bodied. And a refundable tax credit will be available for low-income people that is meant to pick up any slack from Medicaid. This is hardly social Darwinism.
THe other change is a change in how the federal government funds Medicaid in the states.
The other, longer-term change in the House and Senate bills is moving to a per-capita funding formula for Medicaid, with the Senate bill ratcheting the formula down to per-capita growth plus the inflation rate — in 2026. Maybe this will prove too stringent, but it used to be a matter of bipartisan consensus that the current structure of Medicaid creates an incentive for heedless growth in the program.

The way it works now is that Mississippi, for instance, gets nearly $3 from the federal government for every $1 it spends. Why ever economize? In the 1990s, the Clinton administration advanced what it portrayed as an unobjectionable proposal to make Medicaid more efficient while preserving the program’s core function — namely, a per-capita funding formula.
So remember all this when you hear Democrats moaning that the GOP is set to kill millions of people. As Lowry analogizes, for progressives, the welfare state has become the equivalent of the Brezhnev Doctrine that once the Soviets dominated a country, it could never break free. Now once the welfare state has been expanded, it should never be trimmed back.

Guy Benson is also trying to refute the Democrats' demagogic hysteria about the Senate plan.
Republicans' plan would make Medicaid fiscally sustainable, and gradually revert back to a model that prioritizes help to the poorest people, who need the most help. It's perverse that the federal government provides a more generous funding formula for Medicaid's better-off, better-situated expansion enrollees than the original, neediest population for whom Medicaid was supposedly created in the first place. And while the GOP proposal would reform the structure of the program by offering a capped per-capita annual allowance to each state (which would foster restraint, prioritization, innovation, and creativity), the notion that it makes drastic "cuts" to the overall program is deeply misleading. ...

This funding increase of tens of billions of dollars is nevertheless cast as a "cut" because it would spend less than Obamacare would.

Just imagine what the media would be saying if Claire McCaskill were a member of Trump's administration.
n March, Sen. Claire McCaskill was unambiguous. The Missouri Democrat said she never once met with Russian Ambassador Sergey Kislyak in her 10 years serving on the Senate Armed Services Committee.

"No call or meeting w/Russian ambassador. Ever," McCaskill tweeted. "Ambassadors call members of Foreign [Relations Committee]."
Soon after that tweet, it was revealed she did interact with the Russian ambassador.

And now, CNN has learned, McCaskill spent an evening at a black-tie reception at the ambassador's Washington residence in November 2015.

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Yesterday I speculated that the Supreme Court's ruling in the Trinity Lutheran case might be used to overturn states' Blaine amendments blocking state aid to schools with a religious affiliation. Well, it seems that that was indeed the Court's intention with an order remanding a case back to the lower courts that they issued on Tuesday. The WSJ reports,
In 2011, Colorado’s Douglas County adopted a Choice Scholarship Program to let 500 students attend a local private school. But groups including the American Civil Liberties Union sued. The Colorado Supreme Court killed the program citing the state’s version of the Blaine Amendment, one of many state anti-Catholic laws from the 1800s to prevent public money from funding religious schools ( Doyle v. Taxpayers for Public Education).

The Douglas County School District and the Institute for Justice, which represents three families in Colorado, appealed to the Supreme Court in 2015, but the Justices held the petition pending the resolution of Trinity Lutheran v. Comer on Monday. On Tuesday the Court vacated and remanded Doyle to the lower court for reconsideration in keeping with Trinity Lutheran’s holding that Missouri’s application of the Blaine Amendment violated the First Amendment’s Free Exercise Clause.

The High Court typically vacates and remands only when the Justices think there is a “reasonable probability” that the lower court got it wrong. Colorado’s do-over is a warning to other states that might use Blaine Amendments to derail school choice programs that threaten teachers unions and the public school monopoly.
I'm for as much choice as possible in education. I've seen what it means at the charter school where I teach and at the charters in Washington, D.C. where my daughter has worked. The more opportunities there are for students to get out of bad schools and for their parents to choose other options, the better.
The win comes at a good time for school choice advocates who have been building momentum in the states. In May three families successfully challenged a Montana rule that prevented a voucher program from being used at religious schools. On Monday the Georgia Supreme Court unanimously upheld a program of tax credits for scholarships to some 13,000 students to attend private schools.

School choice is spreading because parents want the chance to get their child a better education than they receive in local public schools. Sometimes that enhanced opportunity is offered by religious schools, and the First Amendment does not allow the state to discriminate on the basis of religion.

          May unveils post Brexit plans for EU citizens in UK   
May unveils post Brexit plans for EU citizens in UKHealth care, education to be granted to EU citizens living in UK with special status
          'Fantastic Tribute to Our Country': Watch Trump Lie About the GOP Health Care Bill for Two Minutes Straight   

'A Health Care That Will Take Care of People Finally for the Right Reasons' Trump Says. What Are the 'Right Reasons'?


          RN\ LVN\ LSW Case Manager\Referral Specialist - Tejas Health Care - La Grange, TX   
Experience with office equipment including but not limited to computers, fax machines, telephones and copiers. The Case Manager/Referral Specialist (CMRS) is an...
From Indeed - Mon, 12 Jun 2017 23:08:24 GMT - View all La Grange, TX jobs
          A religious case for repealing the Affordable Care Act   

The proposed changes to America’s health care system advanced by the Republican Congress have been condemned by patient advocates like AARP, doctor advocates like the AMA, and hospital advocates like the American Hospitals Association. But there’s a religious case that has been made in its defense that is worth examining, even though it’s not a […]

The post A religious case for repealing the Affordable Care Act appeared first on The Blogs | The Times of Israel.


          Speech Language Pathologist SLP PRN - Reliant Rehabilitation - Pierce, NE   
Contributing to facility patient care, utilization review, case management, administrative staff/department head, and family health care professionals and...
From Reliant Rehabilitation - Sat, 27 May 2017 06:46:19 GMT - View all Pierce, NE jobs
          US Supreme Court Rejects Gun Rights Appeal   

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http://www.unsv.com/voanews/specialenglish/scripts/2017/06/28/5084/

The United States Supreme Court has rejected another call to decide whether Americans have a legal right to carry guns outside their homes.

The high court released rulings on a number of cases Monday. But it refused to hear a case against a California law that sets limits on carrying guns in public.

The high court left in place an appeals court ruling in the case.

The appeals court confirmed the legality of a measure to limit permits for concealed weapons -- those placed out of sight.

The Supreme Court ruled in 2008 that the United States Constitution guarantees the right to carry a gun, at least for self-defense at home. But the court has refused repeated requests to expand on its understanding of gun rights.

More than 40 states already have rules giving gun owners a right to be armed in public.

A new study shows that Americans are as deeply divided about gun policy as they are about immigration, health care and other issues.

The Pew Research Center questioned 3,900 people nationwide. The resulting study found sharp differences of opinion between gun owners and those who do not own guns.

The study found that more than half of owners support creation of a federal database for recording gun sales. Eighty percent of those who do not own guns also support such an effort.

About half of gun owners support a ban on assault weapons, compared to almost 80 percent of non-gun owners.

Assault weapons have been compared to guns used in armed conflicts. Gun control activists say such weapons are meant to kill multiple people quickly, and not for civilian use.

Yet there was common ground among gun owners and non-gun owners on other issues.

Nearly 90 percent of all those questioned believe the government should bar the mentally sick from purchasing guns.

Also, about 80 percent of those who own guns believe people named on federal no-fly or watch lists should be prevented from buying guns.

Strong majorities of both groups support background investigations of those who buy guns from an individual or at gun shows.

The study also found that at least two-thirds of Americans have lived in a home with a gun. About half of those questioned who have never owned a gun said they had fired one.

About 1,300 of the 3,900 people questioned said they own guns. The rest said they did not.

Most of the gun owners described themselves as white males who are members of the Republican Party.

The study found that people who live in the Northeastern United States are less likely to own a gun than are people in other parts of the country.

I’m Caty Weaver.

Wayne Lee wrote this story for VOANews.com. Christopher Jones-Cruise adapted it for Learning English. George Grow was the editor.

We want to hear from you. Write to us in the Comments Section, or visit our Facebook page.

Words in This Story

concealed – adj. hidden from sight

database – n. a collection of pieces of information that is organized and used on a computer

assault weapon – n. a gun that can shoot many bullets quickly and that is designed for use by the military

multiple – adj. more than one​; many

background – n. the experiences, knowledge, education, etc., in a person’s past


          22 Million Americans Could Lose Health Insurance Under Senate Bill   

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The Congressional Budget Office says the number of uninsured people in the United States would rise to 22 million within the next ten years under the Senate health care bill.

The Senate’s bill would replace the Affordable Care Act, a law that former President Barack Obama supported. The Affordable Care Act is often called Obamacare. Republicans have spent about seven years attempting to cancel Obamacare.

The CBO said in a study released Monday that the Senate bill would decrease the federal budget deficit by $321 billion by 2026.

This is the second health care bill to be considered in Congress. Both the House and the Senate have different health care bills. In order for a bill to become law, it needs to pass both the House and the Senate and be signed by the president.

Senate leaders plan to vote after the July 4th holiday on their version of the bill. Currently, Americans are required to buy health insurance or pay a fine if they do not. The Senate’s bill would end that requirement.

In addition, the bill would end subsidies meant to help lower-income people buy insurance. It would also decrease some taxes on higher-income people. And it would cut billions of dollars of government funding for the health care program for poor and disabled people over the next few years.

Senate Minority Leader Sen. Chuck Schumer of N.Y. and his fellow Democratic Senators, hold photographs of constituents who would be adversely affected by the proposed Republican Senate healthcare bill Senate Minority Leader Sen. Chuck Schumer of N.Y. and his fellow Democratic Senators, hold photographs of constituents who would be adversely affected by the proposed Republican Senate healthcare bill

Opposition to the bill

To pass a bill in the Senate, a majority of senators must vote for the bill. If there is a tie, the vice president can vote to break the tie. Currently Republicans hold 52 of the 100 seats in the Senate. All 46 Senate Democrats are expected to vote against the bill. In order for the bill to pass, Republicans can risk losing only two of their senators.

A group of Republican senators has already said they will not vote for the bill in its current form.

When Obamacare became law in 2010, it passed without any Republican votes. Since the 2016 elections, Republicans gained control of the presidency, the House and the Senate. A change to Obamacare could be possible now.

About 20 million people have received insurance with Obamacare. Many of those people are covered under the government’s Medicaid program for the poor and disabled.

The two bills to change Obamacare propose to cut about $800 billion in federal funds for Medicaid over the next few years. President Donald Trump had stated during his campaign for office that he would not cut Medicaid funding.

Senate Democratic leader Chuck Schumer told ABC that he hopes that Republicans will talk with Democrats and work together on a solution to make Obamacare better.

I’m Mario Ritter.

And I’m Olivia Liu

Olivia Liu adapted this story for Learning English from VOA News and AP reporting. Mario Ritter was the editor.

Words in This Story

uninsured –adj. not having an agreement with a company or agency that helps pay for the cost of a service such as health care

subsidiesn. government payments to producers or individuals that reduce the cost of a good or service to make it easier to get

We want to hear from you. Write to us in the Comments Section.


          Council praised for work to include forces families   
WILTSHIRE Council and its partners’ work with the Armed Forces to ensure they have equal access to health care and other services has been praised in a national report.
          Open Letter to Sam Harris on “The End of Faith”   

Dear Sam,
I am a theist. Worse, I am religious.
Why am I these things? Well, based on what I have read heard and seen here I am just a poor deluded creature who is either to brainwashed or to stupid to know better. Worse than that, I am tribal. I think my tribe is better than everybody else’s because my Good Book tells me so and the rest are just hell bound.
It’s hard for me to believe that otherwise smart people, think such ridiculous things. It’s even worse to hear it from somebody like yourself who puts so much effort in to what you think and discuss, but seems to abandon all reason and adapt a 2 dimensional view of religion based on ‘drive-by’ observation of religious people.
You seems under some impression that if he could just tickle out sensible bits, that we would abandon our religion for ‘reason’. Reason, in this particular case is actually a sly way of saying ‘Naturalism is the correct view of the world and all others are wrong’. Practically every atheist I know is also a naturalist, bound by the senses and will go to some tortured lengths to fit every possible thing in to the box of naturalism.
Further, this idea that all we are concerned about is heaven and hell is a very thin, poorly researched soft bigotry about religion. It seems that a small subset of the behavior of some religious fundamentalists, that they are judgmental, that they regard that their way is the best and only way is such a small minded view. Or that religious moderates are people who are in the regressive left not willing to judge another group is just weird to me. The “moderates” you speak of are better termed as simply as ‘not very religious’.
If you want to be effective in the conversation of ending faith, proposing naturalism over metaphysics or existentialism, you need to be at least remotely accurate in your descriptions of religious people. The fact that you are not hurts your credibility with the people you are trying to reach. As a religious person, who knows intimately many other religious people we are not the deluded creatures you propose. Your descriptions of us is patently false.
It’s clear that you have not deleved into true theology and exegesis. In Christianity, for instance, each letter of every single text has been poured over and analyzed in and out of context. You only need bother to look some of the research in theology to understand that such beliefs are not this ad hoc brainwashing of otherwise intelligent people.
I mean, is your audience, simply your own tribe? Are you talking to naturalists\ atheists or are you trying to convince religious people that naturalism is the correct world view, then you need to know your target audience. If you are targeting atheists, you are already preaching to the choir. If you are targeting religious people, in order to get them to think, you need to get your facts straight otherwise you will be summarily dismissed as a ‘know-nothing’. You are describing religious people based on very thin evidence. You are taking a very small subset of observed behavior and generalizing it over the whole of religiousness. You dismiss it before you even know anything about it. You don’t do that with any other topic. You drill down deeply. You prod and pour over reams of information in order to make an informed decision. But with religion, it seems that you do not approach it with the same vigor, yet you write books against it without understanding.
For myself, I have studied atheism and atheist philosophy and many of your works and find them philosophically incoherent. I counter claim that at the core of understanding existence itself, atheism has nothing of note, worth offering.
The way you speak and proselytize against religion smacks of the street preacher shouting hell and damnation. A condemnation without education. It’s rare that you do this, but you have researched this poorly. You have not even bothered to look at what, for instance, Deuteronomy means to us today or how it’s to be read and taken. Have you considered the original audience of Deuteronomy? Have you looked at the juxtaposition of the Pentateuch over geography and history in the context in which it was written? Have you studied First Temple Judaism and the Talmud? I take it you haven’t and therefore cannot actually speak intelligently on the topic.
You have a long list of religiously affiliated atrocities throughout history. But history tells us much more. The majority of wars from the beginning of history and conflict were not religious in nature, not even close.
It is consistently dismissed by atheists, that the atrocities of the 20th century, which murdered more people than the total of all wars and conflicts, prior to it, throughout history, combined. That you cannot act in the name of ‘atheism’ or ‘no god’. I agree, you cannot act in the name of nothing, but to dismiss that atheism had nothing to do with it is disingenuous at best. The correlation between atheism, secularism and the mass murders of the 20th century by atheist states cannot be ignored. While some of these mass murders could be argued away as incidental, the result of a maniac who is getting rid of people that are simply in the way of their goals many millions were also murdered because they were religious. You cannot simply dismiss that atheism had nothing to do with that. It had everything to do with the murders of millions of religious people.
What about the persecutions of the Christians in China, happening right now? An atheist secular state, is at this very moment attempting the fulfill the wishes of atheists, to rid the world of religion. They have moved on from simply taking down or burning the crosses on the churches, they are razing them. They are imprisoning and likely killing (though it has not been reported) religious leaders all over the country. What is their crime? Their faith, nothing more.
If you were to simply describe a country to me without naming it or it’s form of government, where there is no freedom of speech, where there is free health care, where people cannot own property, where the education is free, where religion is suppressed and the people are oppressed; I would need no more information than that to be able to guess with astounding accuracy that it is a secular-atheist, socialist state. Any attempt to remove atheist ideology as a causal factor in these past and present atrocities is dishonest at best.
You speak of honestly dealing with the baggage of religious history, you cannot do so without dealing with atrocity by atheist ideology. In as much that you cannot divorce the Crusades from Christianity, you cannot divorce the mass murders of the 20th century from atheism. They are linked and no amount of linguistic gymnastics will make that, not true. If you are truly concerned with honesty, you simply cannot dismiss these facts. When you speak to the danger of ideas, this should be included.

You also treat religion, specifically scripture as an explanation about the world around and that is prescriptions about it are divine fact. This is false. We have science to tell us about the world around us.  We do not pretend that the Bible is the ‘Great Big Book of Everything with Everything Inside’. We do not pretend that the Bible was written by God. God didn’t write any of it, man did. But we do believe it was divinely inspired. We do believe in revelation, that revelation exists and that certain people have been chosen throughout history to get God’s message out. Now you can argue whether or not that is true, but it elucidates the fact that context in Scripture is extremely important in order to understand it. It’s a rich and intricately woven text that is meant to speak to all mankind on different levels. The Bible isn’t one book, it’s a collection of 66 books and letters (72 for Catholics). When one asks how you should take it, meaning literally, figuratively, etc., the answer is ‘it depends’. It depends on the purpose, context and the original audience for which the particular text was written. Only then can you understand the actual message(s) contained within. Some books are figurative, some are historical, some are poetry and song, some are wisdom books, some are letters, some are gospel, some are prophetic. There is no ‘one way’ to take the Bible. I would suppose this is true for other Holy books of other faiths, I wouldn’t know I haven’t studied them.

You believe that faith should be scrutinized by science. Faith and religion is not subject to science, it is subject to philosophy. For both science and theology are branches of philosophy, but one is not like the other. It does not mean that faith cannot be scrutinized, it can and it should; but this is not a scientific endeavor.
Why are there so many religions? I don’t know. Wouldn’t it make sense that if a religion is actually true, then certainly that one should take over and be the one way. Sure that’s a 2 dimensional view. There may be more than one way. Some religions may be better than others, I cannot judge that at the core of each. I can however, observe behavior of practitioners. I can say the overall behavior as a group Christians behave better than Muslims at this point in time. I can say Hindus as a group, behave better than Muslims as a group, but no better or worse than Christians as a group. And on and on.
Atheists often argue that since God is not more obvious and clear then he does not exist. This poor philosophy.  A lack of certainty in the way to relate or communicate with God does not mean that God does not exist. No one religion is right about everything, but some may be more right than others. Here, I just say that love is better than hate, kindness and mercy are better than meanness and revenge. Those that practice the former are better than those who practice the latter.
How do we know God exists? We do not look to our Holy books to establish this. In fact, the Bible suggests (in the letters of St. Paul) that you do not need to know anything about religion or scripture to know that God exists.
We establish the existence of God philosophically. Early Christians, did not look to scripture to prove God exists they look to Aristotle. Augustine and Aquinas do not look to scripture for proofs of the existence of God, they look to philosophy. God’s existence, at least with Christianity, is the product of pure reason, not religion. The reason we do not believe in Zeus, Thor, Baal, or all these other gods over God is because we cannot philosophically determine those gods exists. Like you, we cannot prove that those gods do not exist, but we can and have proven by pure philosophical deduction that God not only does exist, but must exist for anything to exist at all. And those arguments have NEVER been disproven. That does not mean that philosophers have not tried and have not brought up objections, but the arguments have not been disproven. This is the basis for our belief that God exists. Not because the Bible said so, but because a perfectly reasonable deduction was made. Religion then comes in to try and understand who this God is.

You do not know this because you have not bothered to investigate rich deep theology that has existed and accumulated throughout the centuries. It would do you well to look up what theology has to say. It would do you well to talk to real theologians and apologists who have studied these matters that you discuss in depth. Why not do a pod cast with real, well educated theologians and find out if you are not wrong on what we believe. If you really want to know then it bares investigation, not this pithy cursory glance that you have given it, seemingly without thought. Because, the things you say we believe and what we actually believe are in vastly different stratospheres. It would be a far more credible book if what you say about our beliefs actually line up with them.
Sincerely,
Pat


          Paying it Forward by Giving Back   

You may be familiar with CDPHP® Insights, an online community of health care consumers who offer feedback to help us improve health care experiences for all. We’re excited to announce that we’ve partnered with the Alliance for Positive Health to expand the CDPHP Insights community and support the Alliance’s efforts. For every new CDPHP Insights […]

The post Paying it Forward by Giving Back appeared first on The Daily Dose | CDPHP Blog.


          Why We're Voting for Obama   



Brenda A.

MELBOURNE, FL



I gained great inspiration from President Obama to take a chance on opening my wine shop, and hope and change have been very good to me.

We just hit the three-year mark on my business, and it's paid off! President Obama is making sure that small business owners like myself can succeed. I know the economy needs to continue improving, and he's doing everything he can for small businesses.

I remember when I saw Barack Obama speak in 2008 in Kissimmee, I knew then that he would be elected president. I've had his back ever since. I believe in Barack Obama.

Tom C.

WEST PALM BEACH, FL

I just graduated from the University of Florida with a Bachelor of Science in Business Administration from the Warrington School of Business. But the four years of rigorous, demanding coursework and the sacrifice I made isn't the real story here. Nor is the fact that the school is ranked 11th overall nationally for its distinguished finance program, an industry I plan to work in. Neither is the story about how I worked full-time throughout the last four years while studying, exchanging vacations and socialization, nice dinners, time with friends and family, and so much more for life as a student.

No, the real story is this: that without the combination of low cost federal loans and federal Pell grants, as well as state grants, I wouldn't have my degree today. What an abomination and stunt to American ingenuity, cultural and socio-economic progress cutting these funds for future generations would be. Although I'm through college, I care deeply, perhaps now more so than before I started on my degree, about the importance of ensuring Pell grants and low-cost loans are widely available, and stay available to any and all who seek them.

I'm confident a vote for President Obama this year is a vote towards protecting our commitment to future students that depend on these social nets. I, for one, am happy to pay my taxes throughout my lifetime to do my part. Unfortunately, not everyone feels that way. But my convictions simply come from my experience - nothing else.

Thank you, President Obama, and members of Congress, who champion, in the face of unadulterated and unrelenting populist pressure, that our long tradition of helping to fund higher education needs to continue to preserve opportunity for all, and investments in the next generation of ambitious innovators, thinkers, and doers are just too important to simply “give up”.

Susan R.

BONNIE DOONE, NC

My story isn't going to be about economics, or healthcare. It's not going to be about anything that catches the eyes of a news reader. My story is a simple, but my life depends on people like President Obama.

I am a military spouse. I am a proud Air Force wife. I am a mother, an advocate, a supporter, and I too take orders and try not to question those in charge. Though I don't actually own a uniform, I put one on every day.

In my lifetime, I have never witnessed and now been a part of an administration that focuses so much on the military and the military family.

I would like to thank President and Mrs. Obama, for caring about us. For putting into place initiatives like Joining Forces that really do help military families. I would like to thank the First Family for listening to us.

Not many have had to experience the military life and though this is a life that we choose, it is still one that is fraught with fear, anxiety, depression, and stress.

I truly believe that if our nation works hard and joins forces that good people like President Obama can continue making change!

Kim J.

ORANGE, CA

I wasn't a supporter of President Obama in 2008. I didn't go to any phone banks or attend any rallies, and there was one simple reason for that: I was a Republican.

Raised in Orange County in a staunchly Republican family, naturally I became very involved in GOP politics. By the end of my junior year in college, I had volunteered on a Republican campaign and interned twice for a Republican member of Congress. Those experiences were meant to be stepping stones toward my dream job: a political career in Washington, D.C., working for a GOP congressman. But after working so hard for Republicans for so long, I came to a very humbling realization – I had been fighting for the wrong side the entire time.

Last summer, it finally struck me how much this administration's policies helped me as a young woman in her college years. From student loan reform to the Affordable Care Act, I have benefited tremendously from the work of President Obama. I re-registered as a Democrat and soon after, jumped at the chance to work for Obama as an organizing fellow with the campaign. I have been volunteering ever since.

Four years ago, I never would have thought I would be a supporter of President Obama, much less a volunteer on his campaign, but I now understand how much the President has fought for me, even when I wasn't fighting for him.


Joyce B.

MC KINNEY, TX

Our adult son was born with the birth defect, Spina Bifida, 44 years ago, and in his 20's was diagnosed with leukemia. We were fortunate enough to have health insurance through an employer that covered the cost of 38 surgeries due to his birth defect, a bone marrow transplant to cure the leukemia, wheelchairs, leg braces, many doctor's vists, therapy sessions, etc. We know firsthand the tremendous expense parents have when faced with the birth of a child with birth defects. Our son was helped first by the government program, Supplemental Security Income, before he had worked enough to qualify for Social Security Disability Income. He has never been able to obtain a full time job because of his physical and learning disabilities, but has worked part-time for many years in minimum wage jobs. He now qualifies for Medicare which is life-saving for him, since he is uninsurable under current law due to his pre-existing conditions. The Affordable Health Care Law will now allow those with pre-existing conditions to obtain health insurance. Although we were fortunate to have healthcare coverage for these many surgeries, we know there are many families with children with disabilities who do not have adequate insurance. Those who oppose this law need to step into the shoes of those who aren't able to obtain health insurance due to pre-existing conditions. President Obama stood by his promise to pass the Affordable Health Care Law which will benefit many people, and we with many other families thank him. He has accomplished many things during his presidency even though he has had tremendous opposition from the Republican party membership. We believe he is leading our country in the right direction on all the major issues facing our country. We will support President Obama during this campaign by volunteering and by our financial contributions as we did in 2008.

David & Joyce B.

Jillian M.

DEER TRAIL, CO

My husband & I live in a VERY rural area in eastern Colorado. We're pretty much surrounded by people who support the republican point of view. We proudly drive our pick-up around with our Obama sticker on it, and do all we can to support "our" President. Things are tough out here...our daughter is a teacher & can't find a job. We believe in what Obama stands for...what our country needs to support for all of our futures. We donate whenever we can & you have all our support. Thanks for all you have done for us and for what you continue to do for Americans.


















Link to C-SPAN for debate archives and more.


          Health Care Costs: How Do We Fix This Broken Record?   

A broken record is figuratively defined as a statement or experience that is frequently, and perhaps tediously, repeated. If you’re a regular reader of this blog, you might think that I’m starting to sound like one. But as health insurers across New York prepare to submit rate requests to state regulators, I find myself answering […]

The post Health Care Costs: How Do We Fix This Broken Record? appeared first on The Daily Dose | CDPHP Blog.


          America's decline?   
Gabby Douglas (gymnastics)
After watching the Olympic Games on TV it is hard to conclude that America is in decline. If it is, somebody forgot to tell our young Olympian athletes. Watching them perform was a treat that every American should have savored. From the hard-boiled professionals of the NBA to the pre-collegiate athletes like our female gymnasts, they all showed us what talent, dedication, and hard work can accomplish. Only the megasized Chinese athletes, a product of a Soviet-style massive government program, came even close in medal count to the Americans.
Michael Phelps (swimming)
Except the Americans are not part of a gigantic government experiment, much to the chagrin of the conservative critique of contemporary America. President Obama has not turned the Olympic movement into another government project. He clearly has no intention to. There are some who delude themselves into thinking that our President is actively conspiring to turn our country into an oppressive central government-run state even as there is little evidence of that. Our Olympic athletes are a product of the best America has to offer: privately run professional leagues, collegiate organized sports, public and private school organized sports, with a smattering of diehard individuals perfecting their special talents. No centralized control necessary because freedom, combined with a strong work ethic and a strong desire to succeed is all we need.
Ashton Eaton (decathlon)
Our Olympic athletes embody the best of America, something that has not changed since the first Olympiad of the modern era in 1896.
During the Cold War there were the titanic struggles between the US and Soviet Union, which used the power of its massive government to create a program designed to foster its image as a super power. The Soviets used the Olympics to show the world they were at the same level or better than the dreaded capitalistic flag bearer that was the

Our Olympic athletes surely 
represent the best 
our country has to offer 
and they have shown the world 
that American values are alive. 

United States. For them the Olympics was just an extension of their foreign policy much like the Chinese today. They have emulated the West in just about everything except their version of the Olympics which is a carbon copy of the old Soviet system.
Jordan Burroughs (wrestling)
America stood fast during the Cold War, preferring to stick to its ideals of personal liberty even when it was tempting to opt for a massive government program to promote success at the Games watched by the entire world.
The Olympic revival, starting with the 1896 games in Athens, Greece, was conceived by Baron Pierre de Coubertin and was initially an all-male affair. Coubertin's vision was that nationalism would play a minor role and that only amateurs would participate. The Games have greatly expanded since then and the ideal of minimizing nationalism has all but evaporated, even though there is no official mention of which country “won” the Games. However, the daily medal counts reports belie the spirit of anti-chauvinism, although only China has a serious government program (along with a few diehard communist countries like Cuba and North Korea).
Kayla Harrison (judo)
Every country on the planet takes pride in the successes of their compatriots, including the USA, which proves that there is no need for the government to be involved to produce a sense of patriotism.
Judging by the performance of our athletes in London, it is difficult to make the argument that the United States is a country in decline, that our values of self-reliance, hard work, and success-oriented behavior are compromised. Our young people are still the envy of the world.
Missy Franklin (swimming)
I always suspected that most of the hand-wringing about America's decline as a country and a culture has a mostly political agenda behind it. There are people with a vested interest in accusing our President of curtailing our Constitutional freedoms, and adopting a “statist” style of governance which in turn is leading us down a ruinous path. No matter that there is little truth to this assertion and the best example the President's critics can come up with is his health care reforms which are based on a private sector model and not a “government takeover” model as is falsely alleged.
If you believe the President is a closet Socialist, hell-bent on eroding our freedoms, turning our government into a gigantic leviathan that will control every aspect of our lives, then I have to admit he has been a colossal failure.
Vincent Hancock (shooting)
But if you believe the President is a democratic reformer working within the limits of our Constitution, who represents the best of our country, then I believe he has been largely successful.
Our Olympic athletes surely represent the best our country has to offer and they have shown the world that American values are alive. America is hardly in decline. You can even make the assertion that American values and America itself is as strong as ever.
We have a lot to be proud of and thankful for.



Link to C-SPAN for debate archives and more.


          “Stand Your Ground”   

776.013 Home protection; use of deadly force; presumption of fear of death or great bodily harm.— A person is presumed to have held a reasonable fear of imminent peril of death or great bodily harm to himself or herself or another when using defensive force that is intended or likely to cause death or great bodily harm to another if: (a) The person against whom the defensive force was used was in the process of unlawfully and forcefully entering, or had unlawfully and forcibly entered, a dwelling, residence, or occupied vehicle, or if that person had removed or was attempting to remove another against that person’s will from the dwelling, residence, or occupied vehicle; and (b) The person who uses defensive force knew or had reason to believe that an unlawful and forcible entry or unlawful and forcible act was occurring or had occurred.
NRA Chief Wayne LaPierre
There is a lot of confusion about Florida's controversial “Stand Your Ground” law. Not content with the anachronistic Second Amendment to the Constitution which is spelled out in my article in Salon, the NRA (America's armaments business lobby) was the inspiration of a law in Florida and several other states that takes the pretty much universal rule of self-defense and embellishes it - as if self defense weren't clear enough. In this case, the law is appealing to the home owner for special protection. It is not enough, apparently to know that if a thug with murderous intentions approaches you in the woods, or the mall or wherever, you have an intrinsic right of self protection. Any schoolkid knows that and it is quite straightforward enough. If someone is about to kill you, you have the right to kill him first. Doesn't take a law degree from Harvard to comprehend the obvious.
But it takes the slick lawyers at the NRA to turn something simple into into a set political piece. Not content with the simplicity of self-defense, the NRA went about doing what they ordinarily would complain about the government doing, which is to complicate the issue with a lot of double talk and legalese when none was required. One should recall the American popular folklore phrase, “If it ain't broke, don't fix it.” By and large Americans, to a fault, believe that is precisely what is basically wrong with government. It is not a mystery that the crusade against health care reform found resonance in part because most Americans didn't think that their health care was broken and therefore the Obama cure was worse than the disease. Unfortunately, they were wrong, but they usually only find out how bad it is when it affects them directly - like when their sister couldn't get her operation paid for because the insurance company found a preexisting condition. By then it is too late. It is possible for things to get fixed if they are indeed broken, but you have to know they are broken first. I digress.
In the case of self-defense law, there was nothing broken, The NRA was just making a political ploy towards those most politically vulnerable members of society, the suburban homeowner, er, swing voter. By singling out the homeowners, the NRA was saying to them that “we care about you.” They know suburban homeowners are particularly insecure, especially the ones with children. There is no one more easily scared than a family with small children. So the “Stand your Ground” law reads like a manual for the homeowner. “The person against whom the defensive force was used was in the process of unlawfully and forcefully entering, or had unlawfully and forcibly entered, a dwelling, residence...”





 Reason to believe? Now there is a loophole worthy 
of a politician about to defraud the taxpayer.

 It cries out that you should be protected in your own home and you shouldn't have to worry about the consequence of killing another person if someone is attempting to break into your residence. You see, under the conventional self-defense law, it was necessary to have an actual bodily threat to invoke self defense. Your life had to be in jeopardy in order to justify killing another human being. Under the “Stand your Ground” law, no such imminent lethal threat is necessary. Just the act of breaking into your home is sufficient. Whether it is a kid with a bad case of the munchies, or a burglar after your TV, or a mass murderer makes no difference. You are the king of your castle and if anybody breaks into your domain uninvited you now have the right to execute him under this brilliant piece of legislation brought to you from the good folks of the NRA.
There will be some defenders of the law who will say that people will misinterpret the law, and that will be undoubtedly the case in the Zimmerman saga. The Martin kid was clearly not trying to break in the house, so the law doesn't even apply, or does it? “The person who uses defensive force knew or had reason to believe that an unlawful and forcible entry or unlawful and forcible act was occurring or had occurred.” Reason to believe? Now there is a loophole worthy of a politician about to defraud the taxpayer. If I say I had “reason to believe” then that's OK? And what would allow me to have reason to believe? That the kid was wearing a hoodie as the wise Geraldo Rivera might say? Or perhaps he was just a kid. (You know what they are capable of.) Or, of course, a minority - perhaps even an illegal alien. What a great opportunity to bag an Illegal. “I swear he looked like he might be entering the house illegally.” Makes sense - he's already here illegally. So the good folks at the NRA not only brought us a law that justifies homicide based on the flimsiest of evidence, but set the stage for slowly recreating the good old days of the Wild West (see “Vigilante Justice” on this blog) all in a cynical ploy to garner more votes for the pro-gun crowd and create more clients for their deadly products. Bravo, you should be all proud of yourselves.

          Health Care Consultant - Health Land Clinic - Vancouver, BC   
Collect, compile and analyze information from clients, health care institutions and organizations and produce proposals for the development of the company, such... $34 an hour
From Indeed - Fri, 10 Mar 2017 21:41:29 GMT - View all Vancouver, BC jobs
          Registered Nurse - RN - Part Time Wound Nurse - Woodland Park Care Center - Salt Lake City, UT   
A current, active license to practice as a Registered Nurse (RN) in State of practice. We are now hiring RN’s for part time Certified Wound Nurse....
From Avalon Health Care Group - Tue, 27 Jun 2017 16:28:24 GMT - View all Salt Lake City, UT jobs
          Director of Nursing - DON - Woodland Park Care Center - Salt Lake City, UT   
Must be a Registered Nurse (RN) in good standing and currently licensed by the State. The Director of Nursing is responsible to plan, organize, develop and...
From Avalon Health Care Group - Fri, 23 Jun 2017 16:45:53 GMT - View all Salt Lake City, UT jobs
          Avalon - Unit Manager - RN - Woodland Park Care Center - Salt Lake City, UT   
Must be a Registered Nurse (RN) in good standing and currently licensed by the State; The Unit Manager will direct the day to day functions of the Nursing Unit...
From Avalon Health Care Group - Fri, 23 Jun 2017 16:45:49 GMT - View all Salt Lake City, UT jobs
          Medication Assistant Certified (MA-C) / Medication Aide - Woodland Park Care Center - Salt Lake City, UT   
State endorsement certification as a Medication Assistant - Certified (MA-C). Documents accurately the administration of medication and performance of resident...
From Avalon Health Care Group - Fri, 05 May 2017 20:29:40 GMT - View all Salt Lake City, UT jobs
          Psychiatrist - Salt Lake Behavioral Health - Salt Lake City, UT   
Universal Health Services, Inc. (UHS) is one of the nation's largest and most respected health care management companies, operating through its subsidiaries...
From Universal Health Services - Wed, 05 Apr 2017 13:06:08 GMT - View all Salt Lake City, UT jobs
          Medical Director -Psychiatrist - Salt Lake Behavioral Health - Salt Lake City, UT   
Universal Health Services, Inc. (UHS) is one of the nation's largest and most respected health care management companies, operating through its subsidiaries...
From Universal Health Services - Wed, 05 Apr 2017 13:06:07 GMT - View all Salt Lake City, UT jobs
          Top Stories: Poll Shows Disapproval Of Trump, GOP Health Plan; Venezuela Attack   
Good morning, here are our early stories: -- Just 17 Percent Of Americans Approve Of Republican Senate Health Care Bill. -- Trump Fails To Reach Beyond Base, As Independents' Disapproval Grows. -- Venezuelan Police Helicopter Fires On Supreme Court, Interior Ministry. -- Sarah Palin Sues 'New York Times', Says Editorial Defamed Her. And here are more early headlines: Enormous Wildfire Still Out Of Control In Utah. ( KUER ) Safety Questions After N.Y. Subway Car Derails, Injuring Several. ( New York Times ) Cyber Attacks Around The World; Ransom Demanded. ( Washington Post ) Islamist Militants Force Southern Filipino Women Into Sex Slavery. ( Telegraph ) Border Wall Prototype Construction Underway In Calif. ( San Diego Union-Tribune ) Germany Clears Building; Siding Similar To That In Deadly London Fire. ( Sydney Morning Herald ) VIDEO: Man Rescued From River By California Highway Patrol. ( Los Angeles Times ) Copyright 2017 NPR. To see more, visit http://www.npr.org/.
          Top Stories: Cause Of London Building Fire; More On The GOP Health Bill   
Good morning, here are our early stories: -- Massive Fire At London High-Rise Started In A Refrigerator, Police Say. -- The AMA's Take On GOP Health Care Plan. -- Real Estate Firm With Ties To Trump May Build The New FBI Headquarters. And here are more early headlines: Renmants Of Tropical Storm Cindy Pose Flash Flood Threat In South. ( AccuWeather ) Arab States Make Demands Of Qatar, Including Closing Al Jazeera. ( Guardian ) The U.S. Halts Beef Imports From Brazil Over Safety. ( New York Times ) North Korea Denies It Tortured Or Mistreated Dead U.S. Student. ( AP ) North Korea Reportedly Tests Rocket; Could Be Used In Missile. ( Reuters ) Another Venezuelan Protester Killed In Demonstrations. ( VOA ) Jurors Still At Work In Murder Re-Trial Of Ex-University Officer. ( WLWT ) World's Ugliest Dog Contest In Petaluma, Calif. ( Argus-Leader ) Copyright 2017 NPR. To see more, visit http://www.npr.org/.
          Top Stories: Tropical Storm Cindy; ISIS Destroys Historic Mosul Mosque   
Good morning, here are our early stories: -- Heavy Rains And Flooding As Tropical Storm Cindy Makes Landfall. -- ISIS Destroys Historic Mosque In Mosul As Iraqi Forces Close In. -- After Georgia Win, A Triumphant Trump Returns To Campaign Trail In Iowa. -- Virginia Community Mourns Muslim Teen Killed On Her Way To Mosque. And here are more early headlines: GOP To Release Proposed Senate Health Care Bill Today. ( ABC ) Man Who Fired Into D.C. Pizzeria On Conspiracy Theory To Be Sentenced. ( WTOP ) Report: U.S. Forces Reportedly Question Detainees In Yemeni Prisons Where Torture Is Alleged. ( AP ) House GOP Proposes Bill To Privatize U.S. Air Traffic Control. ( USA Today ) U.N. Says World Population Near 10 Billion By 2050. ( U.N. News Centre ) Copyright 2017 NPR. To see more, visit http://www.npr.org/.
          Top Stories: Latest On Senate Health Care Bill; Saudi Arabia's Crown Prince   
Good morning, here are our early stories: -- Saudi King Deposes Crown Prince And Names A New Heir, Age 31. -- Here's What We Know About The Senate GOP Health Care Bill. -- Uber Founder Resigns Under Pressure As CEO, Published Report Says. -- Mattel Introduces New Diverse Ken Dolls; Hopes To Reverse Sales Slump. -- Carla Fendi, Former President Of Luxury Fashion Brand, Dies. And here are more early headlines: Tropical Storm Cindy Advances On Louisiana Coast. ( NHC ) Extreme Heat Felt In Various Parts Of The Northern Hemisphere. ( Reuters ) Former DHS Secretary To Testify On Russian Meddling Today. ( PBS ) Trump Son-In-Law, Kushner, Visits Israel On Mideast Peace Effort. ( Time ) Latest On Foiled Brussels Train Station Attack. ( AFP ) Copyright 2017 NPR. To see more, visit http://www.npr.org/.
          Top Stories: Company Won't Take Americans To North Korea; Senate On Health Care   
Good morning, here are our early headlines: -- Tour Company Used By Otto Warmbier Will Stop Taking Americans To North Korea. -- Sen. Bernie Sanders On GOP Efforts To Replace Obamacare. -- Attention Holiday Shoppers: UPS To Add Delivery Surcharges. And here are more early headlines: Georgia Special Election Opens For House Seat. ( USA Today ) Ukrainian Leader To "Drop In" On Trump. ( Guardian ) Philippines Renews Attack Against Militants In Southern City. ( Reuters ) Air Bag Maker Reportedly Seeking Bankruptcy. ( Bloomberg ) Tropical Storm Warnings Issued For Louisiana Coast. ( NHC ) Death Toll In Portugal Forest Fires Is Now 64. ( BBC ) Some Armed Groups In Central African Republic Sign Agreement. ( AP ) Collection Of Nazi Artifacts Discovered In Argentina. ( Deutsche Welle ) Copyright 2017 NPR. To see more, visit http://www.npr.org/.
          Top Stories: Attack At London Mosque; London Fire Death Toll Rises   
Good morning, here are our early stories: -- At Least 1 Dead After Vehicle Hits Pedestrians Near North London Mosque. -- 79 People Are Believed Dead In London's Grenfell Tower Apartment Fire. And here are more early headlines: Supreme Court To Hear Congressional Redistricting Case. ( Washington Post ) Senate Democrats To Protest GOP Action On Health Care. ( Politico ) Officials Say It Took An Hour To Report U.S. Destroyer Collision. ( Reuters ) Brexit Talks Open In Brussels. ( Guardian ) Potential Tropical Storms Forming In Atlantic Ocean, Gulf Of Mexico. ( NHC ) Closing Arguments Today In Murder Retrial Of Ex-University Of Cincinnati Officer. ( WLWT ) Turkey Sends Troops To Qatar For Military Exercise. ( Al Jazeera ) N.Y. Public Theater's "Julius Caesar" Interrupted Again. ( New York Post ) Copyright 2017 NPR. To see more, visit http://www.npr.org/.
          Top Stories: Trump's Cuba Policy; Escaped Georgia Inmates Recaptured   
Good morning, here are our early stories: -- Republicans And Democrats Come Together To Play Ball. -- How Cubans Are Reacting To Trump's Harsher Policies. -- Escaped Ga. Inmates Who Killed 2 Guards Captured In Tennessee, Police Say. And here are more early headlines: Senate Health Care Reform Work Still Secret. ( Houston Chronicle ) Report: U.S. To Send 4,000 Troops To Afghanistan. ( AP ) Russia Claims It May Have Killed ISIS Leader. ( New York Times ) London Tower Fire: Some Victims May Not Ever Be Identified. ( BBC ) Judge Orders Deadlocked Cosby Jury To Continue Deliberating. ( Philly.com ) Bomb Kills 8 At Chinese Kindergarten. ( The West Australian ) Fighting Continues Between Army, Militants In Southern Philippines. ( Reuters ) Security Flaw Detected In Georgia Election System. ( WABE ) Copyright 2017 NPR. To see more, visit http://www.npr.org/.
          Pharmacy Manager - Lloyds Pharmacy - Westhill   
We are looking for an experienced manager, with good personnel management and relationship management skills to join a strong existing team of Health Care...
From Celesio UK - Thu, 25 May 2017 18:15:09 GMT - View all Westhill jobs
          A number certain to strike fear in the hearts of Senate Republicans   
Here's an indisputable fact: The health care legislation Senate Republicans were forced to delay a vote on Tuesday is very, very unpopular with the public.

          VP, Digital Marketing - Minnetonka, MN - USA-MN-Minnetonka   
Job Description: No industry is moving faster than health care, and no organization is better positioned to lead than UnitedHealthcare. Research shows a strong and steady demand from seniors looking t...
          Vice President, Facilities and Redevelopment - North Wellington Health Care - Ontario   
Located in Wellington County where staff have the luxury of choosing to live in either a rural or urban setting. WELLINGTON HEALTH CARE ALLIANCE....
From North Wellington Health Care - Wed, 07 Jun 2017 21:54:17 GMT - View all Ontario jobs
          Manager, Quality and Patient Safety - North Wellington Health Care - Ontario   
Located in Wellington County where staff have the luxury of choosing to live in either a rural or urban setting. WELLINGTON HEALTH CARE ALLIANCE....
From North Wellington Health Care - Fri, 02 Jun 2017 21:49:15 GMT - View all Ontario jobs
          Project Manager (3 year contract) - North Wellington Health Care - Ontario   
Located in Wellington County where staff have the luxury of choosing to live in either a rural or urban setting. WELLINGTON HEALTH CARE ALLIANCE....
From North Wellington Health Care - Tue, 30 May 2017 21:58:50 GMT - View all Ontario jobs
           foxnews    
Secretary #BenCarson compared the GOP health care bill to #Trump’s economic agenda, which plans to cut funding from HUD’s budget. For more on this story, visit FoxBusiness.com
          Spectranetics and General Mills climb; Paychex slides   

NEW YORK (AP) — Stocks that moved substantially or traded heavily on Wednesday: General Mills Inc., up 90 cents to $56.42 The maker of cereals and packaged foods had a better fourth quarter than investors expected. Spectranetics Corp., up $7.95 to $38.35 Most Read StoriesElizabeth Warren: ‘The next step is single-payer’ health careSeattle No. 1 […]
          Save up to 80% on health care for under $40 month (Oodle)   
Save up to 80% on health care. Affordable dental (includes vision, prescription, and chiropractic) and medical plans up to $40, includes entire household. Contact for free info or visit http://swilliams.savewithdiscounthealthcare.com

          Comment on Analysis sees 21 percent premium hike with Obamacare repeal by Robert Lehmert   
Jamie, if health insurance had continued to inflate the way it did under George W. Bush's administration, the health care system would have collapsed, and the economy would have tanked for that reason. The problem that makes universal health care systems expensive is pre-existing conditions. In order to get insurance carriers to cover all applicants without conditions, the ACA guaranteed payments to cover the excess losses arising from pre-existing conditions. When these payments began to be withheld due to a 2015 tax bill, insurers began to lose money and -- as a direct consequence --stopped participating. This is a political problem that was inflicted by politicians. It will exist with any plan that covers people with pre-existing conditions.
          Senate health care bill would affect 4 million Californians, cost state $30 billion a year   
The U.S. Capitol as seen from the Supreme Court Building in Washington, D.C.

File: The U.S. Capitol as seen from the Supreme Court Building in Washington, D.C.; Credit: J. Scott Applewhite/AP

KPCC Staff

The health care bill under consideration in the U.S. Senate could lead to serious reductions in Medi-Cal coverage, including reducing or ending coverage for more than 3.8 million people enrolled in the Affordable Care Act's Medicaid expansion, according to a new analysis by California's Department of Health Care Services and Department of Finance.

The bill could add more than $30 billion per year in additional health care costs to the state budget over the next 10 years, shifting responsibility and costs for health care from the federal government to California. It would add nearly $3 billion in costs by 2020, growing to $30.3 billion per year by 2027, according to the analysis.

"This bill takes a sledgehammer to the improvements we have made in our state’s health care delivery system," DHCS Director Jennifer Kent said in a statement.

The total costs from 2020 through 2027 for California: $114.6 billion, including $92.4 billion of the state's General Fund, according to the analysis.

The analysis is similar to that of the House version of the health care bill, according to the DHCS, costing less up front by an additional $12 billion per year by 2027.

Check back for updates to this story.

This content is from Southern California Public Radio. View the original story at SCPR.org.


          Klobuchar: Dems 'have always been...   
Sen. Amy Klobuchar hits back at Deputy Press Secretary Sarah Huckabee Sanders' comments that Democrats wouldn't sit at the table during health care reform talks.
          In 2010, Obama Defended His Health Care Plan Before The GOP On Live TV. Things Have Changed.   
  The very next month he spent two full days defending the ACA at Heritage House before congressional leadership, doctors, the health care lobby, and patients rights groups. He debated the minute budgetary facts extemporaneously while Paul Ryan relied on half foot thick bin …
          GOP Senator: Dems Have 'Drawn Line in the...   
Sen. Mike Rounds (R-S.D.) joins MTP Daily to discuss working with Democrats on the Senate health care bill.
          Can Dems and GOP Pass Health Care Before...   
Sen. Tom Carper (D-DE) joins Chuck Todd to discuss whether the Democrats can work with Republicans on a bipartisan health care bill.
          Executive Administrative Assistant at Kenya Medical Research - KEMRI   
Kenya Medical Research Institute (KEMRI) is a State Corporation established through the Science and Technology (Amendment) Act of 1979, which has since been amended to Science, Technology and Innovation Act 2013. The 1979 Act established KEMRI as a National body responsible for carrying out health research in Kenya. The Post holder will provide effective coordination, project management and administrative support to the Health Services Unit team. The position is also vital for effective liaisons between the Unit with the rest of the internal Programme functions externally with the Programme and partners and stakeholders. Roles for the Executive Administrative Assistant Job The post-holder will work with the head of the Health Services Unit and senior researchers to plan and then manage the team's operations. Finance Review budgets with finance and ensure correct allocations of project expenditures. Track monthly expenditure by grant code Project forward grant funds remaining by Grant code Work in liaison with finance and grant Investigators on spending plans/financial forecasting Budgeting Liaise with Finance department and PI's to prepare budgets for grant proposals Prepare departments budgets for fieldwork, meetings and travel Procurement Maintain all procurement needs for PI and related projects Arrange procurement of equipment and other purchases in liaison with procurement department Maintains inventory of all equipment and assets of unit /PI grants. Oversee purchase requisition process for group Prepare Asset disposal schedules as guided by the PIs. Oversee Sub-Grants / Sub-Contracts Write sub-contract agreements together with the programme operations team Monitor compliance of sub-contracted partners with terms of engagement General Management/Administrative support Support travel, accommodation booking, seminar & workshop arrangement Taking minutes of meetings Executive Administrative Assistant Job Qualifications Degree in a relevant discipline (e.g Degree in commerce, Business Administration/Management or equivalent.) At least 8 years' experience where there was responsibility for managing substantial projects to a successful conclusion Accounting qualifications or demonstrable experience in managing accounts and planning and reporting expenditure Experience in working with parties under sub-contract to ensure smooth running of projects and timely delivery of goals measured against milestones Experience in general issues of human resources management A high level of skill in use of basic Microsoft Office packages and excellent written and spoken English Experience in work in the health care / health research field Experience in supervising more junior team members Additional qualifications in project management an advantage Experience in providing written reports to funding organisations
          Laboratory Technologists at Kenya Medical Research - KEMRI   
Kenya Medical Research Institute (KEMRI) is a State Corporation established through the Science and Technology (Amendment) Act of 1979, which has since been amended to Science, Technology and Innovation Act 2013. The 1979 Act established KEMRI as a National body responsible for carrying out health research in Kenya. To provide technical support to research teams in the set up of laboratory experiments, analysis of samples/data and recording of applied processes and procedures in order to meet clinical research objectives. Duties for the Laboratory Technologists Job Conduct experiments, interpret and document results through the use of routine and basic laboratory procedures involving manual techniques or use of laboratory instruments. Standardise, calibrate and carry out preventive maintenance and basic troubleshooting on laboratory equipment and instrument. Receive samples and ensure that relevant support documentation is provided and process in line with relevant QC guidelines; document sample and process information. Liaise with Nurses, clinicians, health care workers and public in order to ensure that relevant samples are taken/ provided, resolve discrepancies and to communicate results in line with laid down procedures. Participate in various QAQC, EQA, IQC and regulatory agency activities within the assigned section, including developing and documenting QC monitors. Provide technical advice to researchers in the design of experiments. Set up laboratory equipment and experiments and guide researchers on use of laboratory equipment. Prepare and collate results, update relevant databases and prepare reports as may be required. Monitor lab resources and inform relevant staff on the replenishment. Manage and dispose of waste in line with laid down guidelines including segregation and use of specified waste disposal facilities. Continually comply with all laid down QMS guidelines/ standards/ SOPs and comply with all health and safety guidelines. Supervise field teams as required including allocation of tasks and responsibilities to assigned field And any other duties that may be assigned from time to time. Laboratory Technologists Job Qualifications A Diploma in Medical Laboratory Sciences Registered with the Kenya Medical Laboratory Technicians and Technologists Board Knowledge and understanding of GCLPs and regulatory/ accreditation agency requirements Knowledge of laboratory Health and Safety practices Computer literacy with proficiency in Microsoft applications
          Lawmakers Warn Senate Health Care Bill Could Worsen Opioid Crisis   
Some senators are concerned about how the Senate Republicans health care bill would affect treatment for opioid addiction.
          55 Percent Of Americans Disapprove Of Senate Health Care Bill   
A new NPR-PBS NewsHour-Marist poll shows President Trump's approval ratings below 40 percent and approval of the GOP health care proposal in the teens. This toxic environment makes it even tougher for Republicans to forge a deal to meet their twin goals of repealing the Affordable Care Act and making affordable care more accessible.
          Boston Surgeon Argues Senate GOP Bill Threatens Nation's Health   
NPR's Robert Siegel talks with Atul Gawande, a surgeon at Brigham and Women's Hospital in Boston and a staff writer for The New Yorker, about what the health care industry learned from the Affordable Care Act.
          Group Leader Reception - CSL Behring - Lawrence, KS   
Minimum of 18 months experience in a clerical or customer service related position, preferably in health care of plasma collection environment or equivalent...
From CSL Behring - Sun, 25 Jun 2017 06:34:03 GMT - View all Lawrence, KS jobs
             
Does anyone have a story of web logs actually being used as organizational, domain specific, knowledge management tool? I am interested in the potential use of web logs as a component in an integrated knowledge management scheme within health care organizations and health care communities. The idea of threaded conversations, with appropriate editing to keep it on a topic is appealing. The concept of learning communities across organizations and sites is what I am hoping to explore. The first problem I see is the indexing or navigating of web log material. On an outlining discussion group learned about an associative filing and retrieval system called personal brain http://www.thebrain.com . I have been using it for a year. It is useful. I believe that some conventional search engine, plus a graphical associative navigation tool like the brain, along with the usual hierarchical filing/navigation structures might begin to pull the information together so that I can be usedÖmaking it knowledge. One might suspect that I want to force this freedom to utilitarian purposes. I do. I want folks in my company to learn together across organizational boundaries without having to go up the hierarchy and back down before any sharing occurs. I do understand the enthusiasm for freedom of expression and for unbounded publication of one's thoughts. I routinely read Dave Winer's web logs.
          Report: Solving NJ Pension Crisis Requires Tax Hikes, Benefit Cuts   
A new policy report calls for a sales tax hike and major cuts to retiree health care costs to fund the public worker retirement system.
          Comment on Beautiful life with Avada Health Care gives security by Anonymous   
none
          They Brought This on Themselves   
Leftists have created their own abortion nightmare. They can whine all they want to about the eeeeevil pro-life movement and those aaaaawful conservatives, but the truth is that the Stupak amendment was only made possible by the liberal obsession with government-run health care. Consider this, Planned Parenthood and NARAL: Under any of the various Republican […]
          Beyond repeal of Obamacare   
The proposed Medicaid cuts in the new U.S. Senate bill could impact coverage for 400,000 Arkansas children.

On June 22, Republicans in the U.S. Senate introduced a long-awaited bill to replace the Affordable Care Act, the health care law often referred to as Obamacare. The Better Care Reconciliation Act would rework the ACA's subsidies for individual insurance policies, cut taxes for higher-income households, end the mandate that individuals have insurance, and allow states to opt out of ACA requirements that insurance policies include benefits such as mental health and maternity coverage. It would also put an end to the enhanced funding rate that made it possible to expand Medicaid to cover some 14.4 million low-income adults nationwide.

But the Senate bill, like similar legislation passed by the U.S. House of Representatives in May, would also institute major cuts to the traditional Medicaid program, potentially affecting coverage for millions of children, elderly people and disabled adults nationwide. In Arkansas, 30 percent of the state's population — about 912,000 people — were enrolled in some form of Medicaid in March 2017, according to data from the Centers for Medicare & Medicaid Services. That figure includes enrollment in the Children's Health Insurance Program, or CHIP, which together with Medicaid pays for ARKids A and B.

Marquita Little, health policy director at Arkansas Advocates for Children and Families, said the Senate bill "goes well beyond the political promise of repealing Obamacare. It restructures Medicaid funding. And so, it really is a U-turn on the promise that the federal government has always made to states — that Medicaid would be funded through a state-federal partnership." (Arkansas Advocates for Children and Families has contributed funding to the Arkansas Nonprofit News Network.)

The Senate bill would reshape Medicaid in two ways. First, beginning in 2021, it would phase out the Medicaid expansion created by the ACA, which provides coverage to low-income adults. Approximately 300,000 Arkansans are now enrolled in Arkansas Works, the program funded by the Medicaid expansion. Second, the Senate bill would cap federal spending on the rest of Medicaid, which existed long before the ACA's expansion and which is composed of programs such as ARKids. Rather than Medicaid paying for patients' medical care on an open-ended basis, as is now the case, the federal government would disburse funds to states in lump sums, either on a per capita basis or through block grants. The Congressional Budget Office projects 22 million people would lose coverage if the Senate bill become law.

Parents like Julie Kauffman of Mountain Home are anxiously watching developments in Washington and wondering how the proposed cuts would translate to Arkansas. Kauffman's daughter, Olive, suffers from cerebral palsy that resulted from viral encephalitis that developed 12 days after she was born. After the infant was airlifted to Arkansas Children's Hospital, Kauffman and her husband were told their private Blue Cross policy would pay for less than half of the helicopter ride, leaving them on the hook for $7,000.

"That was kind of our first introduction to, 'Oh, our health insurance doesn't cover what our child needs,' " Kauffman said. The financial office at the hospital told the parents they should get Olive on Medicaid. "I thought, 'We have health insurance, this is ridiculous. We don't need Medicaid.' Two helicopter rides later, and thousands and thousands and thousands of dollars later, we desperately need Medicaid."

Now 3 years old, Olive's condition requires periodic visits to specialists at the Cerebral Palsy Center at St. Louis Children's Hospital, plus regular speech, occupational and physical therapy sessions at a clinic in Mountain Home. She now spends nine hours in therapy per week. "What Blue Cross covers for her and therapy, she maxes out every year in February. That's when Medicaid picks up the rest of her tally," Kauffman said.

It's especially crucial that Olive receive intensive therapy at a young age, Kauffman explained, to maximize her chances of developing the skills necessary to lead a more independent life. "It's now or never. I mean, we have to do it now. She's 30 pounds. She doesn't have head control. She can't sit up and feed herself. She's nonverbal. She's, you know, total care, and unless we get as much bang for our buck now, what does her future look like?" On July 1, a new rule from the Arkansas Department of Human Services, which administers Medicaid in Arkansas, will limit the number of billable minutes of speech, occupational and physical therapy a beneficiary may receive each week without special authorization. The cap is 90 minutes for each category — about half what Olive receives right now. DHS said in a September legal notice that the change is estimated to save the Arkansas Medicaid budget $56.2 million annually. Kauffman said she will seek DHS approval to keep paying for the additional therapy hours, but she's concerned about the future.

"What's happening in the state alone, along with what's coming down from the federal level — it's just terrifying."

Kauffman said her biggest concerns about the Senate bill "are the cuts and the block grants. If it comes down to a block grant system where the federal government gives each state a set amount of dollars, how is that going to be disbursed from child to child? I don't know how they would even begin to figure that out. My kid is expensive, and that's not her fault. ... I understand the thought process that Medicaid cannot sustain at the rate that it's going. But there are also a lot of kids in my daughter's situation who didn't ask for this. They need as much help as they can possibly get, and in a perfect world her private insurance would cover what she needs — but it just doesn't."

Olive previously was on ARKids but now has Medicaid coverage through Supplemental Security Income (SSI) Disability. "Because my husband and I are both self-employed and our income fluctuates, she qualifies for SSI at the moment — but that could change at any moment," Kauffman said. She is a subcontractor for a medical billing company; her husband owns a furniture company, where she also works part time. Although their daughter receives substantial government benefits, the couple also ends up devoting much of their household income to her care as well, from specialized equipment to travel costs to St. Louis to therapy that must be paid for out-of-pocket. For the self-employed, time away from home is time spent not working — an additional drain on family resources.

"We're fortunate to have grandparents who chip in when they can and relatives who help out as needed, but, for the most part, we're just doing the best we can do to get by," she said. "We could have $10 million and it still wouldn't be enough."

Approximately 400,000 kids in Arkansas are on Medicaid — about half the children in the state. Only a small percentage have medical needs as pronounced as Olive's. Nonetheless, Marquita Little said, reductions to federal Medicaid spending proposed by the Senate bill would be "devastating to our medical system in Arkansas.

"Our overall impression is that it's still a dangerous bill for kids, for our most vulnerable populations ... [including] seniors, people with disabilities. By capping funding on traditional Medicaid, we would basically be reducing funding that we have in place for those populations. ... So what that means for Arkansas is that we would be forced to make some tough decisions about how we absorb those cuts. You either have to reduce what you actually cover, or you have to reduce payments that we're making to providers."

Having a child who requires such specialized care has changed her perception of Medicaid and those who benefit from the program, Kauffman said. "The biggest thing is that Medicaid helps so many more people than just what everybody assumes... . You know, people who don't want to go out and find a job and take care of themselves. Medicaid is so much more than that. So I think it's just this misconception ... and I was guilty of that. But now I know how needed it is."

This reporting is courtesy of the Arkansas Nonprofit News Network, an independent, nonpartisan news project dedicated to producing journalism that matters to Arkansans.


          National Nurse Act of 2017 Introduced in Senate   

DURING NATIONAL NURSES WEEK, MERKLEY STANDS UP FOR NURSES WITH BIPARTISAN LEGISLATIVE PACKAGE

Bills would update nursing workforce programs and create a National Nurse for Public Health

WASHINGTON, D.C. – This National Nurses Week, Oregon’s Senator Jeff Merkley [merkley.senate.gov] is standing with nurses in Oregon and across America by introducing bipartisan legislation to support nurses and strengthen the nursing profession.

Merkley on Thursday introduced the National Nurse Act of 2017 and the Nursing Workforce Reauthorization Act of 2017, both with bipartisan support. The National Nurse Act is co-led by Senator Shelley Moore Capito (R-WV), and the Nursing Workforce Reauthorization Act is co-led by Senators Richard Burr (R-NC), Tammy Baldwin (D-WI), and Susan Collins (R-ME).

Merkley, whose wife works in Oregon as a registered nurse, also introduced a bipartisan Senate resolution with Senator Roger Wicker (R-MS), officially honoring May 6-12 as National Nurses Week.

“As the husband of a nurse, I hear firsthand about the challenges and successes that come with working on the frontlines of our health care system,” Merkley said. “Every day, nurses take on difficult, essential, and often thankless tasks that keep our health care system running and that have a huge impact on the patient experience. Each of us has a story about the nurse who made all the difference at a frightening or difficult time for our families. I’ll keep fighting to improve federal policy to fully recognize and support the essential role of nurses in our health care system, and I invite all Oregonians to join me in recognizing the tremendous work of our Oregon nurses this National Nurses Week.”

The National Nurse Act of 2017 (S. 1106) The bipartisan National Nurse Act of 2017 would elevate the role of nurses in America’s public health by designating a National Nurse for Public Health.

The National Nurse position would be created by transforming and elevating an existing position within the U.S. Public Health Service, the Chief Nurse Officer. Similarly to the Surgeon General, the National Nurse for Public Health would help raise awareness among the American public about disease prevention and healthy living. The position would provide leadership by a publicly visible nurse who would collaborate with other health care leaders to address health disparities and set goals for improved public health. Nurses represent the largest single component of the health care profession with more than 3.3 million registered nurses. With a National Nurse for Public Health providing a uniting voice and national leadership, American nurses’ power to transform their patients’ lives and to improve public health outcomes would be even greater.

Chronic conditions such as heart disease, cancer and obesity pose the single greatest threat to the health of Americans and a serious threat to our nation's economy. Nurses provide key services for the prevention and management of these conditions. The National Nurse for Public Health will promote prevention; help improve outcomes; and guide national, state and local efforts in addressing the nation's health.

The National Nurse Act of 2017 is supported by the American Nurses Association, AFT Nurses and Healthcare Professionals, the Case Management Society of America and 105 other national and state nursing organizations and key stakeholders.


          Please Support The National Nurse Act of 2017   

Please Support The National Nurse Act of 2017

Written By Kathy Quan BSN, RN, PHN (and posted with permission)

Nurses were once again voted the Most Trusted Professionals in the 2016 Gallup Poll. This marked the 15th year in a row that nurses have topped the list. It’s indeed an honor to call ourselves nurses and to be able to impart our knowledge on our patients to improve their quality of life and health status.

Today we face uncertainties with the new administration who promises to “repeal and replace” the Affordable Care Act as soon as possible. We need to stand strong together in a bipartisan effort to ensure Americans continue to receive the very best health care. This starts with prevention and nurses are in a unique position to lead the way. With chronic conditions on the rise that continue to bankrupt our federal and personal healthcare dollars, educating patients about their life style, health issues, chronic illness conditions and how to PREVENT complications become even more important today.

Nurses Advance Wellness As nurses we have long been charged with the responsibility of patient education. Now more than ever before we need to advocate for our patients, ourselves and the health status of our country. The American Nurses Association too recognizes the important role nurses serve in advancing wellness and at the beginning of 2017 kicked off its “Healthy Nurse, Healthy Nation” campaign. The vision is to create a healthier nation by maintaining the well being of America’s 3.6 million nurses.

Dream Becomes Grass Roots Effort In 2005, a nurse educator and patient advocate from Oregon named Teri Mills MS, RN, CNE had a dream and wrote an Op-ed in the New York Times calling for unification of the nursing profession in America with a National Nurse. In early 2015, the National Nurse Act (HR 379) was introduced in the House of Representatives by Reps. Eddie Bernice Johnson (a nurse) (D-TX) and Peter King (R-NY). The Senate companion bill (S 1205) was co-led by Senators Jeff Merkley (D-OR) and Shelley Moore Capito (R-WV). The beauty of this non-controversial legislation is that it required NO additional funding for implementation.

The National Nurse Act of 2015 received strong bi-partisan co-sponsor support from 97 Representatives and 5 Senators in addition to 119 nursing organizations including the American Nurses Association, the National Federation of Nurses, and the Federation of Healthcare Professionals. Five state legislative bodies (MA, OR, NJ, NY and VT) overwhelmingly passed resolutions urging Congress to enact this bill.

H.R. 1651 The National Nurse Act of 2017 Introduced Twelve years later the legislation that grew from that grass roots effort known as H.R. 1651 The National Nurse Act of 2017 was reintroduced to the 2017 Congress. This legislation designates the Chief Nurse Officer of the U.S. Public Health Service as the National Nurse for Public Health to raise visibility and increase public and nursing support for health promotion and disease prevention.

The CNO/National Nurse for Public Health would:

1. Function alongside of the Surgeon General and focus on priorities of promoting health, improving health literacy, and decreasing health disparities

2. Serve as a visible national spokesperson for engaging nurses in Leadership, Policy and Prevention efforts

3. Encourage health professionals work and/or volunteer with community programs to improve health

4. Provide guidance and leadership for activities that will increase public safety and emergency preparedness

The National Nurse Act of 2015 came very close to passing. It is hoped 2017 will be year it passes so that the office of the Chief Nursing Officer/National Nurse for Public Health will be better able to guide the nursing profession in promoting, protecting and advancing the nation’s health.

YOU Can Help A small action on your part can go a long way in helping to bring the National Nurse Act to fruition. Please take a moment to contact your elected officials and request that they sign on NOW to support and co sponsor HR 1651. To create the change we want and need, it is imperative that nurses stand together to advocate for health promotion and prevention via a National Nurse for Public Health.


          National Nurse Act of 2017 Introduced!   

FOR IMMEDIATE RELEASEMarch 21, 2017

Congresswoman Eddie Bernice Johnson Releases Statement After Introducing National Nurse Act of 2017

Washington D.C. – Today, Congresswoman Johnson introduced the National Nurse Act of 2017, which would designate the Chief Nurse Officer position of the U.S. Public Health Service as “The National Nurse for Public Health.” Congresswoman Johnson released the following statement describing the importance of the bill:

“The National Nurse Act of 2017 is a common-sense, cost-effective way to improve the health and wellness of all Americans. As a registered non-practicing nurse whose political career began in nursing, I know firsthand how national policy can sometimes fail or inhibit nurses working in the field,” said Congresswoman Johnson. “Therefore, establishing a National Nurse, who would work alongside the Surgeon General, would help advocate for nurses and in turn advance health care for the many Americans who see nurses every day.”

“The National Nurse could focus on the important issues of health promotion, improving health literacy, and decreasing health disparities. Nurses play a critical role in the prevention and management of our nation’s deadliest conditions like diabetes, cancer, heart disease, and opioid addiction. It is my firm belief that establishing a National Nurse for Public Health in America would save so many lives- it is a shame that we have not done so already.”

Key Responsibilities of the National Nurse:

  • Collaborate with the Office of the Surgeon General to identify and address national health priorities;
  • Serve as a visible national spokesperson for engaging nurses in leadership, policy, and prevention efforts;
  • Encourage health professionals to work with community programs to improve health;
  • Increase public safety and emergency preparedness and;
  • Prepare and submit biennial report to Congress on nurses serving in the U.S. Public Health Service.

#####

U.S. Representative Eddie Bernice Johnson is the ranking member of the House Committee on Science, Space, and Technology. In addition to the House Committee on Science, Space and Technology, she is also a current member of the House Transportation and Infrastructure Committee. She has served on this committee since being elected to Congress in 1992 making her the highest- ranking Texan on the committee. As a longtime advocate for improved psychiatric treatment, Congresswoman Johnson co-lead and co-authored H.R. 2646, the Helping Families in Mental Health Crisis Act of 2015, provisions of which were included in the 21st Century Cures Act that was signed into law in December of 2016.

A link to the National Nurse Act of 2017 will be posted at http://nationalnurse.org as soon as this is available. If you would like to receive a copy of the final draft of The National Nurse Act of 2017, please email the NNNO Board.


          Now is the Time for a National Nurse   

With the myriad of health-related concerns our country is currently facing, you may be wondering if now is the time to advocate for the designation of a National Nurse for Public Health? The answer is emphatically YES! A National Nurse for Public Health, as proposed by the National Nurse Act, would capitalize on the expertise of nurses in health promotion and prevention of chronic illnesses like heart disease, type 2 diabetes, stroke, and cancer to strengthen the health of the U.S. population.

Why is now the time for a National Nurse? The burden of chronic illness on our society continues to grow. According to the CDC website, chronic diseases account for the majority of healthcare costs in the US. Chronic diseases are responsible for 7 of 10 deaths each year, and treating people with chronic diseases accounts for 86% of our nation's health care costs (CDC, 2017). As we engage in a continued national dialogue about how to decrease healthcare costs and improved health outcomes, enhanced chronic illness management arises as a top priority. Nurses are experts in and champions of chronic disease management.

Yet, the appointment of a National Nurse would do more than improve health outcomes. In the words of Congresswoman Eddie Bernice Johnson (TX-30) in a recent interview , regarding the National Nurse Act of 2015, Johnson stated, "What we want to do is make sure that nurses have the proper labeling, so that they can influence at that level. The more we can upgrade nurses in decision-making capacities, the more they'll be respected for what they really are and they more utilization we can make of their talents."

The National Nurse Act's history of strong bipartisan backing offers another compelling reason to support a National Nurse at a time when political unity is increasingly rare. At the conclusion of the 114th Congress, The National Nurse Act boasted 5 Senate co-sponsors and 97 House co-sponsors from both sides of the aisle, with representation of over 32 different states across the nation. These past accomplishments strongly position the National Nurse Act for passage in 2017 during the 115th Congress. The designation of a National Nurse is a relevant cause behind which we can rally in unison. Yes, the US currently faces many pressing health policy issues. Who better to navigate these healthcare challenges than a National Nurse for Public Health? Plans are already underway for the introduction of the National Nurse Act of 2017. Stay tuned for an upcoming announcement!


          Adventist Health Care Recognizes NNNO Advocacy Member   

Pictured: NNNO Advocacy Team Member Shevaun German MSN, RN and NNNO President Teri Mills MS, RN, CNE

Shady Grove Medical Center (SGMC) in Maryland is proud of nurse advocate and SGMC’s Critical Care Educator, Shevaun German. Recently Shevaun’s work was highlighted in her hospital’s May-June 2016 edition of RNNews. The newsletter accurately reported the proposed National Nurse role has the potential to address healthcare disparities by communicating disease prevention information to nursing associations that, in turn, would trickle down to its members.


          Ten Co-Sponsors Join in Support of H.R. 379    

Thank you to the following members of the U.S. House of Representatives for joining the now 95 co sponsors for H.R. 379 The National Nurse Act of 2016. It's exciting to see the progress being made for this bill.

Representative Peter DeFazio (OR-4-D) is now the longest serving House member in Oregon’s history. Rep. DeFazio is committed to reining in the escalating costs of health care and ensuring access to quality health care for all Americans. He is a member of the House Nursing Caucus.

In June 2008, Representative Donna Edwards (MD-4-D) became the first African American woman elected to Congress. Rep. Edwards has enjoyed a diverse career as a nonprofit public interest advocate and in the private sector on NASA’s Spacelab project. In 1994, as co-founder and executive director of the National Network to End Domestic Violence, she led the effort to pass the Violence Against Women Act that was signed into law by President Clinton.

Representative Scott Garrett (NJ-5-R) serves as a senior member of the House Budget Committee. Rep. Garrett believes we need meaningful health care reform that decreases costs, increases accessibility and improves on what is already the best health care system in the world.

In the House of Representatives, Representative Gregg Harper (MS-3-R) serves on the influential House Committee on Energy and Commerce. Mississippi’s senior House Republican also sits on the select Committee on House Administration, a special appointment made by former House Speaker John Boehner.

On April 29th, 2016 upon the urging of her constituents, Representative Ann Kirkpatrick (AZ-1-D) signed on as a co sponsor to H.R. 379. Representative Kirkpatrick serves on many health-related caucuses including the Healthcare Innovation Task Force, Youth Drug Prevention Caucus, the Congressional Diabetes Caucus, and the Mental Health Caucus.

The family of Representative Rick Larsen (WA-2-D) has been building a legacy in the Second Congressional District for more than a century. Throughout Representative Larsen’s tenure in Congress he has advocated for health care that fits Northwest Washington’s specific needs, including funding for critical access hospitals, better health services for veterans and Medicare beneficiaries, and health care that fits families’ budgets.

Representative David McKinley (WV-1-R)has represented the First District of West Virginia since January 3, 2011. As one of two professional engineers in Congress, he has a seat on the Committee on Energy and Commerce. Representative McKinley’s wife is a nurse and he is a member of the House Nursing Caucus.

Representative Martha McSally (AZ-2-R) proudly represents the people of Arizona’s Second Congressional District. Prior to serving in Congress, Representative McSally served 26 years in the U.S. Air Force, retiring in 2010 as a full Colonel. She is the first female fighter pilot to fly in combat and first to command a fighter squadron in combat in United States history.

Currently serving his third term in Congress, Representative Patrick Meehan (PA-7-R) serves on the influential House Ways and Means Committee, as well as the Committee on Ethics. Representative Meehan is the husband of a nurse practitioner and is well aware of the need for quality care and access to our health care system.

According to The Lowell Sun, Representative Niki Tsongas (MA-3-D) has convinced constituents of a core common goal: “As long as she is in Congress, the best interests of constituents will always come ahead of party politics. Since 2010, Tsongas has proven she is one of the more independent lawmakers in Massachusetts’ 9-member House delegation. She has shown a willingness to work with Republicans to advance the cause of a stronger economy and military defense system.”


          Texas Nurses Association Joins 15 ANA State Affiliates in Endorsing National Nurse Act of 2015   

August 1, 2016

Dear Congresswoman Johnson:

The Texas Nurses Association (TNA) is pleased to support H.R. 379, the National Nurse Act of 2015. H.R. 379 would designate the same individual serving as the Chief Nurse Officer (CNO) of the Public Health Service as the National Nurse for Public Health.

The TNA is the only full-service professional organization representing the interests of Texas’ 290,000 registered nurses. Our members serve in a variety of capacities, providing general and specialty care as registered nurses and advanced practice nurses (APRNs), a group that includes certified nurse midwives, certified registered nurse anesthetists, clinical nurse specialists and nurse practitioners. These nurses practice in a wide range of settings such as private practices, hospitals, and home health settings around Texas.

Thank you for your leadership in raising the visibility of nurses. The TNA appreciates that H.R. 379 provides for elevation in rank for the CNO, includes a report to Congress on the Commissioned Corps Nursing Category, and achieves a stronger focus on the role of the CNO in advocating for programs that address the health care demands of our nation.

We applaud the intention of H.R. 379 and look forward to working with you on legislation that strengthens America's health care system.

Sincerely,

Jeff Watson, DNP, RN-BC, NEA-BC, NE-BC, CRRN President


          Activists Continue to Push National Nurse Act Forward   

Pictured: Tammy Franqueiro, BSN, RN-BC

Advocates from every corner of the country continue to garner support for the National Nurse Act of 2015 (H.R. 379 and S. 1205). Here is a summary of actions taken during the past several months:

*Students at King University in Tennessee collected signatures on sign on letters that was delivered to four TN U.S. Representatives.

Indiana University at School of Nursing Campuses Unite Behind National Nurse Act

*Nursing faculty at all seven campuses of Indiana University NW wrote letters to U.S. Representatives from Indiana and Illinois urging their co sponsorship for H.R. 379. Letters to the editor of local newspapers and nursing journals are also being sent to engage nursing colleagues and the public in the campaign for a National Nurse for Public Health. Thank you to NNNO Advocacy Team member Evalyn Gossett MSN, RN for her time and dedication on behalf of this campaign.

*Students enrolled in Nursing and Health Care Policy: Issues and Analysis at the University of Texas – Arlington College of Nursing taught by Joy Don Baker, PhD, RN-BC, CNOR, CNE, NEA-BC have shared the National Nurse Campaign Facebook Page with over 4,000 friends. They wrote dozens of letters to members of Congress representing districts in Florida, Georgia, California, Hawaii, Kentucky and South Carolina. Students also sent letters to the editor to nursing websites and peer- reviewed journals. Special thanks to Catherine Huber BSN, RN, CEN and Tammy Franqueiro BSN, RN-BC for their guidance and leadership in promoting this legislation.

Please contact the NNNO if you are a nursing or graduate student and wish to promote the National Nurse Act in a class project.


          More Co Sponsors Added for H.R. 379   
Co-Sponor logo

Thank you to the following members of the House of Representatives who recently signed on in support to H.R. 379 The National Nurse Act of 2015.

Representative Don Beyer (VA-1-D)

Representative Don Beyer (VA-1-D) is serving his first term in Congress. He believes that all American families should have access to quality health care and is fighting for improvements in the U.S. healthcare system, especially for the neediest populations. Representative Beyer committee assignments include Science, Space, and Technology, Natural Resources, and the Joint Economic Committee.

Representative Gus Bilirakis (FL-12-R)

Representative Gus Bilirakis (FL-12-R) serves on the House Energy and Commerce Committee, additionally assigned to the Health Subcommittee. Working in a bipartisan manner, his main priorities include controlling government spending, creating jobs for middle class Americans, finding ways for government to operate smaller and smarter, and lowering taxes. He is also committed to strengthening homeland security, improving education, increasing access to quality health care, protecting veterans’ benefits, and ensuring the long-term viability of Social Security and Medicare.

Representative Tom MacArthur (NJ-3-R)

Earlier this month Representative Tom MacArthur (NJ-3-R) joined the growing list of co sponsors for H.R. 379 The National Nurse Act of 2015. Serving in his first term in Congress, Representative MacArthur serves on a number of committees including the House Armed Services Committee and the House Natural Resources Committee. Last year, he introduced The Excellence in Medicare Act to motivate providers to better serve seniors through performance incentives that would also reduce premiums and copays for seniors. Representative MacArthur and his wife also run In God’s Hands Charitable Foundation in memory of their daughter Gracie. This charity funds a variety of programs from helping wounded veterans to caring for children affected by AIDS in Africa.

Representative Bill Pascrell (NJ-9-D)

Representative Bill Pascrell (NJ-9-D) has built a life of public service upon the principles he learned while growing up on the south side of the Silk City. As the co-Chairman and founder of the Congressional Brain Injury Task Force, Representative Pascrell has raised the nation’s awareness of the dangers of traumatic brain injury (TBI). He is a nationally recognized leader in Congress on the issue of fire safety, having proudly authored the F.I.R.E. (Firefighter Investment and Response Enhancement) Act, which became law in 2001. Representative Pascrell also serves on the House Nursing Caucus.

Representative Adam Smith (WA-9-D)

The top priorities of Representative Adam Smith (WA-9-D) are to encourage broad-based economic opportunity by ensuring all Americans have access to a high-quality education and job-training opportunities, building a stronger transportation infrastructure, reforming our tax code, and supporting social programs that provide a bridge for struggling families to get back to work. Representative Smith is a long time supporter of the National Nurse Act. He also serves on the House Nursing Caucus.

Representative Rob Wittman (VA-1-R)

Representative Rob Wittman (VA-1-R) serves on the House Armed Services Committee and the Committee on Natural Resources, where he is well-positioned to represent the needs of Virginia's First District. He has quickly earned a reputation for being an advocate for our men and women in uniform and for being a champion of the Chesapeake Bay. Representative Wittman is the Co Chair of the recently formed Commissioned Officers Association Public Health Service (COAPHS) Congressional Public Health Caucus.


          ANA-Michigan Endorses National Nurse Act   

May 23, 2016

To The Michigan Congressional Delegation:

On behalf of the American Nurses Association (ANA)-Michigan, representing 147,234 registered nurses in Michigan, we are writing to request your co sponsorship of the National Nurse Act of 2015 (H.R. 379) (S. 1205) and express our full support for this legislation.

Designating the Chief Nurse Officer position as the National Nurse for Public Health will help strengthen efforts by nurses in every community to assist in bolstering a nationwide shift to prevention to yield improved health outcomes. The National Nurse for Public Health’s support for the Surgeon General’s focus on prevention, developing nurses as community health advocates, and promoting professional nursing is key to the role nursing plays in our nation’s healthcare infrastructure.

The projected total coat of chronic disease from 2016-2030 in Michigan is $1.3 trillion. In 2015, 6.1 million people in Michigan had at least 1 chronic disease and 2.4 million had 2 or more chronic diseases. Most of these conditions are largely preventable. By promoting health awareness increasing health literacy, and reducing health disparities, the National Nurse for Public Health would play an important role in improving our nation’s health.

Now more than ever, nurses must continue to be proactive in the fight against illness and disease. We recognize the potential of having the National Nurse for Public Health as a representative who would meet with health care leaders to determine ways to address continued health disparities and access issues for the country’s most vulnerable.

As we continue to transform our health systems at the state and national level, it is important that we work to elevate the role of public health nursing to create community level systems, identify public health concerns, and achieve early intervention for identified needs. A philosophical and cultural shift to focus on wellness here in Michigan and on the national level that is reinforced by nurses in every community would go a long way in promoting health, reducing costs, and saving lives.

We request your co sponsorship for the National Nurse Act of 2015 and are ready to work with you to help move this legislation forward.

Respectfully,

MaryLee Pakieser
President
ANA-Michigan


          A War Fighter's Budget   

The initial remedies were necessarily ad hoc, including mine-resistant vehicles and better intelligence. "In every case," Gates told me, "the problem had to be addressed by going outside the bureaucracy, creating something unique."

Gates' budget is a more systematic response -- his attempt to provide "a place at the table for the guys fighting the wars we are in." While downsizing or eliminating some expensive, high-tech programs, the budget would increase resources for health care, intelligence, reconnaissance, Special Forces, theater missile defenses, helicopters and UAVs. It is more of a shift than a revolution -- Gates estimates that only about 10 percent of the budget is devoted exclusively to irregular warfare -- but moving the balance in this direction is entirely necessary.

There are two broad objections to this budget. First, some argue that the total level of spending is insufficient. The success of the surge in Iraq has demonstrated that the size of our force matters when it comes to counterinsurgency operations. Also, the new budget does not expand the Army sufficiently to avoid the continued need for National Guard and reserve deployments.

In an interview in his Pentagon office, Gates gingerly calls this a "legitimate debate." But he counters that the size of the military has been increasing over the last several years. "Am I saying this is the right number? Maybe, or maybe not. Having increased by 100,000, we might take a pause and see if we can sustain it." Gates argues that the inclusion of more spending in the regular defense budget, instead of in emergency supplemental spending bills, is essential to sustainability -- "so it doesn't disappear when supplementals disappear."

Gates is unapologetic about cutting back on big-ticket items such as the Army's Future Combat Systems. The program's lightly armored vehicles, he notes, have 18-inch clearances and flat bottoms -- perfect targets for roadside explosives. On the other hand, Gates' missile defense cuts are relatively small, especially compared to the declared intention of some congressional Democrats to eliminate the Missile Defense Agency entirely.

The second objection concerns the rise of China, which some believe may lead to a conventional conflict. Gates is not dismissive of China, which is expanding its naval influence and focusing resources on space- and cyber-warfare. But he contends that the "Chinese are being selective in what they are doing. They learned from the Soviet Union, which we bankrupted in an arms race. ... They are looking at asymmetrical areas, so they don't get engaged in a full-scale arms race." And this allows America to be selective in our response. He argues that the proposed "mix" of F-22 and F-35 fighters, along with advanced UAVs, will be an effective counter, and that massive ground forces, in this case, are irrelevant. "Realistically, when would we have proposed to send a large ground army into Asia? In every case, that has been very painful."

Some Republicans want to polarize the budget debate. The Obama administration, according to Sen. Saxby Chambliss, R-Ga., is "willing to sacrifice the lives of American military men and women for the sake of domestic programs favored by President Obama."

In this case, the charge rings with irresponsibility. While the total defense budget should be larger in a time of war, it focuses resources and attention precisely where they are most needed: on our war fighters in Iraq, in Afghanistan -- and at places like Walter Reed.

Correction: This week, I wrote that President Obama "has complained of inheriting a $1.3 trillion debt." I should have used the word "deficit."


          Fox News Poll: 27 percent favor Senate GOP health care plan, as vote gets delayed (Fox News)   

Fox News:
Fox News Poll: 27 percent favor Senate GOP health care plan, as vote gets delayed  —  By two-to-one, American voters oppose the Senate health care bill to replace the Affordable Care Act — even as a majority wants to repeal at least some of the existing law.


          Why Catholics Are Worried About Obama   

The office of the president has meaning and importance that transcend the views of its current occupant. Though elected by a part of America, the president becomes a symbol of its whole. The respect we accord him does not imply agreement or endorsement. It reflects our appreciation for constitutional processes. So a presidential visit is always an honor. The televised arrival of Air Force One, the motorcade, the playing of "Hail to the Chief," the audience standing as the president enters -- all these express a proper respect for democratic legitimacy.

If you cannot honor the man, then honor the office. If you cannot honor the office, then one more democratic bond has been severed.

But the controversy surrounding the Notre Dame invitation highlights growing strains in an important political relationship. In the last election, while evangelical Christians generally remained loyal to the Republican nominee, Catholics decisively shifted their votes toward Obama. In 2004, George W. Bush won the Catholic vote by five points. Obama carried it by nine points in 2008. A number of Catholic thinkers set out a "pro-life, pro-Obama" position -- disagreeing with Obama's pro-choice views but trusting in his moderate instincts and conciliatory temperament.

So far, Obama has done little to justify this faith. His initial actions on life issues -- funding overseas abortion providers, removing restrictions from federally funded medical experimentation on human embryos, revisiting conscience protections for pro-life health care professionals -- have ranged from conventional to radical. And this may be one reason why Obama's support among Catholics has eroded. According to the Pew Research Center, the percentage of Americans who disapprove of Obama's job performance increased by nine points from February to March. Among Catholics as a whole, his disapproval rating jumped 14 points. And among white, non-Hispanic Catholics, the figure doubled -- from 20 percent to 41 percent.

Catholics are having second thoughts, but it could get much worse. If the president and Congress are not careful on several issues, these concerns could open a major rift between the Catholic Church and the Democratic Party.

First, Obama has raised deep concerns among Catholic leaders by signaling he will overturn Bush's executive order protecting health workers from firing and discrimination if they refuse to perform actions they consider morally objectionable. The administration claims the order was overbroad and unnecessary. But Catholic hospitals believe these protections are essential, because of pressure by states and private medical associations for Catholic health care providers to perform or refer for abortions. Catholic leaders want the president to be helpful, not neutral or hostile, in the protection of conscience.

Second, Catholic leaders fear that the Hyde Amendment -- which bans the use of Medicaid funds for abortion except in the rarest of cases -- could easily be reversed by the pro-choice congressional majority.

Third, health care reform will raise the largest debate -- whether abortion should be a covered service. As a candidate, Obama said his health proposal would include "reproductive health services." Planned Parenthood argues that "full reproductive health" must be covered. But any proposed federal entitlement to abortion-on-demand would be unprecedented, push Catholic leaders toward revolt, and possibly doom health care reform entirely.

Americans disagree strongly about the legality of abortion. But for decades there has been a rough consensus that no one should be compelled to participate in abortions or have their federal tax dollars used for abortion. These three changes would shatter that consensus, making the destruction of life an essential part of the medical and legal order while stigmatizing and marginalizing all who object. This would be an outrage and a scandal -- a troubling reinterpretation of religious liberty, which is not merely the freedom to believe, but the freedom to bring religiously informed moral beliefs to professional and political life.

Obama's Catholic supporters would feel betrayed and discredited -- and rightly so. The Catholic hierarchy and Catholic health professionals would feel assaulted by the president -- and they would be correct. And President Obama would not need to worry about future invitations from Notre Dame.


          Obama's Messenger for Moral Incoherence   

Taxpayers will now likely fund not only the use of "spare" embryos from in vitro fertilization, but also human lives produced and ended for the sole purpose of scientific exploitation. Biotechnicians have been freed from the vulgar moralism of the masses, so they can operate according to the vulgar utilitarianism of their own social clique -- the belief that some human lives can be planted, plucked and processed for the benefit of others.

It is the incurable itch of pro-choice activists to compel everyone's complicity in their agenda. Somehow getting "politics out of science" translates into taxpayer funding for embryo experimentation. "Choice" becomes a demand on doctors and nurses to violate their deepest beliefs or face discrimination.

It is probably not a coincidence that Obama has chosen a Roman Catholic -- Kansas Gov. Kathleen Sebelius -- to implement many of these policies as secretary of the Department of Health and Human Services. Obama has every right to a pro-choice Cabinet. But this appointment seems designed to provide religious cover. It also smacks of religious humiliation -- like asking a rabbi to serve the pork roast or an atheist to bless the meal.

Sebelius, though strongly pro-choice, was capable of occasional compromise. But she consistently fought against the serious enforcement of Kansas' late-term abortion restrictions. Kansas became a magnet for late-term abortions.

Still, Sebelius insists that "my Catholic faith teaches me that all life is sacred." This puts her in the same category as House Speaker Nancy Pelosi and Vice President Joe Biden -- Catholics who assert the sanctity of life while defending legal abortion. It has also earned Sebelius a firm rebuke from her archbishop.

The explanations of pro-choice Catholics are varied. Some say they will not impose their private religious views on others. But moral beliefs about human dignity are not religious dogmas such as transubstantiation or the Trinity. They are assertions about the nature of political justice. Removing the transcendent basis for human rights would also remove the central argument of the Declaration of Independence and the primary motivation for American social reform from abolition to the civil rights movement.

Others claim they are merely employing an alternative method to secure the rights of the unborn -- through social welfare programs rather than legal restrictions. In Sebelius' case, the overall abortion rate in Kansas did decline slightly more than the national reduction, though it is difficult to trace this drop to her policies. And the question arises: Couldn't a Catholic politician support women in crisis and effective protections for viable children?

Pro-choice Catholics respond that the legal remedies on abortion have been exhausted, so we might as well focus on the common-ground issue of abortion reduction -- a cause that does deserve support. But legal remedies have not been exhausted; they have been pre-empted by the courts. The exercise of democracy on abortion would probably not lead to restrictions on early abortions. But it would probably lead to broader protections for viable children. And it is difficult to imagine how anyone committed to the principle that "all life is sacred" could oppose such a democratic outcome.

Supporters of the Sebelius position also contend that there are myriad pro-life issues, including the environment and health care. Why favor some above others? It is true that nearly every political issue concerns the preservation of human life. But not every issue concerns the definition of the human community -- who we count as one among us, and who we cast beyond our protection.

If developing life is merely protoplasmic rubbish, it has the legal claims of a cyst or a toenail. But if a politician believes life is sacred, the destruction of more than a million lives a year cannot be merely one issue among many.

Sebelius and other pro-choice Catholic leaders are disagreeing with their church on a fundamental issue of justice -- which is their right. It is also the right of their church to point out their incoherence.


          ABC, CBS, NBC Hyped ObamaCare as 'Reform,' Not GOP Plan (Mike Ciandella/NewsBusters)   

Mike Ciandella / NewsBusters:
ABC, CBS, NBC Hyped ObamaCare as ‘Reform,’ Not GOP Plan  —  The committed Obama PR flacks at the broadcast news networks are experts at using biased terminology.  When President Obama and the Democrats changed the health care system it was consistently presented as “reform,” …


          A Week of Revelation   

On domestic policy, the revelation was different. Candidate Obama was a tonal moderate -- a pragmatist determined to muddle the old divisions of blue and red into a pleasing, post-partisan purple. His mainstream economic appointments seemed to confirm this intention. His stimulus package and bank bailout proposals were expansive and expensive, but not ideologically radical.

And then the budget came -- ideologically ambitious, politically ruthless and radical to its core.

Obama chose a time of recession to propose a massive increase in progressivity -- a 10-year, trillion-dollar haul from the rich, already being punished by the stock market collapse and the housing market decline. This does not just involve undoing the Bush tax reductions but capping tax deductions to collect about $30 billion a year. Despite all the rhetoric of "responsibility" and shared sacrifice, the message of the Obama budget is clear: The wealthy are responsible for the economic mess and they will bear the entire sacrifice so that government can "invest" in the people.

But governments do not "invest," they spend. Such spending can be justified or unjustified. It is wealthy individuals, however, who actually invest their capital in job creation. Most have much less capital than they used to. Under the Obama budget, they would have less still. This does not seem to matter in the economic worldview of the Obama budget. Equality is the goal instead of opportunity or economic mobility. And government, in this approach, is more capable of investing national wealth than America's discredited plutocrats -- meaning successful two-income families, entrepreneurs and professionals.

This is not merely the rejection of "trickle-down economics," it is a weakening of the theoretical basis for capitalism -- that free individuals are generally more rational and efficient in making investment decisions than are government planners.

This ideological shift is also evident in Obama's treatment of charitable giving. The new budget seeks to raise billions for health reform by limiting the charitable deduction for the wealthy. This is a direct claim that the good done by government spending will be more important than the good done by the wealthy. But it is often wealthy people who make the large donations that sustain colleges, universities and teaching hospitals. If government is inherently superior at making such charitable choices in the public good, why not make our entire education and medical systems public? Which seems to be the goal.

As a practical matter, the promise of expensive, shared public goods entirely at the expense of the rich is a transparent deception. A good portion of the budget's spending reduction is illusory -- based on the phony assumption that Iraq and Afghanistan war outlays would have continued at similar levels in perpetuity. The budget's growth assumptions are not remotely realistic. It does little to address the crisis of unsustainable Social Security and Medicare obligations. And its $634 billion health care reform "fund" is merely a down payment -- perhaps a third of the future cost.

So who is going to eventually pay for this accelerating debt, temporarily held by the Chinese and others? As the national debt's percentage of GDP moves from about 40 percent to perhaps 70 percent, there will not be enough wealthy people left to bleed. Once the economy recovers, broad tax increases will be unavoidable. Or Obama's "once-in-a-generation chance" will actually involve the imposition of massive burdens on the next generation.

Conservatives hope Obama's overreach and Harry Reid's and Nancy Pelosi's arrogance will provoke a backlash -- leading markets to revolt, uniting the Republican base and causing doubts among fiscally conservative Democrats. But as an academic at Princeton recently reminded me, "It is only overreach if you fail."

In the meantime, we have learned some important things. On defense policy, the peace candidate is not a radical. On economic policy, the post-partisan could hardly be more partisan. Obama does not want to cultivate conservatives; he wants to crush them. And that is a revelation.


          Cory Booker's marching orders on repeal bill: Two more weeks to "fight against evil" (Alison R. Parker/Shareblue)   

Alison R. Parker / Shareblue:
Cory Booker's marching orders on repeal bill: Two more weeks to “fight against evil”  —  The Republicans have delayed their vote on their health care plan.  But this is not the time to lose focus or allow apathy to settle in.  —  Senate Republicans kept the details of their health care repeal bill a secret for as long as they could.


          The Jindal Phenomenon   

Some have compared Jindal to Obama, but the new president has always been more attracted to platitudes than to policy. Rush Limbaugh has anointed Jindal "the next Ronald Reagan." But Reagan enjoyed painting on a large ideological canvas. In person, Jindal's manner more closely resembles another recent president: Bill Clinton. Like Clinton (a fellow Rhodes Scholar), Jindal has the ability to overwhelm any topic with facts and thoughtful arguments -- displaying a mastery of detail that encourages confidence. Both speak of complex policy issues with the world-changing intensity of a late-night dorm room discussion.

In recent days, Jindal has displayed another leadership quality: ideological balance. He is highly critical of the economic theory of the stimulus package and turned down $98 million in temporary unemployment assistance to his state -- benefits that would have mandated increased business taxes in Louisiana. But unlike some Republican governors who engaged in broad anti-government grandstanding, Jindal accepted transportation funding and other resources from the stimulus -- displaying a program-by-program discrimination that will serve him well in public office. Jindal manages to hold to principle while seeing the angles.

While Clintonian in manner, knowledge and political sophistication, Jindal is not ideologically malleable. His high-pressure Asian-immigrant background has clearly taught him not to blend in but to stand out. He has tended to join small, beleaguered minorities -- such as the College Republicans at Brown University. He converted to a traditionalist Catholicism, in a nation where anti-Catholicism has been called "the last acceptable prejudice." Jindal, sometimes accused of excessive assimilation, has actually shown a restless, countercultural, intellectual independence.

But this has earned him some unexpected enthusiasm. In Louisiana, Jindal is the darling of evangelical and charismatic churches, where he often tells his conversion story. One Louisiana Republican official has commented, "People think of Bobby Jindal as one of us." Consider that a moment. In some of the most conservative Protestant communities, in one of the most conservative states in America, Piyush "Bobby" Jindal, a strong Catholic with parents from Punjab, is considered "one of us."

This is a large political achievement. It is also an indication of what has been called the "ecumenism of the trenches" -- the remarkable alliance between evangelicals and Catholics on moral issues such as abortion and family values against an aggressive secularism. Two or three hundred years ago, the Protestant/Catholic divide remained a source of violence. Two or three decades ago, many conservative Protestant churches questioned if Catholics were properly considered Christians. If Jindal runs for president in three or seven years, he will be widely viewed as an evangelical choice.

Ultimately, however, Jindal is a problem-solving wonk, fond of explaining 31-point policy plans (his state ethics reform proposal actually had 31 points). This can have disadvantages -- a lack of human connection and organizing vision. But this approach also has advantages. Jindal is a genuine policy innovator. "His reforms," says Yuval Levin of the Ethics and Public Policy Center, "are the only constructive thing Republicans are doing on health care anywhere."

And Jindal's resume, intellectual confidence and command of policy make him the anti-Palin. Fairly or unfairly, media and intellectual elites (including some conservative elites) regard Gov. Sarah Palin as the inhabitant of another cultural planet. Jindal, while also religious and conservative, speaks the language of the knowledge class and will not be easily caricatured or dismissed. To journalists, policy experts and Rhodes Scholars, Jindal is also "one of us."

At this point in the election cycle, no Republican can be considered more than the flavor of the month. But this is an appealing one.


          For sale - medical and hospital negligence callaghan zaremski... - $99   

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          The Republican health care bill could be brought down by GOP governors [Ironic]   
Ironic [link] [86 comments]

          Rand Paul wound up giving a statement that sounded suspiciously like Nationalized Health Care. When confronted about it on CNN, he backtracked, then compared it to Soviet Union gulags [Fail]   
Fail [link] [94 comments]

          2Health Insurance is Redefining How Consumers Purchase Insurance Online   

With an innovative yet simple approach to purchasing health insurance, 2Health Insurance is making it simple for the uninsured to find affordable health care with their cutting edge interface and youth friendly website.

(PRWeb August 22, 2012)

Read the full story at http://www.prweb.com/releases/2012/8/prweb9828422.htm


          GOP touts lower premiums, but other insurance costs to rise   
WASHINGTON (AP) -- Republicans are touting lower premiums under their health care legislation, but that reflects insurance that would cover a smaller share of the cost of medical bills....
          Facing defections, Senate GOP leaders delay health care vote   
WASHINGTON (AP) " In a bruising setback, Senate Republican leaders are delaying a vote on their prized health care bill until after the July 4 recess, forced to retreat by a GOP rebellion that left them lacking enough votes to even...
          2:00PM Water Cooler 6/28/2017   
Today's Water Cooler: Health care battle, pending home sales, Uber, Internet of Things, how power corrupts (brain damage), lethal drones
          GOP Sen. Rand Paul Blasts Party Leaders for Ignoring Debt    
Republican Sen. Rand Paul on Wednesday blasted fellow GOP lawmakers for ignoring the government's spiraling debt problem in their rush to repeal President Barack Obama's health care law.
          Protestors in Detroit warn against Republican health care bill   
Some protestors in Detroit think the Senate Republicans' health care bill is bad for Michigan. The group of protestors marched outside of Senator Debbie Stabenow's Detroit office despite the fact that like most Democrats, she opposes the repeal of the Affordable Care Act.
          Obamacare replacement bill wildly unpopular…   
…says article after article and poll after poll. Well, why shouldn’t it be unpopular? The drumbeat of the MSM that’s been denouncing it goes like this: It will kill millions and millions of people. It only favors the rich. It cuts many more millions off from health care. It is secret. There’s probably more I […]
          Casual Senior Health Care Support Worker - British Red Cross - Wales   
The British Red Cross, incorporated by Royal Charter 1908, is a charity registered in England and Wales (220949) and Scotland (SC037738).... £8.16 an hour
From British Red Cross - Tue, 27 Jun 2017 16:07:20 GMT - View all Wales jobs
          Selling the GOP health care bill: Does Trump help or hurt?   
WASHINGTON (AP) -- It was a platform most politicians can only hope for: A captivated, 6,000-person crowd and more than an hour of live, prime-time television coverage to hype the Republican vision for a new health care system....
          Peluncuran Vitacimin White dan Vitacimin Nutriglow oleh Takeda Indonesia   


Peluncuran Vitacimin White dan Vitacimin Nutriglow oleh Takeda IndonesiaSaya selalu kagum dengan ibu pekerja. Sangat. Melihat diri saya sendiri yang masih mengurusi diri sendiri dan pekerjaan saja, terkadang membuat saya lelah. Apalagi, ibu pekerja dengan anak yang aktif, serta harus mengurus suami dan rumah. Bisa dibayangkan, bagaimana lelahnya ibu pekerja. Lelah pikiran, tenaga dan emosi.

Karena sekarang sudah banyak perempuan yang aktif dan tidak hanya berdiam diri di rumah. Tentunya, dengan segudang kegiatan mereka, mereka tak melupakan untuk mengurus keluarga. Untuk itulah, Vitacimin White dan Vitacimin Nutriglow hadir untuk menunjang segala kegiatan perempuan Indonesia.

Pada tanggal 13 Mei 2017 di Surabaya, PT  Takeda Indonesia mengumumkan peluncuran Vitacimin White dan Vitacimin Nutriglow, dua suplemen vitamin terbaru untuk membantu menjaga kesehatan para wanita Indonesia yang dibangun oleh merek Vitacimin C yang telah hadir di Indonesia dari generasi ke generasi, Vitacimin.


Diproduksi oleh Takeda Healthcare Products Co., Ltd., Kyoto, Jepang uang dikenal memiliki standar kualitas tinggi, Vitacimin White dan Vitacimin Nutriglow merupakan suplemen makanan dalam bentuk tablet salut gula yang praktis untuk dikonsumsi setiap hari, membantu menjaga kesehatan. Vitacimin White yang dikemas dalam kemasan warna putih dan biru mengandung Vitamin C, Vitamin E, Vitamin B2, L-Cysteine dan Vitamin B5. Sementara Vitacimin Nutriglow dengan kemasan berwarna putih dan merah mengandung Vitamin C, Biotin, Vitamin B6, Vitamin B2, L-Cysteine dan Nicotinamide. Menurut Mbak Inge Meliana Samadi, Head Of Consumer Health Care, bagi kamu yang memiliki kulit berminyak dan cenderung berjerawat sebaiknya mengkonsumsi Vitacimin Nutriglow. Karena Vitacimin White mengandung Vitamin E, yang biasanya bisa mengakibatkan munculnya jerawat.



“Takeda sangat berterima kasih atas kepercayaan dan kesetiaan yang ditunjukkan konsumen Indonesia terhadap produk Tablet Hisap Vitacimin. Vitacimin telah diakui sebagai pemimpin di pasar Vitamin C tunggal di Indonesia dan kini, tersedia dalam berbagai rasa. Sebagai bagian dari komitmen kami dalam mendukung Indonesia Sehat yang diwujudkan dalam semangat ‘Sehati Indonesia’, Takeda memutuskan untuk memperluas portofolio suplemen makanan kami dengan menghadirkan produk baru: Vitacimin White dan Vitacimin Nutriglow,”tutur Inge Meliana Samadi.

Acara yang digelar di Surabaya pun menghadirkan dua brand ambassador Vitacimin, yaitu Vidi Aldiano dan Ruth Sahanaya alias Mbak Uthe. Seperti yang sudah kita ketahui, kedua brand ambassador tersebut merupakan penyanyi cukup dikenal di Indonesia dengan segala kegiatan mereka. Mereka membutuhkan suplemen makanan yang mampu menunjang kegiatan mereka. Vidi Aldiano mengaku, sudah mengkonsumsi Vitacimin C sejak belia.”Jadi, Vitacimin bagi saya bukan lagi suplemen makanan, tetapi sudah seperti permen bagi saya,”tuturnya. Karena seringnya Vidi mengkonsumsi Vitacimin C, sehingga tablet hisap itu sudah seperti permen. Saya pribadi, setuju dengan Vidi. Saya pun suka menghisap Vitacimin C rasa jeruk kala badan lesu.



Tak jauh berbeda dengan Vidi Aldiano, Ruth Sahanaya pun mengkonsumsi Vitacimin, bahkan sudah diterapkan kepada anak-anaknya untuk mengimbangi kegiatan anaknya yang penuh. “Wanita seperti saya yang harus menjadi seorang ibu dn pekerja dalam satu waktu tentunya menghadapi berbagai tantangan setiap harinya. Oleh karena itu, saya sangat memperhatikan penampilan fisik dan tubuh yang sehat. Selain gejala umum selain flu, saya juga sangat emmeprhatikan keseluruhan penampilan fisik yang sangat penting dalam mendukung performa saya sebagai seorang penyanyi di industri hiburan. Langkah Takeda dalam mempersembahkan Vitacimin White dan Vitacimin Nutriglow serta kampanye ‘Make the Wordl C You’ menunjukkan komitmen mereka terhadap kesehatan dan kesejahteraan kaum wanita Indonesia.”

Menandai peluncuran dua produk terbarunya ini, Takeda Indonesia juga menjalankan kampanye bertajuk “Make the World C You” sebagai dukungan bagi para wanita Indonesia yang bersemangat dalam menjalani hidupnya secara maksimal. Inisiatif untuk menghadirkan kampanye lahir dari pemahaman mengenai semakin berkembangnya peran kaum wanita Indonesia di era modern ini.

Pustika Rucita, B.A., M.Psi., Psikologi dari Tiga Generasi yang berpartisipasi dalam acara peluncuran mengatakan,” Walau kegiatan sehari-hari mereka dipenuhi dengan beragam peran, para wanita tetap menjalani setiap perannya dengan tulus dan tanpa pamrih. Meskipun demikian, mereka tetap membutuhkan dukungan dari orang-orang sekitarnya. Apresiasi dari orang-orang sekitar dapat membuat mereka merasa dihargai dan diakui sehingga membantu mereka untuk lebih percaya diri dalam menjalani hidup.”


Tentang Takeda Pharmaceutical Company


Takeda Pharmaceutical Company Limited merupakan perusahaan farmasi global yang didasarkan pada penelitian dan pengembangan, yang berkomitmen untuk menciptakan kesehatan yang lebih baik dan masa depan yang lebih cerah dengan memanfaatkan ilmu pengetahuan sebagai obat yang dapat mengubah hidup.

Takeda fokus pada uaha penelitian dan pengembangan dalam onkologi, gastreonterologi dan sistem syarat pusat, area terapi serta vaksin. Takeda melakukan penelitian dan pengembangan baik secara internal maupun bekerjasama dengan rekanan untuk menjadi yang terdepan dalam inovasi. Inovasi produk, terutama dalam onkologi dan gastroenterologi, serta kehadiran dalam pasar yang berkembang, merupakan pendorong bagi Takeda untuk terus maju.

Vitacimin White dan Vitacimin Nutriglow memberikan pelengkap nutrisi bagi perempuan Indonesia. Vitamin yang terkandung dalam kedua suplemen makanan ini merupakan pelengkap untuk kebutuhan tubuh sehari-hari.

Acara peluncuran Vitacimin White dan Vitacimin Nutriglow ditutup dengan acara doorprize bagi yang beruntung.





          The Massachusetts Health Care Landscape   
This fact sheet summarizes the Massachusetts health care landscape, including data on demographics, population health, the uninsured and the state Medicaid program. Fact Sheet (.pdf)
          Massachusetts Health Care Reform: Six Years Later   
In 2006, then-Gov. Mitt Romney signed Massachusetts’ comprehensive health reform designed to provide near-universal health insurance coverage for state residents. Building on a long history of health reform efforts, the state embarked on an ambitious plan to promote shared individual, employer, and government responsibility. This brief examines Massachusetts’ experience with coverage and access to careMore


          Massachusetts Special Election Poll   
The Foundation, as part of The Washington Post/Kaiser Family Foundation/Harvard University partnership series, conducted a poll to better understand how health care played into the mix of issues and frustrations that brought voters to the polls in the Massachusetts special election for U.S. Senate. The poll was conducted among a random sample of 880 votersMore


          Health Reform: Lessons From Massachusetts   
As Congress debates comprehensive national health reform, the Kaiser Family Foundation has two reports and an updated fact sheet that examine state-level health reform in Massachusetts and the lessons it offers for policymakers in Washington. Consumers’ Experience in Massachusetts: Lessons For National Health Reform and In Pursuit of Affordable Health Care: On the Ground LessonsMore


          How bad could it be?   

he numbers are becoming increasingly clear; the bloom is off of the Canadian real estate bubble and boom.

Among a variety of indicators, sales of condos in the second quarter of this year in Toronto have fallen by half and a record number of units were left unsold. In Vancouver July residential sales were the lowest for any July in ten years and fell 11.2% from the month of June.

While prices are not dropping yet, the fact that commentators from the business and real estate communities themselves believe a 15% downward adjustment in prices is imminent means that we can likely expect a greater decrease. These are, after all, people whose best interests are served by minimizing any potential housing market panic.

The increasingly interventionist actions being taken by the Conservative government and Finance Minister Jim Flaherty to dampen the market, counter-intuitively if one does not really understand what is behind the real estate market boom of the past few years in the first place, also shows that the powers that be are worried. Very worried.

And they are worried for good reason. It was the government itself that facilitated the creation of the overheated market and it is the government that is ultimately on the hook for the tab should an American style meltdown occur. Which means that, in the end, you are on the hook.

Many of us have, from grade school on, been inculcated with the notion that we live in a "free market" society where prices reflect the interplays between supply and demand that fluctuate due to the rational economic decisions of buyers and sellers. For those who truly enjoy simplistic fantasies our own publicly owned broadcaster, the CBC, has programs with imbecilic "commentators" like Kevin O'Leary or that are cheerleaders for a world that exists only in the demented dreams of libertarians, such as the hilariously summer school economic "thinking" that the radio show "The Invisible Hand" soothes those who might doubt neo-conservative ideas with. Both on, ironically, a "tax-payer" funded network.

But the actual economy is much more of a planned Pyramid Scheme where the greater a company or sector's economic clout and the higher up they are in the pyramid in terms of importance to the fundamental soundness of the country's economy in the eyes of the government, the less they face the vagaries of actual market forces. The nearer to the pinnacle, the more the government intervenes, directly and indirectly. This has been true for decades, but was made most obvious during the 2008-2009 bailouts.

In the case of housing, Canadian society has raised the concept of personal home ownership to near fetishistic levels. It is part of the "Canadian Dream" that you will own your own little plot of land (or sky, in the case of condos). It is a logical extension of what originally brought many to the so-called "New World" in the first place a hundred or more years ago; only now the land is far from free for those who wish to settle it. A staggering number of citizens buy into the notion that owning a home represents some kind of freedom, despite the reality that "their" home is actually usually owned, for at least the first twenty-five years, by whoever provided them with a mortgage. Missing a few mortgage payments will make this abundantly clear.

Given the centrality that personal home ownership holds to the sense of self-actualization of much of the electorate, it is hardly surprising that, especially if it felt that the economy might be stalling, a government might chose to make sure that the "free market" worked in such a way that it would continue to facilitate this dream as a highly dangerous form of "stimulus".

And this is precisely what the Canadian government did in the period after 2008.

Under the auspices of the Canada Mortgage and Housing Corporation (CMHC) the Canadian government has insured the mortgages that Canada's banks have provided to Canadians to the tune of a projected $558 billion this year. This figure, one might note, represents over one-third of Canada's total GDP! This is up dramatically since 2007-2008, directly due to the fact that the government raised the limit on mortgages that CMHC could insure from $450 billion to $600 billion and loosened the rules on what types of mortgage would qualify.

Insured means exactly what you think it does. In the event that Canadians begin to default on their mortgages, and in the event that this default level were to reach the point where the CMHC could no longer cover defaults, the government of Canada, and, therefore, you will be on the hook for the bank's "losses". As Chris Horlacher of the free market, right-wing think-tank, the Ludwig-von-Mises Instistute of Canada shows, the inability of the CMHC to cover defaults in the event of a real bubble burst is highly likely. This is due to the fact that the CMHC's "assets" are largely identical to what it is insuring, namely mortgages! "In the event of a severe downturn in the mortgage market, claims will start pouring in. The CMHC (nor any kind of insurance company) never possesses enough cash to cover all of these potential liabilities, they invest it. The problem here is that the CMHC has bought the very same assets they are insuring against. If the mortgage market collapses, so too will the value of the assets of the CMHC, making them extraordinarily difficult to liquidate in order to raise the cash necessary to pay out their claimants. It’s a catch-22 that spells potential disaster and deeply impairs their ability to actually insure against this particular type of credit risk."

Given this, Horlacher goes on to conclude that "The CMHC remains highly susceptible to even a slight increase in the rate of mortgage defaults, or a rise in interest rates. With the federal government, and ultimately the Canadian taxpayer, on the hook for all of the CMHC’s liabilities we could soon find ourselves in an extremely difficult financial position."

In other words, to facilitate the accessibility of easy credit the federal government took the risk to the banks out of potentially risky mortgages and laid them at our doorsteps.

In addition, for several years, in response to the economic crisis that began in 2008, the government allowed the CMHC to insure mortgages with amortization periods above 25 years, with lower down-payment requirements and with unsustainable, artificially low interest rates courtesy of the Bank of Canada.

This had a direct and intended consequence. It allowed the banks to offer mortgages to people who, in reality, could not really afford to enter the market and this, in turn, allowed those people to, in fact, enter the market. The reality of how this plays out can be seen from the fact that housing prices have risen far more rapidly than income. (These figures also lay to the rest the myth that the Canadian housing market is only experiencing a bubble in two of its major centres. The bubble is far more widespread than that.)

Taking these steps did stimulate growth in the construction industry and helped to dig the banks out of their recently uncovered, and previously denied, liquidity crisis. But it also had the effect of creating what amounts to artificial "demand" for houses and condos in many urban markets, most notably, but far from exclusively, in Vancouver and Toronto. This, in turn, drove prices up in dramatic ways, leading the banks to extend riskier credit to citizens desperate to get in on the action who, in turn were encouraged by the government created environment to buy properties that, by any objective standards, are out of their price range.

The CMHC, an organization that was originally formed, in part, to help to put home ownership within the reach of the average Canadian has recently done so by placing them into dangerous debt situations in an artificially created price bubble where even relatively minor downturns in the economy or drops in housing prices can create an economic disturbance whose ripple effects could lead to economic consequences akin to what is happening in Spain.

The basic facts of this situation have been acknowledged by Flaherty himself who has clearly and repeatedly stated that household debt in Canada has reached levels that threaten economic stability. He has made these cautionary comments in ways that make it seem that he is warning citizens for their own benefit and against their own behaviour.

But there is more to it than that.

The real worry, enough to keep finance ministers awake at night and to get them to try to manage the burst of a bubble, is what will occur should the markets in Toronto, Vancouver and elsewhere experience a rapid downward market adjustment in both prices and demand, especially if people who bought residential units for speculative purposes (and there are more of these than is commonly understood) or at the height of their value suddenly find themselves holding on to mortgages that face higher interest rates down the road and making payments on properties whose values have declined by 15-20% or more (should a runaway effect occur). Given that, in many cases, these people may actually have far less equity invested in their properties than one might suppose, there is a point where default makes a lot more "rational" economic sense then the decision to buy in the first place did.

The worry of financial analysts, and our finance minister no doubt, is compounded, as Finn Poschmann a vice-president at the C.D. Howe Institute noted, by the fact that "Since 2007, Canadian banks have increasingly come to the covered bond market with bonds backed, in whole or in part, by mortgages individually insured by the Canada Mortgage and Housing Corporation. This insurance cover boosts the surety of the bond pool, and marginally lowers the banks’ cost of capital and, arguably, perhaps lowers the cost of homebuyers’ mortgages. But an otherwise functioning financial market also gains government and taxpayer participation, and risk exposure, to uncertain net benefit."

While he, of course, is looking at it from the perspective of the bankers, as he makes clear there are dangerous historical antecedents for this situation, and the government and taxpayers are, as Poshmann puts it "exposed".

This is an understatement.

In the end, this is a direct lesson in how governments help to create the conditions in which the present European style austerity regime becomes "necessary". The Canadian government, to aid with bank liquidity in 2008, to generate a kind of short-term, politically popular, but relatively high risk form of stimulus by loosening the reigns on personal credit accessibility and aiding very directly in the rise of the highly overheated Canadian housing market, and to help to sustain a middle-class fantasy that everyone should be able to afford a home even when we live in a system where this is not possible unless and until the government gets into the business of building and regulating housing as opposed to being the agent that props up the riskiest end of the entire housing sector, that of credit, has put us all at risk by underwriting the "exposure" of the banks themselves.

The government has chosen the most bank friendly model of "intervention" in the housing market; they don't build affordable housing for all, rather they allow the banks, at no risk to themselves, to put citizens into unsustainable levels of personal debt to own what is completely unaffordable housing.

If a real housing correction occurs, and if it results in an entirely predictable and at least somewhat likely wave of foreclosures and defaults, and if the government is forced to cover even a relatively small proportion of the near $600 billion in insured mortgages, the cuts of recent federal budgets will look like happy times with hindsight. The economic "side-effects" will also be devastating.

Even if this is a bullet that we do manage to dodge, Canadians need to ask themselves if the role of their government and their taxes is to fund social programs, health care, direct housing and infrastructure expenditures, or if it is to put all of these necessities at risk by removing actual market and risk factors from the mortgage business for the big banks by insuring and taking on liability for their loans and the lifestyle of a certain segment of the population, potentially on the backs of all Canadians.

==================

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          Senate leaders scramble for deal on health care bill   
The Republican Party's long-promised repeal of "Obamacare" stands in limbo after Senate GOP leaders, short of support,...

          Beyond repeal of Obamacare   
The proposed Medicaid cuts in the new U.S. Senate bill could impact coverage for 400,000 Arkansas children.

On June 22, Republicans in the U.S. Senate introduced a long-awaited bill to replace the Affordable Care Act, the health care law often referred to as Obamacare. The Better Care Reconciliation Act would rework the ACA's subsidies for individual insurance policies, cut taxes for higher-income households, end the mandate that individuals have insurance, and allow states to opt out of ACA requirements that insurance policies include benefits such as mental health and maternity coverage. It would also put an end to the enhanced funding rate that made it possible to expand Medicaid to cover some 14.4 million low-income adults nationwide.

But the Senate bill, like similar legislation passed by the U.S. House of Representatives in May, would also institute major cuts to the traditional Medicaid program, potentially affecting coverage for millions of children, elderly people and disabled adults nationwide. In Arkansas, 30 percent of the state's population — about 912,000 people — were enrolled in some form of Medicaid in March 2017, according to data from the Centers for Medicare & Medicaid Services. That figure includes enrollment in the Children's Health Insurance Program, or CHIP, which together with Medicaid pays for ARKids A and B.

Marquita Little, health policy director at Arkansas Advocates for Children and Families, said the Senate bill "goes well beyond the political promise of repealing Obamacare. It restructures Medicaid funding. And so, it really is a U-turn on the promise that the federal government has always made to states — that Medicaid would be funded through a state-federal partnership." (Arkansas Advocates for Children and Families has contributed funding to the Arkansas Nonprofit News Network.)

The Senate bill would reshape Medicaid in two ways. First, beginning in 2021, it would phase out the Medicaid expansion created by the ACA, which provides coverage to low-income adults. Approximately 300,000 Arkansans are now enrolled in Arkansas Works, the program funded by the Medicaid expansion. Second, the Senate bill would cap federal spending on the rest of Medicaid, which existed long before the ACA's expansion and which is composed of programs such as ARKids. Rather than Medicaid paying for patients' medical care on an open-ended basis, as is now the case, the federal government would disburse funds to states in lump sums, either on a per capita basis or through block grants. The Congressional Budget Office projects 22 million people would lose coverage if the Senate bill become law.

Parents like Julie Kauffman of Mountain Home are anxiously watching developments in Washington and wondering how the proposed cuts would translate to Arkansas. Kauffman's daughter, Olive, suffers from cerebral palsy that resulted from viral encephalitis that developed 12 days after she was born. After the infant was airlifted to Arkansas Children's Hospital, Kauffman and her husband were told their private Blue Cross policy would pay for less than half of the helicopter ride, leaving them on the hook for $7,000.

"That was kind of our first introduction to, 'Oh, our health insurance doesn't cover what our child needs,' " Kauffman said. The financial office at the hospital told the parents they should get Olive on Medicaid. "I thought, 'We have health insurance, this is ridiculous. We don't need Medicaid.' Two helicopter rides later, and thousands and thousands and thousands of dollars later, we desperately need Medicaid."

Now 3 years old, Olive's condition requires periodic visits to specialists at the Cerebral Palsy Center at St. Louis Children's Hospital, plus regular speech, occupational and physical therapy sessions at a clinic in Mountain Home. She now spends nine hours in therapy per week. "What Blue Cross covers for her and therapy, she maxes out every year in February. That's when Medicaid picks up the rest of her tally," Kauffman said.

It's especially crucial that Olive receive intensive therapy at a young age, Kauffman explained, to maximize her chances of developing the skills necessary to lead a more independent life. "It's now or never. I mean, we have to do it now. She's 30 pounds. She doesn't have head control. She can't sit up and feed herself. She's nonverbal. She's, you know, total care, and unless we get as much bang for our buck now, what does her future look like?" On July 1, a new rule from the Arkansas Department of Human Services, which administers Medicaid in Arkansas, will limit the number of billable minutes of speech, occupational and physical therapy a beneficiary may receive each week without special authorization. The cap is 90 minutes for each category — about half what Olive receives right now. DHS said in a September legal notice that the change is estimated to save the Arkansas Medicaid budget $56.2 million annually. Kauffman said she will seek DHS approval to keep paying for the additional therapy hours, but she's concerned about the future.

"What's happening in the state alone, along with what's coming down from the federal level — it's just terrifying."

Kauffman said her biggest concerns about the Senate bill "are the cuts and the block grants. If it comes down to a block grant system where the federal government gives each state a set amount of dollars, how is that going to be disbursed from child to child? I don't know how they would even begin to figure that out. My kid is expensive, and that's not her fault. ... I understand the thought process that Medicaid cannot sustain at the rate that it's going. But there are also a lot of kids in my daughter's situation who didn't ask for this. They need as much help as they can possibly get, and in a perfect world her private insurance would cover what she needs — but it just doesn't."

Olive previously was on ARKids but now has Medicaid coverage through Supplemental Security Income (SSI) Disability. "Because my husband and I are both self-employed and our income fluctuates, she qualifies for SSI at the moment — but that could change at any moment," Kauffman said. She is a subcontractor for a medical billing company; her husband owns a furniture company, where she also works part time. Although their daughter receives substantial government benefits, the couple also ends up devoting much of their household income to her care as well, from specialized equipment to travel costs to St. Louis to therapy that must be paid for out-of-pocket. For the self-employed, time away from home is time spent not working — an additional drain on family resources.

"We're fortunate to have grandparents who chip in when they can and relatives who help out as needed, but, for the most part, we're just doing the best we can do to get by," she said. "We could have $10 million and it still wouldn't be enough."

Approximately 400,000 kids in Arkansas are on Medicaid — about half the children in the state. Only a small percentage have medical needs as pronounced as Olive's. Nonetheless, Marquita Little said, reductions to federal Medicaid spending proposed by the Senate bill would be "devastating to our medical system in Arkansas.

"Our overall impression is that it's still a dangerous bill for kids, for our most vulnerable populations ... [including] seniors, people with disabilities. By capping funding on traditional Medicaid, we would basically be reducing funding that we have in place for those populations. ... So what that means for Arkansas is that we would be forced to make some tough decisions about how we absorb those cuts. You either have to reduce what you actually cover, or you have to reduce payments that we're making to providers."

Having a child who requires such specialized care has changed her perception of Medicaid and those who benefit from the program, Kauffman said. "The biggest thing is that Medicaid helps so many more people than just what everybody assumes... . You know, people who don't want to go out and find a job and take care of themselves. Medicaid is so much more than that. So I think it's just this misconception ... and I was guilty of that. But now I know how needed it is."

This reporting is courtesy of the Arkansas Nonprofit News Network, an independent, nonpartisan news project dedicated to producing journalism that matters to Arkansans.


          Kuehl, Antonovich Call For Lots of Tunnels   
Los Angeles County Supervisors Sheila Kuehl and Michael Antonovich don’t agree on much. Kuehl was one of the most progressive leaders in the state legislature, including the author and longtime champion of bills to create a Canadian-style single-payer health care system. Antonovich has been a leading Southern California conservative for many decades. Despite those basic […]
          U.S. Student Loan Explosion   

The U.S. government passed a unique milestone in May 2017, where it has now cumulatively borrowed more than $1 trillion from the public since President Obama was sworn into office in January 2009, just so it can loan the money back out to Americans who need to borrow money to go to college in the form of Federal Direct Student Loans.

Money Borrowed by the U.S. Government to Finance the Federal Direct Student Loan Program, FY 1998 (October 1997) through FY 2017 (May 2017)

President Obama is directly responsible for this state of affairs. After being sworn into office on 20 January 2009, his first major domestic policy act was to sign the American Recovery and Reinvestment Act of 2009 into law on 17 February 2009 in an attempt to jump start a U.S. economy that had fallen into deep recession. Better known as the "Stimulus Bill", the act boosted the subsidy amount and quantity of Pell Grants paid to low and middle income-earning Americans attending college, but not by enough to cover more than one-third of the average annual cost of a university education, where American students who received these grants would then have to make up the difference through taking out student loans that are subsidized by the U.S. government.

Then, on 30 March 2010, President Obama signed the Health Care and Education Reconciliation Act of 2010, which resulted in the U.S. government taking over the student loan industry from the private sector.

President Barack Obama signed a law Tuesday that he said will end subsidies for banks that guarantee federal student loans, saving $68 billion over 11 years by making loans directly through the U.S. Department of Education. 

The overhaul of the student loan industry is part of the Health Care and Education Reconciliation Act of 2010, which was passed by Congress to reform the nation's health care system. 

According to the White House, starting July 1 all federal student loans will be direct loans administered through private companies that have performance-based contracts with the DOE. 

At present, the law appears set to fail on delivering these promised savings to U.S. taxpayers. For that portion of the story, please scroll down and click through!...

Previously on Political Calculations

U.S. Student Loan Implosion - We looked at the Federal Direct Student Loan program from the perspective of the student borrowers, where $137 billion worth of loans that have come due are either delinquent (more than 90 days without any payment being made) or are in default (more than 270 days without any payment being made).


          Strong and stable AOA will transition leadership at Optometry’s Meeting® in June   
Changes in health care landscape ahead; advocacy is key, AOA leaders say.
          Harnessing nitric oxide in a new way to combat superbugs   

(BPT) - They are called superbugs. As their name implies, they are difficult to treat — and deadly. Earlier this year, in fact, a Nevada woman was hospitalized following a trip to India and later died from a rare bacterial infection that didn’t respond to the 26 antibiotics approved for infectious diseases.

It is an ongoing cycle in science: bacteria evolve, researchers find antibiotics to defeat them, only for the bacteria to develop antibiotic resistance and the cycle starts all over again, posing an ongoing public health threat.

According to a recent report from the U.S. Centers for Disease Control and Prevention, every year, at least 2 million people in America get serious infections with bacteria that are resistant to one or more antibiotics designed to treat those infections, and these superbugs kill at least 23,000 annually as a result.

Shortly after the Nevada woman died, the World Health Organization urged infection researchers and the health care industry to identify ways to fight the most dangerous and life-threatening superbugs.

North Carolina biotech Novoclem Therapeutics is doing just that, but with a different approach. Novoclem has a potential new weapon against superbugs, harnessing the power of nitric oxide, a molecule that helps kill harmful bacteria in the human body.

Early research shows the Novoclem pipeline of nitric oxide-based therapies has the ability to kill leading superbugs considered public health threats, such as Methicillin-Resistant Staphylococcus Aureus (MRSA), a common, resistant strain of bacteria found in hospitals, and Mycobacterium abscessus, a bacterium distantly related to the ones that cause tuberculosis.

“The growth of bacteria that are resistant to antibiotics is a potential problem for everyone; however, it is often a matter of life or death for those living with severe respiratory diseases,” noted Anne Whitaker, president and chief executive officer of Novoclem. “New products to combat multi-drug-resistant microorganisms are desperately needed. We are aiming to answer that need with our new nitric oxide product.”

Controlled release of nitric oxide via Novoclem’s novel technology-in-development mimics the body’s immune system response to disease-causing bacteria. Their first nitric oxide product is expected to be an inhaled formulation to treat severe lung infections in cystic fibrosis patients. Studies indicate the product is a broad spectrum antibiotic and can eliminate nine of the most common microorganisms found in the lungs of people living with cystic fibrosis.

Early studies show promise for the novel nitric oxide approach and additional studies are planned for this year to enable the start of clinical trials in humans next year.

If the therapy proves successful, a major public health crisis could be averted.

For more information about Novoclem and its technology platform, visit www.novoclem.com.


          AOA and GOA-backed bill takes aim at anti-patient, anti-competitive abuses by health and vision plans   
Bill would put patients and doctors back in control of important health care decisions.
          Registered Nurse - RN - Part Time Wound Nurse - Woodland Park Care Center - Salt Lake City, UT   
Proven written and oral communication skills. We are now hiring RN’s for part time Certified Wound Nurse....
From Avalon Health Care Group - Tue, 27 Jun 2017 16:28:24 GMT - View all Salt Lake City, UT jobs
          Health Care Consultant - Health Land Clinic - Vancouver, BC   
Collect, compile and analyze information from clients, health care institutions and organizations and produce proposals for the development of the company, such... $34 an hour
From Indeed - Fri, 10 Mar 2017 21:41:29 GMT - View all Vancouver, BC jobs
          Brownie Points: Wrapping Up the Holidays (and 2008)   
Sustainability was entering the mainstream conversation when I started to write here at Conscious Business.

189 posts later, this space has been a laboratory for my learning, and a place to share what I’ve learned. Meandering and returning to one theme: how does our behavior at work matter?

Early on, I used my own experience to explore basics of environmental sustainability. In 2008, a few things converged in my on-line and off-line lives.

The sheer volume of media coverage on sustainability has both encouraged and disenchanted me. And I became more engaged in off-line sustainability efforts.

And my focus shifted to subtler views, particularly the ideal that sustainability means not wasting people. This past spring, I started a consulting business to help business owners and managers to engage optimally with our employees and colleagues.

Diverted by my non-virtual efforts, and encouraged that topics like water conservation will be amply covered by journalists and bloggers who have both passion and bandwidth, I’ve shifted some of the creativity and attention I once directed to blogging into developing my consulting business.

What a ride!

It has been challenging to stay out in front of people this fall. Many friends and clients are in financial firms; it has been tough to imagine how to connect with people when they are fearful of being booted, bought, or bailed out (or not).

Everyone is stressed, and I’ve started to offer workplace stress management programs. This has been an easier topic of conversation.

But with some people, and some firms, silence and compassion have seemed like the best approach.

And, brownies.

Baking is an excellent science for left brainiacs. Predictably delicious outcomes are almost assured when you use the best ingredients, measure and mix them correctly, and use the right tools.

I’m a pretty good baker, and home-baked breads, cookies and granola have been frequent gifts for my friends and family members.

In past holiday seasons, I’ve sent tins of Dean and Deluca cookies to business friends and clients. People seemed to love them. But this year, the faux homemade cookies in the elegant silver tin looked a little cold.

I intend for my business services to be handmade with good ingredients, and with care for how they are presented. So this year, I decided to bake that metaphor into brownies.

It was great fun to select and source the ingredients, tins, ribbons and cards. (Readers who know me may smile to hear that I used an excel spreadsheet as a project planning tool.)

I fell into a rhythm of baking early in the day, letting the brownies cool while I worked. In the afternoons, I’d construct the packages and schedule deliveries based on where I had other afternoon appointments.

(Knowing that recipients would have an abundance of available holiday sweets, the packages were petite, just enough for a couple of people to share a snack or two while they were fresh. And to avoid raising either the Grinch's ire, or true ethical concern, in firms where gift policies prevail.)

After all of this holiday fun – and it was fun -- it was heartening to see press coverage about home-baked gifts. The health blog at The New York Times, Well, posted at least two items.

Commenters on one NPR story shared my dismay with Claire Crespo’s suggestion that we use cake mix and canned frosting to make good looking gifts that make people smile.

Our willingness to value things that look good, but lack substance, has contributed to our current problems. And it literally feeds our health care challenges.

(Is canned frosting even food?)

I felt more aligned with Nicole Spridakis, who spoke of the pleasures of baking gifts from scratch; her results sound far more elegant than my simple brownies.

Holy Zeitgeist Batman, could home baking be an antidote to the financial crisis?

It seems that the raves I’ve won relate less to my baking prowess, and more to the power of a humble, but well constructed, bakery item to speak to a place in our hearts that can’t be touched by the markets.

That’s the kind of leadership we need -- in abundance -- as we approach this next and very hopeful new year. Eyes wide open.

(The photo is a few of my finished gift packages...I had a heck of a time keeping the ribbons tied onto the round tins. Sigh.)

          "The car industry is slowly but surely engineering me out of the process of driving"   
Richard Meaden
28 Jun 2017

It stands to reason that a magazine dedicated to The Thrill of Driving should find the growing industry (and media) obsession with the autonomous car profoundly unsettling. Rarely a day goes by without a press release or statement from a major manufacturer proudly proclaiming greater and greater commitment to a self-driving future. If news from the US is anything to go by, that’s only set to ramp up further now that the artificial intelligence system piloting Google’s  self-driving car could be considered as the driver under federal law. 

Law, not tech, has always been the single biggest barrier to autonomous vehicles gaining approval for use on public roads, but it seems that even that hurdle has been at least partially removed. Confirming as much in a recent letter to Google, the National Highway Traffic Safety Administration said it agreed with Google that its self-driving car will not have a ‘driver’ in the traditional sense that vehicles have had drivers for the last hundred years or more.

There are still many legal questions to be answered and precedents to be set before cars can become truly autonomous. Knowing the legal profession’s propensity to drag things out for as long as possible, this gives me some hope that humans won’t be entirely legislated off the roads any time soon – but still there’s a horrible feeling of inevitability about the rise of the machines. Or, rather, the rise of Google. 

I love cars and I love driving, but of course there are times when I wish I could get in, fall asleep and wake up at my destination. Jet-lagged returns to Heathrow spring to mind. Or soul-destroying commutes. But having the occasional rotten journey is a price worth paying for the freedom to drive where I wish, when I wish, as fast or as slowly as I wish.  

The question that keeps churning in my head is who asked for autonomous cars? Did you? Nope, me neither. Yet such is the extraordinary amount of energy, investment and fevered conversation in the industry and media, you’d think we’d all been lobbying for them for years. Of course, the challenges of making the technology work are intoxicating catnip to scientists, programmers and engineers, whether they work for Google, Apple or Audi. For them it’s an Earthbound space race, the final frontier. 

> Roborace: an autonomous racing series

There’s been a drip-drip-drip of autonomous technology for years, but it’s only now that the apparently innocent introduction of parking assist, self-parking, radar cruise control and lane departure and blind-spot monitoring can be seen for what they are: a suite of ‘semi-autonomous’ driver aids to soften us up for fully autonomous vehicles. Being old-school, I despise things like lane assist, but, being contrary, I quite like blind-spot monitoring. Do I rely solely on a little yellow warning light to tell me I’m about to change lanes into a hidden car? No, I still turn my head and use my eyes. Just as I look as far down the road as possible to see how the traffic is flowing and adjust my speed accordingly without panic braking. It’s called being in control. 

The problem with driving is, it’s a skill. And, like any skill, you need to practice it, not just to improve, but simply to maintain a certain level. That’s what you and I love about driving, but most couldn’t care less. As the process of driving is dumbed down, so, inevitably, are most drivers, for the less we have to think about, the less we seem to think. That would certainly explain why driving standards are slipping further as mainstream cars are fitted with more and more semi-autonomous technology. 

It all leaves me feeling a bit confused. Betrayed, actually, for it’s the car industry – creator of the machines I love with a passion – that is slowly but surely engineering me out of the process. Road fatalities are frequently touted as grounds for taking drivers out of the loop. It’s hard to argue with the human cost of the estimated 1.2 million who died in road  accidents globally in 2010. But it’s developing countries with poor infrastructure, non-existent driver training, ageing cars and less advanced emergency health care that account for the majority of these deaths. 

Look a little closer to Silicon Valley and you learn that last year guns killed more Americans under 25 than cars. In England, donuts are the danger, obesity accounting for 6 per cent of deaths compared with 1 per cent for road accidents. And this from data gathered in 1998, since when cars have become safer and people fatter. Cars have become the target because it’s easier than tackling the tougher social – and therefore political – issues.   

No-one really knows quite what the autonomous future holds, but we do know Google has a habit of getting its way. Just look at its HMRC tax returns. I’m the first to concede driving isn’t always a pleasure, but it’ll be a cold day in Hell before I’m convinced by a future where autonomous cars turn us all into passengers.


          Guest Attendant - Chartwell Retirement Residences - Collingwood, ON   
Personal Support Worker (PSW), Health Care Aide (HCA) or Developmental Services Worker (DSW) certification] is preferred;...
From Chartwell Retirement Residences - Tue, 20 Jun 2017 17:06:06 GMT - View all Collingwood, ON jobs
          GOP touts lower premiums, but other insurance costs to rise   
WASHINGTON (AP) -- Republicans are touting lower premiums under their health care legislation, but that reflects insurance that would cover a smaller share of the cost of medical bills....
          Selling the GOP health care bill: Does Trump help or hurt?   
WASHINGTON (AP) -- It was a platform most politicians can only hope for: A captivated, 6,000-person crowd and more than an hour of live, prime-time television coverage to hype the Republican vision for a new health care system....
          The Latest: Trump promises 'big surprise' on health care   
WASHINGTON (AP) -- The Latest on Republican legislation to repeal and replace the Obama health care law (all times local):...
          GOP searches for answers on health care   
A day after Senate Majority Leader Mitch McConnell was forced to delay a vote on the Senate version of President Trump's health care overhaul, Republican leaders are looking for a way to overcome resistance from across the Republican spectrum.

          Super PACs help push Trump agenda   
As President Trump struggles with health care reform and the Russia investigation, Super PACs, usually strictly campaign entities, are stepping in to take the unprecedented step of actively supporting a sitting president outside campaign season.

          The Latest: McConnell says good progress made on health bill   

The Latest: McConnell says good progress made on health billWASHINGTON (AP) — The Latest on the Republican legislation overhauling the Obama health care law (all times EDT):



          Nurse, Triage - Park Nicollet - Minnesota   
We're a member of the HealthPartners organization, an award-winning integrated health care system comprised of several organizations....
From Park Nicollet - Thu, 25 May 2017 20:55:52 GMT - View all Minnesota jobs
          Nurse, Triage - Park Nicollet - Eden Prairie, MN   
We're a member of the HealthPartners organization, an award-winning integrated health care system comprised of several organizations....
From Park Nicollet - Thu, 22 Jun 2017 00:16:02 GMT - View all Eden Prairie, MN jobs
          Nurse, Home Care - Park Nicollet - Hopkins, MN   
We're a member of the HealthPartners organization, an award-winning integrated health care system comprised of several organizations....
From Park Nicollet - Mon, 26 Jun 2017 18:24:04 GMT - View all Hopkins, MN jobs
          Asst, Physical Therapist Homecare - Park Nicollet - Hopkins, MN   
We're a member of the HealthPartners organization, an award-winning integrated health care system comprised of several organizations....
From Park Nicollet - Wed, 21 Jun 2017 18:15:12 GMT - View all Hopkins, MN jobs
          Aide, Home Health (Home Health) - Park Nicollet - Hopkins, MN   
We're a member of the HealthPartners organization, an award-winning integrated health care system comprised of several organizations....
From Park Nicollet - Tue, 13 Jun 2017 00:12:48 GMT - View all Hopkins, MN jobs
          Assistant, Medical - Park Nicollet - Lakeville, MN   
We're a member of the HealthPartners organization, an award-winning integrated health care system comprised of several organizations....
From Park Nicollet - Mon, 26 Jun 2017 06:20:37 GMT - View all Lakeville, MN jobs
          20 Signs That The Health Care Industry Has Become All About Making As Much Money As Possible    
Once upon a time in America, people became doctors and nurses because they wanted to help people, building hospitals was a labor of love, lawyers didn’t chase ambulances, health insurance companies did not openly abuse their customers and greedy pharmaceutical companies did not dominate the entire health care industry.
          Getting Down To Business? We Certainly Hope So!   


The President calls all of the Republican senator together to focus on health care legislation.
          Registered Nurse - RN - Part Time Wound Nurse - Woodland Park Care Center - Salt Lake City, UT   
Avalon offers great pay with career growth opportunities including tuition reimbursement and career advancement courses....
From Avalon Health Care Group - Tue, 27 Jun 2017 16:28:24 GMT - View all Salt Lake City, UT jobs
          Health Care Aide PPT Main North 7-15 - The Good Samaritan Society - Salmon Arm, BC   
Hillside Village, Salmon Arm, BC HEU CLOSING DATE Jun-28-2017 at 1500 hours HOURS OF WORK 0700-1500 Main North but not exclusive to. EMPLOYMENT TYPE... $18.25 - $21.86 an hour
From The Good Samaritan Society - Wed, 21 Jun 2017 19:49:12 GMT - View all Salmon Arm, BC jobs
          Physical Therapist - HRS PRN Kennet MO   
MO-Kennett, - Physical Therapist - HRS PRN Kennet MO ( Job Number: 288021 ) Description We are currently recruiting for a Physical Therapist to work per diem with our company. This position offers an exciting opportunity to join a team of dedicated health care professionals that pride themselves in providing quality patient care. Our facilities have a prominent reputation in the community for providing excell
          Guest Attendant - Chartwell Retirement Residences - Collingwood, ON   
Personal Support Worker (PSW), Health Care Aide (HCA) or Developmental Services Worker (DSW) certification] is preferred;...
From Chartwell Retirement Residences - Tue, 20 Jun 2017 17:06:06 GMT - View all Collingwood, ON jobs
          Affordable Health Insurance in Arkansas   
Health insurance might be pricey sometimes; however ignoring it completely can be monetarily devastating. Whether you are self-employed, unemployed, or secured under a business’ health care plan, finding affordable health insurance Arkansas is no longer a troublesome and tedious process. There are lots of controversies around the Affordable Care Act (ACA), and finding exact data … Continue reading Affordable Health Insurance in Arkansas
          Affordable Health Insurance for College Students   
A lot of changes in the health insurance sector have allowed college students to easily get affordable health insurance.  With the Affordable Care Act, college students can stay under their parent’s health insurance until 2 years of age. However- for this, it is important that the parents have insurance plans under the Affordable Health Care … Continue reading Affordable Health Insurance for College Students
          Selling the GOP health care bill: Does Trump help or hurt?   
WASHINGTON (AP) -- It was a platform most politicians can only hope for: A captivated, 6,000-person crowd and more than an hour of live, prime-time television coverage to hype the Republican vision for a new health care system....
          Registered Nurse (RN) - Saint Elizabeth Health Care - Gananoque, ON   
Extensive paid orientation and preceptorship program. Saint Elizabeth is a national health care provider that has been opening the door to new possibilities and...
From Saint Elizabeth Health Care - Tue, 25 Apr 2017 20:21:18 GMT - View all Gananoque, ON jobs
          Building tweeting communities for mental health nursing with @WeMHNurses   
Building tweeting communities for mental health nursing with @WeMHNurses

[@Noemi’s note] I was happy to connect with Emma Jones, who is in her words, a third of the We Mental Health Nurses team at WeCommunities, along with Vanessa Garrity and Mark Brown. This story serves as a first encounter with Edgeryders. It also includes written reflections by Vanessa.

WeMHNurses hosts regular mental health themed twitter chats, as part of a network chat calendar, with wildly diverse topics ranging from “The use of digital technology in everyday practice” to “Workplace democracy in mental health”. The core team runs the day to day operations, on a purely voluntary basis, with the WeMHNurses account, also linking into the wider WeCommunities, which covers many different branches of Nursing and Health Care professions and specialism. Topics for chats tend to mostly emerge from topical conversations within the community or where there is, for example a national policy directive or key piece of published journalism relating to mental health. The community also run sponsored chats for national bodies such as the Dept of Health, Care Quality Commission and NHS England. The WeMHNurses team see their role as being about facilitating broader conversation in a democratised digital space, where everyone can have a voice, regardless of positional authority. The team also see their role as being to make national policy more accessible, in terms of the language being used. The community also has a particular focus on discussing the everyday implications of policy on mental health nursing practice.

The chats are generally facilitated by one of the @WeMHNurses team, with guests are often invited to participate in the chat where the person brings specific expertise to the conversation. This is an open process, whereby anyone can contact the team to suggest a chat topic or to ask to host a chat.The team provide support to individuals who want to host a chat from the @WeMHNurses Twitter handle.

Our ethos is very much that “your opinion matters” and we focus on the user point of view, getting people talking to each other and bringing a variety of perspectives to the conversation. We enjoy working with people who have previously been in services or are currently in services because we really value the lived experience perspective. As we are an independent voice, we will also cover topics that might be considered controversial, political or critical, as we believe that these conversations are important in setting the future direction for mental health nursing.

On reflection, we think that the liveliest and most informative chats are often where there is a real mixture of perspectives, including for example, clinicians, people accessing services, managers, leaders, academics, researchers and policy makers. The conversations that we have online are often very powerful for this reason as we can’t think of many examples from our own professional lives, where there has been such a variety of voices in a room to debate a topic in such a level and democratic way. An example of this is a chat that Vanessa and Mark ran with the Health Service Journal, where we discussed the reduction of inpatient mental health beds across the country. This chat was very much brought to life by people sharing their experiences of how this impacted on them personally when they needed to access inpatient care.

The demographics for our chat suggest that we have a largely UK audience. However, because of the global reach of Twitter, we do have some international representation within our community and we love to encourage this because of the dimension that it brings to the conversation

Before we run a chat, we produce some pre chat information on the wecommunities website. This is generally written in a blog style, so it is broadly accessible reading. We are also looking at how we can make our chats even more inclusive, such as by providing audio for people who struggle to read or who have visual impairment. The challenge for us is that we are all volunteers, so we have to find ways of delivering information quickly.

How come this twitter format for talking about mental health? Is there something in the medium that helps learning, or alleviation for individuals?

As with everything there are always pros and cons. Some would say “there’s only so many characters on twitter” and mental health can be a very complex topic to discuss with limited characters, especially when people are talking about personal experience. On the other hand, it can help you be more focused and concise in what you are trying to say.

I suppose using twitter to talk about mental health is quite personal, as is twitter use in general. There are many who find it hugely therapeutic and helpful, either getting involved in chats, communicating/ networking with others or for gaining support. It is a fab place for the sharing of information, including research and it's also a great forum for challenging stigma and moving the mental health agenda forward.

Bios wordcloud
Wordcloud from participants twitter bios in a recent chat - source.

Is there a cutoff number for participants in a chat? Or a number that makes it effective? I’m wondering because you have such high regularity - every week.

There is not a maximum number of people in each chat, it can be anybody using the hashtag. Often people pop into the chat with just one or two tweets, whilst at the same time, we are having a conversation with other people, who participate in the entirety of the chat. When you are facilitating a chat, which is busy, it can be a challenge responding to every single tweet, but we do try to do this and often we find that people branch off and have separate conversations with other participants, within the chat, which goes down a different path to the structured questions of the main chat. Providing they still use the hashtag, we still capture this conversation in the transcript at the end. This is an example of the latest archived chat on a Tuesday evening, counting 133 contributors, 1200 tweets and with a reach of 7,561,098! This was a joint chat with @wenurses and @weldnurses.

With our over 6000 followers, plus the wider network, I suppose it is hard to say how many people we reach constantly. However, analytics for the chat are captured within the wecommunities website. Nick Chinn is the technical person behind this at Wecommunities.

What do you think draws people in? What makes it a community for you? Is it people interacting with each other, learning, figuring out stuff?

I suppose it is all of that. Everyone involved in the chats is interested in that particular area and that shared interest drives the discussions and questions in the chat, which will often support the development of links between people. Often people in the chats might say: ‘this is a good chat’, and ‘why don’t we do one on this other topic area?’ It then keeps expanding, and there are more things that we get involved in. So, in essence, the community is about sharing knowledge and learning, being open to thinking in different ways and developing a support network as well.

What for the future and how can we support your work?

We are very aware that people establish relationships and friendships offline with people who they have connected with on Twitter and that these relationships are often a great source of strength and support for people. Vanessa and Teresa Chinn, Founder of WeCommunities organised an unConference earlier in the year, through crowdfunding, which brought together 300 people from the community into a physical space to get together and to debate and discuss the future direction of social media in health care. We also provided a parallel online agenda throughout the day, so that the twitter community could still very much be part of it, even if they couldn’t physically attend. Vanessa and Mark from WeMHNurses and Mental Elf on Twitter are also in the process of setting up a Digital mental health conference service, which we are launching at #PDDigital16 later in November.

The Challenge: 

The Question: 

How can we support anyone with an interest in mental health to participate in a conversation?

The Problem: 

Delivering relevant information and support to a broad and diverse group and people

The Solution: 

Regular Twitter chats!

Channels: 


          .NET Developer - Microcode Software Services - Bensenville, IL   
Collaborate closely with Business Analysts on Business Intelligence requirements. Our direct client (Health care company) is looking for a full time .NET... $70,000 - $85,000 a year
From Indeed - Mon, 26 Jun 2017 15:08:35 GMT - View all Bensenville, IL jobs
          Senior Financial Analyst/Investigator - Akima, LLC - Bensenville, IL   
Security, Intelligence &amp; Defense Analysis. A national Health Care Fraud and Abuse Control Program, operating under the joint direction of the Attorney General...
From Akima, LLC - Fri, 26 May 2017 15:10:22 GMT - View all Bensenville, IL jobs
          Rev. Al Sharpton Covers The Latest On The Healthcare Bill   
06/28/17 – Reverend Al Sharpton encourages people to remain steadfast in the fight against the Senate health care bill despite its latest hiccup. Like BlackAmericaWeb.com on Facebook. Follow us on Twitter and Instagram Sign Up For Our Newsletter!
          Liberal Media Focuses on One Statistic in CBO Study on Obamacare Replacement Bill   
The liberal media can only focus on liberal talking points about repealing and replacing Obamacare, which law had increased premiums at an alarming pace and disrupted the health care system and health insurance system. NBC News and CNN only felt like highlighting the potential uninsured…in 2026: NBC News: CBO: Senate health care bill would leave […]
          Mental Health Councellor - Labrador-Grenfell Health - Hopedale, NL   
&quot; Provides consultative services to and works in cooperation with health care providers and a variety of Provincial and Federal Government Departments to... $34.36 - $38.45 an hour
From Labrador-Grenfell Health - Tue, 27 Jun 2017 20:09:44 GMT - View all Hopedale, NL jobs
          Corporate Dem Shoots Down California Single Payer For His Wealthy Donors   

If the history of Canada’s health care system is any indication, the best chance for the the U.S. to have a single payer health care system that guarantees medical services to everyone is to enact it on a state-by-state basis. The California legislature, firmly in Democratic control, had a golden opportunity to pass a single-payer

The post Corporate Dem Shoots Down California Single Payer For His Wealthy Donors appeared first on The Ring of Fire Network.


          Hiring Trends on Granted Echo Boom in Finance and Healthcare 100K Jobs   

Improvements in the stock market and health care industries have resulted in the growth of several 100K jobs in the U.S. Granted mirrors this job growth.

(PRWeb February 22, 2014)

Read the full story at http://www.prweb.com/releases/news/granted/prweb11605308.htm


          Senate health care bill vote delayed   

WASHINGTON — Majority leader Mitch McConnell (R., Ky.) yesterday withdrew a planned vote on the Senate bill to repeal and replace the Affordable Care Act. McConnell delayed action on the measure after it became apparent that Republicans lacked the votes to approve their version of legislation passed by the House in May. While he had

The post Senate health care bill vote delayed appeared first on CDR – Chain Drug Review.


          GOP Senators Postpone Vote On Health Care Bill   
Copyright 2017 NPR. To see more, visit STEVE INSKEEP, HOST: And let's bring another voice now into the conversation. NPR's White House correspondent Scott Horsley has been covering this debate for years and years and years... SCOTT HORSLEY, BYLINE: (Laughter). INSKEEP: ...And is here with us and has been listening to Matt Schlapp. Scott, what did you hear there that was noteworthy? HORSLEY: Well, he is right that Republicans have spent more time demonizing Obamacare than they have really selling their own plan. And part of the challenge is philosophically, the Republicans, at least in Congress, envision a health care system where the government plays a smaller role, where there is more consumer skin in the game, that is, consumers bear more of the responsibility. They feel like that'll inject market forces and help to keep costs down. But you have a president, Donald Trump, who has been marketing great care at low costs for everyone. Everyone's going to be taken care of. So there is a
          The GOP Factional Split On Health Care   
Copyright 2017 NPR. To see more, visit STEVE INSKEEP, HOST: Senate Republican Leader Mitch McConnell is giving up on trying to repeal and replace the Affordable Care Act before July Fourth. But he says he is not giving up. (SOUNDBITE OF ARCHIVED RECORDING) MITCH MCCONNELL: We will not be on the bill this week, but we're still working toward getting at least 50 people in a comfortable place. INSKEEP: That's what McConnell needs and currently does not have to pass legislation. Those following this with great interest include Matt Schlapp, chair of the American Conservative Union - is in our studios. Thanks for coming by. MATT SCHLAPP: Great to be here. INSKEEP: Good morning. What happens politically to Republicans if nothing passes? SCHLAPP: I think it's a big problem. When you go around the country for seven years saying that Obamacare is an abomination, you talk about all of its deficiencies, you say that there are Republican solutions to the health care problems we have in this
          More Time Is Needed To Study Health Bill, Sen. Johnson Says   
Copyright 2017 NPR. To see more, visit RACHEL MARTIN, HOST: The Senate version of the Republican health care bill is still expected to head for a vote later this week, even though opposition to it within the Republican Party itself is growing. Much of that concern has come in response to news of the score from the Congressional Budget Office. The CBO estimates that under the bill, 22 million more Americans would be uninsured by the year 2026. Moderate Republican Senator Susan Collins has already declared she will vote against the bill in its current form. Here she is on ABC News. (SOUNDBITE OF ARCHIVED RECORDING) SUSAN COLLINS: I'm very concerned about the cost of insurance for older people with serious chronic illnesses and the impact of the Medicaid cuts on our state governments, the most vulnerable people in our society and health care providers. MARTIN: The bill can only afford to lose one more GOP lawmaker and still pass. But on the right, several conservative Republicans are also
          Enrollees Who Work Still Need Medicaid, Kaiser Survey Shows   
Copyright 2017 NPR. To see more, visit RACHEL MARTIN, HOST: Over the weekend, White House adviser Kellyanne Conway defended cuts to Medicaid that are outlined in the Senate Republican health care bill. She was on ABC's "This Week," and she said that Medicaid enrollees who are, quote, "able bodied" should be able to find jobs and get health care through their employers. (SOUNDBITE OF ARCHIVED RECORDING) KELLYANNE CONWAY: If they're able-bodied and they want to work, then they'll have employer-sponsored benefits like you and I do. GEORGE STEPHANOPOULOS: Kellyanne, hold... MARTIN: So this isn't exactly a new argument, but Diane Rowland of the Kaiser Family Foundation says there are big holes in it, mainly this one. DIANE ROWLAND: Well, we know that many of the people on Medicaid are already working, many of the adults who are able to go out and get a job, if they can. But we also know that those jobs often do not come with health insurance benefits. And these are very low-income people
          #Jasmine Call #syria #lebanon #kuwait #jo #ksa #iraq #aid #un   




The Women's Cultural and Social Society, is organizing ”Jasmine Call” – two fund-raising events, under the patronage of the Minister of  Information Sheikh Salman 

AlHumood AlSabah, with the aim of providing relief aid to some four million displaced people in Syria. This will contribute to rescuing them from hunger and cold and to 

provide them with such basic needs as food, milk-powder medical and health care supplies, and clothing needs.

The first event:


A concert, performed by the global composer and pianist Malek Jandali, and an art exhibition displaying the fine works of artist Kevork  Mourad. (CVs attached).


26th Jan.2013 (Saturday) at 7.30 p.m., at the theatre of The Gulf University for Science and Technology (GUST), Mishref.

The second event:


A concert, performed by the renowned musician and oud player Naseer Shamma and an art exhibition displaying the fine works of artist Kevork  Mourad. (CVs attached).
27th Jan.2013 (Saturday) at 7.30 p.m., at the theatre of The Gulf University for Science and Technology (GUST), Mishref.
.

We do hope to have your support for this humanitarian undertaking through your participation as a sponsor for which you can choose any of the following categories:

1-                Platinum Sponsor:  KD 10,000.
The sponsor will receive the following benefits:
-      The company's name, as a platinum sponsor, will appear large sized in the press release that will be published in the local dailies.
-      The company's logo will appear in large size on all advertisements, leaflets and brochures of the event.
-      The company will have one full page to advertise itself in the booklet of the event.
-      Four complimentary tickets for both events.
-      The sponsor can install a poster and a roll-up of the company at the entrance of the reception hall.  

2-    Golden Sponsor: KD 5,000
The sponsor will receive the following benefits:
-      The company's name, as a golden sponsor, will appear medium-sized in the press release that will be published in the local dailies.
-      The company's logo will appear in medium size on all advertisements, leaflets and brochures of the event.
-      The company will have half a page to advertise itself in the booklet of the event.
-      Three complimentary tickets for both events.
-      The sponsor can install a roll-up of the company at the entrance of the reception hall. 

3-    Silver Sponsor: KD 3,000
The sponsor will receive the following benefits:
-      The company's name, as a golden sponsor, will figure out small-sized in the press release that will be published in the local dailies.
-      The company's logo will appear in small size on all advertisements, leaflets and brochures of the event.
-      The company's logo will appear in the booklet of the event.
-      Two complimentary tickets for both events.

We will be looking forward to having your favorable response and please accept our highest consideration and best regards.

Secretary General
Lulua Saleh  Al-Mulla.


Enclosures:
-CVs of Malek Jandali, Kevork Mourad, Nasseer Shamma
-Profile of the Women's Cultural and Social Society.










Musician Malek Jandali:

-         Internationally renowned pianist and composer.

-    First Syrian and only Arab musician to arrange music based on the oldest music notation in the world which was discovered in the Bronze Age city of Ugarit, Syria dating back to the 4th. Century B.C. He added to it rhythm and harmony and played it on the piano with globally renowned orchestras. His famous album "Echos from Ugarit" was an outcome of his attempst to mix Arabic modes in an academic way with the classical western harmony.

-         He learned music at the age of 4, and played his first concert at 8. He joined the Arab Conservatory of Music then the Higher Institute of Music in Damscus, where he was tutored by world renowned pianists. He performed in top theatres in the Middle East, Europe, USA, and Syria.

-  Currently works in the State of Georgia, USA, and is studying for a Ph.D. Degree in music.

-         Winner of many music global awards.




Musician Naseer Shamma:

-      One of the most famous Arab musicians who efficiently stands out in solo musical composition.

-      First Arab eight-string Oud player, following the manuscript of the 9th. Century music theorist Al-Farabi. His innovations included the new method of playing the Oud with one hand which allowed handicapped people to play this instrument.

-      He composed the music of many Arab theatrical plays, movies and documentaries.

-      He worked on the attempt to portray formative art through music, and studied the effect of music on formative artists.

-      Founded Beit Al-Oud Al-Arabi in Cairo in 1999, and is currently a professor of Oud in the Cairo Opera House.  He founded "Uyun" group for Arabic music in Cairo, "Sudasi Al-Anamel Al-Thahabiya" band, "Al-Bayareq" musical Band, and "Orchestra Al-Sharq".




Artist Kevork Mourad:

-      Formative Artist who studied in Syria and continued his higher studies in The Institute of Fine Arts in Yerevan, Armenia.

-      Held numerous galleries in Arab countries and USA.

-      Mastered the technique of spontaneous painting at an early stage of his professional life, in which he shares the stage with musicians.

-      Any painting by Kevork is related to the musical colorful rhythm heard through the eyes.

-      One of few artists who worked on merging the formative visual language with the rhythms of musical tunes.

-      Kevork depends in his paintings on the rhythms of musical tunes according to two major trends: spontaneous and rational; The first emphasizes the psychological effect of the color, movement, and the special formative rhythm; while the rational appears through abidance by temporal rhythm, which gives the audience a glimpse on the scale of awareness of the encaustic between rationalization and emotion.


Society in Brief

The Women’s Cultural & Social Society (WCSS),  the first women’s society to be established in Kuwait, was founded on February 3, 1963 by the first batch of female Kuwaiti university graduates.
The main objectives of the Society are:
1-          Developing the educational status of women in all fields.
2-          Ensuring that women take part in the various activities of the community.
3-Increasing women's awareness of their responsibilities and rights, in additional to all the issues of concern to the community.
4-   Encouraging women to take part in the various activities of the community.
 A seven-member board of directors, elected every two years by the general assembly, manages the Society.
The Board of Directors carries out its tasks according to an established statute, whereby Board members chair the operating committees, and the other WCSS members share the voluntary responsibility of practicing cultural, social, health, media and sports activities through various committees.

#syira #music #kuwait #art #wcss


          Senate health care bill negotiations: These are the big issues on the table   
A provision that makes one person happy could bleed votes on the other side.
      
 
 

          Being Black Is A Pre-Existing Condition   
Trump and the GOP's misguided health care efforts will be racist in their consequences.
          Glenn Beck’s MLK dream is perverse, but what’s our vision?   

Glenn Beck says it’s “divine providence” that his “Restoring Honor” rally coincides with the anniversary of Martin Luther King, Jr.’s “I Have a Dream” speech. Maybe so. It’s been a little over a year since the beer summit eclipsed the debate over whether health care is a fundamental right, and these past 12 months have brought a steady parade of similar perversions. Beck parodying King on the steps of the Lincoln Memorial seems an apt finale.

Beck has spent the past several months needling today’s civil rights leaders with the charge that they screwed up King’s dream. He’s asserted that groups like the NAACP and, most menacingly, ACORN lost their way when they veered into the murky waters of “economic justice” and “social justice.” King’s vision, he has lectured, was about equal rights—about discarding racial markers of any kind so every individual can compete in the true American tradition.

Read more.
          GOP Congressman Faces Off With Angry Constituents At Health Care Town Hall   
"You have been the single greatest threat to my family in the entire world," one man told Rep. Tom MacArthur (R-NJ). The GOP congressman, who helped push the Obamacare repeal effort forward, attended a four-hour town hall where he came face-to-face with constituents who may lose their health care due to the American Health Care Act.
          Americans Share Heart-Wrenching Stories About Their Pre-Existing Conditions   
Demonstrators took to the streets to protest President Donald Trump's arrival in New York City and shared how the GOP health care bill would adversely affect them. The bill would effectively replace Obamacare and gut protections for those with pre-existing conditions.
          Republicans Could Actually Pass This Health Care Bill   
They're getting close to the number of votes they need in the House.
          Lindsey Graham: House Health Care Bill Is 'Mortally Wounded'   
“We’re trying to do too much too quick as Republicans," he said.
          Americans Want Chaffetz To Get Them Health Care That Costs Less Than An iPhone   
"My son's hip surgery was $10,000 with insurance. My iPhone $20 a month."
          GOP touts lower premiums, but other insurance costs to rise   
Health_Overhaul_Premiums_12723Republicans are touting lower premiums under their health care legislation, but that reflects insurance that would cover a smaller share of the cost of medical bills.
          Selling the GOP health care bill: Does Trump help or hurt?   
Trump_Health_Care_26107It was a platform most politicians can only hope for: A captivated, 6,000-person crowd and more than an hour of live, prime-time television coverage to hype the Republican vision for a new health care system.
          Listen: What you need to know about the new health care bill   
What is in the new Republican healthcare bill? Does it live up to President Trump's promises? What does it mean for Americans' healthcare? Will it pass in the Senate?
          Trump Unloads on Media Again - U.S. News & World Report   

U.S. News & World Report

Trump Unloads on Media Again
U.S. News & World Report
President claims New York Times story saying he was out of the loop on the GOP health care bill is a 'fake news joke.' By Gabrielle Levy, Political Reporter | June 28, 2017, at 10:14 a.m.. MORE. LinkedIn · StumbleUpon · Google +; Cancel. Trump Unloads ...
How To Spot a Fake TIME CoverTIME
Time magazine gives tips on spotting fake covers like Trump'sThe Hill (blog)
Time Asks Donald Trump's Golf Clubs to Remove Phony Magazine CoverNBCNews.com
USA TODAY -Newsweek -Washington Post -Hot Air
all 218 news articles »

          The Senate healthcare bill could result in a 'nightmare scenario' for drugs   

Peter Orszag

Washington might have just solved the problem of high drug prices. But the road to that would be incredibly painful.

It's an argument laid out in an unsettling column for Bloomberg by former Office of Management and Budget head Peter Orszag titled, "One Nightmare Scenario in Senate Bill: Drug Rationing."

"Senate Republicans may not realize it, but their repeal-and-replace health-care legislation, if passed, would set the U.S. on the road to European-style price controls and rationing of prescription medications. This would follow fairly directly from the enormous cuts to Medicaid that the bill would impose," he writes.

To be clear, Orszag isn't writing this because he thinks it's a merit of the bill that's aimed at repealing Obamacare. It's an unintended consequence, he says, and Orszag is one of President' Barack Obama's guys. 

But the scenario he lays out is fairly simple: The Congressional Budget Office estimates that Federal spending on Medicare will fall by 25% by 2026 under this bill. After that Federal health care funding to states would increase at the rate of inflation, which is an estimated 2% less than the rate of healthcare cost inflation.

You can see how this problem could start to run away from state governments, especially those already suffering from budget constraints.

So Orszag, who now the global co-head of healthcare at investment bank Lazard, thinks that states will have to go into emergency mode, pulling back on big costs like prescription meds. After all, according to the Center for Sustainable Rx Pricing, prescription drugs now make up almost 20% of healthcare costs.

This would hit drug companies and patients subject to drug rationing alike. 

For more on this, read Orszag's full column>> 

Join the conversation about this story »

NOW WATCH: Science says lasting relationships come down to 3 basic traits


          Avalon - Housekeeper - George E Wahlen Ogden Veterans Home - Ogden, UT   
Candidates should have related experience as well as a positive attitude! The Housekeeper will clean resident rooms and other interior and exterior facility...
From Avalon Health Care Group - Tue, 30 May 2017 18:34:43 GMT - View all Ogden, UT jobs
          Kenya: Seeking refuge in Kakuma   
Source: Handicap International
Country: Kenya, Somalia, South Sudan

Record numbers of people are fleeing war, drought, and famine in South Sudan and Somalia. People with disabilities or injuries are forced to take enormous risks to reach a place of safety. Handicap International is working hard to make sure that thousands of people in similar situations across East Africa receive immediate card and long-term support. Collectively, we have a responsibility to ensure that all refugees live safe, independent, and dignified lives.

Refugee camps like Kakuma in Kenya are large, complex structures with many people arriving and leaving every day. Due to the violence and lack of health care in the countries people are fleeing from, a high proportion of people need urgent assistance. Here are just a few stories of South Sudanese and Somalian refugees who are seeking refuge in Kakuma.

Simon, 18, South Sudan

In December 2016, Simon’s family ran out of food. He was searching for honey and wild fruits when he was shot in the leg. The health center near his village had been abandoned so his injury was left untreated. Handicap International met Simon the day after he and his four young sisters arrived at Kakuma refugee camp in Kenya. His parents, after months of not being able to find enough food and water, made the difficult decision to send their children to safety alone. Handicap International has provided Simon with new, more comfortable crutches and will provide support in continuing his education.

Ajeu, 40, South Sudan

Ajeu arrived on May 27 after hitching lifts on the back of motorbikes. He lost his right lower leg in 2005 after a gunshot injury but was still able to grow crops on his land and support his family. In 2015, an infected wound led to the amputation of his left foot and the family began to run out of money and food. Due to the lack of professionals and medication, Ajeu’s leg became infected again. When Ajeu was first identified at the reception center, his leg was wrapped in dirty sacks. He is now being treated at the hospital and will receive mobility aids from Handicap International that will improve his quality of life.

Agnes, 18 months, South Sudan

Agnes arrived at Kakuma in May and was quickly diagnosed with severe malnutrition. Rates of malnutrition are now at alarming levels among refugee populations. Children under five become extremely vulnerable to infection, delayed development, and permanent disability. In response to the alarming increase in these cases, Handicap International launched physical and cognitive stimulation projects for malnourished children like Agnes in Kenya, Ethiopia, Somalia, and Uganda.

Abdullah, 55, South Sudan

Once people have received urgent health care, it is important to make sure that they are able to meet their daily needs in the camp. This means, fair and easy access to food, water and sanitation.

Abdulla, a widower, has been in Kakuma camp with his four children since the end of 2016. Handicap International provided him with a tricycle that helps him move around the camp. Abdulla still needs support from his eldest son with many tasks, which means his son sometimes misses school. Our teams referred Abdullah for surgery and hopes to fit him with a prosthetic limb to give him more independence.

Omat, 8, South Sudan

For financial reasons, many women arrive at Kakuma with their children but without their husbands, leaving them as the sole provider.

Ariet arrived in Kakuma with her three children at the end of April. She felt she had no other option but to leave Juba as food had become too expensive and the family were only eating one meal a day. She was particularly worried about Omat, who has severe cerebral palsy and requires 24-hour care.

Handicap International has provided Omat with an adapted wheelchair, which will also enable Ariet to move around the camp and access services more easily. Our physical therapists are teaching Ariet some simple exercises that she can carry out herself. Over time, these exercises will improve Omat’s mobility and reduce pain.

Yussef, 20, South Sudan

Although refugees find themselves in an uncertain and challenging environment, aspirations are high and education is considered a priority. After years of violence and displacement, many young people have spent very little time at school.

Children and young people with disabilities, like Yusef, are often underestimated by their families and peers. Handicap International makes sure that schools and community spaces are accessible and adapted that everyone has an opportunity to achieve their goals. Yusuf is determined to get his school diploma.

Noor, 31, Somalia

Life in a refugee camp does not mean “life on hold.” Shops, schools, markets, and meetings create a lively community and economy. Handicap International helps people with disabilities to take on active roles and to establish their place in society. Noor has difficulty walking and has lived in Kakuma for several years. Handicap International has provided him with mobility aids which have helped him to set-up a small grocery shop. This additional income supplements his family’s food ration.

Recently, Noor has become involved in HI’s disability rights groups where he is learning how to advocate for the needs of people with disabilities. The groups aim to combat discrimination and to have fair access to all services.

Handicap International works in refugee and internally displaced persons camps in South Sudan, Kenya, Ethiopia, and Somaliland. We will be launching activities in Uganda later this year. There are currently 1.8 million South Sudanese and nearly 1 million Somalian refugees in the region in addition to millions more internally displaced people. These numbers are only expected to rise as the food crisis worsens. It is vital that all governments and aid agencies take into account the needs of people with disabilities.


          Lawmakers Warn Senate Health Care Bill Could Worsen Opioid Crisis   
Some senators are concerned about how the Senate Republicans health care bill would affect treatment for opioid addiction.
          55 Percent Of Americans Disapprove Of Senate Health Care Bill   
A new NPR-PBS NewsHour-Marist poll shows President Trump's approval ratings below 40 percent and approval of the GOP health care proposal in the teens. This toxic environment makes it even tougher for Republicans to forge a deal to meet their twin goals of repealing the Affordable Care Act and making affordable care more accessible.
          Study: Media Calls Obamacare ‘Reform’ But Not GOP Bill   
According to a recent study, broadcast news networks disproportionately referred to the Affordable Care Act as health care “reform” when compared to the GOP health bill. An analysis by the Media Research Center shows that ABC, CBS, and NBC touted Obamacare as a “reform” more than 11 times as often as they did the GOP health care bill. […]
          Powerline Technician, Apprentice and Labour - Proline Power Corp - Ponoka, AB   
We offer competitive wages, great benefits including health care, dental , vision, short and long term disability and much more....
From Indeed - Thu, 13 Apr 2017 17:04:04 GMT - View all Ponoka, AB jobs
          See what’s cooking at the M State summer camps   
Like to cook? Want to build things? Interested in a career in health care or STEM? Then check out the camps scheduled this summer on the campuses of Minnesota State continue reading →
          Check out the summer opportunities at M State   
Like to cook? Want to build things? Interested in a career in health care or STEM? Then check out the camps scheduled this summer on the campuses of Minnesota State continue reading →
          CBO Predictions About The Senate Health Care Bill Are Deeply Flawed   
Yesterday, the Congressional Budget Office published its estimate of the Senate GOP health care bill. Democrats are trumpeting the claim that under the bill, 22 million fewer people will have coverage than under Obamacare in 2026. But the CBO’s estimates are deeply flawed.
          How Would The Senate Discussion Draft Affect Individually-Purchased Health Coverage?   
The Senate health care "discussion draft" has some good points, but doesn't really solve the problem. Here are some suggestions for improvement.
          The New Senate Republican Bill Will Transform American Health Care   
The hotly-anticipated Senate Republican health care bill came out on Thursday morning. The airwaves quickly filled up with predictable talking points from both sides. But once the dust settles, it will emerge that the Senate bill will have far-reaching effects on American health care.
          If The Senate Doesn't Fix The House's Obamacare Replacement, The GOP Will Pay A Steep Price   
Earlier today, House Republicans passed their replacement of Obamacare. The bill contains many important reforms, but it risks throwing millions of low-income Americans off of their health insurance plans. Senate Republicans can fix this—but only if they prioritize sound health care policy.
          How Republicans Can Escape Their Health Care Dilemma, Part 3: Responsible Federalism   
Responsible federalism offers a way to achieve bipartisan health care reform that is both fiscally sustainable even while accomodating very disparate political views about the proper role of government in health care.
          How Republicans Can Escape Their Health Care Dilemma, Part 2: Universal Safety Net   
A universal safety net would ensure adequate primary, preventive and hospital care for all Americans at an affordable cost.
          How Republicans Can Escape Their Health Care Dilemma, Part 1: Universal Catastrophic Coverage   
Universal catastrophic coverage offers the possibility of a bipartisan reform that is politically feasible at an affordable cost.
          Health Reform: If At First You Don't Succeed, Try Again   
This does not have to mean the end of health care reform. The ACA was passed in 2010 after months of infighting among Democrats, with six other bills being approved by committees before a different bill was eventually passed. Republicans should try again.
          Bring GOP Right-Wingers And Pragmatists Together On Obamacare -- By Making Premiums Affordable   
Thursday was a wild day in Obamacare-land, with vote cancellations, last-minute amendments, CBO analyses, and Presidential ultimatums. But the most surprising development of all was this: a way has emerged to get both hard-line and pragmatic conservatives to support the American Health Care Act.
          Registered Nurse - RN - Part Time Wound Nurse - Woodland Park Care Center - Salt Lake City, UT   
We are now hiring RN’s for part time Certified Wound Nurse Use your nursing skills to serve others in our fantastic facility. Avalon offers great pay with
From Avalon Health Care Group - Tue, 27 Jun 2017 16:28:24 GMT - View all Salt Lake City, UT jobs
          Director of Nursing - DON - Woodland Park Care Center - Salt Lake City, UT   
Avalon Health Care is seeking a dependable, organized and dedicated Registered Nurse with great leadership skills to join our outstanding team as a Director
From Avalon Health Care Group - Fri, 23 Jun 2017 16:45:53 GMT - View all Salt Lake City, UT jobs
          Avalon - Unit Manager - RN - Woodland Park Care Center - Salt Lake City, UT   
Avalon Health Care is seeking a dependable, organized and dedicated Registered Nurse (RN) to join our outstanding team as a Unit Manager! The Unit Manager
From Avalon Health Care Group - Fri, 23 Jun 2017 16:45:49 GMT - View all Salt Lake City, UT jobs
          Respiratory Therapist - Full Time - Woodland Park Care Center - Salt Lake City, UT   
Avalon Health Care is seeking a dependable, organized and dedicated Respiratory Therapist to join our outstanding team! Today’s aging population means there
From Avalon Health Care Group - Wed, 14 Jun 2017 17:27:09 GMT - View all Salt Lake City, UT jobs
          Medication Assistant Certified (MA-C) / Medication Aide - Woodland Park Care Center - Salt Lake City, UT   
Within the medication assistant's scope of practice, education, and demonstrated competency, and under the direct supervision of a Registered Nurse, the
From Avalon Health Care Group - Fri, 05 May 2017 20:29:40 GMT - View all Salt Lake City, UT jobs
          1623 - The Republicans Plan B & C to Destroy Health Care & Cut Taxes For Wealthy   

The Republicans continue to pursue destroying health care. The Republican timeline of attempting to destroy health care. How Republicans ran to the left of Obamacare. The side deals Republicans will cut in the Senate. The next phase of Republican plans to destroy the social safety net. How Obama undermined Obamacare. Mitch McConnell is angry at Donald Trump's stupidity. Republican Congressman Francis Rooney, also has no idea what his job is and Al Franken humiliates Rick Perry.

On The Fun Half: Donald Trump's fake Time cover. Trump acts creepy. Reporter calls out Sarah Huckabee for demonizing the press. Ivanka whines and complains on Fox & Friends. Sarah Palin sues the New York Times and your calls and IMs.


          Fox News Poll: 27 percent favor Senate GOP health care plan, as vote gets delayed   
By two-to-one, American voters oppose the Senate health care bill to replace the Affordable Care Act -- even as a majority wants to repeal at least some of the existing law.
          CBO score of Senate health care bill: What does it mean?   
The Congressional Budget Office released its cost estimate for the Senate’s ObamaCare replacement plan on Monday.
          Senior Business Analyst   
NJ-Bridgewater, RESPONSIBILITIES: A Kforce client a world class health care company in Bridgewater, NJ seeks a Senior Business Analyst of Financial Systems. This position will partner with Finance and Information Technology stakeholders to deliver comprehensive SAP BPC based reporting solutions that meet general accounting and financial reporting requirements. Extensive support will be involved in maintaining and
          Massage, Traction, and Manipulation   

Massage, Traction, and Manipulation

 MASSAGE


Worldwide, various forms of massage, traction, and manipulation have been used for several thousand years. Each modality represents a treatment for pain, and steadily increasing numbers of people are seeking these treatments.

Although research on each of these approaches or modalities continues, a long-standing variable unites them all, that is, the concept of touch. In the 1940s, Rene Spitz reported on infants in foundling home who, though they were otherwise healthy and well taken care of, failed to thrive and often died in the absence of being held or touched. Kunz and Krieger additionally defined and taught the principles behind the related concepts of healing touch and therapeutic touch in the 1970s.

Although no consensus exist regarding the complete physiology of massage, traction, or manipulation, these treatment approaches are generally thought to involve more than just the interaction of mechanical forces and human anatomy. The history of touch as a natural and essential component of healing and health maintenance is long.

Throughout history, massage has been woven into the cultural context of medicine. Massage consists of both Eastern and Western variants. In the West, the practice and popularity of massage has varied over time. In recent years, the previous decline in the popularity of massage (probably related to technologic advancements in medicine), has been reversed into a resurgence of interest. In the United States, approximately $2-4 billion is spent each year for visits to massage therapists; these costs account for approximately 26% of the $11.7 billion spent on nontraditional healthcare in the 1990s.

Increasing numbers of Americans are pursuing massage for various reasons (eg, relief of pain, relaxation, conditioning). Although little doubt exists that massage is beneficial for certain conditions, additional research is needed to establish its profile of efficacy. For excellent patient education resources, visit eMedicine's Muscle Disorders Center. Also, see eMedicine's patient education article Chronic Pain.

Definition of basic massage concepts

Massage is a therapeutic manipulation of the soft tissues of the body with the goal of achieving normalization of those tissues. Massage can have mechanical, neurological, psychological, and reflexive effects. Massage can be used to reduce pain or adhesions, promote sedation, mobilize fluids, increase muscular relaxation, and facilitate vasodilation. Massage easily can be a preliminary treatment to manipulation; however, it clearly targets the health of soft tissues, while manipulation targets joint segments.

Massage primarily consists of hand movements, some of which may be traction based. Traction is defined as the act of drawing or pulling or application of a pulling force. Traction sometimes involves equipment, but it can also be applied manually. In addition, traction affects changes in the spinal column itself, with soft tissues only secondarily changed. Effects of massage, like those of traction, tend to be fairly nonspecific.

Types of massage

Western massage

Western massage is the most common type of massage practiced in the United States today. Western massage organizes variations of soft-tissue manual therapy into several categories. Pare of France introduced the basic terminology for Western massage to the United States. The essence of Western massage is use of the hands to apply mechanical forces to the skeletal muscles and skin, though the intent may be to affect either more superficial or deeper tissues.

Types of basic Western massage are characterized by (1) whether the focus of pressure is moved by the hands gliding over the skin (ie, effleurage), (2) by whether the soft tissue is compressed between the hands or between the fingers and thumb (ie, petrissage), (3) by whether the skin or muscle receives repetitive and compressive blows (ie, tapotement), or (4) s by whether hearing stresses are created at tissue interfaces below the skin (ie, deep friction massage).

  • Effleurage
    • In this approach, the practitioner's hands glide across the skin overlying the skeletal muscle being treated.
    • Oil or powder is incorporated to reduce friction; hand-to-skin contact is maintained throughout the massage strokes.
    • Effleurage can be superficial or deep.
    • Light strokes energize cutaneous receptors and act by neuroreflexive or vascular reflexive mechanisms, whereas deep-stroke techniques mechanically mobilize fluids in the deeper soft tissue structures.
    • Deep stroking massage is performed in the direction of venous or lymphatic flow, whereas light stroking can be in any direction desired.
    • Effleurage may be used to gain initial relaxation and patient confidence, occasionally to diagnose muscle spasm and tightness, and to provide contact of the practitioner's hands from 1 area of the body to another.
    • The main mechanical effect of effleurage is to apply sequential pressure over contiguous soft tissues so that fluid is displaced ahead of the hands as tissue compression is accomplished.
  • Petrissage
    • Petrissage involves compression of underlying skin and muscle between the fingers and thumb of 1 hand or between the 2 hands.
    • Tissue is squeezed gently as the hands move in a circular motion perpendicular to the direction of compression.
    • The main mechanical effects are compression and subsequent release of soft tissues, reactive blood flow, and neuroreflexive response to flow.
  • Tapotement
    • This percussion-oriented massage involves striking soft tissue with repetitive blows by using both hands in a rhythmic, gentle, and rapid fashion.
    • Numerous variations can be defined by the part of the hands making an impact with the body.
    • The therapeutic effect of tapotement may result from compression of trapped air that occurs on impact.
    • The overall effect of tapotement may be stimulatory; therefore, healthy persons with increased tolerance for this approach are more likely to find this type of massage useful.
  • Deep friction
    • Pressure is applied with the ball of the practitioner's thumb or fingers to the patient's skin and muscle.
    • The main effect of deep friction massage is to apply shear forces to underlying tissues, particularly at the interface between 2 tissue types (eg, dermis-fascia, fascia-muscle, muscle-bone interfaces).
    • Deep pressure keeps superficial tissues from shearing so that shear and force are directed at the deeper tissue surface interface.
    • Deep friction massage frequently is used to prevent or slow adhesions of scar tissue.

Eastern massage

Over the centuries, Eastern massage systems have been an integral part of the cultures where they are practiced. Systems for evaluation, diagnosis, and treatment are generally not grounded in conventional Western neurophysiology.

Eastern massage includes, Shiatsu (ie, a Japanese system based on traditional Chinese Meridian theory with principles of Western science), among other approaches. The theory of Shiatsu is based on the system of the 12 traditional Chinese meridians (ie, major channels) of the body in which the energy or life force, or Chi, circulates. Acupressure points situated along the course of channels allow access to these channels. In acupressure massage forces are applied, largely by means of digital pressure, to the same points treated with acupuncture needles. Imbalances of energy along the meridians are believed to cause disease and can be rectified by localized finger pressure.

Reflexology and auriculotherapy systems of massage that share the same meridian concept as that of Shiatsu. In these approaches, the meridians are believed to have whole-body representations on the extremities (similar to the homunculus of the brain). The feet (in reflexology) and the ear (in auriculotherapy) have been mapped in detail.

Massage technique

The practitioner controls several variables of massage, including milieu. Actual application of treatment includes rhythm, rate, pressure, direction, and duration. Most massage approaches involve a friction-reducing medium, so that the hands of the practitioner move along the patient's skin with minimal friction. Powders or oils are often used. Massage strokes also should be regular and cyclic. The rate of application for massage varies with the type of technique.

In some approaches (eg, tapotement, percussion), the rate is several times per second while in others it is much slower. The amount of pressure depends on the technique and the desired results. Light pressure may produce relaxation and relative sedation and may decrease spasm; breakdown of adhesions and intervention at a deeper tissue level may require heavier pressure. Treatment of edema and stretching of connective tissue generally requires intermediate amounts of pressure. Direction of massage often is centripetal to provide better mobilization of fluids toward the central circulation. The sequence of tissues treated often is performed in centripetal fashion.

When muscles are treated, motions generally are kept parallel to muscle fibers. If the treatment goal is to reduce adhesions, shearing forces are circular or at least include cross-fiber components. The area to be treated with massage depends upon the condition being treated and may vary from a well-circumscribed area to treatment of contiguous areas.

Duration of treatment depends on the area being treated, desired therapeutic goals, and patient tolerance. Wide variation exists regarding treatment duration, which often is guided by changes occurring to tissue during massage application. If massage is performed before other treatments, duration may be determined by the result needed to optimize the next treatment step. Duration of a massage therapy program can range from 1 wk to months and depends on verifiable therapeutic goals. Patients must be reexamined from time to time, depending on the diagnosis and the therapeutic goals, to ensure satisfactory progress.

 

MASSAGE EFFECTS, INDICATIONS, CONTRAINDICATIONS, AND RESEARCH


Physiologic effects of massage

Massage produces some mechanical effects. Mechanical pressure on soft tissue displaces fluids. Fluid moves in the direction of lower resistance under the static forces of the practitioner's hands, but a moving locus of pressure creates a pressure gradient. Assuming no significant resistance, pressure is decreased proximal to the practitioner's advancing hand. Once mobilized fluid leaves the soft tissues, it enters the venous or lymphatic low-pressure systems. The amount of fluid mobilized in any single treatment is likely to be small; however, the physiatrist must be aware of this physiologic effect in patients with significantly compromised cardiovascular or renal function. When lymphedema is treated, massage is performed more proximally and then moves distally, based on the belief that proximal blockage in the lymph channels must be opened first to allow for subsequent distal mobilization of fluid and protein.

Kneading and stroking massage decreases edema; compression converts nonpitting to pitting edema. In addition to strictly mechanical effects, these massage approaches release histamine, causing superficial vasodilation to assist in washing out metabolic waste products. Venous return increases, which subsequently increases stroke volume.

Some evidence suggests that massage increases blood flow contralaterally; however, the mechanism of this postulated action has not been well established. These effects on mobilization of fluids are more important in flaccid or inactivated limbs because normal compression supplied by skeletal muscle contraction usually is not present in those cases. Studies in recent years suggest that massage may decrease blood viscosity and the hematocrit and increase circulating fibrinolytic compounds. Preliminary data suggest an explanation for the success of massage in decreasing deep vein thrombosis (DVT). Massage may be contraindicated in the presence of existing thrombosis.

Other blood compounds that show increases through massage include myoglobin, creatine kinase, lactate dehydrogenase, and glutamic oxaloacetic transaminase. Temporary increases in these substances represent local muscle cell leakage from applied pressure. Lactate decreases in massaged muscles as well. Massage may decrease muscle spasm and increase force of contraction of skeletal muscle. Decreased spasm and increased endurance may result from wash out of metabolic waste products by fluid mobilization and increased blood flow. Decreased muscle soreness probably results from metabolic wash out.

Reflexive changes

Massage can stimulate cutaneous receptors, spindle receptors, and superficial skeletal muscle as well. These structures produce impulses that reach the spinal cord, producing various effects, including moderation of the facilitated segment. Somatovisceral reflex changes to the viscera are possible in this model.

 Psychological effects of massage

Massage generally increases feelings of relaxation and well being in patients. Whether this is from placebo effect or the result of some previously undiscovered reflex is not fully understood. Practitioners often incorporate a variety of psychophysical techniques, such as guided imagery, into massage treatment. A recent non-randomized prospective trial of massage therapy at a major U.S. cancer center sought to examine massage therapy outcome in a large group of patients. Over 3 y, 1290 patients were treated with regular (Swedish), light touch, or foot massage, based on the request of the patient. The patients filled out symptom cards before and after an average 20-min massage session. Symptom scores were reduced by approximately 50%, with outpatients demonstrating about 10% greater benefit than inpatients. Anxiety, nausea, depression, and pain demonstrated the greatest improvement in symptom score.

Therapeutic goals and indications for massage therapy

Massage may be used as primary therapeutic intervention or as an adjunct to other therapeutic techniques. Uses include, but are not limited to, (1) mobilization of intertissue fluids, (2) reduction or modification of edema, (3) increase of local blood flow, (4) decrease of muscle soreness and stiffness, (5) moderation of pain, (6) facilitation of relaxation, and (7) prevention or elimination of adhesions. Massage may be used to alter pathophysiology of a primary condition (eg, contracture) or to prevent or modify deleterious effects of a previously used treatment modality.

Hospitalized patients who receive massage express improvements in mood, body image, self-esteem, and perceived levels of anxiety. This phenomenon is facilitated by reduction in physical symptoms and distress and may be accompanied by decreased tension, anxiety, and pain perception.

Another therapeutic effect derived from massage is muscle relaxation. Massage appears to reduce tone and enhance circulation to the area. Muscle relaxation also may result from increased sensory stimulation caused directly by massage. This increased sensory input to the spinal cord may result in changes in reflex pathways, leading to central modulatory decreases of muscle tone.

Massage can affect both local and remote circulation in skin and subcutaneous tissue. Studies suggest that massage also may decrease the likelihood of DVT by decreasing the hematocrit and overall blood viscosity and by increasing circulating fibrinolytic compounds.

Other effects of massage are enkephalin release, endorphin production, promotion or absorption of fibrous tissue, restoration of connective tissue pliability, improvement of lymphatic flow (in some studies up to 7-9 times), and increased levels of natural killer (NK) cells. Tanabe and Nakayama have provided animal data that suggest that mechanical stimuli, such as massage, to adipocytes may inhibit expression of adipogenic transcription factor peroxisome proliferator-activated receptor, which is independent of systemic energy consumption. They postulate that such stimuli can assist in reducing the body's fat stores, and may help to reduce obesity.

Contraindications to massage

Massage is contraindicated when it could cause worsening of a particular condition, unwanted tissue destruction, or spread of disease. Massage can spread malignancy, thrombi, atherosclerotic plaques, and infected tissue.

Absolute contraindications to massage include (1) DVT, because increased blood flow in a limb could cause thrombus to detach from the vessel wall, creating an embolism; (2) acute infection; (3) bleeding; and (4) new, open wounds. Relative contraindications include (1) incompletely healed scar tissue, (2) fragile skin, (3) calcified soft tissue, (4) skin grafts, (5) atrophic skin, (6) inflamed tissue, (7) malignancy, (8) inflammatory muscle disease, and (9) pregnancy.

The physiatrist should be aware that massage must be used carefully in patients with chronic pain. The direct hands-on nature of massage may potentiate strong psychophysical effects and unintentional reliance of passive treatment modalities. In all patients, treatment end points must be established at the beginning, and treatment should be terminated when those end points are achieved.

Research in massage

Although many studies of the clinical utility of massage have been conducted, the quality of these efforts has been somewhat variable. Studies of massage have considerably varied in sample size and constitution, use of adequate controls, methodologic errors, and other limitations. The long-term efficacy of massage has not been validated.

Future inquiry must establish the long-term efficacy of massage in a rigorous scientific fashion. Future studies must have valid experimental design that allows both pretesting and posttesting, appropriate sample sizes and statistical analysis, and reliable and valid measurement tools, and they must provide some degree of standardization of duration and frequency of treatment.

 

TRACTION


Traction is the act of drawing or pulling and relates to forces applied to the body to stretch a given part or to separate 2 or more parts. Traction is used effectively in treatment of fractures. In physiatric practice, traction is often limited to the cervical or lumbar spine with the goal of relieving pain in, or originating from, those areas. Since the days of Hippocrates, correction of scoliosis has also involved traction. Various methods of traction have been performed that include having the patient apply pulling force manually with free weights and a pulley, by using motorized equipment, inversion techniques, or an overhead harness.

Physiologic effects of traction

In the cervical spine, the most reproducible result of traction is elongation. In a classic study, Cyriax reported manually applying force of 300 lb, with a resultant 1-cm increase in cumulative lumbar spinal interspace distance. Studies have shown that optimum weight for cervical traction to accomplish vertebral separation is 25 lb. In addition, 2- to 20-mm elongation of the cervical spine has been shown to be achievable with 25 or more pounds of traction force. Studies have shown that anterior intervertebral space shows the most increase in cervical flexion of 30°. Traction in the extended position generally is not recommended because it is often painful and may increase risk of complications from vertebral basilar insufficiency or spinal instability.

Once friction is overcome in the lumbar spine, the major physiologic effect of traction is elongation. Investigators have reported widening of lumbar interspaces requiring between 70-300 lb of pull. This widening averaged up to slightly more than 3 mm at 1 intervertebral level. The length of time that the separation persists remains indeterminate with studies documenting distraction durations of 10-30 min after treatment.

Data on dimensional and pressure changes of lumbar disks caused by traction are not conclusive. Decreases in interdiskal pressure with 50-100 lb of traction have been documented, but evidence exists that some applications actually cause increase in interdiskal pressure. Therefore, evidence is inconclusive, with much information favoring at least temporary reduction of the herniated component of an abnormal lumbar disk with concomitant traction.

Outcome studies related to traction

Few scientifically rigorous studies have been performed to allow us to distinguish the effect of traction from the natural history of pathology (eg, radiculopathy). Criteria have been suggested that would allow the true effects of traction to be delineated. These criteria include (1) randomized controlled trials, (2) blind outcome assessments, (3) equivalent co-interventions, (4) monitored compliance, (5) minimal contamination and attrition, (6) adequate statistical power and description of study design and interventions, and (7) relevant functionally oriented outcomes.

No traction outcome study to date has incorporated these criteria. Despite inadequacies in the literature, randomized controlled trials that meet some of these criteria do provide insight into the efficacy of traction as a treatment modality. One review of randomized controlled trials of traction analyzed English-language studies done between 1966 and 2001. The only conclusion that could be drawn was that the evidence to support the effectiveness of traction for back pain relief is poor. What can be reasonably derived from these studies is that more work is needed to make evidence-based recommendations on the application of traction for back pain.

Lumbar traction

The Agency for Health Care Policy and Research (AHCPR) review of the literature on traction resulted in a conclusion that "spinal traction is not recommended in the treatment of acute low back problems." Studies that claim improvement after traction report modest and short-term improvements with limited or no improvement in overall function. In addition, these studies have significant design flaws. Although a particular group of patients may benefit from a particular type of traction for short- or long-term improvement in functional outcome, the current literature does not identify this patient population.

Cervical traction

Few randomized controlled trials address patient outcomes after cervical traction. Although many studies have revealed statistically significant findings, the clinical importance of those findings is not clear. Studies on emerging protocols for cervical traction, as well as on new devices for applying traction have been reported. The evidence for the efficacy of these devices and methods appear to need further study before widespread application can be recommended.

Techniques for applying traction

Cervical traction is generally accomplished with a free-weight-and-pulley system or an electrical motorized device. Adequate pull is achieved by using a head or chin sling attached to a system that can provide pull in a cephalic direction. Motorized devices are applied easily but require the patient to be attended. Free-weight-and-pulley systems often are used in the home with 20 or more pounds of water or sand and a pulley system attached to a door. If a traction force of only 20 lb is possible, the system is likely to fail to achieve therapeutic results. Advise patients not to attempt cervical traction at home alone because they may find themselves in uncomfortable positions and may need assistance removing the traction devices.

Most home traction systems are difficult for patients to set up without assistance. Home cervical traction may cause increase in pain or may fail to produce significant pain relief unless professionally monitored on a periodic basis. At the initiation of home traction, the patient is required to demonstrate proper use of equipment to the satisfaction of the prescribing physician or therapist.

In the lumbar spine, adequate pull with weights and pulleys or motorized devices to achieve vertebral distraction usually can be obtained with the proper apparatus. Generally, a harness is attached around the pelvis (to deliver a caudal pull), and the upper body is stabilized by a chest harness or voluntary arm force (for the cephalad pull). Motorized units have the advantage of allowing intermittent traction with less practitioner intervention. If the goal of traction force is to distract lumbar vertebrae, 70-150 lb of pull are usually needed. Friction between the treatment table and patient's body usually requires traction force of 26% of the total body weight before effective traction to the lumbar spine is possible. Many traction devices use a split table that eliminates the lower body segment friction.

Body weight should theoretically provide enough pull to distract lumbar vertebrae and eliminate mechanical devices. Gravity traction is applied almost exclusively in the lumbar region. After 10 min of inversion traction, documented increases in intervertebral separation are noted; however, adverse effects also are reported frequently, including increased blood pressure, periorbital and pharengonal petechiae, headaches, blurred vision, and contact-lens discomfort.

Other traction technique considerations

In cervical traction, determine sitting versus supine position based on patient's comfort and ability to relax. Maximal distraction generally occurs between 20-30° of flexion without rotation or side bending.

Supine position is chosen most commonly for lumbar traction since the sitting position may result in outcome limiting discomfort from the harness. Hip flexion of 15-70° is routinely incorporated to cause relative lumbar spine flexion; this may facilitate optimal vertebral separation.

Studies have shown that, in the cervical spine, intermittent traction of 20 lb peak (10 seconds on, 10 seconds off, for a total of 15 min of treatment time) provided improvement in range of motion (ROM) with less accompanying pain than did 15 min of manual or static traction of 25 lb. Constant cervical distraction forces of 30 lb generate maximum vertebral separation in 7 seconds or less, and no further separation is gained with applications of up to 60 seconds.

In addition to patient preference, data suggest that some relative advantage exists to an intermittent versus continuous protocol of cervical traction. Some studies report that continuous traction is necessary in the lumbar spine to fatigue muscles and allow strain to fall on joints; however, no statistical difference has been observed with either continuous traction of 100 lb for 5 min or intermittent traction of 100 lb, peaking for 15 min. As in traction on the cervical spine, improved patient tolerance favors an intermittent protocol.

In the sitting position, application of approximately 10 lb is required to counterbalance the patient's head in cervical traction. Traction of 30 lb applied to a neck flexed up to 24° can cause vertebral separation, but increase of force to 50 lb produced no clear-cut additional separation. In the lumbar spine, a pull, which equals approximately 50% of the weight of the body part, is needed to overcome friction. As previously noted for the lower body, this amounts to approximately 26% of total body weight.

The optimal duration of traction has not been clearly demonstrated. Studies have revealed recommendations varying from 2 min to 24 h in the cervical spine. Duration of approximately 15-25 min commonly is prescribed. Cervical traction generally is prescribed at a frequency of daily for the first week and then every other day (ie, 3 times per week) for total treatment duration of approximately 3-4 wk.

In the lumbar spine, treatment generally is recommended in the 8- to 40-min range per session, daily for the first week, and then every other day (ie, 3 times per week) for a total of 3-4 wks. In both cervical and lumbar traction, goals of treatment determine the time course, as well as the end point of treatment. Possible treatment end points may include pain relief, achievement of normal ROM, return to work or other desired activity, lack of improvement and symptoms, and inability of the patient to cooperate with treatment.

Indications for traction

The literature does not give clear indications what types of neck or low back pain (LBP) may improve from traction. Studies strongly suggest that traction does not produce significant influence on long-term outcome of neck pain or LBP. Practitioners who rely on sound scientific advice ma

          Clerk/Program Clerk - Canadian Blood Services - Winnipeg, MB   
Canadian Blood Services is a collaborative community of donors, volunteers, health care professionals, employees and corporate partners committed to saving and...
From Canadian Blood Services - Fri, 23 Jun 2017 07:53:38 GMT - View all Winnipeg, MB jobs
          Respiratory Therapist - Full Time - Woodland Park Care Center - Salt Lake City, UT   
Avalon Health Care is seeking a dependable, organized and dedicated Respiratory Therapist to join our outstanding team! Today’s aging population means there
From Avalon Health Care Group - Wed, 14 Jun 2017 17:27:09 GMT - View all Salt Lake City, UT jobs
          Licensed Field Based Care Manager/Social Worker - Reno, NV   
NV-Reno, You're looking for something bigger for your career. How about inventing the future of health care? Optum is offering an innovative new standard for care management. We're going beyond counseling services and verified referrals to behavioral health programs integrated across the entire continuum of care. Our growth is fueling the need for highly qualified professionals to join our elite team. Brin
          Race Report: Welland Long Course   
When planning my races this summer I was fairly stuck on where I wanted to race on June 25th. I debated whether I should go to Ironman 70.3 Mont Tremblant or whether should I race in Welland. Ultimately, the pros of racing in Welland won out: the proximity to Toronto, the timing (doing a half-ironman just 9 weeks before a full Ironman wasn't enough time to recover and ramp up the training and then taper - for a full time working step-mum anyway!), the venue, the community, the course is better suited for me (windy and flat!), practice on the Barrelman course, getting to race alongside my sister (Sara), and mostly because I LOVE racing with Multisport Canada. And what a great event the Multisport crew and volunteers put on in Welland! It truly is a spectacular race. The course, the location and the organization are tough to beat.



THE PRE RACE

The week before the race was far from an easy week. I had raced a half-ironman two weeks prior to Welland which I had put in a good two week taper for. That meant that I would race Welland at the end of a Build Week. I usually taper for all my races, but with Ironman on August 20th being one of my key races this year, it meant that I would not be able to do so for Welland. So, the week leading up to this race was as follows:

Saturday: 95km ride + 4km run
Sunday: 6000m swim
Monday: 7km descending run
Tuesday: 3000m swim, including 2000m race pace swim & 22km run
Wednesday: 1500m swim, 90minute ride with 6x(1min at VO2max-4min at Threshold)
Thursday: 2000m swim
Friday: 1500m swim, 30min bike & 3km descending run
Saturday: 1hr bike with 3x(2min at race power) and 3km run off the bike, and then I got married in the afternoon!

Still a bit of low volume week, but add about 50 hrs of work (including giving about 20 x 1hr massages) and it's a lot!



THE RACE

The Swim

I positioned myself close to Nigel Gray (NRG head coach, great guy and super speedy). I knew that I could swim at around his pace and draft him if I needed. So, when the gun went off I tried to stay on Nigel's feet. I don't have a lot of speed at the start so I found myself working really hard to stay with him, but eventually I settled into a rhythm. I tried to pass him a couple times, but when I was out of his draft I couldn't pass so I stayed on his feet. This worked well until about 1400m into the race, when speedy Hector caught us from the 2nd wave. Nigel was able to hang on to Hector's feet, but I was left behind :( So, I swam solo the rest of the way, worrying about how much time speedster Angela Quick would gain on me by the end of the swim.

Stats: 2000m, 29:11, 1:28/100m, 38 strokes per minute

The Bike

I had a quick transition and was off and on my bike in 2nd place, with my main focus being to try to make up time. I knew within a few pedal strokes that I didn't feel as fresh as I did at Eagleman, but I put that out of my mind. I just tried to push hard, and that's just what I did the whole way. Yes, my heart rate was higher than I wanted, and the power was a bit lower, and other athletes seemed to be just flying by me on the bike, but I tried to stay positive and focused on my nutrition, my cadence and staying low and aero. When things happen that are beyond your control it's best to focus inward and on what you can control (like nutrition, cadence, bike position). I got a bit frustrated as the winds picked up, but I continued to remained focused and *eventually* I was back at T2.

Stats: 1:33:31, 36kph, Garmin Says: 200W NP (198W avg power), avg HR of 165bpm, cadence of 83rpm





The Run

I started the run with spectators saying I was about 2 minutes behind the leader, so I put aside all thoughts of properly pacing myself for a 15km run and just decided to run as hard as I could for as long as I could. If I got in the lead I would slow things down a bit. I remained focused on what I could control: taking in fluid/nutrition and pouring cold water on my head at the aid stations. But I didn't pay attention to my heart rate, which said I was running to hard! My first 7km were at around a 4:10/km pace until I made it into the lead. Then I slowed down a bit to try to get my heart rate under control, but that was proving difficult. In the last few kms I had to slow my pace significantly and I was experiencing signs I had run to hard at the start. Then I got an extremely bad cramp in the last km that forced me to slow to about a 5:00/km pace and I was so glad the finish line came when it did!

Stats: 1:04:29, 4:17/km and Garmin says: avg HR 173





Overall, I'm extremely happy to take the overall female win! An added bonus is that I got to win a race on my honeymoon. Who else can say that?!? I'm also happy that I can compete at this level, while working full time and dealing with a lot more stress in my life than ever before!

Next up: Gravenhurst Olympic Triathlon

Thank you:

- The Multisport crew, volunteers and officials
- My parents for their continued love and support throughout this crazy adventure of mine.
- My sisters for being my inspiration to work hard and never give up. Seeing Sara out there on the run helped me push through my own discomfort (Sara had the 4th fastest run time in her age group!)
- Adam for keeping me calm when I get anxious and for making me want to be the best version of myself. It helps so much to have him there on race day.
- My health care team of Dr. Mark Schofield, David Lamy (RMT), Bill Wells (Chiro) and Michael Hong (Acupuncture). I wouldn't have been able to race this one without you.
- Kim Lumsdon at KLSC
- All my readers for their support and for following me in my triathlon endeavours
- Fellow athletes at the race and training partners, especially Sara and everyone at WattsUp and TTC!
- Endurosport for building me the perfect bike and all your mechanical help
- My sponsors: Title Sponsor:High Rock Capital Management, WattsUp Cycling, MultiSport Canada, Blade Wheels, The Urban Athlete, Fitt1st Bike Fitting


          THE BLOCKCHAIN IN THE IoT REPORT: How distributed ledgers enhance the IoT through better visibility and create trust   

where blockchain will deployThis is a preview of a research report from BI Intelligence, Business Insider's premium research service. To learn more about BI Intelligence, click here.

Blockchain isn't just for bankers anymore. Most of the buzz around the distributed ledger has focused on its uses in finance, where it originated. But one of the most promising blockchain trends is its growing disruptive presence in the Internet of Things (IoT).

Companies are pioneering innovative new solutions that use blockchain for tasks like tracking goods as they move and change hands in the supply chain, monitoring the location and condition of assets like industrial machinery at remote work sites, or storing medical data, and they are transforming the IoT

In a new report from BI Intelligence, we analyze the developing role of blockchain in the IoT ecosystem. First, we look at how blockchain works, both generally and as part of an IoT solution. We then identify the areas most suited to use blockchain as part of larger IoT projects, specifically looking into the supply chain, asset tracking and monitoring, and health care. Finally, we discuss the challenges companies looking into blockchain solutions for IoT programs will face, and explore what the future holds for blockchain in the IoT.

Here are some of the key takeaways:

  • Blockchain is emerging as a key tool with numerous applications throughout the IoT. Companies are developing innovative solutions that use blockchain to cut costs and improve services.
  • While solutions address a number of potential pain points in the IoT, several challenges exist that could hold back widespread adoption. These issues include blockchain’s complexity, companies’ loss of control, regulation, and hardware requirements.
  • Blockchain is poised to provide a new, powerful tool for companies developing and implementing IoT solutions, offering increased versatility, security, and efficiency.

In full, the report:

  • Explains how firms are already exploring ways to make use of blockchain in all sorts of IoT projects.
  • Provides an overview of disruption in critical sectors including the supply chain and asset management.
  • Analyzes how blockchain is poised to see rapid expansion as a tool used in IoT solutions that reduce costs, increase efficiency, and remove reliance on cloud-based platforms.

Interested in getting the full report? Here are two ways to access it:

  1. Subscribe to an All-Access pass to BI Intelligence and gain immediate access to this report and over 100 other expertly researched reports. As an added bonus, you'll also gain access to all future reports and daily newsletters to ensure you stay ahead of the curve and benefit personally and professionally. >> Learn More Now
  2. Purchase & download the full report from our research store. >> Purchase & Download Now

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          Governor LePage Supports Effort to Repeal and Replace ObamaCare   
For Immediate Release: Wednesday, June 28, 2017 Contact: Adrienne Bennett, Press Secretary, 207-287-2531

AUGUSTA -Governor Paul R. LePage issued a statement today about Republican efforts in Washington. D.C. to enact meaningful health care reform.

"I fully support the President's efforts to repeal and replace ObamaCare, which has been disastrous for our nation, with real reform that lowers costs and provides the American people with high-quality health care," Governor LePage said. "If the Senate's version of the health care bill includes a couple of improvements, I would be glad to endorse it. First, Medicaid expansion should be frozen. If states have not already expanded Medicaid, they should not be allowed to. As Maine's experience has already proven, Medicaid expansion is ruinous to a state's fiscal health. Second, invisible risk pools must be included as a way to reduce premiums and increase access to health insurance. This reform has the potential to drive affordable health insurance for the entire nation."

Governor LePage met this morning with U.S. Senator Susan Collins in Washington, D.C. to discuss his concerns with the Senate's proposal for health care reform. His concerns are outlined in the attached letter to Senator Collins. The Governor also sent a letter to Senator Angus King.

"Rather than seeking a starring role in Washington's latest hyper-partisan drama, Senator King should focus his efforts on doing what is right for the Maine people he was elected to represent," said Governor LePage. "So-called ‘scandals' concocted by Washington politicians come and go, but reforming health care is vital for the lifelong health and well-being of Mainers."
          Mealey's Health Law - Defense Expert Excluded In Case Alleging Illegal Kickbacks For Lab Work   
CHARLESTON, S.C. - An expert for health care defendants accused of running kickback schemes cannot testify because his opinion draws on legal conclusions that should be left to the court to decide, is based on unsound methodology and would mislead a jury, a South Carolina federal judge held June 26 in excluding the expert from the case (United States of America, et al. v. Berkeley Heartlab, Inc., et al., Nos. 9:14-cv-00230, 9:11-cv-1593 and 9:15-cv-2485, D. S.C., 2017 U.S. Dist. LEXIS 98147).
          Colbert's Climate Change "Catfight"   
Stephen Colbert let a climatologist and...some guy...duke it out on climate change. Bottom line: Climate is not the same thing as weather!


The Colbert ReportMon - Thurs 11:30pm / 10:30c
Science Catfight - Joe Bastardi vs. Brenda Ekwurzel
www.colbertnation.com
Colbert Report Full EpisodesPolitical HumorHealth Care Reform

          Personal/Home Support Worker/Health Care Aide - ParaMed - Fort Frances, ON   
E.g. violations are subject to progressive discipline up to and including dismissal. Working in the community is a challenging and rewarding experience as you...
From ParaMed - Tue, 23 May 2017 10:18:53 GMT - View all Fort Frances, ON jobs
          Personal/Home Support Worker/Health Care Aide - ParaMed - Red Lake, ON   
E.g. violations are subject to progressive discipline up to and including dismissal. Working in the community is a challenging and rewarding experience as you...
From ParaMed - Tue, 23 May 2017 10:18:58 GMT - View all Red Lake, ON jobs
          The Battle Over American Health Care: What's At Stake In The Senate's Bill   
Copyright 2017 Fresh Air. To see more, visit Fresh Air . DAVE DAVIES, HOST: This is FRESH AIR. I'm Dave Davies in for Terry Gross, who's off this week. Nearly six months into the Trump administration, the nation is once again embroiled in a debate about health care as Senate Republicans seek to repeal and replace the Affordable Care Act, or Obamacare. After weeks of crafting the bill behind closed doors, Majority Leader Mitch McConnell is trying to corral 50 Republican senators to vote for it. It's proving difficult in part because an analysis by the nonpartisan Congressional Budget Office found it would lead to millions more uninsured Americans and require many more to pay for their health care. Some conservatives don't like the bill because it leaves much of the structure of the Affordable Care Act in place. So far, McConnell doesn't have the votes to move the bill to the Senate floor for consideration. He'd hoped to have a final vote on the bill before the July Fourth recess but
          Resistance Reporting Finds Hundreds of Protests in May, Most of Them Staunchly Anti-Trump   
With a decrease in attendance at anti-Trump demonstrations from April to May, does the resistance have enough fuel?

Protests and rallies against the Trump administration and its policies have been a constant since January, as hundreds and sometimes thousands of people gathering to protest a bevy of issues.

New data from the Washington Post "tallied 495 protests, demonstrations, marches, sit-ins and rallies in the United States" in May, with attendance numbering between 100,807 and 128,464. The number of protests and the number of participants in May show a marked decrease from April, when 950 protests drew roughly between 637,198 and 1,181,887 people. Data about demonstrations in the U.S. is collected by the Crowd Counting Consortium, with updates posted on the Washington Post every month.

A majority of the rallies and demonstrations, about 68 percent, were in opposition to Trump’s policies, with 54.5 percent boasting anti-Trump messages and 13.5 percent taking stances on “issues that contradict the president.” A large number of the protests centered around the House Republican bill to repeal and replace the Affordable Care Act, including a protest outside a town hall meeting in Plattsburgh, New York, with Rep. Elise Stefanik. There were also a number of protests that, while not explicitly anti-Trump, defended an issue stance contrary to the president’s beliefs. Some of these events included support for workers, protests against police violence and a Take Back the Night march addressing sexual violence.

Only 5 percent of the recorded events supported Trump and his policies—a slight increase from only 2 percent of pro-Trump rallies in April. One of the rallies occurred during Trump’s commencement address at the U.S. Coast Guard Academy in Connecticut.

Furthermore, 27 percent of demonstrators participated in marches and actions targeting other politicians or issues that were neither anti-Trump nor pro-Trump, showing an increase from April. Protesters rallied against the removal of statues of Confederate leaders, and demonstrators in Alamogordo, New Mexico, protested a deep borehole research project. The data also notes that protests over budgetary and personnel decisions in grade schools remained common.

At 465 recorded events in May, no arrests were made. However, the number of people arrested increased from 160 in April to 349 in May. The data shows that 259 of the May arrests stemmed from 19 cases of nonviolent civil disobedience. During a protest at a legislative committee in Harrisburg, Pennsylvania, 23 people were arrested. Only six events with arrests were a result of violence or the destruction of property.

study from the University of Maryland revealed the demographics of the anti-Trump resistance. The data found that about one-third of participants at the Women’s March in January were new activists and had never participated in protest action before. Furthermore, these first-time protesters ended up repeatedly participating in rallies and demonstrations, as 45 percent of March for Science participants and 70 percent of People’s Climate March participants (both taking place in April) also had joined in the Women’s March.

The data also showcased racial diversity among protesters, with nearly a quarter of respondents being non-white. A majority of respondents were also Democrats and had voted for Hillary Clinton for president, although the resistance was also drawing in third-party voters.

While Crowd Counting Consortium’s numbers for June have not been released yet, this month has seen a number of protests, including Pride marches across the U.S. A majority of these rallies have focused on the Senate’s health care bill, and many marches have taken place to protest police brutality since Officer Jeronimo Yanez was acquitted of all charges in the fatal shooting of Philando Castile.


          Dietary Aide - Riverside Health Care - Fort Frances, ON   
Registered private career college in Ontario; Successful completion of, or current enrolment in a Food Service Worker training program at an....
From Riverside Health Care - Fri, 23 Jun 2017 15:54:36 GMT - View all Fort Frances, ON jobs
          APNewsBreak: Icahn says Taj casino likely to close   

Billionaire investor Carl Icahn says the struggling Trump Taj Mahal casino "will almost certainly close."

The would-be purchaser of the casino told The Associated Press on Thursday night that the casino's finances are dire.

Four of Atlantic City's 12 casinos have closed this year, and the Taj Mahal would be the fifth.

Icahn, sounding very much like a man growing tired of the whole topic, said that even though he won't back out of a deal he made with owner Trump Entertainment Resorts to acquire the Taj Mahal and pump $100 million into it, he wishes he never answered the phone when the company first called him about it.

"One overriding fact is perfectly clear: The Taj is quickly running out of money and will almost certainly close," Icahn told the AP. "Reprehensibly, the union, instead of working with, and trying to help, the company to keep the Taj alive, is instead doing everything to destroy the possibility of saving the jobs of over 3,000 employees. I will not walk away from what I agreed to with the company, but I must admit I wish I never took their phone call."

Union members said they will picket outside the casino on Friday night to protest a court-ordered termination of employees' health care and pension plans.

Trump Entertainment has declined to comment. It had threatened to close the Taj Mahal on Nov. 13 if it didn't get a judge to free it from making health care and pension payments for the casino's 3,000 workers. The company now promises to keep the casino open at least through November.

Trump Entertainment Resorts acknowledges its finances are dire but says it is doing everything it can to preserve the casino and the jobs. It previously warned it was in danger of running out of money in early December, before it got a bankruptcy court judge to cancel its contract with Local 54 of the Unite-HERE casino workers' union.

Icahn said he was approached by Trump Entertainment about canceling the $286 million in company debt he owns and converting that into ownership of the Taj Mahal. The plan involves him investing $100 million into the casino but only if the union contract is canceled and if the state contributes $175 million in aid — a request already rejected by state Senate President Steve Sweeney. An earlier plan, since dropped, also called on Atlantic City to grant large tax breaks to the company.

Icahn said he had "walked into a hornet's nest here."

"Frankly, several of my advisers have told me that if the city and the state did not come up with the money, they'd be doing me a large favor," Icahn said. "Even if we get the concessions from the city and the state, we're going to lose a lot of money. Everybody thinks I'm trying very hard to do this. I'm not."

___

Wayne Parry can be reached at http://twitter.com/WayneParryAC


          APNewsBreak: Icahn says Taj casino likely to close   

Billionaire investor Carl Icahn says the struggling Trump Taj Mahal casino "will almost certainly close."

The would-be purchaser of the casino told The Associated Press on Thursday night that the casino's finances are dire.

Four of Atlantic City's 12 casinos have closed this year, and the Taj Mahal would be the fifth.

Icahn, sounding very much like a man growing tired of the whole topic, said that even though he won't back out of a deal he made with owner Trump Entertainment Resorts to acquire the Taj Mahal and pump $100 million into it, he wishes he never answered the phone when the company first called him about it.

"One overriding fact is perfectly clear: The Taj is quickly running out of money and will almost certainly close," Icahn told the AP. "Reprehensibly, the union, instead of working with, and trying to help, the company to keep the Taj alive, is instead doing everything to destroy the possibility of saving the jobs of over 3,000 employees."

Union members said they will picket outside the casino on Friday night to protest a court-ordered termination of employees' health care and pension plans.

Trump Entertainment has declined to comment. It had threatened to close the Taj Mahal on Nov. 13 if it didn't get a judge to free it from making health care and pension payments for the casino's workers. It now promises to keep the casino open at least through November.

For decades Atlantic City enjoyed a monopoly on gambling on the East Coast. But as casinos popped up in neighboring states, gamblers found they no longer needed to drive or ride buses to New Jersey to play the slots or table games. Atlantic City's casino revenue has fallen from $5.2 billion in 2006 to $2.86 billion last year, and it will be considerably less this year with the closures of at least a third of its casinos.

Trump Entertainment Resorts acknowledges its finances are dire but says it is doing everything it can to preserve the Taj Mahal and the jobs. It previously warned it was in danger of running out of money in early December, before it got a bankruptcy court judge to cancel its contract with Local 54 of the Unite-HERE casino workers' union. The move saves the company $14.6 million a year.

Icahn also owns Atlantic City's Tropicana Casino and Resort, which he bought out of bankruptcy in 2010. He said he was approached by Trump Entertainment about canceling the $286 million in company debt he owns and converting that into ownership of the Taj Mahal. The plan involves him investing $100 million into the casino but only if the union contract is canceled and if the state contributes $175 million in aid — a request already rejected by state Senate President Steve Sweeney. An earlier plan, since dropped, also called on Atlantic City to grant large tax breaks to the company.

Icahn said he had "walked into a hornet's nest here."

"Frankly, several of my advisers have told me that if the city and the state did not come up with the money, they'd be doing me a large favor," Icahn said. "Even if we get the concessions from the city and the state, we're going to lose a lot of money. Everybody thinks I'm trying very hard to do this. I'm not."

___

Wayne Parry can be reached at http://twitter.com/WayneParryAC


          HealthCare.gov's EZ form not for legal immigrants   

HealthCare.gov's simpler online application is being touted as a big win for consumers. But it can't be used by legal immigrants and naturalized U.S. citizens, who represent millions of potential new health insurance customers.

That's prompting worries that many Hispanics and Asians will end up in long enrollment queues when the second sign-up season for coverage under President Barack Obama's health care law gets underway next month.

The administration says immigrants are not being overlooked, and points to other improvements in the application process. Officials say what they can do is limited by the law's requirements.

Advocates aren't buying that explanation.

"The whole idea was that HealthCare.gov was going to be a seamless and easy process, but that doesn't seem to be the case for immigrants," said Alvaro Huerta, an attorney at the National Immigration Law Center in Los Angeles. "I think this is happening because the federal government hasn't taken the steps necessary to resolve issues with their verification system."

The White House wants more Latinos to sign up under the health care law for 2015. As the nation's largest minority group, Hispanics tend to be younger and more likely to be uninsured.

The law offers taxpayer-subsidized private health insurance for people who don't have access to coverage on the job. Open enrollment for 2015 starts Nov. 15. It's estimated that 6 million more people will sign up for next year, bringing the total to about 13 million.

The federal HealthCare.gov website will be the sign-up platform in 38 states, two more than it served last year. States in the federal marketplace include immigrant-rich Florida, Texas, and Nevada. The remaining states are running their own insurance exchanges.

While immigrants living in the country illegally cannot get coverage through the law, millions who are lawfully present are entitled to benefits, as well as people who were born overseas and later became U.S. citizens.

The new easy online application for most consumers will feature 16 screens, instead of the 76 that people muddled through last year. But immigrants and naturalized citizens are a major exception, a category the administration calls "complex cases."

Andy Slavitt, the official who oversees HealthCare.gov operations, said there have been several improvements to help immigrants, including expanding the list of documents that people can use to establish eligibility and updating the computer system so it won't get hung up on special characters used in some names.

"I wouldn't say by any means that we have achieved the best we can, but I do think we have taken appropriate steps across the board," Slavitt said. "I would suspect in future years we will be able to do more and more electronically."

Consumers navigating the new HealthCare.gov will encounter early on a screen with a series of questions, the gateway to the streamlined application. But legal immigrants, naturalized citizens, and families in which someone is an immigrant or naturalized citizen will have to work through more screens and answer more questions.

About half of Latino adults were born abroad, according to research from the Pew Hispanic Center. Of those who have become U.S. citizens, 21 percent lack health insurance. That's well above a 15 percent uninsured rate among naturalized U.S. citizens who are not of Hispanic origin. Latinos are also more likely to be married to an immigrant.

"Immigrants could be unjustly excluded even though they are eligible," Huerta said.

Asian-American groups are also concerned.

"The problems will persist for our communities," said Bonnie Kwon, health law program manager for the Asian & Pacific Islander American Health Forum in San Francisco. "It shows a lack of commitment to provide adequate access for immigrants."

Many immigrants need help to get through the application, said Kwon. Trained helpers are in short supply. So the more time it takes to finish one application, the fewer uninsured people can be helped.

Slavitt disagreed that the administration has overlooked immigrants. The law's requirements mean that some people have to answer more questions and supply more documentation. He also said immigrants will benefit indirectly from the EZ application because it may free call-center operators from handling routine cases.

"The immigrant community has been a particular thrust, and more of a passion, for us," Slavitt said. "These are the people our team spent time with all of the year. If we don't make it easier for them on the front end, it will mean spending more time with them on the back end."


          AP-GfK Poll: Disapproval, doubt dominate on Ebola   

Americans have at least some confidence that the U.S. health care system will prevent Ebola from spreading in this country but generally disapprove of the way President Barack Obama and the Centers for Disease Control and Prevention have handled the crisis so far.

Most disapprove of Obama's handling of the Ebola outbreak, according to an Associated Press-GfK Poll. Just 1 in 5 approve of the CDC's work on Ebola so far, and only 3 in 10 say they trust that public health officials are sharing complete and accurate information about the virus. And only 18 percent have deep confidence that local hospitals could safely treat a patient with Ebola.

Amid worry here, most Americans say the U.S. also should be doing more to stop Ebola in West Africa. Health authorities have been clear: Until that epidemic ends, travelers could unknowingly carry the virus anywhere.

"It seems to me we have a crisis of two things. We have a crisis of science, and either people don't understand it or ... they don't believe it," said Dr. Joseph McCormick, an Ebola expert at the University of Texas School of Public Health. And, "we have a crisis in confidence in government."

Some findings from the AP-GfK poll:

HEALTH CARE GETS MIXED REVIEWS

Nearly a quarter of Americans are very confident the U.S. health care system could prevent Ebola from spreading widely, and 40 percent are moderately confident.

But nearly half don't think their local hospital could safely treat an Ebola case, and 31 percent are only moderately confident that it could.

After all, Thomas Eric Duncan, the first Ebola patient diagnosed in the U.S., at first was mistakenly sent home by a Dallas emergency room, only to return far sicker a few days later. Then, two nurses caring for him somehow became infected. The family of one of the nurses, Amber Vinson, said Wednesday doctors no longer could detect Ebola in her as of Tuesday evening.

Asked how the Centers for Disease Control and Prevention handled those cases, 42 percent of people disapprove and 22 percent approve.

FEAR VS. KNOWLEDGE

Despite months of headlines about Ebola, nearly a quarter of Americans acknowledge they don't really understand how it spreads. Another 36 percent say they understand it only moderately well.

Ebola doesn't spread through the air or by casual contact, and patients aren't contagious until symptoms begin. Ebola spreads through close contact with a symptomatic person's bodily fluids, such as blood, vomit, feces, urine, saliva, semen or sweat.

People who say they do understand are less concerned about Ebola spreading widely in this country. Among those who feel they have a good grasp on how it spreads, 46 percent are deeply concerned; that rises to 58 percent among those who don't understand it as well.

Likewise, a third of those with more knowledge of Ebola are confident in the health system's ability to stem an outbreak, and 27 percent think their local hospital could safely treat it. Among those who don't understand Ebola, fewer than 1 in 5 shares either confidence.

WHAT SHOULD BE DONE

A whopping 93 percent of people think training of doctors and nurses at local hospitals is necessary to deal with Ebola, with nearly all of them, 78 percent, deeming it a definite need.

Nine out of 10 also think it's necessary to tighten screening of people entering the U.S. from the outbreak zone, including 69 percent who say that's definitely needed.

Some would go even further: Almost half say it's definitely necessary to prevent everyone traveling from places affected by Ebola from entering the U.S. Another 29 percent say it's probably necessary to do so.

More than 8 in 10 favor sending medical aid to Ebola-stricken countries and increasing government funding to develop vaccines and treatments.

SOME NEW STEPS

The CDC had issued safe-care guidelines to hospitals long before Duncan arrived last month, and it made some changes this week after the unexpected nurse infections. Now, the CDC says hospitals should use full-body garb and hoods and follow rigorous rules in removing the equipment to avoid contamination, with a site manager supervising. Possibly more important, workers should repeatedly practice the donning and doffing and prove they can do it correctly before being allowed near any future patients.

While Duncan wasn't contagious during his flight, his arrival spurred U.S. officials to begin checking passengers arriving from Liberia, Sierra Leone and Guinea for fever, an early Ebola symptom, just like they're checked before leaving those countries.

Wednesday, the CDC moved to fill a gap in that screening: Starting next week, all of those travelers must be monitored for symptoms for 21 days, the Ebola incubation period. They'll be told to take their temperature twice a day and must report the readings to state or local health officials.

That's not just for West African visitors. It includes U.S. government employees, who had been doing their own 21-day fever watches upon return from fighting the epidemic, as well as doctors and other workers for aid organizations and journalists.

The AP-GfK Poll was conducted Oct. 16-20, using KnowledgePanel, GfK's probability-based panel designed to be representative of the U.S. population. It involved online interviews with 1,608 adults and has a margin of sampling error of plus or minus 2.8 percentage points for all respondents. Respondents were first selected randomly using phone or mail survey methods and later interviewed online. People selected for KnowledgePanel who didn't otherwise have access to the Internet were provided with the ability to access the Internet at no cost to them.

___

Online:

AP-GfK Poll: http://www.ap-gfkpoll.com


          TV runner-up Aiken seeks win in NC House race   

Eleven years after becoming a national TV sensation, Clay Aiken still attracts a crowd in central North Carolina. In an hour he could only get a block or so down the street during an old textile town's fall festival while fans stopped to talk and take pictures.

"I can't believe you're here!" exclaimed Suzanne Strickland, 23, after she and her mother left their craft booth at Erwin Denim Days. "I saw you watching 'American Idol'!"

Finishing second for Congress won't cut it for the 2003 runner-up on the Fox show that vaulted him to a singing career and another second-place finish on NBC's "Celebrity Apprentice." Rather, he would just be another Democratic candidate who failed to beat the odds on North Carolina's congressional map since Republicans redrew it and shifted the delegation's makeup to the right.

While national Democratic groups haven't arrived with financial support, Aiken believes there's a path to victory in the U-shaped 2nd District over Republican Rep. Renee Ellmers. He's trying to attract independent and Republican voters who recall his appearances as a crooner, and he's hoping to catch breaks on the waves of unhappiness with Republican state government and gridlocked Washington politics.

"People are very dissatisfied with Congress in general and getting absolutely nothing done," Aiken said in an interview. He said Ellmers, a nurse, is wrongly fixated on repealing President Barack Obama's signature health care law, rather than fixing its problems. "If after three or four years, you still haven't gotten anything done, then what are you getting paid for?"

Ellmers, who like Aiken was a first-time candidate four years ago when she upset Democratic Rep. Bob Etheridge, is throwing political inexperience back at Aiken and suggesting he's role-playing to win votes.

"He's an entertainer. He's an actor," Ellmers, 50, said in an interview after addressing the Kiwanis Club in Apex earlier this month. "He believes that he can change costume and get into character and speak to whichever group and win them over."

Ellmers is surely favored in a district anchored by Fort Bragg, affluent suburbs west of Raleigh, retirees near the famous Pinehurst golf resort and solid red south of Greensboro. The 2011 redistricting made the district swing more Republican, as Mitt Romney received nearly 58 percent of the 2012 presidential vote there, according to an analysis by the business advocacy group the North Carolina Chamber.

If the race were competitive, outside groups would be investing in Aiken's candidacy, said North Carolina Chamber political director Nathan Babcock, but he expected they won't because they've got more pressing races.

Scott Falmlen, a longtime Democratic political consultant in Raleigh, believes there's a recipe for Democratic success in the district and says Aiken is following it well. But Falmlen isn't willing to predict a victory. Aiken raised more than $1 million for his campaign since February, benefiting from Broadway and Los Angeles events along the way. He hired veteran strategists and scheduled a bus trip through the district in the campaign's final three weeks. Ellmers, who has raised more than $1.8 million this cycle, is battling anti-incumbent sentiment.

Aiken has "presented himself as a very credible candidate and I think some people wondered whether that would be the case," said Falmlen, who isn't working with Aiken. "He comes across as knowledgeable of the issues."

During a Saturday in the 2nd District, Aiken, 35, engaged well-wishers as they browsed jewelry and ate barbecue, stopping for photos and hugs. But he also discussed veterans' medical care and Medicaid expansion. He gave stickers to GOP voters that read "Republaiken," wordplay on his name and the opposition party.

Ellmers "has done absolutely nothing and I'm ready for a change," said registered Republican Peter de Young, 67, of Pinehurst, who met Aiken at a street fair in Cameron.

Ellmers, who frequents cable news shows and heads the Republican Women's Policy Committee, blames Senate Democratic leader Harry Reid for refusing to consider House legislation. "I can't force the Senate to act, but the American people can," she said, suggesting they should turn the Senate majority Republican next month.

Aiken has tried to distance himself from Obama, saying he disagrees with him on issues and believes several changes should be made to the president's signature health care law. But during their lone televised debate, Ellmers contended that, in the end, "you support Obamacare."

Aiken is a gay man running in a largely conservative district. Among passers-by in Erwin, it wasn't an issue. "That's his choice, that's his life. It doesn't affect me at all," said Susan Boggs, 38, of Erwin.

Aiken supports gay marriage while Ellmers does not, though she publicly opposed the 2012 constitutional amendment in North Carolina that banned gay marriage. Both said during their debate that the issue of same-sex marriage, which is being decided in federal courts across the country, is out of their hands.

Aiken received almost 12 million votes nationwide while narrowly losing to "Idol" winner Ruben Studdard in 2003. This year, he edged out a well-known local businessman in the Democratic primary. It may take the ardent support of local "Claymates" — Aiken's fan base during his "Idol" run— to win the title of congressman.


          Hospital of Ebola patient posts poor ER benchmarks   

Diplomas from outstanding medical schools. Records free of discipline. A team trusted by a president.

For all the strengths of Texas Health Presbyterian Hospital Dallas, the first U.S.-diagnosed Ebola patient walked through its seemingly weakest link: the emergency room.

Presbyterian met or exceeded 75 percent of 138 specific measures of care, according to its most recent data. But its emergency department failed to meet all five national patient safety and quality benchmarks the hospital reported. Those measure how long it takes for patients to be seen, admitted, or otherwise cared for in the ER.

"When wait times get longer, it creates an environment where people are more likely to make mistakes," said Dr. Ashish Jha, a Harvard University professor and director of the Harvard Global Health Institute. "It's a recipe for things not going well."

The hospital itself says emergency wait times may indicate understaffing or overcrowding that "can result in treatment delays and more stress for patients."

Thomas Eric Duncan first entered Presbyterian's ER on Sept. 25, complaining of abdominal pain, severe headache, dizziness and nausea. He was discharged after a few hours, but returned two days later and eventually died of Ebola. Two of his nurses became infected.

For the year ending March 31, patients in Presbyterian's emergency department waited 44 minutes on average before their first contact with a health care professional, 50 percent longer than state and national waits. They spent more than five hours in the emergency department, on average, before being admitted, more than an hour longer than state and national averages. Presbyterian reported meeting one of six emergency department benchmarks in 2012-13.

Hospital spokesman Wendell Watson said, "Wait time is only one component of patient care and patient experience." Others insist longer wait times can reflect a workflow problem, with lags for X-rays, tests or admissions.

"To miss your benchmarks in emergency room waiting times is probably the greatest indication that your ER is not up to snuff," said Jamie Court, president of the nonprofit Consumer Watchdog.

In other areas where Presbyterian reported data and for which federal benchmarks exist, the hospital largely met or exceeded national averages.

Presbyterian — where former President George W. Bush underwent a heart procedure last year — exceeded seven national benchmarks for strokes, earned perfect scores on a number of surgical measures and met six of 10 criteria on heart attacks, according to its data. It had nearly no infections from IV insertions, about 75 percent fewer than national benchmarks.

Those infections had been a problem for Presbyterian in 2011, when increasing cases prompted a hospital task force. This summer, a Presbyterian infection prevention specialist published a study describing how the hospital dramatically decreased infections by strictly enforcing rules about how long to scrub the hubs of catheters before inserting them.

Health safety consultant Michael Millenson, a visiting scholar at Northwestern University, says it's laudable that Presbyterian addressed the problem, but added that federal standards are weak and it took years to do what should have taken weeks.

Texas Health Resources began posting detailed data online — from heart attack mortality rates to post-surgical infections — for each of its 17 hospitals this summer. U.S. hospitals are required to send such indicators to the U.S. Centers for Medicare & Medicaid Services, but do not generally post them on their websites.

"We've committed to show it all, both the good and the bad," said now-retired Texas Health CEO Douglas Hawthorne.

___

When Duncan initially appeared in Presbyterian's ER, several potential warning signs apparently went unnoticed.

"He had symptoms that could be Ebola but could be any number of things when he showed up at his first visit," said Dr. Greg Moran, an emergency and infectious disease specialist at UCLA who reviewed Duncan's medical records. "The miss was basically a simple question that the physician didn't ask: Had he traveled? I don't see documentation that the physician asked that question."

Duncan had recently arrived from West Africa, where the largest outbreak of Ebola ever recorded is occurring. But the only reference to Africa came in a brief nurse's note.

Two medical specialists reviewed hospital records detailing Duncan's ER treatment for The Associated Press, which received the documents from his family. They noted that Duncan had somewhat abnormal blood and urine test results that could have raised questions, particularly about his kidney function. Along with a fever that spiked at 103, that might have indicated an infection, mild dehydration, the onset of diabetes, or nothing at all, they said.

But combined with Duncan's travel information, the results would have prompted them to consider the possibility of Ebola, they said.

Instead, Duncan was sent home after four hours with a prescription for antibiotics and a handout about sinus infections. Four hours later, a specialist reviewed his CT scan and ruled out a sinus infection. The records don't indicate that information was passed on.

"Diagnosing Ebola is very different from treating Ebola," said Watson, who added Presbyterian has changed the screening process in its ER to obtain a patient's travel history immediately and make it more easily visible in its electronic records system.

Jha, who also serves on a federal commission studying ER mistakes, said 5 percent of all emergency room visits are misdiagnosed — "a very high error rate."

___

At Presbyterian, ER doctors don't actually work for the hospital.

Texas, like some other states, bars most hospitals from employing physicians directly, said Allison Winnike, a University of Houston health law professor.

"The idea is to keep the physicians independent from the hospital so they could act on what's best for the patient and not what's best for the hospital," said Dr. William Durkin, a former president of the American Academy of Emergency Medicine.

Presbyterian's ER doctors are private contractors who work with Texas Medicine Resources LLP, which has had the contract to provide them for 38 years, according to Dr. Ralph Baine, the president of Emergency Medicine Consultants, a related company that handles many administrative functions for the doctors. Those two companies operate out of the same Fort Worth office.

Supplies, support staff and other emergency department needs are provided directly by Presbyterian. The setup has no impact on care, Baine said, adding, "Our physicians are held to the same standard of care regardless of the legal structure under which they operate."

But Daniel Zingale, who pioneered California health reform plans, said having non-staff physicians creates a certain amount of risk. Even under ordinary circumstances, he said, it's a challenge to maintain coordination and flow of information in a system divided between health plans, hospitals and providers.

"In a public health emergency, there are clear advantages to a more integrated and seamless system," he said.

Consumer Watchdog says having physicians working in independent groups rather than directly for the hospital can lead to weaker care.

"If you have doctors who are not salaried and on staff, you're less likely to hit public health benchmarks as you are about the business goals of that contract," said Court, the group's president.

The AP has attempted to contact dozens of individuals directly involved in Duncan's care. None has been willing to speak. Messages left for the ER doctor who first treated and released Duncan, as well as his attorney, have gone unanswered.

Texas Medical Board records show that none of Duncan's 20 doctors have ever been disciplined, investigated by the board for malpractice, had restrictions placed on their licenses or been linked to any criminal history. Dallas County court records show relatively few malpractice cases filed against them.

Some earned medical degrees from schools including Harvard and New York University. On average, they have about 14 years of experience. Among 32 nurses involved in Duncan's care whose records could be located, none had a disciplinary record. They averaged about six years of experience in Texas.

Presbyterian has conceded its Ebola training was not fully deployed, and apologized for Duncan's initial misdiagnosis. A public-relations push has included posting videos of nurses praising the facility and a "PresbyProud" Twitter campaign. Watson says Presbyterian wants to move forward: "We are determined to be an agent for change across the U.S. health care system by helping our peers benefit from our experience."

But the mistakes are baffling, said Dr. William Schaffner, an infectious-disease specialist at Vanderbilt University Medical Center in Tennessee.

"I would have thought that literally every hospital would have said, 'Hmmm, one of those patients could walk into my emergency room and so we had better start reviewing our infection control program, make sure it includes these Ebola-specific issues, make sure we have the personal protective equipment and make sure that our staff is prepared,'" he said.


          'BradCast' 6/27/2017: (Guests: Health care reform analysts Allen Dobson and Randy Haught)   
Independent investigative journalism, broadcasting, trouble-making and muckraking with Brad Friedman of BradBlog.com
          'BradCast' 5/24/2017: (Guest: Journalist, health care reform advocate Jacki Schechner)   
Independent investigative journalism, broadcasting, trouble-making and muckraking with Brad Friedman of BradBlog.com
          'BradCast' 3/24/2017: (Guest: Journalist, health care reform advocate Jacki Schechner)   
Independent investigative journalism, broadcasting, trouble-making and muckraking with Brad Friedman of BradBlog.com
          'BradCast' 1/27/2017: (Good news where we can find it, and Journalist John Judis on 'The Australian Lesson' for health care)   
Independent investigative journalism, broadcasting, trouble-making and muckraking with Brad Friedman of BradBlog.com
          Today, We are Chosen!   
1 Peter 2:9 (New King James Version)
9 But you are a chosen generation, a royal priesthood, a holy nation, His own special people, that you may proclaim the praises of Him who called you out of darkness into His marvelous light;

What a wonderful word of encouragement this is. Proclaim the praises of Him who called you out of darkness and into His marvelous light. My friend of many years Bro. Hank Dunkerson prophesied today that praising him openly will open up Heaven and His blessings will come down. Hank saw an escalator going up with the Praises of His people and Blessing and Mercy and Grace and Riches were coming down. I believe that is a beautiful revelation of the reality of what God does when He hears our voices or sees our voices (in print) as Sis. Judy Warner expressed.

There is no doubt, that with all that is happening in the world today and right here in our own country. The global and national economy, unemployment, H1N1, poverty, government socialism of the banks, automakers and soon health care. We are certainly a Chosen Generation for sure. But we must realize that we are chosen for a purpose. Each of us must find our purpose and be obedient to His call on our lives. Let us together examine the four parts of this verse together.

1. A "Chosen Generation", I believe we will see the greatest outpouring of the Holy Spirit. Prophesied and promised for all generations but we are the chosen generation that will experience the Gifts of the Spirit, Miracles, Restoration and Renewal. Faith will be our guide as we seek His will in the Holy Scriptures. His Word is alive and speaking to all who will open it's content and receive. Chosen, to bring the message of deliverance and salvation to all the world beginning at home first. As for me and my House we will serve the Lord!

2. A "Royal Priesthood", I believe we are God's children and Jesus is our Brother and this gives us a priestly privilege with the gifts of God and His riches in Glory by Christ Jesus. God is not selfish nor is He withholding a portion for a rainy day. God has made us a joint Heir with Jesus and we can participate in His spending plan. TARP Funds? Stimulus Plan? Bailout? No! God's supply in our lives is not temporary or short term. There are no loans with interest due, just a free flowing outpouring of all that He has and all that we can receive. You can not out give God. He said that He would cause men to give unto us. I have a need that God has already answered and I am remaining obedient to be able to receive the blessing. I will walk in the Royal Priesthood that God has established for us all, will you?

3. A "Holy Nation", I believe that this nation was established to be the epicenter of evangelism to the world, but it seems as though that we have lost sight of that. We are constantly at battle to keep prayer in our schools and government meetings, the sanctity of human life is diminishing. Atheism is prevalent everywhere and we act as though we have "IT" all going on. The church as a whole is expressive of the phrase "having a form of Godliness, but denying the Power thereof". We pray in tongues, lay on hands, preach the word, baptise in water and nothing is changing. People are leaving their "Houses of Worship" and they are still not healed, they are still broken, they are still lost, they are still needful, and we do not know why. I am brought to remember what Jeremiah asked " is there no balm in Gilead? Is there no Physician there? Surely you know that Gilead was where the physician was and the balm to heal their wound. But Jesus is the great Physician and His supply of Balm is plentiful. This nation must return to the Word of Truth and not just preach the word, but let it come alive in the lives of those who read and hear. John said in Revelations "blessed is he who reads these words" understanding is not a requirement to be blessed, Faith unwavering in the Word is though. A return to Truth will make us a "Holy Nation" once and for all and bring healing to the church. It was once said "so goes the home, so goes the church. So goes the church so goes the nation. I will dwell in His Word and allow it to be alive in my voice. Again as for me and my house we will serve the Lord.

4. His own "Special People". That really sums it all up, but most of us do not realize how special we are. Jesus gave His life on the Cross for us. He gave, so that we can receive. We are Special. We are set apart from the world, we are only in this world (passing through) and not of this world. We are aliens in an unfamiliar world and we need to realize that God has chosen us to be His own Special People. I thank God that He chose me. and as you read this, I hope you will realize that He has chose you as well. You are Special!
Your in Christ Jesus,
Pastor Ron
          As You Age, Here's How To Steer Your Health Care   
Giving person-centered care based on individual patients' goals is not yet a reality in most health systems. But you can do things to steer your care now.
          Registered Nurse (RN) - Saint Elizabeth Health Care - Gananoque, ON   
Recognized as Canada’s largest social enterprise, we employ 8,000 people and visit 18,000 clients every day....
From Saint Elizabeth Health Care - Tue, 25 Apr 2017 20:21:18 GMT - View all Gananoque, ON jobs
          Director of Nursing - DON - Woodland Park Care Center - Salt Lake City, UT   
Today’s aging population means there’s a growing demand for healthcare professionals in post-acute care, and a wave of career opportunities available at Avalon...
From Avalon Health Care Group - Fri, 23 Jun 2017 16:45:53 GMT - View all Salt Lake City, UT jobs
          Avalon - Unit Manager - RN - Woodland Park Care Center - Salt Lake City, UT   
Avalon Health Care is seeking a dependable, organized and dedicated Registered Nurse (RN) to join our outstanding team as a Unit Manager!...
From Avalon Health Care Group - Fri, 23 Jun 2017 16:45:49 GMT - View all Salt Lake City, UT jobs
          Registered Nurse / RN - PRN Part Time - Salt Lake Behavioral Health - Salt Lake City, UT   
Respected health care management companies, operating through its. Evaluates patient care through collaborative efforts with health team....
From Universal Health Services - Thu, 15 Jun 2017 13:07:04 GMT - View all Salt Lake City, UT jobs
          Respiratory Therapist - Full Time - Woodland Park Care Center - Salt Lake City, UT   
Avalon Health Care is seeking a dependable, organized and dedicated Respiratory Therapist to join our outstanding team!...
From Avalon Health Care Group - Wed, 14 Jun 2017 17:27:09 GMT - View all Salt Lake City, UT jobs
          Intake Therapist - Full Time Graves - Salt Lake Behavioral Health - Salt Lake City, UT   
Universal Health Services, Inc. Behavioral health facilities and ambulatory centers nationwide. Nation's largest and most respected health care management....
From Universal Health Services - Thu, 01 Jun 2017 13:04:42 GMT - View all Salt Lake City, UT jobs
          Intake Registered Nurse - RN - Full Time - Sign On Bonus - Salt Lake Behavioral Health - Salt Lake City, UT   
Universal Health Services, Inc. Behavioral health facilities and ambulatory centers nationwide. Nation's largest and most respected health care management....
From Universal Health Services - Wed, 17 May 2017 13:06:12 GMT - View all Salt Lake City, UT jobs
          Cook - Full Time and Part Time - Salt Lake Behavioral Health - Salt Lake City, UT   
Universal Health Services, Inc. Behavioral health facilities and ambulatory centers nationwide. Nation's largest and most respected health care management....
From Universal Health Services - Fri, 14 Apr 2017 13:07:08 GMT - View all Salt Lake City, UT jobs
          Psychiatrist - Salt Lake Behavioral Health - Salt Lake City, UT   
Universal Health Services, Inc. Health facilities and ambulatory centers nationwide. Largest and most respected health care management companies,....
From Universal Health Services - Wed, 05 Apr 2017 13:06:08 GMT - View all Salt Lake City, UT jobs
          Medical Director -Psychiatrist - Salt Lake Behavioral Health - Salt Lake City, UT   
Universal Health Services, Inc. Health facilities and ambulatory centers nationwide. Largest and most respected health care management companies,....
From Universal Health Services - Wed, 05 Apr 2017 13:06:07 GMT - View all Salt Lake City, UT jobs
             

Earlier this month, we inaugurated a First Monday Happy Hour with Joe, for the Independent Living residents of Heron Point. Like the Philadelphia Protestant Home, I began coming here in 1994, but on the health care side. Living in Elkton, MD at the time, Heron Point was my introduction to Chestertown, and the 36 mile drive down route 213 to get there. Frankly, it was that drive that sold me on the Eastern Shore, not long thereafter moving in this direction, first to Galena. So I guess you could say that all things Chestertown, for me, began here, at Heron Point. Now, 20+ years later, I have many friends, and the opportunity (unlike PPH, which is far away, and I only go a few times a year now) to perform throughout the community, in
various capacities for multiple populations; from health care, to church services to concerts and special events, and now, happy hour. These days I no longer regularly visit senior communities, particularly health care, focusing instead on public performance. Heron Point is the one exception, and a place where I have many friends. Grateful.  
          Selling the GOP health care bill: Does Trump help or hurt?   
WASHINGTON— It was a platform most politicians can only hope for: A captivated, 6,000- person crowd and more than an hour of live, prime-time television coverage to hype the Republican vision for a new health care system. Bob Corker, R- Tenn. "But I'd let Mitch handle it," he continued, referring to the lead role Senate Majority Leader Mitch McConnell has played thus far.
          The Latest: Trump promises 'big surprise' on health care   
The White House did not elaborate on what Trump meant. Earlier Wednesday, Trump told reporters getting approval of a Senate health care bill will be "very tough. Senate Minority Leader Chuck Schumer is calling on Trump to meet with Republicans and Democrats on the Senate bill.
          Little progress evident as GOP hunts health bill votes   
WASHINGTON— Senate Majority Leader Mitch McConnell explored options for salvaging the battered Republican health care bill Wednesday but confronted an expanding chorus of GOP detractors, deepening the uncertainty over whether the party can resuscitate its bedrock promise to repeal President Barack Obama's overhaul. A day after McConnell, short of...
          GOP touts lower premiums, but other insurance costs to rise   
WASHINGTON (AP) -- Republicans are touting lower premiums under their health care legislation, but that reflects insurance that would cover a smaller share of the cost of medical bills....
          Selling the GOP health care bill: Does Trump help or hurt?   
WASHINGTON (AP) -- It was a platform most politicians can only hope for: A captivated, 6,000-person crowd and more than an hour of live, prime-time television coverage to hype the Republican vision for a new health care system....
          ENVIRONMENTAL COORDINATOR - Detour Gold Corporation - Detour Lake, ON   
Health Care Spending Account. Ensure incident response measures are in place, lead investigations and prepare reports....
From Detour Gold Corporation - Tue, 20 Jun 2017 21:04:32 GMT - View all Detour Lake, ON jobs
          PROCESS PLANT MILLWRIGHT - Detour Gold Corporation - Detour Lake, ON   
Health Care Spending Account. Identify, develop and implement continuous improvement opportunities; The Process Plant Millwright will be responsible for the...
From Detour Gold Corporation - Tue, 20 Jun 2017 15:04:28 GMT - View all Detour Lake, ON jobs
          PROCESS PLANT ELECTRICAL SUPERVISOR - Detour Gold Corporation - Detour Lake, ON   
Health Care Spending Account. Develop and implement standards and procedures that meet all statutory/regulatory requirements;...
From Detour Gold Corporation - Tue, 20 Jun 2017 15:04:26 GMT - View all Detour Lake, ON jobs
          PROCESS PLANT MECHANICAL SUPERVISOR - Detour Gold Corporation - Detour Lake, ON   
Health Care Spending Account. Develop and implement standards and procedures that meet all statutory/regulatory requirements;...
From Detour Gold Corporation - Tue, 20 Jun 2017 15:04:24 GMT - View all Detour Lake, ON jobs
          PROCESS PLANT (MILL) OPERATOR - Detour Gold Corporation - Detour Lake, ON   
Health Care Spending Account. Monitor and analyze process data and take action to optimize plant performance; Promote a positive health, safety and environment...
From Detour Gold Corporation - Mon, 05 Jun 2017 17:52:33 GMT - View all Detour Lake, ON jobs
          Treatment of opioid addiction in King County expands with ICHS’ new Suboxone program   
The launch of a Suboxone treatment program at International Community Health Center (ICHS) expands local capacity to treat opioid addiction to help address the rampant abuse of heroin and prescription pain medication in King County.

ICHS medical providers and pharmacies add to a limited number in the area that are currently qualified to prescribe Suboxone, an FDA-approved medication that treats opioid dependence.

Patients take Suboxone home, like any other prescription medication. Suboxone’s chemical composition helps avoid painful withdrawal.

“Opioid addiction needs to be treated and viewed the same as other medical conditions,” said Randon Aea, ICHS behavioral health manager. “For example, diabetes can be managed with support, behavior change and medication. Suboxone is proven to be safe and effective in helping people address the disease of addiction in a similarly successful fashion.”

Aea said a medical assessment, drug screening and education about the program are required for all participants, each of whom is also encouraged to seek substance abuse treatment and counseling. Patients initially see their ICHS medical provider once per week to ensure they are taking the appropriate amount of Suboxone. Once at the right dose, they may require less frequent visits.

“The prescription of Suboxone is just one step, albeit an important one,” said Aea. “Once the mind and body are stable, and free of pain and dependence to opiates, a person is better prepared to address the circumstances that may have led to their dependency.”

King County has made confronting opioid addiction a priority, announcing in January 2017 that it is moving forward on recommendations presented by a task force of experts that include prevention, increasing access to treatment on demand and reducing the number of fatal overdoses.

In 2016, 220 people in King County died from opioid overdose. According to the Washington State Patrol Crime Lab, the percentage of King County drug seizures testing positive for heroin has increased six-fold from 2008 to 2015.

ICHS’ Suboxone Treatment Program is available at its Holly Park, Chinatown-International District and Shoreline clinic locations and pharmacies, and will soon be available at ICHS’ Bellevue Clinic. Most insurance companies, including Medicaid, cover Suboxone treatment. ICHS’ commitment to health care for all, regardless of ability to pay, includes a sliding scale fee for those without insurance.

More information can be found at the ICHS website or by calling ICHS at: 206-788-3500.




          Psychiatrist - Salt Lake Behavioral Health - Salt Lake City, UT   
Business strategy is to build or purchase health care properties in. Universal Health Services, Inc....
From Universal Health Services - Wed, 05 Apr 2017 13:06:08 GMT - View all Salt Lake City, UT jobs
          Medical Director -Psychiatrist - Salt Lake Behavioral Health - Salt Lake City, UT   
Business strategy is to build or purchase health care properties in. Universal Health Services, Inc....
From Universal Health Services - Wed, 05 Apr 2017 13:06:07 GMT - View all Salt Lake City, UT jobs
          JOB OPENING IN ROYAL AMANDA HOSPITAL APPLY NOW   
We are looking for talented and dedicated medical staffs and non medical professionals who will join us in making every effort to sustain our world-class standard for health care currently we are have opening in different staffs categories in our Hospital send their updated resumeCVto careers@royalamandahospitalonline Job Location Ireland Ne
          Death Penalty Costs: Utah   
Problems: Utah Death Penalty Cost Study
Dudley Sharp, 3/4/2016

To: Governor Gary Herbert and staff
Utah House, Senate and staff
Attorney General Sean Reyes and staff
Utah Prosecution Council
Utah Sheriffs' Association

Media throughout Utah

Re: Problems: Utah Death Penalty Cost Study

From: Dudley Sharp

Utah's death penalty cost study (1) has some problems.


1) No Evaluation of Actual LWOP or Death Penalty Costs

The study is based upon calculating the differences in costs between the death penalty and life without parole, without establishing the specific costs of either the death penalty or of life without parole ("LWOP", being the relevant capital murder cases).

The study did this by, allegedly, looking at all the things that Utah has to do in a death penalty case and in a LWOP case and calculating ONLY the costs of the, alleged,  differences between the two, wherein this study found $1.6 million more costs in a death penalty case.

Because of errors in methodology, we know this to be, wildly, inaccurate.


2) How Problematic

This process had several identifiable problems:

a) Gary Syphus, the fiscal analyst who did the death penalty vs LWOP cost study, stated: "To be clear I did not estimate LWOP costs" (2).

We are precluded from fact checking a detailed look at both death penalty and LWOP costs, which are, totally, absent from the study, thereby lowering any confidence in its conclusions

added 11/21/16 --  To be very clear, the methodology of the study, as detailed, and Syphus' conclusions must be very inaccurate;

b) confidence, further lowered, because the study excluded 1) the increased costs of medical and geriatric care,  for LWOP and  2) possibly excluded an increase of costs of higher security for LWOP capital murderers; 3) excluded the increased costs of the additional appellate LWOP costs; and 4) the cost savings of plea bargains to LWOP, only possible with the death penalty option and a cost credit which is applied to the death penalty side of the ledger and which can be a huge number, dramatically lowering death penalty costs, depending upon the number of LWOP pleas.

This study provides zero information for all of those calculations, wrongly excludes them, because none were looked at, establishing  many errors, undermining any confidence in the study.


3) UNDERESTIMATING LWOP COSTS

According to Syphus, the "study" used the average incarceration costs per year for THE ENTIRE PRISON POPULATION and applied those to LWOP (2).

Such underestimates LWOP costs.

a) Medical Costs

LWOP murderers will die in prison and will have a higher average costs for medical care, because, as per Syphus, the average Utah LWOP inmate will live to 76, which incurs geriatric care costs, WHICH Syphus averaged out over the ENTIRE PRISON POPULATION, instead of applying it to LWOP, only (2).

As an example, the study averages costs inclusive of, say, a 20 year old, healthy inmate who gets a 1 year prison sentence for assault and has $0 medical costs per year and an 85 year old inmate, on kidney dialysis, who received a LWOP sentence for capital murder, at age 45, with medical costs at $348,000 per year.

This methodology destroys any confidence in the study and results in, totally, unreliable numbers, as is conceded.

In 2012, in Utah Dept. of Corrections (UDC) found that:

"About 9 percent of the state's total prison population is older than 55. (UDC) estimates health care costs of those inmates are 12 times more expensive than those of younger inmates." (3)

Syphus averaged out those 12 times more expensive geriatric LWOP cases, over the ENTIRE PRISON POPULATION, lowering the real, true geriatric LWOP medical costs and destroying any confidence in the studies findings, as all reality was destroyed, as conceded.

Based upon Syphus' average expected age of 76, the average LWOP prisoner will have about 26 years of geriatric care  which for prisoners starts at ages 50- 55, and, in Utah, averages about additional $22,000 per year (4), or $572,000 per inmate for those additional 26 years, costs which Syphus nullified by averaging the costs over the ENTIRE PRISON POPULATION.

Added to that will be 5 more years of increased medical care, maybe an additional $11,000 or so per LWOP prisoner/yr., $55,000, total, to add up to the 31 years Syphus calculated as the additional years for LWOP over a death row inmate, or an estimated $627,000 total, more per LWOP inmate (4), which was excluded in the study (4).

Because of the way Syphus calculated the study, it is possible that this error could be double, or $1.254 million, as the $627,000 was excluded from the baseline of LWOP, as would apply to all other cost issues, to follow.

Utah's medical/geriatric prisoner costs are at a low level compared to many other states, as detailed (4).

For example, the renal failure unit at the Federal Medical Center (Devens)  costs $348,000/PER YEAR/PER INMATE for their 115 aging inmates, at $4 million per year for that unit, EXCLUDING MEDICATION COSTS (5).

b)  Higher security costs

As a rule, LWOP capital murderers will be in higher security than general population inmates, and such will be more costly. 

However, the spokesperson for UDC, unofficially, says that increased security in Utah does not cost more.

Such is an astounding management of costs, if accurate.

For example, one of California's maximum security units costs $172,000/PER YEAR/PER INMATE (6).

As per Syphus, Utah's average prisoner cost is about $27,000/yr/inmate (2).

It appears that Utah does a better job at controlling incarceration costs than most states. But we will still have to wait on UDC's specific cost statement, which I have been waiting on since 3/1/16 and, as of 6/2/16, have not received.

c) Inaccurate Appellate Costs

Syphus states that the legal appeals costs are within the average for the incarceration costs for the ENTIRE PRISON POPULATION, as with medical costs, which indicates a highly inaccurate and strange way to arrive at very wrong numbers for LWOP costs (2).

Syphus claims that appellate costs are part of the incarceration cost average (2), which makes no sense, further lowering our confidence and, if true, indicates the same problem of averaging over the ENTIRE PRISON POPULATION and, again, dramatically,  lowering LWOP appellate costs.

For example, one would be averaging appellate costs of all inmates who plea bargained and have $0 appellate costs with those LWOP capital murderers who did not plea and have years of appeals, again, an averaging which, vastly, underestimates LWOP appellate costs, again, a lost cause for confidence.


4)  OVERESTIMATING DEATH PENALTY COSTS

Plea bargains to LWOP

With no detailed pre trial, trial and appeals costs of the LWOP cases, there is no way to calculate the actual cost credit of a LWOP plea, a cost credit only possible with the death penalty option and a plea which can create significant cost savings, which shows as a cost credit to the death penalty and which was not calculated in this study.  further destroying any confidence in the study.

No death penalty = no plea to LWOP.

Depending upon 1) how many LWOP cases are the result of a plea; 2) the cost savings of those pleas and 3) how many death row cases a state has, there is a scenario whereby the plea cost savings eradicate any alleged excessive costs of the death penalty, if there are any, and/or which would make the death penalty less costly than LWOP.

But, we are left guessing, as the study leaves out all of those important details.

Conclusion

The death penalty debate is rife with horribly inaccurate and/or misleading death penalty costs studies, some intentionally and obviously fraudulent (6), and Utah's is, not unexpectedly, just another example of that major problem.

The many problems with Utah's study cannot be clarified and/or corrected without a detailed review of both death penalty and LWOP costs, wherein, LWOP costs will rise, possibly dramatically, just as death penalty costs will go down, also possibly,  dramatically.

NOTE: These study problems are not the fault of Syphus, but of the parameters given to him by the authority requesting the study. It is unfortunate he didn't detail the problems of the study and that I had to do so.

ALTERNATE STUDY PARAMETERS

1) The easy route:

Ask all relevant entities how many people they will lay off with death penalty repeal. Likely, none, meaning death penalty repeal will have no known budgetary effect, nullifying the need for a specific, detailed cost review.

2) Detailed route:

A complete, detailed, specific  study of all financial and cost aspects of both death penalty and LWOP cases, inclusive of only capital murderers in the LWOP category.

Here is a suggested protocol for such a study (7).

UTAH'S DEATH PENALTY MANAGEMENT PROBLEMS

I have been told that Utah averages about 20 years of appeals, prior to execution.

That is not a death penalty problem. That is a management problem.

The average time for appeals, prior to execution, is 11 years, nationally, and 7 years, in Virginia.

Virginia has executed 111 murderers, since 1976, within an average of 7 years of full appeals. Their last execution, 10/1/2015, occurred after 5 years of full appeals (see Virginia within footnote 6).

If Virginia can do it, Utah can.

As a rule, there is no legal or rational reason for appeals to take longer than 6-10 years, on average, that being 2-3.3 years , each, at the state supreme court, federal district court and federal circuit court levels. Cases accepted by SCOTUS are rare.

Utah needs to fix her mismanagement problem.

Sincerely, Dudley Sharp

1) see page 2 of document, titled "Incremental Impact for One Death Penalty Offender to Execution -  State and Local, http://le.utah.gov/interim/2012/pdf/00002860.pdf
sent to me by Gary Syphus, Utah Fiscal Analyst, on 2/10/16

2) From email correspondence between myself and Gary Syphus, 2/15/16

3) "Utah one of 4 states whose inmate health care costs doubled",  Brooke Adams, The Salt Lake Tribune, October 29, 2013

4)  My cost numbers are based upon UDC published material in footnotes 3 and 4 and are, most likely, very close to the real numbers.

I have estimated $22,000/yr for geriatric LWOP prisoners (10% of prisoners) and a $1800/yr average for all those younger than geriatric (90% of prisoners), for an average cost of about $3700/yr/inmate, as per UDC (link, hereto) and an approximate 12 times greater cost for geriatric inmates than for the younger prisoners, also as per UDC in (3).

See Health Care Costs, Costs in Comparisons, UDC,
http://corrections.utah.gov/index.php?option=com_content&view=category&id=2&Itemid=119&limitstart=60

5) "The Painful Price of Aging Prisons", Washington Post, May 2, 2015

6) See Death Penalty Costs: California within
Saving Costs with The Death Penalty
http://prodpinnc.blogspot.com/2013/02/death-penalty-cost-saving-money.html


7) Death Penalty Costs vs Life Without Parole Costs: Study Protocol

          urgently Required NursesRadiographerLab Technician in SINGAPOREDUBAIQATAR   
Nursingis a profession within thehealth caresector focused on the care of individuals families and communities so they may attain maintain or recover optimal health andquality of life Nurses develop a plan of care working collaboratively with physicians therapists the patient the patients family and other team members that focus on treat
          Casual Senior Health Care Support Worker - British Red Cross - Wales   
The British Red Cross is committed to being an inclusive employer with a diverse workforce. Follow us on Twitter @RedCrossJobsUK and on Linked in - British Red... £8.16 an hour
From British Red Cross - Tue, 27 Jun 2017 16:07:20 GMT - View all Wales jobs
          Health Care Bills Could Hit Southern Colorado City Hard; Aurora's Motels Becoming Less Affor...   
The nation’s first round of health care reform brought Medicaid expansion and, a local health care leader says, improved medical treatment for poor working people in the Southern Colorado city of Pueblo. Now, that official says, those gains are threatened by Republican reform proposals in Congress. Then, inexpensive motels along East Colfax Avenue have provided a haven for people who might otherwise be homeless, but rates are rising and options are disappearing as development closes in on the community. And, with a solar eclipse coming on August 21, a look back to an 1878 eclipse that drew science celebrities, including Thomas Edison, to Colorado.
          A Christmas I Can Never Forget.   



Twenty three years ago, we had lost hope. With a dying baby, I was facing my other children with empty stockings. Our cupboards were bare. We were becoming a statistic of families in crisis, our daughter denied insurance and we had to fall into poverty to cover her hundreds of thousands of dollars in medical bills. I prayed for a miracle.  This is our miracle story of HOPE and a yet unknown Santa or Santa's who gave us the catalyst to change the course of our lives.  We are incredibly blessed by the miracles of that evening. I can never forget.

Our Tiny Titan never gave up and neither did we.

Christmas is a time of giving and miracles. Miracles are meant to be shared .In this days of sadness and tragedy  in the world and with so many struggling with joblessness, uncertainty of health care in our country, and others facing life changing medical conditions. We all need to believe in good and caring. I knew I needed to share it for FREE to offer HOPE and move hearts. I have arranged with my Publisher, Better Endings, New Beginnings to give it away.

Tiny Titan, One Small Gift on Kindle Electronic Download. Beginning tomorrow Tuesday December 18 through Saturday December 22 for FREE.

Chapter 9, "Christmas" has been told through major media over the years, landing in Women's magazines, media many Christmas feature stories and even the other side of the world when  Nippon TV recreated the Christmas story for the December 12, 2007 episode of the World's Most Amazing Stories. It is our gift to share the events of that Christmas forward.

If you read no other part of the book, take a few minutes and read Chapter nine.I have also posted the Christmas Chapter here on my blog for anyone to read when they have time. 

Chapter 9 Christmas from Tiny Titan, One Small Gift

To learn more about Noonan Syndrome

Have a very blessed Holiday season from our family to yours.

Ann Yurcek

Tiny Titan, One Small Gift is Part One of the Printed Copy of Tiny Titan, Journey of Hope available at Amazon.com 
Mom's Choice Award Winner-Best Adult Non-Fiction
5 Star Dove Award

Http://www.annyurcek.com
          nose clip water sports unhindered breath swimming waterproof   


Original Price: US$ 10.78
Current Price: US$ 5.39 (Saving 50 OFF)

Description:
The Water Sports Unhindered Breath Swimming Nose Clip with soft pads for maximum comfort. It according to anatomic designed to fit shape of nose. This small, low profile nose clip is a ideal for training with the people who first learned to swim. The Nose Clip is designed to prevent water from entering nostrils. it can be used for any water-based activity and is especially suitable for synchronized. It is must product for the home and health care.
          Trump promises "big surprise" on health care   

          Registered Nurse (RN) - Saint Elizabeth Health Care - Gananoque, ON   
Recognized as Canada’s largest social enterprise, we employ 8,000 people and visit 18,000 clients every day....
From Saint Elizabeth Health Care - Tue, 25 Apr 2017 20:21:18 GMT - View all Gananoque, ON jobs
          Respiratory Therapist - Full Time - Woodland Park Care Center - Salt Lake City, UT   
The Respiratory Care Practitioner (RCP) administers respiratory therapy care and life support to patients with deficiencies and abnormalities of the...
From Avalon Health Care Group - Wed, 14 Jun 2017 17:27:09 GMT - View all Salt Lake City, UT jobs
          In brief: NGS details reasons for denials, TiLite shakes up representation   
11/08/2013
HME News Staff

INDIANAPOLIS – Prior authorization requests submitted as part of the PMD demo are being denied because of conflicting information in face-to-face exams and other medical records, and insufficient face-to-face exam information, National Government Services (NGS) announced in a recent bulletin. The list of reasons covers denials as of Oct. 24. NGS says face-to-face exams often do not specify: how a PMD will sufficiently improve the beneficiary’s daily life; what are the beneficiary’s mobility limitations (his or her ability to get into and out of a PMD); what is the beneficiary’s mental or physical ability to operate the device; or what is beneficiary’s ability to stay stable while using the device. Other face-to-face exams neglect to include the beneficiary’s weight, NGS says.

TiLite announces new rep agreements

PASCO, Wash. – TiLite, a manufacturer of titanium and aluminum wheelchairs, has announced new U.S. sales representation agreements that will take effect Dec. 1. Permobil will represent TiLite in Florida and Puerto Rico; The Roho Group will represent the company in Illinois and most of Wisconsin; and Target Medical will represent it in Tennessee and Mississippi, according to the Oct. 30 news release. “We are excited to extend our partnerships with these top players in our industry,” stated TiLite CEO David Lippes in the release. MSL Associates will continue to serve these areas until Nov. 30, according to the release.

Conference news from Medtrade Spring, NCART

Early bird rates for Medtrade Spring start Nov. 12 and stay in effect through 2013. Medtrade Spring takes place March 10-12 at the Mandalay Bay Convention Center in Las Vegas. FMI: www.medtradespring.com ... The second annual National CRT Leadership and Advocacy Conference will take place April 29-May 1, 2014, at the Hyatt Regency Crystal City in Arlington, Va. Contact NRRTS or NCART for more details.

Alpine branches out into Idaho

SALT LAKE CITY - Alpine Home Medical Equipment is expanding into Idaho with the acquisition of Eagle Rock Oxygen and Medical Equipment in Idaho Falls, the company announced Nov. 4. Alpine says Eagle Rock’s staff will continue to serve patients from the same location. In business since 1997, Alpine Home Medical has nine branches in Utah.

AxelaCare acquires SCP Specialty Infusion

LENEXA, Kan. – AxelaCare Health Solutions, a specialty home infusion services provider, has acquired SCP Specialty Infusion, the parent company of Sirona Infusion, which provides acute home infusion, the company announced Nov. 5. The buy doubles AxelaCare’s number of pharmacies, according to a release. “We are excited that Chris (York), an industry leader in home infusion, and his team at Sirona are joining us to build a ‘best in class’ home infusion company,” stated Ted Kramm, AxelaCare CEO, in the release. “Their strength in acute infusion, great geographic coverage in the west and growth profile complements our strengths in IVIg and chronic care, and also expands our platform to provide innovative patient outcomes technology.”

Carex acquires ThermiPaq

NORWELL, Mass. – Carex Health Brands has acquired the ThermiPaq Hot & Cold Therapy brand and other assets from the Springfield, Ill.-based Thermionics Corp., according to a Nov. 4 news release. Carex offers hot/cold pain therapy, including the Bed Buddy moist heat ThermaTherapy and TheraMed brands, and home medical equipment. “This acquisition further solidifies our leadership in the market and allows Carex to improve service to our existing customers through an expanded hot/cold portfolio,” stated Matt McElduff, president of Carex Health Brands, in the release. 

Insulet posts third quarter results

BEDFORD, Mass. – Insulet’s revenues reached $61.1 million in the third quarter compared to $54.8 million during the same period last year, a 12% increase, the company announced Nov. 7. The medical device company’s gross profit for the period was $27.4 million, also a 12% increase. Insulet’s revenues in the first nine months of the year were $178.6 million vs. $153.5 million for the same period last year, while gross profit was $79.4 million vs. $67 million. Increased operating expenses were due to the settlement of a patent-infringement dispute with Medtronic involving Insulet’s OmniPod.

Hasco launches new TV ad campaign

ADDISON, Texas – Hasco has begun airing new TV ads in central Florida, hoping to raise awareness of the wheelchair-accessible transportation options that are available to a growing baby-boom population, the company announced Nov. 8. “This will help them make better-informed decisions as their needs change,” stated Hal Compton, Hasco Medical CEO, in a release. “We also expect this to help increase our fourth quarter sales and trade-ins on modified vehicles.” Similar commercials will soon air in other areas served by Hasco’s Ride-Away stores, like Tampa, Fla., and Washington, D.C.

ARI acquires Duo Web Solutions

MILWAUKEE – ARI Network Services, a website, software and data solutions provider, has acquired Duo Web Solutions, a social media and online marketing services provider, the company announced Nov. 5. “This acquisition is in direct alignment with our strategy to grow the digital marketing services side of the business,” stated Roy Oliver, ARI president and CEO, in a release. “Duo Web Solutions’ proven social media services, including reputation management and SEM services, will now be available to dealers, distributors and manufacturers in all the verticals we serve.” Terms of the deal were not disclosed.

Involve community pharmacists in COPD care, study says

OXFORD, England - COPD patients working with community pharmacists stick with their medications and have improved inhalation techniques, a recent study published in the British Journal of Clinical Pharmacology suggests. Patients in the study’s intervention group learned about their disease, medication and how to use inhalers. They also discussed disease management, quitting smoking and adherence. “This trial should encourage community pharmacists to engage in COPD care aiming to sustain an effective and safe pharmacotherapeutic treatment in patients with COPD,” study authors wrote. While patients working with pharmacists stuck with their medication and improved inhalation techniques, investigators did not find that they decreased their moderate exacerbation rate, dyspnea or smoking habits.

Short takes

CMS has approved the Accreditation Commission for Health Care for continued recognition as a national accrediting organization for hospices that wish to participate in Medicare or Medicaid. ACHC’s recognized status will last through Nov. 27, 2019…November is COPD Awareness Month and Inogen is offering a $500 discount shopping card to the winner of its “Share for COPD Awareness Giveaway,” it announced Nov. 7. To enter, the oxygen therapy company asks people to share their success stories about living with COPD... Ottobock debuted the film “Limitless” at the ReelAbilities Disabilities Film Festival on Nov. 3. “Limitless” is an original film featuring Ottobock employee Leslie Pitt Schneider, who lost a limb early in her life…It’s been 45 years since Al Thieme invented the Amigo power operated vehicle or scooter in his Bridgeport, Mich., garage. “The reason for starting Amigo Mobility was to ‘find a better way’ for a family member to stay active,” said Theime, in an Amigo Friendly Wheels newsletter in November. The company has expanded to a 55,000-square-foot facility and has manufactured more than 222,000 Amigo scooters.

People news

John Dudash, president and CEO of MITY Enterprises, will take the helm of Broda Seating, the company announced Nov. 6. MITY is the parent company of Broda Seating, and was acquired by Prospect Capital Corporation in September…Scot Dube is now president and CEO of Sigvaris North America. Dube succeeds Charles Handschin, who retired from Sigvaris after serving more than 14 years as president and CEO.


          STNA / Nursing Assistant - Whispering Hills Care Center - PT (Part Time) - Consulate Health Care - Mount Vernon, OH   
Operating in 21 states, we offer services ranging from short-term transitional care to Alzheimer’s and dementia care....
From Consulate Health Care - Sun, 11 Jun 2017 08:37:21 GMT - View all Mount Vernon, OH jobs
          STNA / Nursing Assistant - Crestline Nursing Center - Consulate Health Care - Crestline, OH   
Operating in 21 states, we offer services ranging from short-term transitional care to Alzheimer’s and dementia care....
From Consulate Health Care - Fri, 02 Jun 2017 09:18:18 GMT - View all Crestline, OH jobs
          LPN / Licensed Practical Nurse - Crestline Nursing Center - Consulate Health Care - Crestline, OH   
Operating in 21 states, we offer services ranging from short-term transitional care to Alzheimer’s and dementia care....
From Consulate Health Care - Sat, 13 May 2017 10:50:14 GMT - View all Crestline, OH jobs
          RN / Registered Nurse - Crestline Nursing Center - Consulate Health Care - Crestline, OH   
Operating in 21 states, we offer services ranging from short-term transitional care to Alzheimer’s and dementia care....
From Consulate Health Care - Fri, 28 Apr 2017 11:55:59 GMT - View all Crestline, OH jobs
          Nursing Home Administrator - Grove City Medical Center TCC - The Transitional Care Center of Grove City Medical Center - Grove City, PA   
Quality Life Services, a multi- location health care company has an excellent opportunity for an experienced PA licensed Nursing Home Administrator interested...
From Indeed - Sun, 21 May 2017 16:17:46 GMT - View all Grove City, PA jobs
          GOP senators’ Trumpcare: Meaner in many ways than even House plans   
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          What’s the Senate hiding on health care bill?   
Bernie Sanders recently offered on Twitter what he described as a display of all the Senate Republicans’ public considerations of the American Health Care Act, aka Trumpcare: a photo of a blank piece of paper. Not a bad jibe, and a window into the deepening bipartisan dismay that Majority Leader Mitch McConnell and his  Republicans soon […]
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Hospitals and nursing homes, by failing to properly maintain their water systems, may be putting older patients at high risk of an unusual form of pneumonia, with federal officials tracking 1 in 5 suspected or confirmed  cases of life-threatening Legionnaire’s Disease to health care facilities. Anne Suchat, acting director of the Centers for Disease Control […]
          Blues’ Payment Model Keeps Pace with Inflation   
News and Commentary

Blues’ Payment Model Keeps Pace with Inflation

Blue Cross Blue Shield of Massachusetts believes its newly inked provider pact with Caritas Christi Health Care — a community-based hospital network in New England with a network of 1,100 physicians that cares for about 60,000 members — will help bury the industry’s fee-for-service payment model.

In a nutshell, the payment plan — dubbed an alternative quality contract — combines a fixed payment per patient based on age, sex, and health status with an incentive payment earned for the quality and effectiveness of the care provided. This is the plan’s eighth AQC deal, which arrives as Massachusetts hosts a fierce debate over whether the traditional fee-for-service approach to paying providers should be axed. And while it may sound a lot like capitation, that’s not a word anyone at the health plan likes to bandy around.

The AQC plan is similar to a capitation agreement in that it establishes a per-member, per-month payment. But Deb Devaux, executive director of community transformation for the insurer, is careful to highlight some significant differences from a payment method that sparks bitter memories among providers from when it was tried in the ’90s.

“Capitation wasn’t funded adequately,” she says. With this new plan, the managed care organization worked with Caritas to establish the track record on health care costs for their patients, looking back over previous claims to come up with a reasonable idea of what the annual fee should be.

But the BCBS plan is intending to rein in costs by reducing waste and poor utilization. So the providers’ rates will rise at a sharply lower pace than the blistering 8 percent to 10 percent annual pace the plan has been experiencing for several years.

“These contracts are structured so that providers’ rates don’t rise so sharply, and the employer gets the benefit,” says Devaux. “We targeted about 2 percent [over inflation] and we want to fall in line with inflation, which has been 3 percent to 4 percent up to now.”

While about 20 percent of providers in Massachusetts have switched to global payment, many physicians continue to mount fierce resistance. In particular, the state medical association says that only big provider groups with a large patient base have the revenue and sophisticated information technology needed to successfully pull it off. Small practices just can’t do it.

But Devaux notes that the new BCBS pact with Caritas includes small physician practices that are part of a larger association, offering one model that other small practices might follow. Sticking with the current system, Devaux adds, is not an option.

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          Accountable Care Organizations Give Capitation Surprise Encore   
Cover Story

Accountable Care Organizations Give Capitation Surprise Encore

Many see ACOs as the model for reform, but if provider groups dole out payment, then what roles will health plans play?

There was a time when change in the managed care world rolled eastward from California. The Golden State launched public-private initiatives, experimented with payment systems, and forged unique relationships between payers and providers.

These days, however, what is cutting edge gets tried in Massachusetts, from universal coverage to new approaches to heart treatment encouraged by the Framingham Heart Study to whatever it is that the consistently pioneering Harvard Pilgrim Health Care happens to be doing.

Provider-centric

Now, Massachusetts legislators are considering doing away with fee-for-service care and replacing it with accountable care organizations (ACOs), a provider-centric system buoyed by global capitation. The ACO model is far from a sure thing, inasmuch as it would entail more concessions from physicians, health plans, hospitals — and others. The state’s Special Commission on the Health Care Payment System, which pushes ACOs, admits that they won’t become the mainstay of the state’s health care infrastructure for five years at least.

Still, the Congressional Budget Office — in the midst of all the attention given health reform and rising costs — recently cited ACOs as a possible money-saver. The House version of health care reform calls for a three- to five-year Medicare ACO pilot. Each ACO would be operated by a group of doctors and hospitals that would be paid by Medicare to care for all the health needs of at least 5,000 elderly or disabled people.

In addition, the Dartmouth Atlas Project is running studies. “We are working with four sites very closely, and we will have two launched by the end of this year,” says Elliott Fisher, MD, who runs the project and is the nation’s foremost proponent of ACOs. “We have another 50 sites across the country that have expressed an interest, and 35 have joined a learning collaborative designed to get sites ready to go in the next year or two.”

Just what is being cooked up? The House definition of an ACO is malleable, to say the least, mandating that it be “a group of physicians or other physician organizational model” that meets criteria that the Department of Health and Human Services will establish.

The Massachusetts commission left the details to legislators and a new authority to be installed that will oversee the payment system. “The thing that’s right about what they did is that they didn’t say, We know exactly how ACOs should be structured in 2015 and that’s what we’re going to decide at this moment,” says Peter V. Lee, executive director of national health policy for the Pacific Business Group on Health.

Global capitation

Still, for our purpose, a definition is helpful, and we’ll use the one supplied by Fisher. An ACO is a provider-led company willing to be accountable for the full continuum of care for its patients. Key elements:

  • Legal entity (e.g. IPA, physician-hospital organization, hospital, physician group)
  • Willing to report performance measures
  • Big enough to be actuarially stable

Global capitation will be used. A report by the Dartmouth Institute for Health Policy & Clinical Practice and the Engelberg Center for Health Care Reform at Brookings Institution outlines how providers in an ACO would be paid. “Spending benchmarks must be projected with sufficient accuracy based on historical data (or other comparison groups) and savings thresholds to provide confidence that overall savings will be achieved. Sufficient measures of quality to provide evidence of improvement are also essential.”

In other words, if the costs for treating the entire population of primary care patients assigned to the physicians in the ACO are expected to increase 5 percent next year in a specific geographical area, and the ACO keeps that hike to 2 percent, the providers get to keep some portion of the extra 3 percent. (See “ACOs Might Break Down Silo Walls,” below.)

ACOs might break down silo walls

Treatment in an accountable care organization (ACO) would be a departure from the way things are done now, says Justine Handelman, executive director for legislative and regulatory policy at the Blue Cross & Blue Shield Association.

Say you are diagnosed with congestive heart failure. The primary care physician will run tests and then refer you to a cardiologist. “So you make an appointment with the cardiologist and basically your PCP is out of the picture at that point,” says Handelman of the current traditional health care system. “You go see your cardiologist and he or she examines you, runs the same tests and says, ‘I think you need to have surgery. I’m going to recommend you go see a thoracic surgeon.’ You go see that thoracic surgeon. You go to the hospital and you have your surgery. Then you get discharged and your cardiologist comes and follows up with you.”

All done in silos, in other words.

“Today’s system mostly pays fee for service,” says Handelman. “Physicians submit their claim and get paid for the service that is provided.”

Paid by the episode

In an ACO, or a virtual ACO (since the countryside isn’t populated with Geisinger-type delivery systems), the entire team will be paid for the episode of care, says Handelman. “They have incentives to make sure that they are not duplicating tests for the sake of duplicating. The primary care physician, cardiologist, and surgical team are all talking and coordinating and deciding what other medical conditions might be a factor. Then they have incentives to make sure they do all the right care to prevent readmissions because they know that they are getting paid a capped global fee based on the average cost of that treatment.”

The care team has incentives to follow every checklist to prevent infection and error. “They think: We want to do this right so that there are not unnecessary complications that are going to cost more money because we might not get paid. If it is a complication that couldn’t have been foreseen, then that’s factored in and health plans aren’t just going to deny the extra payment.

“But if you got a site infection because people didn’t wash their hands or change tubes at the appropriate intervals, then that’s a different story.”

It is an entirely co-operative approach, says Handelman. “There is buy-in on everything that’s being used by the entire care delivery team. It is not the health plan saying, “This is the way it is going to be. It is sitting down with the medical community and seeing what are the best guidelines and practices that we should be looking at as we move forward.”

Princeton University economist Uwe Reinhardt, PhD, says that ACOs are a good idea “as ideas go.” However, “it is not at all a new idea. It’s the Kaiser model, the Ellwood-Enthoven model.”

Jan Berger, MD, president and CEO of Health Intelligence Partners and a member of MANAGED CARE’S editorial advisory board, says, “As much as many say that this is different from old capitation models, I do not clearly see the difference. Again, it will depend on the details.”

Specifics, please

Marylou Buyse, MD, president of the Massachusetts Association of Health Plans, would like to see more details as well. As far as she can tell, just as in the capitation system of old, gatekeepers will be necessary. “This will be a challenge for preferred provider organizations and self-insured plans because they don’t have a gatekeeper,” says Buyse. “And how will they function under an ACO model if an individual doesn’t identify a primary care provider or practice? How an entity will be designated to coordinate the care and determine where payment goes is a very open question.”

This will be daunting on several levels. The New York Times, reporting on Massachusetts’s exploration of ACOs, points out that “Global payments are hardly a new idea, as the concept closely resembles the capitation model that incited a backlash by consumers who accused health maintenance organizations of skimping on care.”

Patients will notice if ACOs actually do change how care is provided, says Jeff Goldsmith, PhD, the founder and president of the consulting company Health Futures. “To assume that the patients are going to be oblivious to this, or not be affected by the actions of the ACO, is naïve,” says Goldsmith. “When someone signs up for a managed care plan there is, for better or worse, a contract with employers and employees that states what it is that they are entitled to. If none of those stipulations and conditions exist in an ACO arrangement, well then how is the ACO actually going to change anything?” (See “An Argument Against ACOs,” below.)

An argument against ACOs

Jeff Goldsmith, PhD, isn’t straddling the fence when it comes to accountable care organizations (ACOs) which, among other things, have been touted as a fix for Medicare. “It is the most bizarre thing to hear all of this discussion about Medicare directly contracting with provider communities that have no infrastructure — none — to change how care is provided,” says Goldsmith, president of the consulting company Health Futures. “The idea that you can squash hospitals and physician communities together and expect to change practice patterns and incomes is a fantasy.”

Goldsmith emphasizes that he very much respects the Dartmouth Atlas Project and Elliott Fisher, MD, the man who runs that operation and who is a main advocate of ACOs.

However, the idea that hospitals and physicians together constitute virtual organizations “is one of the silliest ideas I’ve ever heard in my life. In most of the places I’ve worked, they can’t function in any meaningful way as virtual organizations.”

Goldsmith collected data on a large hospital in the Sunbelt (he declines to identify it) that shows that most of the treatments and tests that patients are prescribed occur at places other than the hospital.

Bombproof

“When the ACO gets its spending targets and says, ‘Oh, I want to control my cost for radiation therapy,’ the radiation oncology monopoly in town is going to go, ‘Oh, fine, well here is our price. Meet it or go pound sand,’” Goldsmith says. “A lot of the clinicians that you want to be influencing are in bombproof economic positions. This is something which, if you are sitting up at Dartmouth, you don’t get.”

However, the main reason ACOs won’t work in most places is what Goldsmith describes as a “thundering absence of collegiality” among doctors today. “Where did IPAs succeed?” he asks. “They succeeded where there was strong medical leadership and physicians were willing to delegate responsibility for making difficult choices about rates and utilization control to a group of their colleagues. It is really the medical directorate and board at that IPA where the hard stuff goes on.

“And if you haven’t reached the point in a medical community where people are willing to trust that medical director and board to determine what is fair and the negotiating process and all the rest of it, you don’t get anywhere. My point is that most physician communities are really more like coral reefs than they are like sentient beings. They are like a colorful ecology.”

Maybe it will be different this time, says Justine Handelman, executive director for legislative and regulatory policy at the Blue Cross & Blue Shield Association. “What we realized from back in the 1990s and capitation is that you really do need to bring the providers on board and work with them on what makes sense.”

Higher level

It is “sort of back to the capitation model, but at a higher level,” says Ronald A. Paulus, MD, MBA, executive vice president for clinical operations and chief innovation officer at Geisinger Health System. “I think what we found is that it is not just being at financial risk; it is about the collaboration and partnership between the plan and the delivery system.”

If ACOs are to be globally capitated, then the question arises: Just where do health plans fit? “In most places, I would suspect that the big boys would develop new ways of contracting effectively with ACOs,” says Fisher. “Massachusetts is the example here. The need for the big insurers to play along is that they can provide data and manage the insurance risk — as well as make it possible for bills to be paid when people travel. The big insurers could also help structure benefits so that incentives for patients are part of the equation. Medicare could be a payer just like any other, with a global payment or shared savings approach for the ACOs. Medicaid too.”

Goldsmith can’t see it. If Fisher is the ACOs’ champion, then Goldsmith is probably its most vocal critic. Goldsmith doesn’t like ACOs for many reasons, not least of which is what he sees as the lack of a clearly defined role for health plans.

“To dismiss the fact that health plans are fundamentally in the risk-managing business, and to ignore 35 years worth of institutional learning and just have Medicare go directly to, in effect, capitating provider communities, just raises a whole bunch of policy and, frankly, common sense questions,” says Goldsmith.

He adds that risk-sharing arrangements that have worked, such as Health Care Partners Medical Group in Los Angeles, required “a degree of collaboration and thoughtfulness that you just can’t plunk down on Salem, Ore., like some alien spacecraft.”

Buyse acknowledges that the role of insurers in an ACO world seems vague right now, but she points out that the Special Commission on the Health Care Payment System took care in its report to state that ACOs should not bear insurance risk. That leaves an opening for insurers to play a critical role in the development and ongoing financial wellbeing of ACOs, she believes.

In addition, ACOs will need plenty of data. “Health plans are in a much better position to be able to capture such information on larger populations than any individual ACO will be in,” says Buyse. “Collaboration and data sharing between physicians and providers within the ACO will be necessary so that we can avoid multiple administrative build-outs across providers that duplicate what health plans are already doing.”

“Health plans,” Lee says, “are very likely in most cases to be the organizers of the payment systems for the ACOs. They will be providing the glue that will hold ACOs together.”

That’s if they decide to get together. Buyse thinks that “not all physicians and hospitals will be able to join a model ACO or would be interested in being part of an integrated system.”

Fisher noted that an ACO needs to be big enough to be actuarially stable, a necessary foundation for capitation. “I think what Geisinger found is that it is not just about financial risk,” says Paulus. “It is about the collaboration and partnership between the plan and the delivery system.”

Financial responsibility

Fisher says that Geisinger qualifies as an ACO and Paulus understands why. “We’ve found that the area where we both provide the insurance and therefore have the financial responsibility and provide most of the care — i.e., we can influence the clinical workflows and delivery to the greatest extent possible — is where we can make the biggest impact and do the most interesting things,” says Paulus. Those interesting things will do a lot to champion the ACO model. For instance, the local daily newspaper in Columbia County, Pa., the Press Enterprise, recently reported that teachers in the Central Columbia School District would see their average annual salary jump by $7,000 under a new three-year contract.

“Back in April, Central was predicting a big rise in insurance premiums,” the Press Enterprise reported on July 26. “To lower costs, the district switched from Capital Blue Cross to Geisinger Health Plan for all employees.... While other school districts are facing 7 to 8 percent increases in insurance costs, Central is dealing with just a 2.5 percent