The Health Care Promises We Cannot Keep – Kaiser Health News

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It was a promise Matt Perrin wasnt able to keep.

Ill never take away your independence, hed told his mother, Rosemary, then 71, who lived alone on Cape Cod, Mass., in a much-loved cottage.

That was before Rosemary started calling Perrin and her brother, confused and disoriented, when she was out driving. Her Alzheimers disease was progressing.

Worried about the potential for a dangerous accident, Perrin took away his mothers car keys, then got rid of her car. She was furious.

For family caregivers, this is a common, anxiety-provoking dilemma. Theyll promise Mom or Dad that they can stay at home through the end of their lives and never go to assisted living or a nursing home. Or theyll commit to taking care of a spouses needs and not bringing paid help into the home. Or theyll vow to pursue every possible medical intervention in a medical crisis.

Eventually, though, the unforeseen will arise after a devastating stroke or a heart attack, for instance, or a diagnosis of advanced cancer or dementia and these promises will be broken.

Mom or Dad will need more care than can be arranged at home. A husband or wife wont be able to handle mounting responsibilities and will need to bring in help. A judgment call this will only prolong suffering, theres no point in doing more will be made at the bedside of someone who is dying.

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We want to give loved ones who are sick or dying everything we think they want but we cant, said Barbara Karnes, 78, an end-of-life educator and hospice nurse based in Vancouver, Wash. And then, we feel weve failed them and guilt can stay with us for the rest of our lives.

She hasnt forgotten an experience with her mother-in-law, Vi, who moved in with Karnes, her husband and two children after becoming a widow 30 years ago. At the time, Vi was in her 70s, weak and frail. Karnes was working full time and keeping the household going.

My mother-in-law and I got into a disagreement, I dont remember what it was about. But I remember her saying to me, You promised you would take care of me, and making it clear that she felt Id let her down. And I said, I know, I was wrong I cant do it all, she remembered. I still feel bad about that.

No caregiver I know sets out to deceive another person: Its just that none of us have a crystal ball or can predict what the future will hold, she said. And the best we can do isnt always as much as we thought was possible. We have to figure out a way to forgive ourselves.

Richard Narad, 64, a professor of health services administration at California State University, spent months after his wifes death in December 2011 mentally reviewing the last hours of her life before achieving a measure of peace.

His wife, April, was diagnosed with Type 1 diabetes at age 5 and was legally blind when the couple married in 1994. A year later, she had the first of a series of strokes. Eventually, April was diagnosed with congestive heart failure. In the last 18 months of her life, she was hospitalized 13 times.

April Narad had told her husband she wanted full code status in the event of an emergency in other words, do everything possible to keep me alive. But she was nervous about his willingness to honor her wishes because his own end-of-life views differed from hers.

I think certain care is futile and you need to give up earlier, he explained.

In the end, April was rushed to the hospital one night after dinner, gasping for breath. There, Narad directed medical staff to pursue full code interventions. But when a physician came out to tell him that death appeared inevitable, Narad remembers saying, Well, if thats the case, just call it.

Had he broken a promise to insist that other treatments be tried? Narad spent months wondering but eventually accepted that he acted in good faith and couldnt have saved Aprils life.

With illness, older couples can end up re-evaluating commitments theyve made. Kathy Bell, 66, of Silver Spring, Md., promised her husband, Bruce Riggs, 82, that shed stay with him through all the changes in our lives when they married in 1987. Then in August 2011, he received a diagnosis of Alzheimers.

The couple moved into a senior living facility, but as Riggs condition worsened he had to go to a memory care facility in 2014. The following year, Bell had lunch with a man whose wife lived at the same facility. He told her his therapist had recommended he start dating.

That planted the idea of possibly doing this myself at some point, Bell said, and two years ago she met a man who has become a regular companion.

Does she feel shes broken her promise to her husband, who was committed to a monogamous marriage? No, I dont, Bell said, adding that its not clear whether he knows me at this point. He doesnt talk. The way I view it: I still love him. I still go to see him. Im still taking care of him.

Promises can be explicit spoken aloud or implicit, understood without direct communication. Both kinds can inspire regret.

Debra Hallisey, 62, a caregiver consultant based in Lawrenceville, N.J., describes making an unspoken promise to her father, Don, when he was diagnosed with congestive heart failure in 2014. Their agreement, which was never voiced: Neither would tell Halliseys mother, Doris who has diabetes, mobility issues and is legally blind how sick he was.

Debra Hallisey and her parents, Don and Doris, celebrating their 60th wedding anniversary.(Courtesy of Debra Hallisey)

I knew he was shielding [Mom] from knowing the truth. When she would ask questions, he wouldnt say anything, Hallisey said. Because her mother was disabled, Hallisey accompanied her father to doctors appointments.

When Halliseys father died in February 2015, Doris was profoundly shocked and Hallisey was overcome by remorse. It was then, I said to my mother, Mommy, there are no more secrets. If something is wrong, I am going to tell you, and together were going to determine the best thing to do, she said.

In line with that promise, Hallisey has been direct with her mother, who uses a walker to get around her home in Somerset, N.J., and has round-the-clock home care. If and when Doris becomes unable to walk, shell have to move, Hallisey has said.

Ive told her, Mommy, Ill do everything to keep you in this house, but you have to use your walker and work at staying strong. A wheelchair wont work in your house, Hallisey said. I know that keeping her at home is a promise I may not be able to keep.

Matt Perrin made the decision to move his mother, Rosemary, to assisted living in 2017, after realizing he couldnt coordinate care for her escalating needs at a distance. (Rosemary lived on Cape Cod; Perrin lived in New Hampshire.) Because hed vowed to protect her independence, I felt so guilty a guilt that I had never felt before, he admitted.

Rosemary resisted the move passionately, but after a few months settled into her new home.

I felt relief then, and I still do, Perrin said. I wish I didnt make that promise to my mom, and I wish she werent living with Alzheimers. But Im thankful that shes in a place thats really good for her, all things considered.

Judith Graham: khn.navigatingaging@gmail.com,@judith_graham

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The Health Care Promises We Cannot Keep - Kaiser Health News

Health care needs will increase as aging population grows – WKOW

MADISON (WKOW) -- Within the next ten years, health care needs will grow dramatically.

The so-called silver tsunami, or the aging baby boomer population, is expected to put more strains on the health care industry.

According to the Association of American Medical Colleges, the nation's population of people over 75 will increase by 75 percent between 2017 and 2032. The Wisconsin Department of Health Services has predicted that by 2040, there could be more than 1.5 million Wisconsin residents over the age of 65.

In 2010, there were 780,000. That would be an increase of 100 percent.

"That's just staggering," said the Wisconsin Hospital Association's vice president Ann Zenk.

The WHA is also tracking the impact baby boomers will have on health care in its latest health care workforce report.

Zenk said that the rapidly aging population isn't exactly good news for the health care industry, which is already strained.

"We're seeing patients having to spend unnecessary days in the hospital, waiting for a place to be discharged to," she said. "Some of those gaps are due to the shortage of nursing assistants and other entry level workers."

Health care needs will grow by 30 percent in the next ten years, Zenk said, which will increase the need for even more nurses, doctors, physician assistants, and other specialized providers.

It's not a lost cause. Plenty of people in the state are catching on to the fact that it's about growing the workforce efficiently as well as quickly.

Madison College has a new, year-long program for licensed practical nurses, or LPNs.

Dr. Ernise Williams, the associate dean of the nursing program, told 27 News that job is becoming more vital as patient care gets more intense.

"The patients may not be able to receive the level of care that they need to get out of the hospital on time," she said.

Williams encourages her students to diversify their options so they can fill in where there are gaps in health care. LPNs can fill in where needs are crucial, like in patients' homes. With more nurses available for home visits, it can free up hospital beds.

Advanced practice clinicians can also step in to provide care when there are physician shortages.

But despite the gaps, the WHA's report said that healthcare workforce is, in fact, growing.

The Wisconsin Center for Nursing reported that in 2016, 3,000 people graduated from nursing schools. In each year since, they've been able to graduate 3,500.

"That's huge," said Zenk. "But we're going to need even more."

Since 2009, hospitals in Wisconsin have been able to double the number of advanced practice clinicians working. That includes nurse practitioners and physician assistants.

"The APC workforce is expected to double again in the next decade," she said.

Zenk said they work at the state and federal levels to make sure lawmakers are passing laws that don't make things harder for the workforce to efficiently grow.

Growing, but not fast enough.

"I think we have to be creative," said Williams. "We have to be creative because we do need to grow, grow, grow, so it woul dbe the process by which the grow, grow, grow is implemented."

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Health care needs will increase as aging population grows - WKOW

Mick Mulvaney summons feuding top health care officials Alex Azar and Seema Verma to White House for cool-off meeting – CBS News

Acting White House chief of staff Mick Mulvaney summoned the administration's two top health policy officials to meet with him at the White House in an effort to cool down a months-long feud that is reaching a boiling point. Health and Human Services Secretary Alex Azar and Centers for Medicare and Medicaid Services administrator Seema Verma could met with Mulvaney Wednesday, several senior administration officials confirm to CBS News.

A White House official confirmed that the two have fought over the administration's efforts to come up with a replacement to the nation's health care law, the Affordable Care Act. Politico first reported their battles over an Obamacare alternative, stating that Verma spent six months developing a proposal, only to have Azar scuttle it before President Trump could see it. According to Politico, Azar thought Verma's plan would end up strengthening the ACA, rather than replacing it.

The two have also been at "each other's throats" on several other issues, too, ranging from the administration's work on lowering drug prices to who gets credit for any perceived victories involving health care, according to multiple White House sources.

President Trump did not attend Mulvaney's meeting with the two. White House officials maintain that Verma continues to have the support of the president, but Mr. Trump has made it clear that he wants the bickering between Azar and Verma to stop. Mr. Trump "doesn't care if they like each other, but they have a job to do," one official said. Their jobs are not in jeopardy, the source said.

"Secretary Azar's and Administrator Verma's top priority is to advance the president's health care agenda through lowering drug costs, advancing competition in the marketplace, and ensuring Americans have access to high quality, affordable healthcare," an HHS spokesperson said in a statement to CBS News.

But some White House officials say the dispute has become an obstacle to working relations between the two.

"I would not want to be in between those two," a senior White House official said of the battle between Azar and Verma.

White House officials claim that the situation has unraveled to a point where the two sides are now spilling or "leaking" unfavorable stories about each other to news outlets.

One story initially broken by Politicoand confirmed by CBS News involves a claim Verma filed in 2018 for $47,000 with the government for stolen property, including jewelry, after her luggage was stolen from a rental car while she delivered a work-related speech in San Francisco. The claim was for about $43,000 for jewelry and $4,000 for clothes. She received just $2,852.40.

Some Democrats attacked the claim as a waste of taxpayer money. Congressman Joe Kennedy, of Massachusetts, called it a "bailout for stolen goods she chose not to insure," according to USA Today.

Verma's claim has become an annoyance for many in the West Wing, but CMS considered the story to be part of a smear campaign against her.

"These recent leaks are part of a targeted campaign to smear the Administrator and undermine the accomplishments of CMS," a CMS spokesperson told CBS News in a statement. "The Administrator's number one priority is continuing to deliver on the President's bold healthcare agenda to ensure Americans have access to high quality, affordable healthcare."

Both Azar and Verma have powerful allies in the administration. Azar is close to White House counsel Pat Cipollone and Attorney General Bill Barr, while Verma, who oversaw Indiana's Medicaid program, has close ties to Vice President Pence.

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Mick Mulvaney summons feuding top health care officials Alex Azar and Seema Verma to White House for cool-off meeting - CBS News

‘A fing soap opera’: The health care drama riveting the White House – POLITICO

Acting White House chief of staff Mick Mulvaney has called both Azar and Verma to the White House for a meeting on Thursday in an attempt to mediate the duos months-long personality and policy clashes. Already, Trump told Azar and Verma to knock it off and get along to no avail, said two senior administration officials.

The White House press office declined to comment. A HHS spokesperson said Secretary Azars and Administrator Vermas top priority is to advance the presidents health care agenda through lowering drug costs, advancing competition in the marketplace, and ensuring Americans have access to high quality, affordable healthcare.

A CMS spokesperson echoed the same sentiment: The Administrators number one priority is continuing to deliver on the presidents bold health care agenda to ensure Americans have access to high quality, affordable healthcare.

Get the latest on the health care fight, every weekday morning in your inbox.

Its unclear where Trump stands this week after POLITICO reported over the weekend that Verma tried to have taxpayers reimburse her for $47,000 worth of property stolen during a work trip. Verma also has come under fire for spending millions of dollars on contracts for Republican communications consultants, whose jobs entailed boosting her public profile.

A person familiar with the presidents thinking said he would like both the Secretary and the Administrator to stop the friendly fire and work together.

In interviews, nine current and former senior administration officials and Republicans close to the White House detailed how the rift between the two turned toxic on numerous fronts.

Azar and Vermas fighting has persisted for months, leaving officials from the Office of Management and Budget and the White Houses two policy councils as frustrated bystanders, and the tension between the two has only escalated in recent weeks.

The deteriorating drama has formed battle lines among White House aides with camps split between Verma and Azar, contributing to the stalemate. Azar has the backing of two of the administrations most powerful lawyers, while Verma has known Vice President Mike Pence for years and had a direct line to the president during talk of unveiling an Obamacare replacement.

But the constant bickering now threatens to blow back on both of them, as allies allege one is smearing the other. The risk is that one looks so consumed by this conflict that he or she appears unable to carry out the duties of the job.

The two have clashed over matters small and large, including policy issues such as the presidents desire to lower drug prices seen as a key talking point for his reelection campaign.

What a fucking soap opera, said one person familiar with the dynamics. This does not help either of them.

Throughout the Trump presidency, health care has been one of the administrations chief tripwires. The White House and Republican lawmakers failed to repeal Obamacare after years of conservative outrage over the sweeping health care law. The first Secretary of Health and Human Services Tom Price resigned after facing multiple investigations into his use of private aircraft for taxpayer-funded work trips. Policy-wise, other high-profile health care efforts have either been stalled in the courts or over disagreements including Vermas push to institute the first-ever Medicaid work requirements and her efforts to develop an Obamacare replacement plan.

Meanwhile, Azar has come under fire for cutting Verma out of the departments decision-making and attempting to block her access to the president and a high-profile event related to a Medicare executive order. The health secretary blocked Verma from traveling with Trump on Air Force One in October for the unveiling of a Medicare executive order in Florida, according to a half-dozen officials with knowledge of the multi-day episode. Verma was only allowed aboard the plane after the White House intervened. An HHS spokesperson denied that Azar or anyone at the agency blocked Verma from boarding the flight.

Within the White House, both Azar and Verma have their defenders as well as serious detractors.

As an attorney, Azar remains close to White House counsel Pat Cipollone and Attorney General Bill Barr, powerful allies in the Trump orbit. Azar has a reputation throughout the administration as a fierce bureaucratic infighter, who does not hesitate to create a paper trail to inoculate himself against potential criticism.

Secretary of Health and Human Services Alex Azar. | Zach Gibson/Getty Images

Hes also known for his fierce temper, dubbed by several senior administration officials as the purple rage because of his face color when he becomes angry.

Verma is close with Vice President Mike Pence, with whom she worked in Indiana when he served as governor. White House aides have spotted her dining in the Navy mess with Jared Kushner, with whom she worked on health care-related information technology initiatives. She also has a direct line to the president, speaking to him with some frequency when the White House was contemplating unveiling a potential Obamacare replacement plan.

On Verma, the criticism is that she is a micromanager who only trusts people inside her very inner circle and refuses to share information more broadly inside HHS, said a former senior administration official. Although the president knows and likes her, he once accidentally called her Reema in an Oval Office meeting.

The president likes them both, said a Republican close to the White House. There is a reason Alex has earned his stripes on drug pricing, but Seema has also been very effective. That is why this is annoying. Very senior people involved in policy are just wondering why they cant just figure this out.

When asked if their ongoing fights were restraining the administrations health care policy, a former senior administration official called that a no-brainer.

Your two highest health care officials feuding will be damaging to policy wins, the official added.

Rachana Pradhan contributed to this report.

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'A fing soap opera': The health care drama riveting the White House - POLITICO

Morristown woman posed as nurse for 6 years at 8 health care providers – WATE 6 On Your Side

GREENEVILLE, Tenn. A Morristown woman, who fraudulently claimed to be a nurse at eight employers over a six-year period, now faces up to 45 years in federal prison and fines up to $750,000.

Misty Dawn Bacon, 44, of Morristown entered a guilty plea in U.S. District Court in Greeneville on Thursday to wire fraud, health care fraud, and identity theft.

She will be sentenced on April 3.

This defendant created a substantial danger to public health through her lengthy criminal scheme. Anyone who fraudulently poses as a licensed professional will be vigorously prosecuted by this office and an appropriate punishment will be sought, U.S. Attorney J. Douglas Overbey said in a news release.

Our office will bring the full measure of the law against those who attempt to take this sort of dangerous and unlawful advantage of persons needing appropriate medical treatment from duly licensed health care professionals, Overbey said.

As part of the plea agreement, Bacon, a convicted felon, admitted to providing fraudulent information on job applications by using the registered nurse license numbers of others to gain employment.

Bacon posed as a registered nurse, despite not having a nursing degree or a nursing license and having no nursing experience, according to the news release from the U.S. Attorneys Office.

She was hired by at least eight health care providers between September 2012 and November 2018.

Over the six-year period, she worked in a variety of medical settings, including nursing homes, rehabilitation and assisted living facilities, a doctors office, and home health agencies, the U.S. Attorneys Office said.

While posing as a nurse, Bacon had access and rendered medical care to numerous patients, dispensing medications, obtaining invasive access to patients bodies, and gaining access to patients sensitive and private medical information, the U.S. Attorneys Office noted in the news release.

Bacon made numerous false entries in patients medical records and submitted false claims to public and private health care benefit programs.

Two of her employers voluntarily repaid health care benefit programs over $500,000 for claims submitted upon learning of Bacons imposter status.

Posing as a medical professional and putting the lives of innocent patients at risk is not acceptable, said TBI Director David Rausch. Our Medicaid Fraud Control Division remains committed to working with our federal partners to ensure healthcare fraud and identity theft cases like this one are addressed and investigated thoroughly.

The case resulted from an ongoing investigation by the Tennessee Bureau of Investigation, the Tennessee Department of Health, and the Jefferson City Police Department.


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Morristown woman posed as nurse for 6 years at 8 health care providers - WATE 6 On Your Side

Ocasio-Cortez Makes Connection Between 20% Jump in Healthcare Costs and Industry-Sponsored Spa Days for Congressional Staffers – Common Dreams

After end-of-the-year reports showed healthcare costs for Americans rose an average of20% in 2019, Rep. Alexandria Ocasio-Cortez on Twitterhighlighted evidence of the cozy relationship between the for-profit health insurance industry and U.S.lawmakers.

The New York Democrat noteda retreat at a luxury resort in Virginia taken last April by more than 40 senior congressional staffers where they rubbed elbows with and listened to talks given by health insurance lobbyists.

"One of the sneaky and most corrupting aspects of lobbying is to court a member's staff," Ocasio-Cortez tweeted.

Health insurance costs have gone up *20%* in the past year.

This is the healthcare system of choice that so many politicians are committed to protecting with small, incremental tweaks.

Meanwhile, Big Pharma & insurance lobbyists treat Congressional staffers to spa weekends. https://t.co/58VDRPf7HY

Alexandria Ocasio-Cortez (@AOC) December 12, 2019

If you think Im joking about the spa weekend bit, Im not!

One of the sneaky and most corrupting aspects of lobbying is to court a members staff - especially their chief.

It just happened earlier this year with lobbyists fighting Medicare for All:https://t.co/Xp3rq8Y1XW

Alexandria Ocasio-Cortez (@AOC) December 12, 2019


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Staffers in attendance at the event came from both sides of the aisle and heard healthcare and pharmaceutical lobbyists' pitches for so-called "reforms" to the healthcare systemwhich did not include Medicare for All.

"This event wasn't about fixing the healthcare system," former health insurance executive-turned-Medicare for All advocate Wendell Potter told The Intercept at the time. "It was about protecting the healthcare industry, no matter the cost to patients, families, workers, or employers. The industry is the root cause of our healthcare crisis. A congressional staffer serious about finding solutions wouldnt touch that retreat with a 10-foot pole."

The federal Consumer Price Index report revealing the rise inhealthcare costswas released a day after CBS reported that more than half of American families are being forced to cut back on holiday spendingbecause of expenses includingmedical expenses specifically.

More than 70% of respondents to a survey taken by the insurance company Aflac said it was the second year in a row that they had cut holiday costs by eliminating travel, gift-giving, or other traditions.

Many of the people surveyed faced high healthcare costs this year despite having insurance; 30% of the respondents who had visited the hospital this year reported that they had been responsible for at least $1,000 in out-of-pocket costs.

"One of the themes is medical expenses outpacing the amount of insurance people have," Shields said. "They are beyond what co-payments or deductibles will cover and that results in greater out-of-pocket costs."

Thursday's report also came two days after Gallup released a poll showing that a quarter of Americans delayed or avoided getting healthcare due to costs.

"This is the healthcare system of 'choice' that so many politicians are committed to protecting," Ocasio-Cortez said.

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Ocasio-Cortez Makes Connection Between 20% Jump in Healthcare Costs and Industry-Sponsored Spa Days for Congressional Staffers - Common Dreams

Republican Satisfaction With US Healthcare Costs Surges – Gallup

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WASHINGTON, D.C. -- Republicans' satisfaction with the costs of healthcare in the U.S. has jumped 17 percentage points in 2019, rising to 43%, up from 26% in 2018. At the same time, independents' and Democrats' levels of satisfaction show less change, at 25% and 9%, respectively.

A similar partisan-based pattern in Americans' satisfaction with their own healthcare costs was previously reported.

These results come from Gallup's annual Health and Healthcare poll, conducted Nov. 1-14. Democrats are in the midst of their presidential nomination campaign, during which healthcare has been a major focus, with most candidates proposing a publicly sponsored health plan option if not a single-payer system. Republicans recently released a new plan to replace the Affordable Care Act, which they have unsuccessfully tried to repeal in recent years.

One of the key purposes of the ACA, also known as "Obamacare," was to control healthcare costs in the U.S. After President Barack Obama signed it into law in 2010, 31% of Republicans and 19% of Democrats were satisfied with the costs of healthcare in the U.S. Six years later, at the end of Obama's second term in 2016, Democrats had become more satisfied with healthcare costs (28%) while Republican satisfaction had sunk to an all-time low (11%).

However, since then -- coincident with Donald Trump taking office -- partisan satisfaction has again flipped. In November 2017, Republican satisfaction with healthcare costs had risen to 23%. At the same time, Democrats' satisfaction with these costs had fallen modestly to 24%. Over the next two years, Republicans' satisfaction continued to rise while Democrats' continued to fall, producing the largest partisan gap in ratings to date -- 34 points in 2019.

The surge in satisfaction with U.S. healthcare costs among Republicans has been largely responsible for an uptick in satisfaction among all Americans. Twenty-six percent of U.S. adults now say they are satisfied with these costs, up from 20% last year and the highest level since 2009.

Americans have consistently registered low levels of satisfaction with healthcare costs in the U.S. No more than 28% of Americans have been satisfied with these costs since 2001, with satisfaction generally hovering near 22%.

This year, Republicans are substantially more satisfied with healthcare costs, both for themselves and the country more broadly, while Democrats are slightly less satisfied. It is possible that this partisan-based divergence may be a response to the rhetoric from both parties. Republicans have again begun beating the drum for a repeal of Obamacare and have announced a plan to replace the law, while Democratic presidential candidates have talked extensively about "Medicare for All," despite a continued majority of Americans favoring a private health system for the country.

Republicans have clearly staked out their position ahead of the 2020 presidential election, with their new plan to replace the ACA. What plan Democrats propose is still dependent on which candidate clinches the party's nomination -- but it likely will involve a defense of the ACA and greater government involvement in the country's healthcare system, which Democrats favor by a wide margin.

View complete question responses and trends.

Learn more about how the Gallup Poll Social Series works.

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Republican Satisfaction With US Healthcare Costs Surges - Gallup

What we learned at the HIMSS Healthcare Security Forum – Healthcare IT News

BOSTON After two days of wide-ranging and detailed discussion about the multi-faceted challenges of healthcare cybersecurity, data privacy and patient safety, some themes have emerged from the HIMSS Healthcare Security Forum, which took place earlier this week.

Here are a few top-level takeaways.

The challenges of the CISO (and all healthcare infosec professionals) are many. Whether it's getting adequate resources from cost-conscious CFOs one speaker suggested leaders communicate the stakes in business terms, framed as the catchall term of "risk," rather than the specialized field of cybersecurity or gaining clinician buy-in, the CISO has many more jobs than just keeping ones and zeroes on lockdown.

One consistent theme was the shift in how the CISOs are perceived not just as security scolds who run phishing tests and shut down shadow IT, but as active strategic leaders, communicating regularly with other stakeholders across the enterprise to help with innovation and business transformation.

"A lot of it has to do with understanding an organization's culture," said Anahi Santiago, chief information security officer at Christiana Care Health System.

Still, there are the day-to-day challenges, such as keeping up with regulatory compliance and maintaining good vendor relationships in a world of "hyper-outsourcing." And those challenges will only get more complex in the world of myriad mobile devices, empowered consumers, artificial intelligence and more.

"Many healthcare providers aren't prepared for the new risks they will be introducing into their orgs over the next 3-5 years," said keynote speaker Dr. John Halamka, newly minted president of Mayo Clinic Platform.

But, he added: Try innovating in a zero-risk environment. You cant.

The key is to find an acceptable balance between innovation and risk management, based on mitigation, organizational benefits and strategic urgency, he said.

"Healthcare is moving forward and transforming, and it's going to do it with or without us," Santiago said. "And it's great to see more and more folks talking about the fact that not only do we have a seat at the table but we're engaged in discussions that are helping with that transformation.

"We're moving in the right direction," she added. "We're maturing. There's still a lot of work to do. But at least there are some answers out there."

"No one is going to do the hard thing to breach your organization when the easy thing is going to work every single time," said keynoter Michael Coates, CEO and cofounder of Altitude Networks, who previously served as CISO at Twitter and head of security for Mozilla.

Similarly, perhaps, some professionals who may feel overwhelmed by the dizzying array of cybersecurity threats and compliance imperatives may consider taking some cues from the KISS principle.

"It's easy for folks to get lost in the most esoteric and complicated vulnerabilities and not manage the basic stuff," says Johns Hopkins CISO Darren Lacey.

Erik Decker, chief security and privacy officer at University of Chicago Medicine, was on hand in Boston to describe the value of HHS' Health Industry Cybersecurity Practices framework, which he helped spearhead.

As Decker explained recently, the guide can be viewed as something like "a cookbook," he said, "a series of recipes that will help you mitigate and manage the most prevalent threats we face in healthcare."

In a world where basic mistakes like missing patch notifications are far, far more common than targeted cyber attacks on patient-connected infusion pumps, ensuring that attention is paid, piece by piece, to low-hanging fruit, will offer much more protection than many realize.

At the Boston conference, there was a panel discussion entitled "Security in the Cloud Era." And the fact that healthcare finds itself in a "cloud era" when security and the cloud used to not that long ago be considered mutually exclusive by many healthcare security pros, is remarkable.

Over the past 12 months, providers have doubled the share of workloads deployed to the public cloud to 25%, according to HIMSS research.

"I am all about trying to secure her information as it goes to the cloud," said John Houston, vice president, privacy and information security, and associate counsel at UPMC, who manages "hundreds" of different cloud vendors of all shapes and sizes and estimates that some 70% of his compute workload is now remote hosted.

"We all need to be concerned about that reality: We're moving very quickly to the cloud," he said. "Risk follows information. And we'd better figure out a way to get our arms around it."

That's going to be a challenge, and will depend on a fundamental rethinking of some longstanding security practices.

"Perhaps 80% of what a traditional IT or cybersecurity person knows today is irrelevant when moving to the cloud," Halamka said. "Its effectively an entirely new job."

Lee Kim, HIMSS director of privacy and security, was at the Healthcare Security Forum in part to discuss a new report on the intersection of patient safety and cybersecurity.

Dispiritingly, but perhaps unsurprisingly, "we found that patient safety and cybersecurity professionals at hospital organizations simply don't speak to each other too much," said Kim.

"What is healthcare about? At the end of the day it's about patients and patient safety," she said. In the era of IoT and networked medical devices, many without adequate logging mechanisms and forensic data to investigate the reason for aberrational events, "this should be the goal of all healthcare organizations."

But too often, whether in purchasing decisions or simply where their offices are, safety and security teams are siloed from each other.

Too often, IT security labor "deep down in the bowels of the hospital, never seeing the light of day," said Kim. "That's symbolic."

But as Dr. Saif Abded, healthcare cybersecurity expert and co-founder of AbedGraham, explained: "Cybersecurity is patient safety. If you're thinking of it in some other way, like something that sits in a back room somewhere, you're missing the point."

"I think about patients a lot," said Geisinger CISO Stephen Dunkle. "And when I stop doing that, it's probably time to retire."

At the Healthcare Security Forum, attendees were able to ask questions during the panel discussion via the online app Slido. A sampling of some of their questions suggests a trend:

They're good questions. And ones that have been asked before. (Many times, by many different stakeholders.)

What happens with regard to a wider rethink of the law is ultimately up to Congress and other federal policymakers. In the meantime, other HIPAA changes are coming.

But Houston, speaking, one presumes, for many other security and compliance pros buckling under the weight of many overlapping, often contradictory, state, federal and international laws, said a new and more streamlined approach was needed.

"We need uniformity," he said. "My organization has hospitals in three countries and four or five states. We operate in a lot of different jurisdictions. It's very difficult to operate when you really have such a disparity in how information security has to be delivered."

"If we're now dependent on machine learning and AI, what happens when the AI is corrupted?" asked Halamka. "What if an adversary wants to pollute my data set, and I end up with an algorithm that's not set for purpose? These are things we have to start to consider."

And that's just in the near term. Further out in 15-20 years, as Brian Cady, principal security architect at Providence St. Joseph Health, estimated revolutions such as quantum computing could have major and transformative implications for cyber offense and defense.

In the meantime, Greg Singleton, director of the Health Sector Cybersecurity Coordination Center at HHS, said healthcare organizations should be on guard against more quotidian cyber risks: VPN vulnerabilities, outdated Windows versions, networked PACS systems.

"Understand your environment and make sure you don't have something that's inadvertently exposed that could pose a risk," said Singleton.

Also, he highlighted the value of information sharing with groups such as HC3. "It's important that people reach out," he said. "We can do good stuff together."

More here:

What we learned at the HIMSS Healthcare Security Forum - Healthcare IT News

Podcasts About Beyonc, Arias and Health Care: Worth a Listen – The New York Times

At the end of a year filled with more podcast debuts than ever, its sometimes easy to overlook returning shows just as worthy of your time. If you havent given them a try yet, there are plenty of past episodes for your ears to indulge during holiday travels. Below are some recent podcasts that came back for new seasons, followed by a few newcomers to check out.

Dan Weissmann kicked off his podcast last year by likening health care costs to water, arguing that Americans (the fish in this metaphor) are so surrounded by it that we cant see how it changes everyones lives in very real, very painful ways. So each episode of An Arm and a Leg sets out to show you the water, examining a different persons battle to pay for the care they need. Weissmanns charming, empathetic and occasionally expletive-laden approach makes for an entertaining but sobering bottom line: Our health care system is broken, and everyone is suffering for it. Season 3 opens with Stephanie Wittels-Wachs the sister of Harris Wittels and the creator of Last Day, the new podcast that begins with his death. But her episode isnt about addiction or opioids. This is about the battle she pursued to convince the Texas state legislature to cover her daughters hearing aids.

The shows exploration of the hidden traumas within families will undoubtedly convince you that yours isnt the only one with skeletons in its closet. While the first two seasons focused on individuals, Season 3 begins with a three-episode arc unpacking Americas own family ghost. Set in Mobile, Ala., this mini-series focuses on the descendants of the enslaved people aboard the last known slave ship to arrive illegally (50 years after importing humans was banned) on U.S. shores. The ship, the Clotilda, was dismissed by the white residents of Mobile as fantasy, and the descendants living in Africatown have fought for centuries to be believed about their origin story.

How do you make British palaces and their bygone occupants come alive without a trip to the U.K.? You listen to Outliers Stories From the Edge of History. Kings and queens are not the focus here. Instead, each episode is devoted to someone the history books rarely if ever mention: Katherine of Aragons African lady-in-waiting, King George Is Turkish valet, the mistress-turned-wife of the Duke of Gloucester (who happened to be a convicted sorceress). Following each episode is a must-listen interview with the given episodes writer, who explains the choice of narrator to reveal historys forgotten moments.

The first season of this James Beard Award-winning podcast took a deep dive into the exclusionary traditions around gender, identity and femininity in the kitchens of fine-dining restaurants. Katy Osuna, the host and former chef de partie in the three-Michelin-starred Manresa restaurant, is back with a second season that again questions the unspoken rules that keep restaurant work in a vice grip. The new season, Overhead, employs the same storytelling by professional restaurant workers to demonstrate how badly the economics of restaurant labor need disrupting.

The Metropolitan Operas podcast is back for a second season, all about one thing: desire. Hosted by the Grammy Award winner Rhiannon Giddens, each episode features a different aria, exploring how the performance embodies operas most enduring and universal theme. Guests include opera singers like Roberto Alagna, Diana Damrau and Sondra Radvanovsky, as well as fans like Dan Savage, Anna Chlumsky and Dame Judi Dench. Even for a philistine like me, who fell asleep when a date took her to the opera, Aria Code presents a mesmerizing appreciation of these powerful solo performances brimming with universal feelings.

The creators of Making Oprah and Making Obama are back for a third season, and this time theyve left Chicago city limits. The new host, Jill Hopkins, a local radio personality, singer, storyteller and self-proclaimed Beyonc superfan, takes us on a deep dive into pre-Destinys Child Beyonc. Hopkins focuses on the rigorous training that Beyoncs original group, Girls Tyme, endured to try to make it big as a preteen band with adult-grade performances. Really what Making Beyonc provides is the vision of Beyoncs father, Matthew Knowles, as a salesman who channeled his ambition through his daughters extraordinary talent, and the insane competitiveness, pain and professionalism the young girls had to shoulder as they tried to make their (and their parents) dreams come true.

Earhustle isnt the only show made within the walls of San Quentin State Prison. Thanks to the California Arts in Corrections Program and audio classes from KALW, incarcerated men at San Quentin and Solano State Prison have joined forces to produce this moving new show. They take turns interviewing each other stories run the gamut from forgiving abusive fathers to finding peace through yoga. Then following each story is a collective reflection on it, as the men challenge each others ideas of masculinity and offer reassurances that their childhood traumas are not their fault.

In this new podcast, the religion reporter Michael OLoughlin complicates the conventional wisdom that views the AIDS crisis in the 1980s and 90s as a clash between a community dying from an epidemic and the religious institution that turned its back. With survivor testimony and interviews with religious leaders, OLoughlin, himself a gay Catholic man, shares the stories of those who found God in their care for the sick.

If you love hearing authors read their own work, and appreciate well-written prose enhanced with moving soundscapes, youll enjoy this new podcast from Lit Hub, the literary website. Writers like Matt Gallagher, Lidia Yuknavitch and Caitlin Doughty read original works that explore ideas of family, history and the power of a good story. Each episode matches a different sound designer and composer with a writer, and the result is a private reading just for you. The first episode, with Mitch Albom reading from his forthcoming memoir, Finding Chika, is a moving story of adopted fatherhood.


Podcasts About Beyonc, Arias and Health Care: Worth a Listen - The New York Times

Private health insurance premiums should be based on age and health status – The Conversation AU

Private health insurance has come under intense scrutiny in recent months, as it becomes clear health insurers are failing to stop the exodus of young people dropping their cover.

Legislated age-based discounts began in April 2019 but havent achieved their aim of keeping young people in private health insurance. In July to September, the largest decreases in coverage were for people aged between 25 and 34, and in particular 25- to 29 year-olds, with more than 7,000 people in that age group dropping their private health insurance cover in that period.

This trend should come as no surprise. Weve known since the 1970s that young people drop out of private health in voluntary insurance markets, especially those with an underlying universal public system such as Medicare. If too many young people exit the system, premiums go up for everyone.

This was also confirmed by last weeks Grattan report, which argued private health insurance premiums should be made cheaper for Australians aged under 55.

Read more: How do you stop the youth exodus from private health insurance? Cut premiums for under-55s

Its time to change the way insurers are allowed to charge premiums. These should be based on the persons likelihood of using their private health insurance determined not just by their age, but also their health status or risks rather than charging everyone the same.

This could lead to unaffordable premiums for the elderly or the sick. But this potential problem can be addressed through other measures.

In Australia, private health insurance operates under a legislated community rating system. Insurers are forced to charge everyone the same premium for the same cover, irrespective of their age, gender or health status.

This means the young and healthy subsidise older, sicker Australians. Young people end up paying high premiums, relative to their underlying health risk and, as weve seen, this encourages the young and healthy to drop their cover.

Read more: Youth discounts fail to keep young people in private health insurance

The alternative is to establish a risk rating system, where premiums are based on the persons underlying risks.

Risk-based insurance schemes operate successfully in many countries including the United States, New Zealand, Germany, China and Switzerland.

This would mean those who are at low risk (based on their age and other risk factors) pay lower premiums, and those who are at high risk (older people who are more likely to have health problems) pay higher premiums than they currently do.

Risk ratings for private health insurance would challenge the principle of solidarity and affordable access to coverage. These are the reasons community ratings were established in the first place.

Responding to last weeks Grattan Institute proposal to move towards age-based premiums, Private Healthcare Australia chief executive Rachel David told Nine newspapers the community rating rule was critical to keeping health care affordable for our ageing population.

To solve the problem of older and higher-risk members being priced out of private health insurance, private health insurance rebates would need to be redirected.

Rebates are currently a means-tested percentage off the price of your insurance premiums. These discounts are based on income/age and are irrespective of your health needs.

Under a risk-rating scheme, the rebates would need to become risk-based rebates. The rebates would be provided based on a persons health status, such as their age and health conditions, to discount their insurance premiums.

Risk-based rebates would help tackle equity, as those who face higher premiums would get greater rebates.

An additional rebate would apply to people whose expenses are above a certain threshold, to provide additional financial support for those who face the higher premiums. This would help ensure higher premiums dont become prohibitive.

Such a move would require redistributing the A$9 billion in taxpayer subsidies that currently flow to the private health insurance system.

Read more: Do you really need private health insurance? Here's what you need to know before deciding

Risk-based payments are often criticised because of the extensive data requirements consumers would need to disclose, including more personal details, information about the persons past claims and the illness for which theyve been diagnosed.

Risk-based systems are also criticised because of the sophistication of the techniques needed to calculate (and subsidise) individuals risk correctly.

These challenges can be addressed with modern computer-based techniques, meaning this is no longer an unsurmountable task.

It is possible to make Australias private insurance system more sustainable and stop young people leaving the system by relaxing the community rating restrictions and adjusting the rebate system.

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Private health insurance premiums should be based on age and health status - The Conversation AU

4 Healthcare Stocks With FDA Approvals on the Horizon – The Motley Fool

In 1992, Congress passed the Prescription Drug User Fee Act (PDUFA) allowing the U.S. Food and Drug Administration (FDA) to collect fees from drug manufacturers to fund the drug review and approval process. To promote getting novel medicines to patients expeditiously, the act requires the FDA to make its decisions within certain deadlines.

These PDUFA dates provide crucial timing information for biotech investors since FDA approval or lack thereof can create tremendous swings in stock price. Let's explore four companies with PDUFA dates lined up in the first quarter of 2020.

Image source: Getty Images.

Jan. 17 marks the PDUFA date forAimmune Therapeutics (NASDAQ:AIMT) and Palforzia, its immunotherapy for peanut allergy in children and teens. The Palforzia powder is mixed into the patient's food to deliver a small daily dose of peanut protein. Submission of the Biologics License Application (BLA) to the FDA occurred in March, while the FDA convened an advisory committee panel in September to weigh in on the drug's data. The Allergenic Products Advisory Panel voted seven-to-two that the efficacy data supported approval. The panel voted eight-to-one in favor of Palforzia based on its safety profile.

Palforzia addresses a market of more than 1.6 million children and teens in the U.S. with peanut allergies. Combine what appears to be favorable data and a large potential need, and Aimmune's stock could be off to the races. The stock has consistently trended upward since summer.

Epizyme (NASDAQ:EPZM) develops novel treatments for cancers with known genetic causes. Tazemetostat, the company's lead compound, targets the protein EZH2 found in a variety of blood and solid tumors. Epizyme faces a PDUFA date of Jan. 23 for tazemetostat as a treatment for epithelioid sarcoma, a rare subtype of soft tissue sarcomas (STS). First, though, the FDA scheduled an advisory panel to be held on Dec. 18. The outcome of this event will greatly influence its subsequent decision.

From a commercial point of view, seeking a subtype of a subtype with a known genetic marker means the company is seeking very specific patients. This personalized approach can be quite successful as an intervention but challenging to educate oncologists to identify the appropriate patients. Unfortunately, STS, the broader group of cancers this falls into, does not have many good treatment options so physicians likely will embrace new tools for treatment.

After reviewing phase 2 clinical trial data presented at the European Society of Medical Oncology Annual Meeting in October 2018, I'm not excited. Tazemetostat works better in patients who did not receive prior treatment, which seems logical. Those with more advanced disease fared worse. The response rates measuring tumor shrinkage were low, but that is common in STS. The benefit is that this oral treatment seems to work in line with other infused chemotherapy products and thus offers a convenient, potentially less toxic way to combat cancer. I await the views of the panel later this month.

Esperion Therapeutics (NASDAQ:ESPR) holds the distinction of having two PDUFA dates just days apart on Feb. 21 and Feb. 26. First up is bempedoic acid, a once-a-day oral treatment to reduce low-density lipoprotein cholesterol (LDL-C) when added to other lipid-lowering medications. The second PDUFA date will see the FDA weigh in on a combination pill of bempedoic acid and ezetimibe to lower LDL-C in patients with primary hyperlipidemia.

According to Esperion, bempedoic acid works in the liver to prevent cholesterol biosynthesis. Phase 3 clinical trials enrolled more than 4,000 patients with over 2,600 receiving bemedoic acid. This gives the FDA quite a bit of data to mine for both efficacy and safety. Keep in mind that this non-statin alternative could potentially address high cholesterol in 96 million Americans using Esperion's estimate. Therefore, the FDA will not take this decision lightly.

Esperion's current $1.4 billion market cap looks cheap should bempedoic acid get approved. However, because of the size of the potential market, the product launch will require substantial investment. I imagine a pharma suitor will emerge to acquire the company following approval.

March 8 is the PDUFA date for Horizon Therapeutics' (NASDAQ:HZNP) teprotumumab as a treatment for active thyroid eye disease (TED). TED, a serious and progressive eye disease, causes a protrusion on the eye called proptosis. This leads to vision impairment including double vision and vision loss. Teprotumumab, potentially the first-ever FDA approved treatment for TED, successfully demonstrated in phases 2 and 3 clinical trials that it improved proptosis, double vision, and quality of life.

The data looks compelling for the FDA to approve teprotumumab for this autoimmune disease. Horizon also boasts a multidrug product portfolio that generated $936.5 million in net sales so far this year. It expects to achieve between $1.28 billion to $1.3 billion in net sales for all of 2019. An approval for Horizon will add yet another product to its stable. However, for investors, any positive share-price reaction will likely be muted compared to other companies where the approval is the first or only product to get approved.

FDA advisory committee reviews and the approval decisions can propel the stocks of drug developers dramatically. Correct predictions of the outcomes can generate substantial returns for biotech investors. Aimmune and Esperion seem to have the greatest chance for success and commensurate stock appreciation.

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4 Healthcare Stocks With FDA Approvals on the Horizon - The Motley Fool

Dozens of health-care providers oppose potential insurance regulation changes in open letter – Calgary Herald

Repair planner Gary Ferguson writes an estimate to front end damage to a pickup at Herbers on Parsons Road.File photo

Almost 90 doctors and medical professionals opposed potential unfair changes to insurance regulations they said could cause those injured in motor vehicle accidents to pay more for medical care in a Thursday open letter to Premier Jason Kenney and Finance Minister Travis Toews.

Released by insurance fairness advocacy organization Fair Alberta Injury Regulations, the letter signed by 87 medical practitioners expressed concern that the insurance industry is now advocating for concussions and some other chronic conditions to be classified as minor injuries alongside sprains and strains.

Open Letter Re FAIR Insurance Regulations by Moira Wyton on Scribd

Patients with more expensive, complex and long-lasting injuries would have to pay more, the signatories said, because insurance payments for minor injuries have been capped since 2004.

Concussions, PTSD and chronic pain are not minor injuries and should not be categorically described or treated as such, said the letter. Expansion of the regulation is unfair to innocent Albertans who have been victimized in vehicle accidents.

Those are conditions that can haunt people for life, said Fair Alberta spokesman Mark Feehan in a previous interview.

Jerrica Goodwin, press secretary to Toews, said in an emailed statement to Postmedia that the government has not yet made any decisions on the regulation in question or other further changes to the insurance industry.

Government is currently reviewing the challenges associated with Albertas automobile insurance system, she said. This is a complex issue and our government will be looking at reforms to Albertas insurance system and will be considering a wide range of options.

The letter isnt the first time Fair Alberta has opposed insurance changes by the current UCP government.

In November, the province decided to end the five per cent auto insurance cap introduced by the former NDP government because they were hearing from companies that they were losing money by paying out morein benefits than they were making in premiums.

Premier Jason Kenney said recently that personal injury claims have been growing massively, contributing to higher premium costs.

Our goal is to ensure affordable and accessible insurance for Albertans, while ensuring the long-term sustainability of Albertas insurance system, said Goodwin, noting that they are engaging with key stakeholders throughout the process.

With files from Anna Junker



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Dozens of health-care providers oppose potential insurance regulation changes in open letter - Calgary Herald

At Harvard, Grad Students Form A Picket Line Over Wages, Health Care And Protections – NPR

Union members protest at Harvard University in May over an increasing number of harassment and discrimination cases. The union began an indefinite strike Tuesday, with one of its key proposals aimed at strengthening protections against harassment and discrimination. Michael Dwyer/AP hide caption

Union members protest at Harvard University in May over an increasing number of harassment and discrimination cases. The union began an indefinite strike Tuesday, with one of its key proposals aimed at strengthening protections against harassment and discrimination.

Graduate students at Harvard University began an indefinite strike Tuesday after a deadline to fulfill contract demands such as pay equity and health insurance were not met by administrators.

Negotiations between the two sides are ongoing, but the union which represents about 4,400 student workers said an agreement is not close to being met. Representatives with Harvard Graduate Students Union-UAW accused the university of neglecting several issues that students have faced for years.

The strike began on the last day of classes for the fall semester, impacting thousands of students preparing for final exams.

"Our negotiations have not yielded a fair agreement," Ege Yumusak, a Ph.D. candidate on the bargaining committee, told NPR.

"[Most] importantly, we haven't heard responses from the administration on our demands for our basic rights and protections, such as protections against harassment and discrimination, that other unionized workers on this campus have, as well as thousands of student workers across the nation," Yumusak said.

Negotiations began in October of last year, with tentative agreements being reached on several proposals. However, bargaining reached an impasse.

Harvard administrators described the strike as "unwarranted" in a statement Tuesday.

Union negotiators allege that the Ivy League university is failing to recognize the rising cost of living in the Greater Boston area. The latest proposal from university officials offered to raise the minimum rate to $15 an hour, with an 8% increase over three years for salaried student workers. However, the union said the university, with its multibillion-dollar endowment, can do better.

Grad students are also calling for the university to implement better protections from academic harassment and discrimination by establishing an independent third-party arbitrator. The proposal would not replace Title IX the federal law that prohibits gender discrimination on campus and mandates sexual misconduct investigations which union leaders said has "failed too often to be considered reliable."

Affordable health care is also on the union's list of demands. Grad students are seeking improvements to what they call inadequate dental, mental health and specialist coverage.

According to union leaders, there are also several issues the university either has refused to negotiate on or has not offered a proposal on.

Despite the disruptions during exam time, Yumusak said undergraduates are showing solidarity.

"We expect many of them to join us at the picket line," she said. "They understand that our working conditions are their learning conditions."

In addition, in solidarity with the labor action, dozens of Harvard faculty members have promised that strike participation will not have an adverse effect on their evaluation of grad students' work or academics.

Support for the strike has extended outside Harvard's campus. All 11 congressional representatives from Massachusetts, including presidential hopeful Sen. Elizabeth Warren, signed a letter Tuesday urging university officials to reach an agreement with the union.

Paolo Zialcita is an intern on NPR's Newsdesk.

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At Harvard, Grad Students Form A Picket Line Over Wages, Health Care And Protections - NPR

Cerner taps Amazon Web Services to ramp up healthcare AI capabilities, predictive technology – FierceHealthcare

Health ITcompany Cerner is deepening its partnership with Amazon Web Services to build new prediction tools and a virtual medical scribe for healthcare providers.

Cerner named AWS itspreferred cloud provider in July. At the AWS re:Invent conference in Las Vegas this week, Cerner expanded that partnership by naming AWS its preferred cloud, artificial intelligence, and machine learning provider.

"For 40 years, Cerner ushered in health cares digital age by moving medical data from paper charts and manila folders into electronic health records,Cerner CEO and Chairman of the Board Brent Shafer said during the AWS re:Invent conference Monday.

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Cerner's work with AWS will put the company at the"leading edge of cognitive data," Shafer said.

"Where were headed is taking the digital age to a new level to reduce costs, providing more insights into diseases, and giving clinicians back valuable time," he said.

RELATED:Cerner, Amazon Web Services partner on new cloud-based cognitive health platform

The Kansas City-based company will use AWSs broad portfolio of services, including machine learning, analytics, and Internet of things (IoT), to help create the "next chapter of healthcares digital age," company executives said, which will focus on advancing the patient care experience, improving the health of populations, and reducing the per capita cost of healthcare.

As part of the multi-year agreement, Cerner willmigrate its core applications to AWS and willstandardizeits artificial intelligence and machine learning workloads on the public cloud.

Using AWS' capabilities, Cerner is developing a new platform, called theCerner Machine Learning Ecosystem (CMLE), to helpdata scientists build and deploy machine learningmodels for healthcare applications at scale, the company said. The goal is to uncover predictive and digital diagnostic insights that will offer earlier health interventions.

One potential use case: Developers will be able tocreate chatbots that give patients access to their personal health records and answer patients' questions about medication, diagnoses, and medical conditions.

The health IT company is focused on developingpredictive technology to help organizations preventhospitalreadmissions and reduce healthcare waste. To do this, the company is leveraging de-identified patient data to help make early determinations of what is causing return hospitalizations.

RELATED:Microsoft, Humana ink 7-year strategic partnership to leverage cloud, AI and voice technologies

The company already is working with a post-acute healthcare provider on a project to identify patients at risk of hospital readmission. usingmachine learning applied to historical data migrated to the AWS cloud.

The collaborationis part of agrowing trendof healthcare providers, payers, and technology vendors migrating to cloud platforms offered by big tech giants. Mayo Clinic has entered into a 10-year strategic partnership with Google to use the tech giant's cloud platform to accelerate innovation through digital technologies. Insurance giant Humana and Microsoft announced a seven-year strategic partnership to usecloud and artificial intelligence technologies to build predictive solutions and intelligent automation to support Humana members and their care teams.

These technology partnerships raisesome thorny issues around connections topatients' health data.Google is facingsignificant blowback, including scrutiny from regulators and lawmakers, following news that it iscollecting personal health information on millions of patients in a partnership with Ascension.

Cerner also wants to use machine learning andvoice tools to automate medical documentation and clerical work for doctors.

RELATED:Amazon Web Services launches Transcribe Medical speech recognition service for clinicians

At the conference on Sunday, AWS announced the launch ofAmazon Transcribe Medicalas a speech recognition service for clinical documentation. Cerner plans to use Amazon Transcribe Medical's transcription application programming interface to develop a digital voice scribe. That voice toll will "automatically listento clinician-patient interactions and unobtrusively capturethe dialogue in text form," Jacob Geers, solutions strategist at Cerner said in an AWS press release. "From there, our solution will intelligently translate the concepts for entry into the codified component in the Cerner EHR (electronic health record) system," he said.

The digitization of health care has inadvertently caused an increase in documentation for physicians, according to Shafer.

"Working with AWS will allow us to capture doctor-patient interaction and integrate it directly into the electronic workflow of the physician. This new advancement will help doctors and providers spend less time filling out forms and more quality time with their patients," he said.

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Cerner taps Amazon Web Services to ramp up healthcare AI capabilities, predictive technology - FierceHealthcare

Meridian ‘hopeful’ agreement can be reached with OSF HealthCare – week.com

PEORIA (WEEK) -- OSF HealthCare recently announced it would terminate its agreement with Meridian and that the health insurance provider owes OSF "millions of dollars."

Now, Meridian says they are working with OSF on terms for a new contract and is "hopeful than an agreement will be reached," according to a press release sent Tuesday by Meridian.

"In the meantime, our members continuity of care remains our number-one priority. In the event we are unable to reach an agreement, we have a comprehensive process in place to transition our members to alternative providers within the MeridianHealth network," according to the release.

On Monday, OSF said Meridian owes millions of dollars to the Peoria-based health care provider "millions of dollars for outstanding claims for services provided over the past five years."

OSF's notice of termination said the agreement would end December 15.

We are unfortunately at a standstill with Meridian because for years they have failed to honor the most basic components of our agreement and will not come forward to resolve outstanding accounts, said Randy Billings, OSF HealthCare senior vice president of population health in the press release by OSF Monday. We are concerned for Meridian members, which is why we contacted the Illinois Department of Healthcare and Family Services and Meridian members to make them aware of the situation.

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Meridian 'hopeful' agreement can be reached with OSF HealthCare - week.com

‘An Arm And A Leg’ Podcast Explores The Cost Of Health Care In America – WUWM

Leading up to the 2020 election, Americas unusual approach to health care is on full display. The hot-button issue is a consistent talking point for both Democrats and Republicans since it has a huge impact on all American citizens.

Health care costs are prohibitively expensive, sometimes costing thousands of dollars for a quick trip to the emergency room, as many have experienced. These stories were part of the inspiration for the podcastAn Arm and a Leg, which showcases the horror stories and hard-fought victories of people dealing with Americas health care system.

Dan Weissman is the host and executive producer of the podcast, which premiered its third season in December. The fourth episode of the third season comes out on Thursday and deals with the hidden costs of emergency room visits.

"This is a long struggle and the cavalry is not coming."

"One of the things that I ended up thinking about, especially as we had completed two seasons, is that this is a long struggle and the cavalry is not coming," says Weissman.

Lake Effects Joy Powers spoke with Weissman about the impact and stories of health care costs in the U.S.:

Dan Weissman, host and executive producer of "An Arm & A Leg" podcast, speaks with Lake Effect's Joy Powers.

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'An Arm And A Leg' Podcast Explores The Cost Of Health Care In America - WUWM

Give it 5 stars: How doctor ratings affect your health care | TheHill – The Hill

Consider a fantastic experience at a restaurant with delicious food, timely customer service, and amazing ambiance.A diner may feel compelled to give that business a five-star rating on Yelp. It exceeded expectations and the restaurant can benefit from the power of a positive online review.

Now consider a visit with a physician.What would make it a five-star experience? And how would excellent service be defined in the medical setting?

As a physician, my goal is always to deliver effective and empathic health care to all of my patients. My goal is not to receive a high rating. Due to bias, subjectivity and other motivations, the random online patient ratings system is a hinderance, not a reliable guide, to good health care.

For many Americans, the end of the calendar year means they have already met health insurance deductibles and out-of-pocket maximums. This can make medical services less expensive and lead patients to search online for new physicians. However, in deciding on a doctor, patients need to be cautious not to confuse customer satisfaction with evidence-based, patient-centered care.

When making decisions about their health, patients are acting increasingly like typical consumers, who value online ratings. According to a 2018 study from NRC Health, 92.4% of consumers use online reviews to guide most of their ordinary purchasing decisions. The survey revealed that 59.9% of patients say theyve selected a doctor based on positive reviews, and nearly the same percentage (60.8%) of patients say theyve avoided doctors based on negative reviews.

These trends have huge implications for the quality of health care in the U.S., since patient ratings depend on often-inaccurate and potentially biased patient perceptions, rather than on more objective measures of good medicine.

Research shows that patient ratings tend to be biased against female and minority physicians. A 2018 study in the Womens Health Issues journal showed that women gynecologists are 47% less likely to receive top patient satisfaction scores compared with their male counterparts owing to their gender alone.

Another 2019 study in Health Equity found significant difference in patient satisfaction scores between underrepresented and white physicians.

Additionally a 2018 paper in the Journal of General Internal Medicine shows the different expectations that patients have for female and male physicians. Female patients tend to seek more empathic listening and longer visits, especially with female physicians. As a result, patient satisfaction with female physicians is subjected to gendered stereotypes and expectations with hidden rules for appropriate behavior.

Even if this implicit bias is overlooked in physicians, online reviews for products and services are hardly reliable.

Recently the skin care brand Sunday Riley settled with the Federal Trade Commission after the company was accused of posting fake reviews of their products on Sephora's website for two years.Thirty percent of Amazon product reviews also were found to be falsified by Fakespot, which analyzes online ratings for accuracy.

But the rippling effects of a fake review of body lotion pales in comparison to fake reviews of physicians, who deal with life and death.

In spite of this, the NRC study showed that 83 percent of patients trusted online ratings and reviews more than personal recommendations. Yet patient reviews on heavily trafficked sites, such as Vitals.com, Healthgrades.com, and WebMD.com are not vetted for accuracy.There is no verification that reviews are even written by actual patients.

This means that anyone an angry former employee or a grumpy neighbor can tarnish a physicians online reputation and sway potential patients with the click of a button.Conversely, there is nothing preventing associates of physicians from posting fake positive reviews.

Due to federal privacy laws, there is little recourse for physicians who are faced with negative online reviews. Unlike other businesses, physicians cannot respond to comments posted online because it violates patient privacy to simply acknowledge someone is a patient.This leaves doctors particularly vulnerable to personal and professional attacks.

When a Miami plastic surgeon attempted to sue two patients earlier this year for what he described as inaccurate reviews, he received negative press and additional negative reviews (that may or may not have been from actually patients).

Perhaps most importantly, though, high patient satisfaction scores have been linked to worse care.Motivation to achieve a high rating can influence doctors to prescribe unnecessary treatments and order unwarranted tests. Patients can use the threat of a poor online rating to leverage their requests.

A 2018 study in JAMA reported that telemedicine patients who received an antibiotic for a respiratory tract infection (e.g. a cold) gave high ratings.This is concerning since respiratory tract infections are usually viral and rarely warrant antibiotic use, which can lead to dangerous outcomes for patients.

Recently a Washington state physician sued her former employer, Kaiser Permanente, alleging the way the company used patient satisfaction scores hurt her career and incentivized doctors to over-prescribe painkillers. Evidence shows that patient satisfaction has played a role in the opioid epidemic.

This intense focus on patient ratings is a factor contributing to physician burnout, which also negatively affects patient care. Many doctors are under pressure to see more patients with shorter appointment times, but still maintain excellent customer service.

Patients may not know or understand that a physician may be running late not because she is rude, but because she was comforting a patient with a new cancer diagnosis.Its hard to imagine that this empathetic doctor deserves a poor online rating, but there is nothing preventing this result.

The consensus from physicians themselves is clear: there is an active petition with over 40,000 signatures to remove online ratings from Yelp and Healthgrades.com.

To be sure, checks and balances on physicians are undoubtedly important. While physicians take an oath to do no harm, no industry is free from bad actors. If in doubt, see Dr. Death podcast for an extreme example of this malpractice. Monitoring by state medical boards and hospital quality assurance committees are traditional ways to ensure patient safety.

When seeking medical care, patients can view online reviews with the understanding that they can be flawed, biased and subjective. Patients deserve the best healthcare possible and need to understand good ratings do not always lead to good doctors. Save the stars for the restaurants, not the physicians.

Lisa Ravindra is an assistant professor of Internal Medicine and a primary care physician at Rush University Medical Center in Chicago. She is a Public Voices fellow through The OpEd Project.

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Give it 5 stars: How doctor ratings affect your health care | TheHill - The Hill

Brits freak out when told the price of health care in the United States – Boing Boing

Brits freak out when told the price of health care in the United States / Boing Boing

"So if you're poor, you're dead." That's what a woman in the U.K. said when she was told the price of health care services in the U.S.

No doubt many people in the U.S. do die from the high price of health care, but the ones who survive but can't pay their bills are likely to be sued by the hospital.

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Brits freak out when told the price of health care in the United States - Boing Boing

Lower number of people covered leads to higher rural health insurance premiums, study finds | The Source – Washington University in St. Louis Newsroom

Small risk pools may contribute to the challenges faced by private insurance plans in rural areas, in which case risk reinsurance, or insurance for the insurer, is a potential policy solution, finds a new study from the Brown School at Washington University in St. Louis.

A health insurance risk pool is a group of individuals whose medical costs are combined to calculate premiums.

A lot of our prior work on market-based insurance has shown that premiums tend to be higher in rural areas, and there is anecdotal evidence, often put forth by insurers, that a lack of health care providers is a factor in making insurance more expensive, said Abigail Barker, research assistant professor and author of Effect Of Population Size On Rural Health Insurance Premiums In The Federal Employees Health Benefits Program, published Dec. 3 in the December issue of the journal Health Affairs.

Insurers are sometimes required to contract with certain providers in order to satisfy network adequacy standards, but this research suggests that a more important factor is likely to be the low numbers of lives covered in a particular place, said Barker, who is faculty lead for data and methods at theCenter for Health Economics and Policyat the universitys Institute for Public Health.

The model controls for provider availability and various other possible explanations, and I find that additional enrollment is the factor most associated with lower premiums, she said. This makes sense because insurance is fundamentally about spreading risk, and it relies upon having large numbers of people in a given risk pool in order to work well.

Using data from the 2013-16 Federal Employees Health Benefits Program, Barker focused on premium and enrollment data for state-specific plans which offer insurance policies and set premiums at the regional level.

In nonmetropolitan counties, she found that each additional plan enrollee was associated with a 10-cent lower per capita biweekly premium, whereas this effect was trivial in metropolitan counties.

Low health care provider counts were not associated with higher premiums in nonmetropolitan areas, nor was the degree of insurer competition an important predictor of premiums, she said. However, there was substantial correlation over time, which suggests that some variables may be viewed less as sources of premium variation and more as influencing long-term premium levels.

Barkers current work for the Rural Policy Research Institute focuses on understanding how markets can be successfully integrated into the health care sector, using the Affordable Care Act and Health Insurance Marketplaces data as well as Medicare Advantage data to inform rural health policy.

Barker will present her findings Dec. 4 during an eventat the National Press Club in Washington, D.C.

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Lower number of people covered leads to higher rural health insurance premiums, study finds | The Source - Washington University in St. Louis Newsroom

63% Say U.S. Health Care Has Huge Problems and Thats an Improvement – Yahoo Finance

Heres a nugget of good news: Nearly two-thirds of Americans surveyed by Gallup say that the U.S. health care system is in a state of crisis or has major problems. Yes, thats good news because Gallup says its one of the least negative assessments since it started tracking the issue in 1994 and the lowest since 2002. Over the last 25 years, the average share of Americans who rate the health care system as being in crisis or having major problems has been 69%.

Of course, the results are clouded by partisan differences in perception of the health care system. Republicans negative views have dropped significantly since hitting a peak of 80% in 2016, the last year of President Obamas second term.

The bottom line: Americans' perceptions of the state of the U.S. healthcare system have been steady, with between 60% and 70% assessing it as having at least major problems, Gallups Justin McCarthy says. This has been consistent across four presidencies with differing approaches to healthcare policy.

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63% Say U.S. Health Care Has Huge Problems and Thats an Improvement - Yahoo Finance