FALSE: Convicted Ampatuan brothers are ‘Liberal Party members’ – Rappler

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Claim: Facebook page Pork Ng Ina Mo claimed that Andal Ampatuan Jr., who was convicted in the gruesome Maguindanao massacre in 2009, was a Liberal Party member. (READ: WATCH: Trial of the decade: Highlights of Ampatuan massacre case)

The page posted it on December 20, a day after the verdict on the Ampatuan massacre was handed down.

The post also included a graphic that included a screenshot of a tweet by Liberal Party president Kiko Pangilinan and a photo of former Datu Unsay, Maguindanao mayor Andal Ampatuan Jr. wearing a yellow shirt.

The caption for the post reads: Isn't it wonderful how Dilawans praise the conviction of the Ampatuans, who are members of their political party?

The post has gained over 300 shares with 650 reactions and 140 comments, as of writing. The claim was flagged by Facebook Claim Check, a tool used for spotting potentially false posts spreading on social media.

Rating: FALSE

The facts: The masterminds of the Ampatuan massacre were officials of the Lakas-Kampi-CMD, the party of former Philippine president Gloria Macapagal-Arroyo. In fact, the Ampatuans were expelled from Lakas-Kampi CMD two days after the massacre.

The Ampatuans were allies of Arroyo, head of the Lakas-Kampi-CMD coalition at the time of the massacre. Arroyo is now a close ally of President Rodrigo Duterte.

The Ampatuan family delivered votes for Arroyo in the 2004 presidential elections as well as a 12-0 sweep in favor of her selected senatorial slate, Team Unity, in the 2007 elections.

When the massacre happened, Zaldy Ampatuan one of those convicted in the massacre was the regional chairman for Lakas-Kampi, while his father, Ampatuan clan patriarch Andal Ampatuan Sr., was the party's provincial chairman for Maguindanao province. Both were stripped of these positions following the massacre.

Andal Ampatuan Sr. was also among those accused of masterminding the massacre. He died in 2015 while on trial for the massacre.

At the time of the massacre, the senior Ampatuan had already reached the limit of 3 terms for the post of provincial governor of Maguindanao. The man convicted for leading the gruesome massacre, then-mayor of Datu Unsay town Andal Ampatuan Jr., was selected by the family to succeed his father as governor.

Then-vice mayor of Buluan town Esmael Mangudadatu (now Maguindanao 2nd district representative) also chose to run for governor. (READ: Who is Toto Mangudadatu?)

Mangudadatu's wife, his female siblings and other relatives were among those slaughtered in the massacre. They were headed for the provincial capitol, Shariff Aguak, to file a certificate of candidacy on his behalf when they were abducted and eventually murdered. Glenda Marie Castro and Gemma B. Mendoza/Rappler.com

Keep us aware of suspicious Facebook pages, groups, accounts, websites, articles, or photos in your network by contacting us at factcheck@rappler.com. Let us battle disinformation one Fact Check at a time.

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FALSE: Convicted Ampatuan brothers are 'Liberal Party members' - Rappler

Star Wars and the US health care system share this: bloat – STAT – STAT

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The final film in the epic Star Wars saga, Star Wars: The Rise of Skywalker hit theaters this weekend. It should have had fans around the world buzzing. Instead, many of them are either yawning with disinterest, or speculating on YouTube about just how bad the last installment in the 40-year-old series might be. The critics have panned the film in early reviews, with Rotten Tomatoes pegging the critical score at a meager 58%. What happened to Star Wars?

As a doctor, movie lover, and proud tech geek, I often see parallels between work and my other hobbies.

When I think about Star Wars, especially what has happened to the franchise after the Disney acquisition of Lucasfilm in 2013, some stark comparisons to the U.S. health care system come to mind. Our system is in many ways fragmented, bloated with administrative expense and, if were candid, mismanaged at the macro level. Star Wars has followed a similar path since the new Disney trilogy was launched in 2015 that, in my view, accounts for many of the problems the franchise is currently suffering from.

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Rewind to the first Star Wars movie (now called Episode IV: A New Hope), youll find a far different production than the $200 million extravaganzas produced by Disney. A New Hope debuted in the summer of 1977 and went on to become one of the highest grossing films of all time. It featured a clear plot that pitted good against evil, realistic (for the time) special effects and, most importantly, substantial character development inspired by timeless mythological storytelling. Moviegoers were thrilled, and many of them went back to the theaters to see Star Wars again and again.

A New Hope was followed up by two excellent sequels that continued the saga in 1980 and 1983, both which adhered closely to the formula established in the first film.

Fast forward 42 years, and you have a far different Star Wars. The basic elements of an action-adventure set in space are the same. Unfortunately, the iconic film series is now packed with a multitude of characters (some important, many not) and bloated storylines that ping-pong viewers between concrete plot development and over-the-top action sequences. Some moviegoers are satisfied on the surface with the glitz and fancy CGI, but true fans of the series complain that their underlying expectations werent met by the fragmented stories and lack-luster character development. Moreover, the new films now also incorporate elements of current politics that feel out of place in a story meant to transcend time.

Health care in the 1970s was, in many ways, the starting point for the system that we have today. I believe it has followed a similar course to Star Wars. The bill that laid the groundwork for what we now know as Medicare and Medicaid was being implemented, and President Richard Nixon unveiled his plan to require employers to offer health insurance to employees while providing subsidies to those who had trouble affording medical care.

The U.S. health care system made sense. It was becoming clear, affordable for most people, and was set to provide the best medical care in the world. With these legislative imperatives, it appeared everyones health care needs were now going to be met.

However, like the unravelling of Star Wars, bloat began to seep in to the health care system. A bevy of laws required more governance and more administrative staff to ensure compliance and reimbursement for medical services. One can chart the growth in how expensive U.S. health care has become by simply looking at the growth of the ratio of administrators to doctors since the 1970s.

According to a Harvard business Review blog post by Robert Kocher, there are now 10 administrators for every one doctor in the U.S. today. And 95% of new hires in health care arent doctors or nurses, they are administrative hires that have little to do with caring for patients. This represents a growth rate of over 3,200% from where we were in 1975:

By the late 1990s, national health care spending in the United States had sky rocketed and accounted for 12.1% of total GDP the highest thus far in the history of the country. Fast forward to the 2010 and the introduction of the Patient Protection and Affordable Care Act, commonly known as the ACA, which had the potential to dramatically improve the system. Unfortunately, this potential came along with new ACA requirements for electronic medical records, dramatically increasing workloads on physicians with little discernable benefit for patients. Moreover, expanded regulation and insurance benefits mandated by the ACA resulted in even more administrative expenses.

While the ACA did successfully increase insurance coverage, the additional costs were often borne by patients in the private insurance market in the form of skyrocketing insurance premiums and higher out-of-pocket deductibles. Today, the health care system now consumes an eye-popping 17.8% of GDP.

As was the case with the growth in Star Wars film budgets under Disney, bigger and more expensive didnt necessarily translate into better health care. Bigger in health care has led to a reality in which my fellow doctors have their attention diverted into electronic medical records and away from patients, a situation that has contributed to an epidemic of physician job dissatisfaction and burn out.

The following decade was one in which political divisions and competing reimbursement models created an ever more convoluted and fragmented approach. The system is again poised to be a political football in the 2020 presidential election. Recent polling suggests that health care is the number one concern among U.S. voters.

Yet it is tragic that the U.S. now ranks amongst the lowest among developed nations for health care, despite spending the most. This reality is shocking, given that the U.S. is widely acknowledged as having some of the best doctors in the world, along with the most advanced medical technologies and therapies.

As in the new Star Wars, which due to bad management decisions from the top of Lucasfilm has had a rotating cast of directors and writers, there are too many competing stakeholders in the health care system for the average patient to even keep track. And as major tech companies begin moving deeper into the industry, they have inadvertently ignited controversies over patient privacy. Drug costs that many Americans simply cant afford are another pain point. Against this backdrop, its easy to see why the system leaves so many feeling insecure and vulnerable.

In the movie business, the focus should always be on the audience. Giving the audience thrilling films that transported them to a galaxy far, far away is what made Star Wars successful in the first place. The analog in health care is a laser focus on the patient. Delivering the best care possible is what made the U.S. health care system the envy of the world. With the potential re-thinking of the health care system in 2020, my hope is that we can regain that patient focus by simply letting doctors do the work they love.

And as for Star Wars, The Rise of Skywalker, smaller might be the future. After all, who doesnt love the Internets latest sensation, Baby Yoda?

Amit Phull, M.D., is medical director and vice president of strategy and insights at Doximity.

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Integrating mental health care into primary care will require big changes | TheHill – The Hill

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Imagine a visit to your primary care doctor that did as much to assess and treat your mental health as it did your physical health. How would such an encounter differ from the ones most of us are accustomed to? Your doctor would ask about your mental wellbeing along with questions about your diet, exercise, lifestyle choices and social behaviors such as smoking. He or she would integrate behavioral health counseling into your physical health care, providing guidance so you can self-manage your medication, nutrition and exercise.

Under this scenario, a physicians primary care practice would be fluent in behavioral health clinical guidelines and standards of care, confident in clinical decisions, and deeply familiar with the community social supports available to patients.

Sounds great, doesnt it? A growing body of research gives us good reason to think it would be. Unfortunately, making this scene a reality for primary care patients across the country is much more complicated than adding a few questions to physicians typical script. For example, while patients interact directly with a practices reception staff, physicians and other health care providers during their visit, there is a whole back-end infrastructure that patients may not be aware of that enables the practice to function from billing and coding protocols to electronic medical records systems to care management platforms that often isnt built to support behavioral health care integration.

Still, I know that the integration of mental health care into primary care is possible, in part because were making strides in this direction in New York at both the state and city levels, and in part because its a health industry-wide goal thats too important to give up on.

In my roles as a public health leader, practitioner, professor and researcher, I have focused on reconceptualizing and transforming community-based health care delivery systems. Plenty of primary care physicians are reluctant to change how they operate in order to integrate behavioral health care into their practices. This is understandable; doing so would involve developing a familiarity with new assessments, medications, diagnoses and treatment styles a new way of practicing the craft that they have honed for decades. The overhead for accommodating these changes, in addition to the back-end system changes mentioned above, is significant and often prohibitive. What will catalyze such systems-level seismic shifts in motion?

Policy has a role to play. As our countrys health care system and especially legislation regarding its financing continues to evolve at the federal, state and local levels, incentives to integrate mental health care into primary care must be baked into health care financing structures. New York is demonstrating how this might be done. The states Office of Mental Health is building incentive structures to encourage primary care providers to adopt the Collaborative Care Model, or the integration of behavioral health services into the primary care setting. The Collaborative Care Medicaid Program, launched in the state in 2015, offers primary care providers a method of financial sustainability to integrate behavioral health care into the primary care setting through supplemental monthly payments at a specified case rate.

There are still restrictions on health care practices that qualify for and maintain participation in the program; for example, practices must demonstrate achievement of quality metrics and ongoing use of patient registries to continue receiving the full case rate. Additionally, the upfront start-up costs of establishing the necessary infrastructure can be a heavy lift for many independent primary care practices.

Policy changes are not enough. Beyond changing financial incentive structures at the health care system level, we must empower primary care providers to see for themselves how integrating behavioral health care into their practices truly benefits patients and improves health outcomes. In New York City, this education is a critical part of the Department of Health and Mental Hygienes mandate to provide ongoing technical assistance to primary care providers to help them understand how offering behavioral health services will support their success in a value-based purchasing landscape.

Health departments across the country should make it part of their mission to convey the significance that behavioral health integration may have to the primary care providers they serve. Not only is what were doing in New York City replicable elsewhere, but its also highly adaptable to the unique socioeconomic characteristics and needs of other cities that can tailor the model in a culturally humble and accessible manner.

I hope that we in the health care field wont stop there. Lets continue to expand our goals, think broader, reach wider, and acknowledge that beyond the primary care environment, there are many other settings that would benefit from more focus on behavioral health. Consider hemodialysis centers, where people with chronic kidney failure undertake weekly dialysis. Or bring to mind oncology, hematology, palliative care and other community-based settings and the significant occurrence of anxiety, depression, mood disorders and other mental health conditions in these contexts. These are optimal environments to drive behavioral health integration beyond just the primary care setting.

We also must keep in mind that the integration of mental health care into primary care settings is a journey, with each step a milestone. It is part of a broader strategy towards embracing population health as an ideology, not just a model clinical outcome towards which we strive. Whether it starts with enabling a private practice behavioral health clinician to co-locate within a partnering primary care facility, or with having the primary care facility itself directly offer the full suite of behavioral health services, we need to be comfortable that each milestone itself is a means of integration across a continuum of strategies and options.

Were past the point of wondering whether behavioral health care integration can help save lives we know it does. Lets talk more about how were going to make it happen.

Hewett Chiu is an adjunct assistant professor of health administration at New York Universitys Robert F. Wagner Graduate School of Public Service. He also is executive director, MHSC at the New York City Department of Health & Mental Hygiene and president of the Academy of Medical & Public Health Services.

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Robert Gehrke: Getting health care to low-income Utahns never should have taken so long or cost so much – Salt Lake Tribune

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It was great news, meaning as many as 120,000 low-income Utahns will have access to health insurance with the feds paying 90 cents of every dollar in cost. And they can sign up on Jan. 1.

Bill Tibbitts, an anti-poverty advocate who has fought for the expansion, thanked Herbert for his work to get it done.

If only they had adopted my Healthy Utah plan five years ago, the governor replied.

For more than five years since, these legislators relentlessly fought to block Medicaid expansion and to deny care to those who desperately needed it. They succeeded, until voters revolted.

But even after voters, more than 555,000 of them fed up with the ideologically driven intransigence, took the nearly unprecedented move of backing a ballot initiative, lawmakers immediately dismantled portions of it, and opted for a scaled-back partial expansion.

Ignoring the will of the people has meant that, since April, Utah has been covering tens of thousands fewer people than otherwise would have been eligible and at a substantially higher cost while being gaslighted by legislators who claimed it was in the name of fiscal conservatism.

It was surreal watching legislative leaders patting themselves on the back Monday for a job well done.

The [approval] will provide more Utahns with the coverage they need while saving Utah taxpayers millions of dollars in potential costs, said House Speaker Brad Wilson.

Wilson was among the legislators who voted to kill Herberts Healthy Utah plan back in 2015, which, again, is nearly identical to the proposal Wilson is now championing.

The five-plus years of delay had a significant cost.

Over the past nine months when lawmakers were clinging to their scaled-back partial expansion Utah has foregone more than $530 million in federal Medicaid support, according to calculations by Joe Weissfeld of Families USA. Spread over the course of the past six years, it has cost the state an estimated $5.5 billion money you and I paid into the Medicaid program but which Utah lawmakers refused to accept when it was supposed to come back to help the poor.

Thats the dollars and cents or nonsense side of it. Then there are the lives lost.

Even if you think that estimate is inflated, go ahead and cut it in half and it is still a heartbreaking toll.

Stacy Stanford, an analyst with the Utah Health Policy Project, said she got involved in the fight for expansion because she was one of those who spent five years in the so-called coverage gap. Along the way, she said, she encountered a lot of people in the same circumstance and a lot of them died without ever getting the coverage they needed.

There are just so many stories like that, she said. Now we dont have to tell those stories anymore.

Now the challenge becomes getting people signed up. Since the partial expansion got underway in April, enrollment has fallen well short of the projections about 40,000 now covered, rather than the 70,000 expected.

Now, tens of thousands more will be eligible for coverage and at long last have access to preventative care, and possibly early life-saving diagnoses. Theyll be free from the threat of one health crisis leading to financial ruin. Finally, those people have the prospect for a healthier, happier new year.

To find out if youre eligible for Medicaid and to enroll, visit medicaid.utah.gov.

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Hospitals, not drugs, are the big driver of health care costs – New York Post

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Its perfectly fine for politicians to look at ways to keep prescription drugs affordable. But why does the bigger problem of soaring hospital bills get so little notice?

Centers for Medicare and Medicaid Services data out this month show that retail prescription drug prices declined by 1.0 percent last year, to $335 billion, while spending for hospital-care services rose at about the same rate as in 2017, to $1.2 trillion.

And thats nothing new: The Bureau of Labor Statistics reports that drug prices have gone down for more months this year than theyve gone up, something the White House understandably celebrated.

Hospitals represent a third of total US health-care spending, drugs just a tenth. And a new analysis in the journal Health Affairs shows that over the past four years, hospital spending jumped 15.2 percent while retail prescription-drug spending rose just 5.7 percent, less than the overall Consumer Price Index.

One reason pharmaceutical prices get all the attention is that many more people see them: Insurance typically covers a far bigger part of a hospital bill. (And people just dont use hospitals as often as they buy drugs.)

Another reason: Hospitals and unions for their staff have vast political clout. Here in New York, health-care union 1199 is universally feared, while the Hospital Association of New York spreads campaign cash all over state government.

These angles may be why President Trump is almost alone in pushing on hospital costs. His recent executive order requiring them to publicly post their prices as well as the lower prices they agree to with insurers starting in 2021 is a landmark that has the industry screaming and suing.

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Former health insurance executive: Buttigieg uses industry talking points against progressive health care policy | TheHill – The Hill

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A former health insurance executive criticized South Bend, Ind., Mayor Pete ButtigiegPeter (Pete) Paul ButtigiegBloomberg has already spent 0 million on ads in presidential race Buttigieg surrogate: Impeachment is 'literally a Washington story' Buttigieg campaign introduces contest for lowest donation MORE for his time at consulting firm McKinsey & Co. and his work with a medical care provider, accusing the top-tier presidential candidateof using health insurance industry talking points against more progressive health care policy.

Hes absolutely using the talking points that I used to create in my old job and my former colleagues are still turning out, Wendell Potter, who spent 20 years in the health insurance industry, told Hill.TV during an interview that aired on Tuesday.

Potterpointed to Buttigiegs recent jab at rivals Sens. Bernie SandersBernie SandersButtigieg surrogate: Impeachment is 'literally a Washington story' Michael Moore: Sanders can beat Trump in 2020 Buttigieg campaign introduces contest for lowest donation MORE (I-Vt.) and Elizabeth WarrenElizabeth Ann WarrenWarren in Christmas tweet slams CBP for treatment of detainees Buttigieg surrogate: Impeachment is 'literally a Washington story' Buttigieg campaign introduces contest for lowest donation MORE (D-Mass.) as a prime example. Though he didn't mention them by name,the South Bend, Ind., mayorsuggested in an MSNBC interview earlier this month thatthe twoprogressive candidates were calling for a health care policythat "would eliminate the job of every single American working at every single insurance company in the country.

In my old job in the industry, I used to play the jobs card too and I call it that because every time reform is proposed that insurance companies dont like they say, Oh, theyll have to lay people off, he said, referring to Buttigieg's claim. Its called playing the jobs card and hes doing that.

Buttigieg campaignspokesperson Sean Savettpushed back against Potter's remarks, sayinghis claim that Buttigieg is parrotingindustry talking points "doesn't hold up."

"Petes 'Medicare for All Who Want It' plan would make some of the boldest, most progressive changes to our health care system in decades in order to achieve universal coverage for all Americans," Savett said in a statement. "It has also been attacked by the health insurance industry because it would create competition and force insurers to lower costs and improve care or lose customers."

Sanders and Warren have been advocating for a "Medicare for All" planthat would ultimately do away with private insurance.

Getting rid of private insurance has beena point of contention between these progressive candidates and moderate candidates like Buttigieg and former Vice President Joe BidenJoe BidenLawyer for Giuliani associate to step down, citing client's financial 'hardship' Buttigieg surrogate: Impeachment is 'literally a Washington story' Presidential candidates should talk about animals MORE, who have both advocated for expanding existing health care coverage andadding a public option plan.

Buttigieg, meanwhile, has defended his work at the insurance company where he previously worked as a consultant, Blue Cross Blue Shield of Michigan and maintained that he wasnt involved in the decision-making process at McKinsey.His campaign has also noted that the mayor has been critical of his former employer, calling its work with U.S. Immigration and Customs Enforcement disgusting.

Buttigieg, whohas made itto the top of the polls in Iowa and New Hampshire, has faced increasing scrutiny from critics, who argue that he hasnt been forthcoming about his past work.

A feud has emerged between Buttigieg and Warren after the Massachusetts senator called on him to make his fundraisers public and disclose his past clients at McKinsey. In an effort to address this criticism, the South Bend, Ind. Mayor has since acceded to both demands.

However, Buttigiegs campaign left out more than 20 high-profile fundraisers from a list of bundlers it released earlier this month, potentially opening his campaign for more attacks over the issue of transparency.

Tess Bonn

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‘Epidemic’: 75% of workplace assaults happen to health care workers – ABC News

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Three-quarters of all workplace assaults happen to health care workers, according to the Occupational Safety and Health Administration. And right now, unlike other professions, there is no federal law requiring prevention, reporting, or action if a health care worker is assaulted while on the job.

You can get into a cab or an Uber, or onto a train, and it says that assaulting an employee is a felony and you can go to prison, Michigan State University professor Judy Arnetz, an expert in workplace violence in the health care sector, told ABC News. And yet, people walk into hospitals to take care of patients every day and they are getting assaulted every day.

From 2009 to 2013, health care professionals reported more than 730,000 cases of assault, according to the Government Accountability Office. And these numbers are likely low due to an issue of underreporting, Arnetz maintains.

There have been reports of workers being bitten, shoved, kicked, shot, and even killed.

Workplace violence is in every health care institution across the country, Arnetz said. Large and small, urban, rural -- it occurs everywhere.

And the problem is growing, prompting a push for legislation to help stem the tide.

A bill passes the House

In February, Rep. Joe Courtney, D-Conn., introduced a bill that would require OSHA to issue a nationwide standard for establishing and implementing workplace violence prevention plans for health care professionals. The bill, the Workplace Violence Prevention for Health Care and Social Service Workers Act, or H.R. 1309, passed the House on Nov. 21 with bipartisan support.

H.R. 1309 would require risk assessment and identification, as well as action, tailored to each type of health care facility outlined in the bill. Each treatment center would have to establish procedures for communication, train its workers to recognize high-risk situations, record incidents using a violent incident log, and plan for future incidents by recognizing past violent incidents.

Experts like Arnetz acknowledge the bills broadness, but still believe it would be a positive step forward by simply putting prevention, in Arnetz's words, "on the dashboard.

Organizations would be required to do the bare minimum, Arnetz said. Record keeping, collecting data on incidents that occur, making sure that there is a prevention plan in place and that employees are involved in that.

Nurses celebrated the measure.

But the American Hospital Association opposed the bill, which is pending in the Senate Committee on Health, Education, Labor, and Pensions, saying hospitals "already stress workplace violence prevention."

ABC News reached out to the committee, which said it was working on its 2020 agenda.

Healthcare workers experience more workplace violence compared to any other private sector professional. A bill passed in the House that could help protect these workers.

Courtney pointed to the fact that 32 Republican representatives supported the bill, along with the Kentucky Nurses Association.

Were hoping that they are going to prevail on [Senate Majority Leader] Mitch McConnell, Courtney said, referring to the Kentucky nurses. Because, you know, saying no to nurses is not easy.

McConnell declined comment.

The rate of violence has increased

The level of violence against health care workers has increased dramatically -- 63% -- from 2006 to 2016, according to H.R. 1309.

Courtney suggests that this increase is due to the rise of heroin and opioid use, as well as an overall increase in general behavioral health issues. Regardless, he says health care professionals didnt sign up for this.

If the bill becomes law, Courtney says it could help more than just health care professionals. By saving on workers compensation costs, lost time from work, and burnout, companies could end up saving money, despite paying for training and the costs of raising standards.

But for many health care workers who have promised to "do no harm," the bill has come too late. Harm has been done to them.

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'Epidemic': 75% of workplace assaults happen to health care workers - ABC News

Opinion: Bernie Sanders on healthcare, homelessness and Trump – Los Angeles Times

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Warming up for a giant campaign rally in Venice on Dec. 21, Bernie Sanders, the three-term U.S. senator from Vermont making his second run for the Democratic presidential nomination, sat down for an hour with the Los Angeles Times editorial board to talk about the economy, healthcare, immigration, homelessness and other top issues. The following is a partial transcript, edited for clarity and brevity.

Sanders: So this is a major improvement over the old building. God, the traffic, I dont have to tell you. It wasnt bad today. We went, it must have been a mile, and it took us what, 45 minutes or something.

Nick Goldberg, editor of the editorial pages: You complain about that at the rally later, youll make some

Sanders: Thatll win me some votes. (Laughter)

Goldberg: So lets get started. Welcome. This is the editorial board only. The meeting is for the purpose of helping us make decisions about who were going to endorse in the race. Were on the record. Youre being videoed. Youre welcome, if you want, to make a very short, one minute or so intro.

Sanders: Im used to 60-second remarks.

Goldberg: And we have a couple of our [editorial board] members on the phone.

Sanders: We are at an unprecedented and dangerous moment in American history. We have a president who is a pathological liar, who is running, in my view, one of the most corrupt administrations in American history, who rightfully was impeached, was a racist and a sexist and a homophobe and a xenophobe and a religious bigot. And it gives me no pleasure to say that. But that is who the president of the United States is.

I will do everything in my power to defeat him. And in fact, I believe I am the strongest Democratic candidate to do that. We could discuss that later. But the crisis that were facing as a nation, as a world, is not just Donald Trump. And wed be wrong to think that just defeating Trump will solve all of our issues. Were dealing with massive levels of income and wealth inequality. Im deeply concerned about big money controlling the political process and undermining American democracy, not to mention all the voter suppression thats going on among Republican governors.

The more I study the issue, the more frightened I become about climate change. And the scientists now are telling us that they have underestimated the severity and the degree to which climate change is ravaging this country and the world. And there is no middle ground in terms of dealing with climate change. I wish that it was. But right now well need to throw all of the resources and intelligence that we can in leading the world, because this is not just an American issue, to literally save the planet for our kids and future generations. This is a major, major, major crisis.

So, I mean there are many, many other issues out there, obviously, but I just wanted to lay out some of the concerns that I have.

Goldberg: Let me kick it off then by asking you, do you think that the U.S. can repair the damage that Donald Trump has done? Can it be done quickly and easily? And how would you go about it?

Sanders: The answer is I think it will be difficult. I really do think it will require extraordinary leadership. I think what Trump did in the 2016 campaign is rather intelligently pick up on the fact that there are, what, tens and tens of millions of people in this country who are suffering, who are in pain, who are going nowhere in a hurry, are seeing decline in their standard of living, seeing a decline, literally, in their life expectancy, worried about their kids. And theyre looking around them and theyre saying, Who is concerned about me? Is the Democratic establishment worried about my kids? [Are they] worried that Im working for nine bucks an hour, that I dont have any healthcare? That my kid cant go to college? And he played on that.

Now he turned out to be a fraud and a liar, but he certainly exposed, I think, the weakness of the Democratic and the political establishment in general, including the Republican establishment. So what we are going to need is leadership in this country that brings people together around the issues that are of concern to all of us. So if youre a conservative Republican, you want healthcare, if you are a conservative Republican, you want to be able to send your kid to college.

And I think the issues that we have been talking about in this campaign, that I talked about four years ago when I was here, those issues have resonated with the American people. And in fact, as I think you all know, they have become kind of mainstream now in at least in the Democratic Party, when they were seen as pretty out there four years ago.

So I think when you talk about raising the minimum wage, when I think you talk about making educational opportunity available to all regardless of income, where youre talking about canceling student debt, when you talk about healthcare for all as a human right, Medicare for all, when you talk about climate change, criminal justice reform, immigration reform, sensible gun policy in this country, a womans right to control her own body and many other issues, those issues in fact do resonate with a whole lot of Americans and we bring those people together around those issues.

Goldberg: Before we move around the table, let me exercise my prerogative and ask you one other question. What do you say to voters who worry that in a general election a candidate as far to the left as you are is gonna alienate swing voters and moderates and independents?

Sanders: Excellent question, Ive heard it once or twice. (Laughter) I want you to think about this. In my view, and Ive thought about this a whole lot, anyone who underestimates Donald Trump as a candidate, for a variety of reasons, will be very mistaken.

He is going to be a very, very strong candidate. He certainly has a very strong base. He will have unlimited amounts of money to campaign on. He is a pathological liar. He will merge in an unprecedented way agencies of government with his campaign, because he doesnt particularly believe in the rule of law. So he is going to be a very, very tough opponent.

The only way that you beat Trump is by having an unprecedented campaign, an unprecedentedly large voter turnout. And well have to combat every single day the voter suppression which youve recently seen manifest itself in Wisconsin and Georgia. And we can expect that to take place all over the country. We are living in perilous times, and Republicans understand that if they can keep poor people and people of color and young people from voting, theyve got a better shot to do it. And I have zero doubt that they will do it. Theyve appointed right-wing judges who will sustain their efforts. So we have to combat that in every way we can.

But the reason I believe that I am the strongest candidate, and the reason I believe our approach is right is if you want a large voter turnout, if we understand that there are tens of millions of people in this country who dont vote, whove kind of given up on the political process, that young people although were seeing some real gains there and were working really hard on this thing young people, who are by and large progressive my guess is roughly speaking for every three people under 30 who vote, two of them are going to vote progressive, okay, but many of them dont vote I think I am by far the strongest candidate to reach out to those people. I think Im the strongest candidate to bring together a multiracial coalition of African Americans, of Latinos, of Asians.

So to answer your question, I dont believe that the [way to win] this election is to just speak to Republican women in the suburbs. Thats one theory. And I think many of those women will vote for me because they are appalled, correctly so, about Trumps personal behavior and his temperament. I think we can win many of them. Not all of them. But on the other hand, the key to this election is can we get millions of young people who have never voted before into the political process, many working people who understand that Trump is a fraud, can we get them voting? That is the key to this election. So Ive heard that hypothesis, I just dont agree with it.

And let me add to that if I might, [there are] people who run the same old, same old type of campaign. And you know, [former Vice President] Joe Biden is a personal friend of mine, so Im not here to, you know, to attack him. But my God, if you are, if youre a Donald Trump and you got Biden having voted for the war in Iraq, Biden having voted for these terrible, in my view, trade agreements, Biden having voted for the bankruptcy bill. Trump will eat his lunch.

Jon Healey, deputy editorial page editor: So youve noted the widening income inequality. [But] when you look at the consumer confidence indices, they suggest that most people are feeling better about where we are, and their expectations for the future are better and better. If you look the trend lines since the [last recession], its gone steadily up. And in fact, the numbers now in both consumer confidence and expectations for the future are where they were in 99, 2000. So how do you reconcile those two things, where youve got a campaign which is trying to reach out to people who feel that theyve been left behind, but much of the country thinks things are going pretty well right now?

Sanders: I read statistics til Im blue in the face, and Ive got to tell you, I read polls til Im blue in the face. Today theres a poll that says this, and yesterday theres a poll that says that. Half of the people in this country are living paycheck to paycheck. Agreed? Thats a fact. All right?

I dont know the exact number, but theres a hell of a lot of people in this country who if their car broke down and they needed $500 to fix that car, dont have that 500 bucks. Theyll have to go to some payday lender to get to come up with the money. We got 45 million people who are dealing with student debt, and some of it is outrageous levels of student debt. In this city, you got 50,000 people who are sleeping out on the streets.

So I dont accept the premise. I mean, I think what people say is, you know what? If I want to go out and get a job today, I can get a job. Thats true. But on the other hand, and I do this all over the [country], you know, Ive held a whole lot of town meetings and you talk to people. Yeah, I can go out and get a job, but I cant find a job that pays me a wage that allows me to deal with healthcare and pay my rent or put gas in the car. So the economic crisis that were facing now is not unemployment, which is low. It is wages. And last year in the midst of the so-called booming economy the media talks about it, Trump talks about it you know what real inflation [adjusted] wages went up last year? Anyone happen to know?

Healey: Less than a percent?

Sanders: Yeah, one point exactly. 1.1%. What we are looking at is a continuation of a trend in which the very, very wealthy do phenomenally well. I mean, its a fact I keep mentioning I dont know if anyone pays any attention at all of my rallies, that in the last 30 years, the top 1% have seen a $21-trillion increase in their wealth; [the] bottom half of America has seen a decline in their wealth.

So to answer your question, unemployment is low. You want to go out, you can get a job. But by the way, whats also frightening is according to the studies, most of the new jobs being created are low-wage jobs.

And, you know, when were on the campaign trail, we go to restaurants all the time. Thats what we do. And invariably the kids, the young people who will come up to me, who are waiters and waitresses, you know, these are people who often have a college degree, and theyre waiting tables today. And Ill never forget this, I was in New Hampshire a month ago talking to teachers. And a teacher said, You know, my son just graduated college, wanted to be a music teacher. He ended up being a salesman at a liquor store in New Hampshire. He made more money doing that than being a teacher.

So to answer your question, unemployment is low but wages are terribly low in this country, and many people are struggling to get the healthcare they need to take care of their basic needs.

Kerry Cavanaugh, editorial writer: Theres been a lot of focus on a $15 minimum wage. But how does the federal government create more $30-an-hour jobs, $45-an-hour jobs?

Sanders: Thats right. If Im allowed to toot my own horn here, when I was here four years ago and I talked ... about a $15 minimum wage, everyone thought that I was kind of extreme. Since then, seven states, including this state, have passed a $15 minimum wage, as has the U.S. House of Representatives. So your point is well taken.

Nobody should think for one moment that, Ahh! We got a $15 an hour minimum wage. Weve solved our economic problems. It is a minimum. It is a minimum. And I have been to this state, Ive been to Iowa, needless to say, New Hampshire. Ill never forget a woman in Des Moines, Iowa, making $10.25 an hour trying to raise three kids. She cant. Alright, so Im not here to tout that a $15-an-hour minimum wage is the end of the world. Its not, but it is the minimum. We have to do that.

The question of how we create good paying jobs, $25-, $30-an-hour jobs, is the more important question. I think one way we do that, and obviously its going to be a combination of federal policy and the private sector, as president of the United States, what I will do is demand and do everything that I can to end the kind of corporate greed and irresponsibility that we see right now. We were just over in San Bernardino. We had a rally there yesterday, where Amazon apparently has a lot of influence. Theres a lot of pollution, and kids come down with asthma and all that stuff. And people in the warehouses are making $11 or $12 an hour while Amazon is, as you know, an enormously profitable corporation that paid $0 in federal income taxes last year.

So I think what a progressive president has got to do is say to these corporations, You know what? Make money. Thats great. Create jobs. We want you to do that. But it cannot just go to CEO compensation or your stockholders. Weve got to break this mentality, which has been prevalent for so many decades, that the only thing that a corporation has to do is make as much money as possible for its stockholders and pay it CEOs outlandish levels of compensation. And we have to do it culturally, and we have to do it legislatively to say, You know what? Make money. Thats fine. You want to be rich, thats fine. But you cannot have it all. You cant break unions or deny workers the right to join a union. You cant continue to harass women on the job. You cant pay abysmally low wages and expect, you know, to be treated respectfully by the federal government.

Youre going to have to be good corporate citizens. You cant shut down plants in America and move to low-wage countries. You have a certain responsibility. So thats the bottom line. Thats the role I think leadership plays with the private sector.

We also want to stimulate small-business growth in America. But then the role that the federal government can play is enormous. I happen to believe in a federal job-guarantee program, and Ill tell you why. Because there is an enormous amount of work to be done in this country, and I think about it differently than maybe others do. But I look at our childcare system, which is completely dysfunctional, which is so unfair to working families, and more importantly to the children. I dont know the exact number, but hundreds of thousands of good jobs with well-trained, well-paid childcare workers.

I look at our infrastructure, which there is no argument is crumbling, whether its roads, bridges, highways. God, Ive been driving around in L.A. in the last few days. What a traffic disaster you have here. You know, water systems. Everyone knows about Flint, Mich., and we were there. My wife and I were there and it was one of the most emotional and difficult meetings weve ever had, you know, behind closed doors, dealing with parents whose kids were poisoned. But it is not just Flint, Mich., it is all over this country. It is California. I dont know if you know this of course you know this, you live here but there are tens of thousands of homes where we turn on the water, you cant drink the water. So we have major infrastructural crisis. And, last but not least, if we are going to combat climate change, we need to transform our energy system away from fossil fuel to energy efficiency and sustainable energy. And in doing that, we can create up to 20 million good-paying jobs. So the federal government can be very aggressive.

Teachers. What a pathetic state of affairs when you have good teachers who are leaving the profession because theyve got to work two or three jobs. So we pay teachers. I mean, when we rebuild our country infrastructure, education, climate, environmental protection we create a whole lot of good-paying jobs. Thats the role of the federal government.

Dr. Patrick Soon-Shiong, executive chairman, Los Angeles Times: Well, first of all, thank you. I was upstairs because Im with the most inspiring 15 kids from a Jesuit high school in Compton. Senator, listen, first of all, thank you for coming. I want to talk about healthcare. Just so you know, background: I came from South Africa, apartheid. Grew up in South Africa, was the first Chinese doctor, came to this country. Its the greatest country in the world.

So During the debate, we held a focus group at the L.A. Times, with 25 undecided voters. The concern that they related to us was that your Medicare for all plan, as communicated, would not win in the swing states. Question is, what do you mean by Medicare for all?

Sanders: Look, healthcare, as everybody knows, and even the president of the United States recognizes, is a complicated issue. And we have got to do better [explaining Medicare for all]. And sometimes it is difficult, because youre on a debate when you have 75 seconds. Im not so sure as a doctor you can explain healthcare in 75 seconds. Correct? Maybe you can.

Soon-Shiong: If you give me two minutes, maybe.

Sanders: Okay. All right. Well, you dont get two minutes when youre up on the stage, by the way. Thats too much. Unless you cheat and go beyond the red light.

Soon-Shiong: But thats a problem, right?

Sanders: It is a problem.

Soon-Shiong: Because you really should have enough time to [explain it], and maybe in your rallies where you do have time.

Sanders: I do have time. And come to the rally this afternoon. As soon as we leave here were going to a good rally, and I will talk about [healthcare]. But that is one of the problems. On a complicated issue, you are often asked to explain it in 10 or 20 seconds, or 75 seconds. But we have more than that now, so let me explain what I mean. First of all, we go all over the country and we say, OK, tell me about healthcare. And the stories that you hear and we have them on tape, we video these things, we put them out there are just unbelievable. So I start off, Patrick, with the strong belief that there is something fundamentally wrong when we are spending twice as much per capita on healthcare as the people of any other country.

I live 50 miles away from Canada. Is the Canadian healthcare system perfect? No, it is not. But they guarantee healthcare to all of the people spending half as much. We spend about $11,000, theyre something around $5,000 or $6,000 a year. Meanwhile, you got 87 million people in this country who are uninsured or underinsured, and the keyword here is underinsured. Everybodys Ah, well, you dont have any health insurance, thats a problem. But you know what? You may have health insurance, but if you have a $10,000 deductible then your health insurance doesnt mean a damn thing to you because you cant go to the doctor when you need to. OK? You dont have the money to do that. You have 30,000 people who [will] die this year because they dont get to a doctor on time.

And heres what is unbelievable, and Ive been talking about this more, and this resonates with people, by the way: Some half a million people go bankrupt in this country for medically related reasons. Now, that might be the only reason. Now youre struggling financially, youre diagnosed with cancer. Just think about it. You tell me. You make $50,000 or $60,000 a year, youre diagnosed with cancer, you run up a bill for $50,000, $100,000. How do you pay that bill? I mean, its insane. So we are living in a country which says that you can suffer financial ruin for the rest of your life, for what crime did you commit? You were diagnosed with cancer or heart disease. How disgusting is that? It really is. I use that word advisedly. So this system I think is dysfunctional and its really quite indefensible. And we can argue about where we go from here.

But I think on top of everything else, I mean we dont have five hours to discuss it, is the complexity of the system. OK? And I think its not only healthcare, its everything else. People are sick and tired of filling out a million forms for every thing. My wife has a PhD, all right, and she goes crazy trying to fill out the healthcare things, choosing what healthcare program you want, you know, when youre fighting for the coverage that you think you are entitled to. We need a simple system. And the beauty of a simple system and the advantage of single payer over a system which has thousands of separate policies is that it is easier to administer.

Youre asking me what Medicare for all is. It is no more premiums, not for you as an employer. You must spend a fortune, I imagine, right now on healthcare. All right, no more premiums for the worker, for the employer. No more co-payments, no more deductibles, no more out-of-pocket expenses. All gone. Medicare for all expands Medicare to cover dental care, which last I heard is healthcare, hearing aids, eyeglasses and home healthcare. And we do that.

How we do fund it? We fund it through a progressive tax system such that, I suspect your company, by the way, will save money. Youll be paying more in taxes but less in your overall healthcare costs, and the savings will go to the workers. Youll be better off on the Medicare for all. And one of the things that we have not succeeded at, I think, is getting large corporations to understand that. Because we are the only major country on earth not to guarantee healthcare, theyre competing against international concerns who dont have to worry about paying their workers healthcare. Because its government sponsored.

Goldberg: Do you think theres a problem with the way [Medicare for all] is being sold?

Sanders: Yep. The answer is yes. I think there is enormous ignorance about the nature of healthcare, why we spend so much, why our outcomes are not particularly good. Yes. Life expectancy, childbirth, infant mortality. So Im not arguing. I think youre right. But please understand, which I think you do know, that there are people who are benefiting big time from this dysfunctional healthcare system.

Robert Greene, editorial writer: Senator, youve made your position on President Trump quite clear. I want to ask you, is there anything that hes done, any policy that he has, any actions hes taken that you think are worthy and worth building on?

Sanders: I have such contempt for somebody who is trying intentionally to divide this country up based on the color of peoples skins or where they came from or their religion or their sexual orientation. That disgusts me so much. So were in the midst of that. And somebody who was a, you know, is a pathological liar. And a corrupt person.

I mean, he has talked about the need for infrastructure repair. Yes, thats true. Has he done anything? No. Hes talked about the need to lower the cost of the prescription drugs. Has he taken on the pharmaceutical industry? No, he has not.

He has talked about trade policy and, in fairness, probably what has recently happened is probably modestly better than the previous NAFTA. So you want to give him credit and, and the Democrats in the House credit for that? Fine. But I think the overwhelming result of his administration is contemptible.

Mariel Garza, editorial writer: So theres been a lot of talk about electability in this race what is electability, whos electable. There are a fair amount of women who believe that when we talk about electability, when we use that word, its really code for, a woman cant beat Trump. And I wonder if you, if you believe that thats true.

Sanders: I surely do not. I mean, it 100% has to do with the candidate. But I will say that whether youre a man or a woman, Trump is going to be harder to beat than many people think. They think, this guy is a buffoon, of course hes going to be beaten. Not so easy. But it gets back to the question, the original question is, its not a woman or a man or whatever. Its a question of the kind of campaign that you run. And I think in this unprecedented moment in American history, you need an unprecedented campaign. And I think you need ideas that are going to excite and energize millions of people who right now are not particularly active in politics, and who may not vote at all. So I think the question that we want to ask is, which candidate out there is capable of growing voter turnout? Thats the real question. And if youre not dealing with that, I think Trump is going to be hard to defeat, thats true whether youre a man or a woman. But if the question is can a woman beat Trump? Of course.

Carla Hall, editorial writer: You mentioned the thousands of people sleeping on the streets here in the city, and in the county. President Trumps approach to homelessness has been pretty much to scapegoat homeless people and vaguely hint that he would move them all into a big empty federal building somewhere. How would you address homelessness?

Sanders: You know, we started talking about the economy, and what I suggested is that there is so much work to be done in this country. I mean starting with childcare, starting with healthcare. We need more doctors, we need more nurses, we need people who are not pushing paper but providing care to older people. We have a proposal that would build 10 million units of housing. In terms of low-income housing, Im proud to tell you that I co-sponsored successfully with Barbara Lee of Oakland what was called low-income, I think, I forget the name, the low income housing trust fund or something, which Obamas people put, I think, several hundred million dollars into. Nowhere near enough. But it was the first piece of legislation to actually address low-income housing.

But to answer your question, and Ive learned as you travel around the country, boy you do learn this, the housing crisis is not just in L.A.. Its not just in San Francisco or Seattle. It is virtually in almost every part of the country. And it has to do not only with homelessness, which is a disgrace a half a million people homeless in America. It has to do with the fact that 18 million families are spending 50% of their income on housing. It has to do with gentrification all over this country, which is driving rents up to levels that, that working families just cannot afford. We have a proposal that would build some 10 million units of housing and put a hell of a lot of people back to work at good wages, union wages, and it would, in fact, end homelessness as we know it.

We were down in, what do you call it here?

Greene: Skid row.

Sanders: Skid row not a highly technical term (laughter), I thought you had a more sophisticated name for it where, for example, instead of arresting people, you bring them into a shelter, which seemed to me a pretty sensible thing. But the problem with homelessness is not just providing a home. Often, youve got to deal with addiction. Youve got to deal with counseling, you need wraparound services, etc.

Soon-Shiong: Correct. Can I follow up on that? And two, maybe three different topics. Really, the homelessness issue here is really mental health issues.

Sanders: Right.

Soon-Shiong: So the mental health issue is really

Sanders: And addiction is part of it.

Soon-Shiong: And being thrown out of the jails theres a real issue.

The other question I really want to ask you about, and it relates to privacy, it relates to tech, it relates to Facebook, Google, etc. It relates actually to our democracy because it leads now to local news. Newspapers completely being destroyed. In California we have, its a largest incidence of small, local town newspapers being destroyed because frankly the [concept of] fair use is not being fairly used, where these platforms can take this data, say theyre not media, and use them. Whats your feeling about that? How do we save, across this nation, local newspapers that can speak truth to power?

Sanders: Its a huge issue. And youre absolutely right. I can tell you from personal experience, when I was mayor of Burlington, which was a larger city in Vermont of 40,000 people, I cant remember how many radio stations we had. We had newspapers, we had small weekly newspapers all over, right?

Newspapers are in trouble. I would say that what we want to do and by the way, this is not just media, this is many other sectors of our society is have an attorney general who understands antitrust law. And thats true in agribusiness. Its true in many parts of our economy. Start breaking up these huge conglomerates, which have just an unbelievable influence over our general economy.

Media is something different. Because without a free media, you dont have a democracy. So it raises another issue, and we have some ideas out there about and its a tricky thing. You dont want government control over media. You dont want a handful of giant conglomerates to control the media. But were going to have to sit down and have a conversation about how we support local independent media. I dont have a magical answer

Soon-Shiong: But Facebook and Google hide behind the fact that they can give fake news because theyre not media.

Sanders: And also I may add in terms of, you tell me if Im wrong, you know more about this than I do. They gobble up a huge amount of the advertising revenue.

Soon-Shiong: They gobble up everything, in fact, thats exactly why papers are being destroyed.

Sanders: Thats right.

Soon-Shiong: So one of the ideas is, datas now the next oil, basically equal to a utility. Why is there not a data tax on these organizations? That is where that should actually be.

Sanders: Well, I think the idea is that a handful, what have we got, Google, Facebook, who else is out there? Twitter, right? Twitter controlling what percentage of the advertising revenue?

Healey: Google and Facebook together are north of 80%, I think. [Editors note: Analysts put the figure at close to 60%.]

Sanders: Wow, is that right? This is an issue that cannot be ignored, I agree with you.

Michael McGough, senior editorial writer: Senator, when you were here last time, four years ago, we had a discussion about whether you were maybe too averse to military intervention. You thought Hillary Clinton was the opposite. And one of the things you said when we were talking was, as proof that you werent pacifist, was that you had voted for the war in Afghanistan after 9/11. You had some second thoughts about that in the debate. And Im wondering, are you more averse to intervention now than you were when you were running in 2016, and what sort of standards would guide you as president in deciding whether to send U.S. forces abroad?

Sanders: Well, its not a question of more or less. Obviously you have to look at the particular circumstances. No. 1, I think unlike Trump, who has exploded military spending while cutting back on diplomacy and our State Department, I would do exactly the opposite. I think you need and Ive been around the world and met with some of our diplomats. Youve got some really strong and good people who know the language, who know the culture. So we had got, I mean the bottom line is that war has got to be the last response, not the first response. It is very easy for politicians, because its almost always very popular to say, You know what? The only thing that fill-in-the-blank understands is force and were going to go to war.

Its a good speech. It polls very well but it ends up in some cases with horrible circumstances, i.e. the war in Iraq. So I voted against the first war in the gulf. Literally, its one of the first votes that I cast that I thought I would be unelected two years later because that war was popular. I voted against it, led the effort against the war in Iraq. God, I wish check out what I said then, it turned out to be a pretty prescient, and I wish that wasnt the case, but it was. I helped lead the effort to end U.S. intervention in Yemen following the dictatorship in Saudi Arabias lead. So No. 1, youve got to do everything you can to bring people together diplomatically without the use of military force.

Are there some circumstances where genocide is going to be committed where you may have to use military force or other reasons? Yeah, I suspect there will be. But also you want to be mindful that you need, to the degree you can get it, to use international support. Strengthen the United Nations. People say the U.N. is ineffective. Yeah. Compared to what? Nuclear war? You know, so weve got to strengthen the United Nations, and see where we can resolve international conflict.

The other thing that I would say on this is that, in issues like Israel-Palestine, issues like, Saudi Arabia-Iran, the United States for many years has had a kind of one-sided policy. We have loved the brutal dictatorship in Saudi Arabia. We have been very 100% pro-Israel. And I say this as somebody whos proudly Jewish who spent time as a kid, on a kibbutz in Israel. But we need to have an evenhanded foreign policy which brings people together.

And I wont deny for one second, this is complicated stuff. It is not easily resolved. But we throw all of the resources that we can to bring people together. And you gotta do things like rethinking this war on terror, which has cost us some $5 trillion. And I guess people can argue the situation is worse than it was before we got into it. So theres a lot of rethinking. Got to deal with authoritarianism all over the world.

Scott Martelle, editorial writer: Hi, good morning. Thank you. Senator, you call for comprehensive immigration reform, and thats been tried multiple times before and its been failing for decades. As president, what can you do to get a comprehensive immigration reform package through Congress?

Sanders: Yeah, I dont want to tell you Ive been one of the leaders of that in terms of the discussions or the negotiations in Congress, but I have been involved in it. And the truth is, I do believe it can be done. I absolutely do believe it. Trump, of course, because of his xenophobia and his obsession with building a wall, has exacerbated the situation. I think despite Trumps xenophobia, the American people do want comprehensive immigration reform. And I think when you have a president who can speak and Im the son of an immigrant, as a matter of fact, who came to this country with nothing when you can speak to the contributions of the immigrant community, the fact that so many immigrants are working so hard, raising their families, abiding by the law, are so important to our economy, when you can explain that to the American people rather than demonize immigrants, I think we could strengthen the support that exists at the grass-roots level for immigration reform.

Now as you also know, a president has certain authority regarding executive orders. So on day one, what I have promised and will fulfill, is to reinstate the legal status of the 1.8 million young people and their parents in the DACA program. That we can do. And we can stop the very ugly practices at the border in which, you know, babies are literally snatched from the arms of their mothers or children thrown into cages. We can do that as well. But to answer your question, I think there is broad support among the American people. I think theres more Republican support, which I think would be able to play out without having a xenophobe as president of the United States.

Garza: I have a pretty quick question. And that is, normally I wouldnt ask somebody about their health, because you know, we all know that 80 is the new 60

Sanders: 50! 40! 30! (Laughter)

Garza: But the truth is you have had a heart attack fairly recently. And I wonder, you know, convince us that, that you are hale and hearty enough for whats going to be a brutal campaign and probably a pretty, well, we know its a tough job.

Sanders: Yes, its a tough job. Look, all I can say is youre quite right. I did have a heart attack two and a half months ago in Las Vegas. I had two stents put in. I was in the hospital for 2 days and got quite good healthcare. Thank God. I had an artery that was blocked and I think that was dealt with. As I understand it, and (to Soon-Shiong) doctor, you can tell me if Im wrong, but I think that procedures done about a million times a year, roughly speaking in the United States. Its not an unusual procedure. I have been blessed with good health my entire life. I think you can ask my staff the last time other than the heart attack, that I missed work. Im in just, I was a kid, a long-distance runner, so I have a lot of endurance. Since the heart attack we have been running a pretty vigorous campaign.

These guys had me working, what did we do, four rallies in the last couple of you know, I work hard. And youre right. I mean it is, needless to say, president of the United States might be slightly stressful job (laughter) and a difficult job. But I suspect Ill be on the golf course a lot less than Donald Trump is. I dont play golf. But, I mean, thats a fair question. All that I can say is, in some respects, I feel better than I did before the heart attack. I guess having three arteries that work is better than having two, right?

See the article here:

Opinion: Bernie Sanders on healthcare, homelessness and Trump - Los Angeles Times

Opinion: Response to ‘Expand access to health care by expanding the role of Missourians deserve physician-led care’ – The Missouri Times

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The Americans for Prosperity-Missouri and the AARP argue that allowing nurse practitioners to treat patients without physician supervision would help ease a health care shortage in Missouri, particularly in underserved areas.However, the editorial failed to mention several important facts. First, like most of the states in the Union, Missouri is not only short of physicians, but also of nurses.By encouraging more nurses to move into a provider role, nurse practitioner independence would have a negative impact on the supply of bedside nurses.

Secondly, while advocates claim that allowing nurses to practice independently will fill the need for primary care in underserved areas, studies have consistently shown that states with independent practice have not this promised increase in rural health shortage areas. Instead, independent nurse practitioners end up working in the exact same places as physicians. Additionally, less nurse practitioners are entering into primary care. More and more, nurse practitioners are forgoing primary care to work in specialty offices.In fact, in areas with independent practice, it is not uncommon to see nurse practitioners opening cosmetic practices offering botox and fillers rather than bread-and-butter primary care medicine.

The opinion piece argues that nurse practitioners are already trained and qualified, and that research has shown that nurse practitioner care is equivalent to that of physicians.Unfortunately, the authors neglect to mention that every single study that has ever claimed to show nurse practitioner safety and efficacy has been performed in a setting in which nurses were supervised by a physician.There are absolutely no studies that show nurse practitioner safety and efficacy when practicing independently.

Moreover, most of the studies that purport to show nurse practitioner safety have been of low quality, often following healthy patients over very short time frames, with one often-cited study having a time frame of only two weeks.These studies are not appropriately designed to show whether nurse practitioners, especially practicing independently, can safely and effectively care for patients over the course of a lifetime in a primary care role.

Additional concerns have been raised regarding the quality of training and education of newer nurse practitioners.While physicians are required to have 15,000 hours of training and experience before being permitted to treat patients independently, nurse practitioners are required to complete just 500 hours.Unlike medical school, many nurse practitioner programs are 100% online, and clinical experience lacks the standardization required of physician trainees. Many nurse practitioner programs no longer require nursing experience, allowing students with any bachelors degree to become a nurse practitioner.

There is no doubt that Missouri needs more physicians and nurses.Legislators would be better off focusing their efforts on ways to increase the supply of both critically important professions, rather than trying to pass off one as the other.

For example, Missouri has led the way in enacting legislation to create a new profession called Assistant Physicians which become effective in late 2014.Assistant physicians are physicians who have completed medical school but not a residency program.They work under the supervision of a fully licensed physician.Since 2015, approximately 300 Assistant Physicians have obtained a license.

Rebekah Bernard MD, Carmen Kavali MD, Purvi Parikh MD, Ainel Sewell MD, Amy Townsend MD, and Roy Stoller DO are Board Members of Physicians for Patient Protection. Physicians for Patient Protection is a grassroots organization of practicing and retired physicians, residents, and medical students. Our mission is to ensure physician-led care for all patients and to advocate for truth and transparency regarding healthcare practitioners. We advance our mission by educating our colleagues, by influencing policy and legislation, and by educating our patients and the public.

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Opinion: Response to 'Expand access to health care by expanding the role of Missourians deserve physician-led care' - The Missouri Times

5 health IT executives to watch in 2020 | FierceHealthcare – FierceHealthcare

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As healthcare becomes more technology-driven, digital health and IT leaders will be the key executives to watch.

Some of these influential technology leaders are pushing forward withartificial intelligence, data analytics and telehealth capabilities to improve patient care. Others are bringing in technology expertise from outside healthcare to help make the industry more consumer-centric ortacklethecomplex issue of interoperability.

And everyone is keeping an eye on the big tech giants and their next moves in healthcare.Haven, the technology-driven healthcare venture lead by Amazon, JPMorgan and Berkshire Hathaway, has built a team withsome of the brightest in healthcare technology including Zocdocs Serkan Kutan and Blue Cross Blue Shield IT leader Dana Safran Gelb.

Top health industry issues of 2020: Will digital start to show an ROI?

Each year, PwC's Health Research Institute (HRI) names the top issues for the health industry in the coming year. What made the list for 2020? Join HRI for a discussion of the most important trends for providers, insurers, pharma/life sciences and employers.

Here are five healthcare technology leaders were keeping an eye on in 2020. Think we missed someone? Find me on Twitter at @HeatherLandi.

John Halamka, M.D.,president of Mayo Clinic Platform

Health IT pioneer and digital health leader John Halamka is leaving his post at Beth Israel Lahey Health after 23 years to move over to Mayo Clinic starting Jan. 1. He will be leading digital health strategy at the Rochester, Minnesota-based academic medical center as president of Mayo Clinic Platform.

Halamka refers to the Mayo Clinic Platform as an innovation factory for collaboration. Hell lead initiatives that encompass artificial intelligence, the internet of things and an ecosystem of partners to advance Mayos digital health efforts. Mayo is in the midst of a digital transformation supported by a new10-year partnership with Google to move patient data over to the tech giant's cloud platform.

Halamka will play a key role in this partnership to advanced cloud computing, AI and data analytics toadvance the diagnosis and treatment of disease.

Angela Yochem, executive vice president and chief digital and technology officer, Novant Health

Angela Yochem came to Novant Health in 2018 with deep technology roots at Fortune 500 companies. As executive vice president and chief digital and technology officer, she has been tapping into that tech expertise as she redefines the North Carolina health systems approach to technology.

In June, the health system launched theNovant Health Institute of Innovation & Artificial Intelligence (AI), which will use AI to enhance personalized patient care.

That institute, which Yochem co-leads, has already produced AI-based solutions to improve care, such as a tool that helps treat stroke patients more rapidly.

Novant Health also is working with healthcare AI company Jvion to use predictive analytics to reduce readmissions for congestive heart failurepatients. A project with KenScis AI platform is focused on improving the patient experience in its hospitals.

Natalie Pageler, M.D., chief medical information officer at Stanford Childrens Health

Stanford Childrens Health is pioneering cool technology to improve care for pediatric patients. From using virtual reality to help distract and entertain children who are preparing for procedures to diabetes digital health tools, the organization focused on using technology to address the needs of children and their families.

As CMIO, Natalie Pageler, M.D., a board-certified pediatric intensivist, leads the hospitals digital health program with a focus on meeting the needs of tech-savvy patients and families in the Silicon Valley area. Shes focused on expanding virtual visits to enable patients and their families better access to pediatric experts. From 2017 to 2018, Stanford Childrens grew virtual visits by more than six times, from less than 200 visits a year to 1,100 annual visits.

The hospital is on track to double that to 2,500 telehealth visits in 2019. The virtual visits save hundreds of miles in travel for patients who need specialty care.

Vivian Lee, M.D., president of health platforms, Verily

Vivian Lee, M.D. is leading Verily Life Sciences' expanding footprint in healthcare. The life sciences arm of Googles parent company Alphabet has been shifting from research into clinical care and gaining big-name partners.

Verily partners with health insurers like Blue Cross Blue Shield as well as Walgreens and life insurance company John Hancock to provide chronic care management through its Onduo virtual diabetes clinic. Its also developing machine learning tools to help detect diabetic eye disease.

Under Lees leadership, Verily also is moving into population health and supporting the shift to value-based care. The company is working with Atrius Health and the Palo Alto Veterans Affairs healthcare system to improve patient outcomes through population health projects. Verily also is taking on aging by teaming up with Wake Forest Baptist Health to test technologies to help older people stay healthy and independent at home.

Mariann Yeager, CEO of The Sequoia Project

Mariann Yeager is a 20-year health IT veteran taking on the complex problem of healthcare interoperability. She leads the Sequoia Project, apublic-private partnership that advocates for nationwide health IT exchange.

The organization was tapped by the governments IT agency, the Office of the National Coordinator for Health IT, to oversee the implementation of a big data exchange project called the Trusted Exchange Framework and Common Agreement.

Under Yeagers leadership, The Sequoia Project will create baseline technical and legal requirements for different health IT systems, companies and groups to communicate with each other and share electronic information.

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5 health IT executives to watch in 2020 | FierceHealthcare - FierceHealthcare

Ohio Valley Health Care model train station lit for the holidays – WTAP-TV

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PARKERSBURG, W. Va. (WTAP) - The Ohio Valley Health Care is a senior facility that has many amenities to help seniors live a comfortable life.

But the organization felt like something was missing.

They found that most activities have more women participating than men.

"We have a couple residents that worked for the railroads, so we thought lets do a model train," said Jay Miller, administrator, Ohio Valley Health Care.

Jay says, they shared the idea with Joe Stephens who builds trains and train stations and they werent expecting it to be this big.

For some seniors, the trains are therapeutic as they sit in front of the window. The train station turned out to be a treat that both men and women enjoy.

"Its great for me to see the smiles on their faces and to me its not just a job, its not about the money, these people mean a lot," said Joe Stephens, owner of Stephens Outdoor Railways.

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Ohio Valley Health Care model train station lit for the holidays - WTAP-TV

Family Healthcare of Hagerstown receives grant – Herald-Mail Media

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Family Healthcare of Hagerstown recently received a jointly funded grant for $235,000 from the Maryland Community Health Resources Commission and Aetna Better Health of Maryland.

Money from the grant will help serve high-risk patients, those with chronic diseases and those who are frequent users of the hospital and/or emergency room.

The program,called "Integrating Pre-Provider Welcome Visits for Better Outcomes," welcomes and supports patients as they transition to individualized care at the clinic.

Along with capital and workflow improvements, the program has allowed Family Healthcare of Hagerstown to hire two additional licensed practical nurses to provide more support for patients, thereby decreasing patient no-shows.

The pre-visit nurse coordinators support patients in person and by telephone. They work with patients before their scheduled clinic appointment to address barriers to care so patients can achieve better health outcomes.

Before the initiative, staff members were noting that some patients weren't keeping clinic appointments and frequently were using hospital or emergency room services.

To address both, the nurses are spending more time working directly with patients so appointments are kept, medications lists are reconciled, full medical records and histories are gathered, and barriers are addressed.

In turn, patients are better prepared for their clinical appointments and health care providers are fully equipped with necessary information. That allows more time during the visit for the patient and provider to focus on health issues.

Implementation began in May. In just four months, more than 400 patients received care.

"We have an excellent staff caring for very complex patients, so having staff and patients working closely alongside one another maximizes time and effort,"Kim Murdaugh, executive director of Family Healthcare of Hagerstown, said in a news release.

We are especially excited to support the grant for Family Healthcare of Hagerstown" said Angelo Edge, chief executive officer of Aetna Better Health of Maryland. "Their work with high-risk patients is an essential to helping close the gaps in patient care."

"The Community Health Resources Commission is thrilled to support Family HealthCare of Hagerstown," said Mark Luckner, the commission's executive director. "This program will help create a medical home at Family Healthcare of Hagerstown for individuals with chronic conditions."

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Family Healthcare of Hagerstown receives grant - Herald-Mail Media

Rosy Outlook for Outpatient and Home Healthcare Industry – Yahoo Finance

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The Zacks Medical - Outpatient And Home Healthcare industry comprises companies that provide ambulatory care in an outpatient setting or at home. These companies utilize advanced medical technologies for diagnosis, observation, consultation, treatment and rehabilitation services.

The industry participants also include operators of HMO medical centers, kidney dialysis centers, freestanding ambulatory surgical units, emergency centers and other outpatient care centers.

Here are the three major industry themes:

Zacks Industry Rank Indicates Encouraging Prospects

The Zacks Medical - Outpatient and Home Healthcare industry falls within the broader Zacks Medical sector. It carries a Zacks Industry Rank #92, which places it in the top 37% of more than 250 Zacks industries.

The groups Zacks Industry Rank, which is basically the average of the Zacks Rank of all the member stocks, indicates solid near-term prospects. Our research shows that the top 50% of the Zacks-ranked industries outperforms the bottom 50% by a factor of more than 2 to 1.

We will present a few stocks that have the potential to outperform the market based on a strong earnings outlook. But its worth taking a look at the industrys shareholder returns and current valuation first.

Industrys Stock Market Performance

The industry has underperformed both its sector and the Zacks S&P 500 composite in the past year.

The industry has lost 14.9% over this period against the S&P 500s rally of 29.3% and the broader sectors increase of 10% in the same timeframe.

One Year Price Performance

Industrys Current Valuation

On the basis of the forward 12-month price-to-earnings (P/E), which is commonly used for valuing medical stocks, the industry is currently trading at 19.65X compared with the S&P 500s 18.67X and the sectors 21.66X.

Over the last five years, the industry has traded as high as 20.26X and as low as 14.67X, with the median being at 17.87X, as the charts below show.

Price-to-Earnings Forward Twelve Months (F12M)

Price-to-Earnings Forward Twelve Months (F12M)

Story continues

Bottom Line

Technological advancement has led to simplification of procedures related to outpatient services and also made them less time consuming. Participation in alternative payment models also plays a major role.

Here are three stocks that either have a Zacks Rank #1 (Strong Buy) or 2 (Buy), which investors can take a look at. These stocks are also well positioned to grow in the near term. You can seethe complete list of todays Zacks #1 Rank stocks here.

Amedisys, Inc. (AMED): Amedisys provides home health and hospice services throughout the United States to the growing chronic, co-morbid, and aging American population. The stock sports a Zacks Rank of 1.

For this Baton Rouge, LA-based company, the Zacks Consensus Estimate for 2019 revenues indicates an improvement of 18.5%. It has an average positive earnings surprise of 21.1% in the trailing four quarters.

Price and Consensus: AMED

DaVita Inc. (DVA): DaVita is a leading provider of dialysis services in the United States to patients suffering from chronic kidney failure, also known as end stage renal disease (ESRD). Its services include outpatient dialysis services, hospital inpatient dialysis services and ancillary services such as ESRD laboratory services and disease management services. The stock sports a Zacks Rank #1.

For this Denver, CO-based company, the Zacks Consensus Estimate for 2019 earnings suggests growth of 48.7%. It has an average positive earnings surprise of 8.1% in the trailing four quarters.

Price and Consensus: DVA

Hanger, Inc. (HNGR): The company delivers orthotic and prosthetic (O&P) patient care, and distributes O&P products and rehabilitative solutions. The company manages O&P networks, and provides therapeutic solutions to patients and businesses in acute, post-acute, and clinic settings in the United States. The stock carries a Zacks Rank of 2.

For this Austin, TX-based based company, the Zacks Consensus Estimate for 2019 revenues indicates an improvement of 4.7%. The consensus mark for 2019 earnings indicates an increase of 15.4%.

Price and Consensus: HNGR

5 Stocks Set to Double

Each was hand-picked by a Zacks expert as the #1 favorite stock to gain +100% or more in 2020. Each comes from a different sector and has unique qualities and catalysts that could fuel exceptional growth.

Most of the stocks in this report are flying under Wall Street radar, which provides a great opportunity to get in on the ground floor.

Today, See These 5 Potential Home Runs >>

Click to get this free report

Hanger Inc. (HNGR) : Free Stock Analysis Report

DaVita Inc. (DVA) : Free Stock Analysis Report

Quest Diagnostics Incorporated (DGX) : Free Stock Analysis Report

Amedisys, Inc. (AMED) : Free Stock Analysis Report

To read this article on Zacks.com click here.

Zacks Investment Research

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Rosy Outlook for Outpatient and Home Healthcare Industry - Yahoo Finance

Retail Clinics Make Important Contribution to Healthcare – Managed Healthcare Executive

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Every fall, another somber seasonal marker arrives: the flu. The CDC estimated that in the winter of 201819, about 42 million people got sick from the flu, causing 647,000 hospitalizations and 61,000 deaths. These numbers would be lower if more adults heeded medical advice to obtain a flu shot, yet only about one-third of prime-aged adults do so.

Enter the retail clinic. Retail clinics arrived on the healthcare scene in the early 2000s as a convenient and affordable alternative to doctors offices, urgent care centers, and emergency rooms (ERs). Because they are usually in big box stores or pharmacies such as Walmart and CVS, retail clinics are conveniently located. And because they serve customers on a walk-in basis, they are convenient to access. Their services include basic primary care for minor illnesses and injuries, such as sore throats, bug bites, and minor burns as well as preventive primary care, such as vaccines and diabetes glucose monitoring.

Providing these medical servicesat convenient times and locationsmay affect how many people end up in the ER for minor conditions. A recent study found that the prices in retail clinics are around 80% lower than ER prices for the same service. Retail clinics thus have the potential to not only expand medical services but to do so while saving money. But do they live up to this potential?

This question animates a recent research article by Diane Alexander, economist, Federal Reserve Bank of Chicago; Janet Currie, Henry Putnam Professor of Economics and Public Affairs, Princeton University; and Molly Schnell, assistant professor of economics, Northwestern University. Economics writer Lisa Camner McKay summarizes their research.

While ideally researchers assess how a populations health changes when a retail clinic opens, such extensive health data is difficult to assemble. To gain traction on the impact of retail clinics, then, Alexander, Currie, and Schnell analyzed how the numbers of ER visits for different categories of illness are affected by the presence of retail clinics in the state of New Jersey.

They found that people who live within two miles of a retail clinic after it opens do indeed have fewer visits to the ER for the minor illnesses and injuries that retail clinics treat than do people who live farther away. Retail clinics also reduce ER visits for illnesses that can be prevented via appropriate primary caremost notably, visits for the flu decline by 13%. This suggests that retail clinics, with their low, transparent prices and convenient hours, make an important contribution to the healthcare landscape.

A theory of retail clinic usage

Before diving into the data, Alexander, Currie, and Schnell developed a theory as to how the presence of retail clinics affects the healthcare setting in which patients receive treatment. This theory provides concrete predictions that they then test with data. The authors assumed that patients select a venue based on the severity of their condition and the cost of the treatment, making retail clinics best suited for low-severity conditions, doctors offices best suited for mid-severity conditions, and ERs best suited for high-severity conditions. The arrival of a retail clinic, then, will affect how many people visit the ER via two mechanisms: substitution and prevention.

First, the authors theorize that patients with low-severity, treatable conditions will substitute the ER for a retail clinic when a retail clinic is convenient. These conditions include minor illnesses and injuries that can be treated by a nurse practitioner or general medical practitioner, such as ear infections, eye infections, upper respiratory tract infections, sore throats, urinary tract infections, sprains, and strains. The authors call this class of condition primary care treatable.

Because these conditions require treatment relatively quickly, these patients may end up in the ER if they cant get a doctors appointment. If a retail clinic opens nearby, however, some of these patients should switch to the clinic because of its convenience and low cost. In particular, patients with the least-severe conditions in these categories should be more likely to switch venues, leaving the ER to handle fewer but more severe visits in the primary care treatable category.

Related: Walmart Launches Digital Healthcare Site

Second, the authors theorize that ER visits will be prevented when a retail clinic opens because more people will receive preventive primary care. In this class of conditions, dubbed emergent, preventable, the authors focus on influenza and diabetes. These are illnesses that can be avoided or controlled in an outpatient setting if they are treated properly (with flu shots and glucose monitoring), but if they go untreated, they will land some patients in the ER.

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Retail Clinics Make Important Contribution to Healthcare - Managed Healthcare Executive

Americans are retiring to Vietnam. Here’s why – Los Angeles Times

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When John Rockhold drew a low number, No. 12, in the 1971 draft lottery, his adolescence in the San Fernando Valley forever changed. Seeking to avoid the Army, he signed up for the Navy just after graduating from Granada Hills High School. As an enlisted petty officer, he spent months operating boats that dropped off SEALs at night along long and humid Vietnamese shorelines where American troops were trying to stop the communist north from taking over the south.

More than 58,000 U.S. service members died in the war, and since it ended in 1975, innumerable American veterans have returned to Vietnam, seeking understanding, forgiveness or reconciliation. Now some are coming for more mundane reasons: inexpensive housing, cheap healthcare and a rising standard of living.

After his military career, Rockhold worked as a defense contractor, operating mostly in Africa. He first returned to Vietnam in 1992 to work on a program to help economic refugees. He settled in Vietnam in 1995, the same year the United States and Vietnam normalized relations. He married a Vietnamese woman in 2009.

In fact, he liked it so much that he persuaded his mother to move to Vietnam from Santa Maria, Calif., also in 2009.

She came for the wedding, and decided to stay, he said with a laugh. She lived in Vietnam until her death in 2015 at 94.

Rockhold, now 66, sits on several boards and is raising two children, 10 and 9, with his wife, Tu Viet Nga. The children were born via caesareansection; the procedure, including a four-day hospital stay, cost about $1,200, far less than it would have in the United States. The family lives in a 20th-floor condominium overlooking the Saigon River and the sprawling city beyond. They bought the four-bedroom, 3-bathroom unit, measuring about 1,840 square feet along with a separate veranda, for about $250,000 in 2011.

Rapid growth in Vietnam and its Southeast Asian neighbors has created a situation that would have been unthinkable in the past: Aging American boomers are living a lifestyle reminiscent of Florida, Nevada and Arizona, but in Vietnam. Monthly expenses here rarely exceed $2,000, even to live in a large unit like Rockholds, including the help of a cook and a cleaner. The neighbors are friendly: A majority of Vietnamese were born well after the war ended in 1975, and Rockhold says he has rarely encountered resentment, even when he talks about his service as a combat veteran.

The vast majority of the owners in his apartment building are members of Vietnams burgeoning urban middle class; many work in government or in education, and can afford to take vacations abroad. He estimates that no more than 1 in 5 residents in the 25-floor complex are foreigners.

The Vietnamese were extremely nice to me, especially compared to my own country after I came back from the war, Rockhold said at a coffee shop recently inside a polished, air-conditioned office tower that also houses a restaurant and cinema.

In semi-retirement, Rockhold keeps busy: He helps Vietnam import liquefied natural gas, and is involved with a charity that provides solar energy to low-income households. His wifes family farm is about a 45-minute drive from where he once saw combat. It didnt ever pass my mind that 30 years later I was going to own some of Vietnam, Rockhold said with a chuckle.

Vietnam has relaxed visa rules to lure American retirees like Rockhold, along with their savings. Geopolitics are a factor; Vietnam has seen spillover benefits from the economic boom in China but also has an ambivalent relationship with its far larger and more powerful neighbor, with which it fought a brief war in 1979. Expatriates tend to consider Vietnam more hospitable than China; Ho Chi Minh City, formerly Saigon, retains a cosmopolitan character.

The government wont say precisely how many American retirees live in Vietnam. Interviews with about a dozen such retirees suggest that some are here on one-year tourist visas; others are here just for a season or two; and still others have qualified for long residence by marrying Vietnamese citizens, as Rockhold did.

One Army veteran, Michael Gormalley, a former platoon sergeant, returned to Vietnam as a volunteer English teacher for rural high schools in 2008. In 2014 he started teaching at a Vietnamese university.

He arrives at school at 7 a.m., before it gets too hot in the classrooms, which are not air-conditioned. He leads groups of blue-uniformed, necktie-wearing, exam-wary teenagers who might have classes six days a week. The 71-year-old former school principal in Pittsfield, Mass., said he had added teaching hours to show respect for the Americans and Vietnamese people who lost their lives during the Vietnam War.

Frederick R. Burke, a lawyer with the law firm Baker McKenzie who is well-connected in the American expatriate community here, remarked on the number of veterans living in Vietnam. They want to come back and want to reconcile, he said. Often theyve married a Vietnamese woman, and their Social Security and veteran benefits go a lot further here than they do in Los Angeles.

Vietnam has joined other Southeast Asian countries to lure retirees from wealthier parts of the world.

Cambodia, another nation that struggles with the legacy of United States military intervention, is also attempting to attract American retirees. The countrys per capita GDP is about $1,400, and for that sum, an expatriate can easily pay a months rent, energy costs and a housekeepers wages.

Sri Lanka, where a brutal civil war ended in 2009, is issuing renewable two-year visas to retirees 55 and older if they can support themselves and have at least $15,000 in a local bank account. A typical expatriate cost of living is $1,000 to $2,000 per month.

Historically, the Philippines, Thailand and Malaysia were more common destinations for American retirees. But a higher cost of living, especially in coastal areas like California and New York, has pushed many farther afield.

Rockhold, the Navy veteran, said that healthcare had vastly improved in Vietnam. He added, This is one of the safest cities in the world; petty pickpocketing is almost unheard of.

Remarkably, he said, some of his friends are Americans who never served in Vietnam. The cost of living is so low, he said. Its a communist country, but if I blindfolded you and put you in downtown Saigon, you wouldnt know it.

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Americans are retiring to Vietnam. Here's why - Los Angeles Times

The global Internet of Things (IoT) in healthcare market size to grow at a CAGR of 27.6% – PRNewswire

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The global Internet of Things (IoT) in healthcare market size to grow at a CAGR of 27.6% during the forecast period

NEW YORK, Dec. 26, 2019 /PRNewswire/ --

Read the full report: https://www.reportlinker.com/p05184178/?utm_source=PRN

The IoT in healthcare market size is projected to grow from USD 55.5 billion in 2019 to USD 188.0 billion by 2024, at a Compound Annual Growth Rate (CAGR) of 27.6% during the forecast period. The IoT in healthcare market is driven by factors, such as advancement in technology coupled with rising demand for self-health management service and rise of digitalization and increase in the overall level of connectivity and innovations taking place in the modern healthcare ecosystem. However, lack of skilled digital workforce, and challenge for organizations due to security concerns related to the violation of crucial patient information are expected to retrict thre growth of the IoT in healthcare market.

Systems and Software segment to grow at the highest CAGR during the forecast periodThe IoT in healthcare market by component is segmented into medical devices, systems and software, services, and connectivity technology.The systems and software segment is expected to grow at a rapid pace during the forecast period.

Systems and software are the most promising components in the IoT in healthcare market as they create a high degree of smart characteristics and autonomy in the IoT ecosystem. They are designed to meet interoperability challenges that occur due to varied heterogeneous devices, along with managing large volumes of data and offering them security and privacy.Hospitals, surgical centers, and clinics segment to hold the largest market size during 2019The IoT in healthcare market by end user has been segmented into hospitals, surgical centers, and clinics; clinical research organizations; government and defense institutions; and research and diagnostic laboratories. IoT solutions in the healthcare sector are majorly catered by this segment that consists of hospitals, surgical centers, and clinics, as they are the most approached care centers by patients.

APAC to grow at the highest CAGR during the forecast periodAsia Pacific (APAC) is expected to grow at the highest CAGR during the forecast period. Factors, such as flexible economic conditions, industrialization- and globalization-motivated policies of the governments, as well as expanding digitalization, would support the growth of the IoT in healthcare market in the region.

In-depth interviews were conducted with Chief Executive Officers (CEOs), innovation and technology directors, system integrators, and executives from various key organizations operating in the IoT in healthcare market. By Company: Tier I: 45%, Tier II: 40%, and Tier III: 15% By Designation: C-Level Executives: 40%, Directors: 35%, Managers: 15% and Others: 10% By Region: North America: 15%, APAC: 35%, Europe: 40%, and RoW: 10%

The report includes the study of key players offering IoT in healthcare solutions and services.It profiles major vendors in the global IoT in healthcare market.

Major vendors in the IoT in healthcare market are Agamatrix (US), Armis (US), Capsule Technologies (US), Comarch SA (Poland), Cisco Systems (US), GE Healthcare (US), IBM Corporation (US), Intel (US), KORE Wireless (US), Medtronic (Ireland), Microsoft Corporation (US), OSP Labs (US), Resideo Technologies (US), Royal Philips (Netherlands), SAP SE (Germany), Sciencesoft (US), Softweb Solutions (US), STANLEY Healthcare (US), Telit (UK), and Welch Allyn (US). It further includes an in-depth competitive analysis of key players in the IoT in healthcare market, along with their company profiles, business overviews, product offerings, recent developments, and market strategies.

Research CoverageThe market study covers the IoT in healthcare market across segments.It aims at estimating the market size and the growth potential of this market, across different segments, such as component, application, end user, and region.

The study further includes an in-depth competitive analysis of key players in the market, along with their company profiles, key observations related to product and business offerings, recent developments, and key market strategies.

Key Benefits of Buying the ReportThe report will help the market leaders/new entrants in this market with information on the closest approximations of the revenue numbers for the overall IoT in healthcare market and the subsegments.This report will help stakeholders understand the competitive landscape and gain more insights to position their businesses better and to plan suitable go-to-market strategies.

The report further helps stakeholders understand the pulse of the market and provides them with information on key market drivers, restraints, challenges, and opportunities.

Read the full report: https://www.reportlinker.com/p05184178/?utm_source=PRN

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The global Internet of Things (IoT) in healthcare market size to grow at a CAGR of 27.6% - PRNewswire

Think Twice When Choosing Skin Care Products as Gifts for Kids with JA – Juvenile Arthritis News

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As I searched online for Christmas presents for my loved ones recently, I browsed selections of pre-made gift kits. Many of them were bath or skin care based. I saw adorable bubble bath sets for children, makeup and nail kits, and baskets of soaps and creams marketed to young men and women.

Skin care products can make lovely gifts. I bought a unicorn tumbler full of bath bombs for my young cousin. But as I shopped, I thought about how I wouldnt buy gifts like these for myself. As someone withjuvenile-onset psoriatic arthritis, I would worry that they might flare my skin. I realized many of these gifts wouldnt be suitable for kids or young adults with juvenile rheumatic conditions.

Additionally, conditions such as systemic arthritis, dermatomyositis, scleroderma, psoriatic arthritis, and lupus can cause rashes, lesions, and other skin issues, which can be further irritated by skin care products.

Those with skin conditions cant usually tolerate the ingredients used in pre-made bath sets and makeup kits. Items such as bath bombs are not recommended for those with particular skin conditions. Other products may be drying and irritating to those with sensitive or inflamed skin.

But that doesnt mean you have to avoid giving pampering gifts altogether. Many kids with juvenile arthritis benefit from the soothing effects of a warm bathand the confidence boost of wearing makeup. Instead, when choosing a gift, consider the products quality.

If youre thinking of giving soaps, makeup, and lotions as gifts dont be afraid to ask the childs parents which products they use. And stick to those brands. Dont be misled by product labels containing words like natural, healing, or even psoriasis-friendly. While the claims might be valid, its best to stick to products that the family already trusts the brands they use are likely either doctor recommended or theyve discovered them after much trial and error.

Quality is essential for those living with chronic skin conditions. Dont be surprised if the products and brands that the person uses are a little expensive. You dont need to break your budget, but remember that its better to choose quality over quantity. A trusted eye shadow palette with one or two colors is worth much more than another with multiple shades that may irritate the skin.

You might also consider gifting skin care accessories such as makeup brushes or sponges, or a cosmetic bag to keep products in.

You could put together a custom-made bath kit. For younger kids, a bath caddy filled with bath toys and crayons, a hooded towel, a brush and comb, and fun, colored puffs. Older kids and teens might prefer bathrobes, slippers, eye pillows, spa socks, and candles or essential oils. I like this idea because you can pick and choose each item and customize it to the recipient.

Ive received lots of bath and beauty products in the past. Many of them came from my parents, who knew how careful I needed to be with skin products. Im always extremely appreciative of the lotions, makeup, and perfumes they gift, particularly as they can be pricey.

Sometimes Ive received products that I didnt feel comfortable using. But I accepted them with a smile and a genuine thank you. Im grateful for the gift of someone thinking of me, taking the time to buy me a gift, and wrap it up.

***

Note: Juvenile Arthritis News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Juvenile Arthritis News, or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to juvenile arthritis.

Elizabeth Medeiros is a young adult who has dealt with juvenile arthritis since she was a small child. However, her pain hasnt stopped her from working on a product design degree in Boston. Her passion is to create products that make life easier for the chronically ill, such as shoes and walking canes. When shes not in class, Elizabeth enjoys writing about how shes coped with arthritis at such a young age. You can find more of her writings at ArthritisGirl.Blogspot.com and on Instagram @GirlWithArthritis.

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Think Twice When Choosing Skin Care Products as Gifts for Kids with JA - Juvenile Arthritis News

Researchers Have Identified 100 Mysteriously Disappeared Stars in The Night Sky – ScienceAlert

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Across the Milky Way there are vacant spaces where a star once brightly shone. Some left clues in a dramatic death, or faded into retirement. Others simply moved into a new neighbourhood.

Not all vacancies have such convenient explanations, though. Some were there one moment and gone the next, inviting speculation over rare types of star death, extreme astrophysics, and, of course advanced alien technology.

By comparing star catalogues dating back to the 1950s with more recent datasets, researchers with the Vanishing & Appearing Sources during a Century of Observations project have identified around 100 bright dots that seem to have vanished without a trace.

The search is an ongoing one for lead researcher Beatriz Villarroel and her colleagues, one that started several years ago as part of a hunt for potential signs of alien intelligence.

"Finding an actually vanishing star or a star that appears out of nowhere! would be a precious discovery and certainly would include new astrophysics beyond the one we know of today,"says Villarroel, a theoretical physicist from Stockholm University.

In an earlier study Villarroel and her team compared the positions of some 10 million objects recorded in the US Naval Observatory Catalogue (USNO) with their counterparts in the Sloan Digital Sky Survey (SDSS).

They were left with about 290,000 missing objects, most of which could easily be accounted for on closer inspection. Eventually they found a single star that genuinely seemed to have disappeared, and even that discovery came with lingering doubts.

It was an intriguing find, but hardly constituted compelling evidence of new kinds of astrophysics.

In this latest study they compared 600 million objects in the USNO catalogue with a collection put together by the University of Hawaii's Pan-STARR system.

The naval catalogue spans around 50 years of sky surveys, capturing details of the entire sky in five colours down to a visual magnitude of about 21.The cosmic objects in the Pan-STARR data release include slightly dimmer objects, down to a magnitude of roughly 23 as compared to the SDSS's 22.

Having more stars to compare means potentially more 'missing' stars, while capturing objects of a lower magnitude means making extra sure there's nothing sitting in the star's place.

The comparison revealed 151,193 candidates for missing stars. This number was whittled down to 23,667 possibilities by widening the search field, cutting away stars that seemed to have moved farther than expected.

That short list was visually inspected, excluding around 18,000 images that were messed up by flaws or artefacts. Lastly, the team removed images where the missing star was towards the edge of the field, just to reduce risk of any false positives.

One final sweep using yet another method for comparisons removed other possible flaws in data collection, or unclear results. That left 100 dark shadows where a star once shone.

When a star dies, it usually goes out with a bright shout as a super nova, or quietly fades into a softly glowing ember like a white dwarf. They don't tend to just stop shining.

There could be some clues in the fact that the pool of candidates were in general a little redder in colour than the typical USNO catalogue object, and were generally faster moving. Working it out will take further research.

"We are very excited about following up on the 100 red transients we have found," says Villarroel.

There are plenty of explanations that need exploring before we can be confident this represents anything exotic, something the team hopes to accomplish with citizen science projects.

One possibility is that the object occasionally flares enough to be seen before dimming again a few magnitudes. Another explanation although very unlikely is they're all just scratches after all, and never existed to begin with. It could also be a dull star we assumed was farther away and has just moved too far to be noticed.

A more exciting thought is that a few might be super-rare failed supernovas, forming black holes without the fireworks display. As cool as that would be, it's a stretch to think this would explain all of the observations.

If the disappeared stars turn out to be none of these things, we may need to entertain new physics.

"We believe that they are natural, if somewhat extreme, astrophysical sources," says Martin Lpez Corredoira from the Instituto de Astrofsica de Canarias in the Canary Islands.

There is that other explanation. The one we'd all like to be true, but can't take seriously until we have a lot more evidence:Aliens could be covering these stars up to absorb their light, converting it into useful energy before shedding it as low grade radiation. Or the initial flares might be short lived, intense signals from alien technology.

In moments like this, we can all let our imaginations run a little wild, even if the researchers are hesitant.

"But we are clear that none of these events have shown any direct signs of being ETI [extra terrestrial intelligence]," says Corredoira.

Which might just be what the aliens want us to think.

This research was published in the Astronomical Journal.

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Researchers Have Identified 100 Mysteriously Disappeared Stars in The Night Sky - ScienceAlert

Mysteriously Disappearing Stars Lead to Theories of New Astrophysics and Alien Technologies – Interesting Engineering

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Astrophysicists deal with unknown phenomena all the time. One such phenomenon is the case of mysteriously disappearing stars.

RELATED:7 WEIRD STARS THAT HAVE ASTRONOMERS SCRATCHING THEIR HEADS

Researchers with the "Vanishing & Appearing Sources during a Century of Observations" (VASCO) projecthave identified 100 such stars that once existed and then magically stopped. They did so by comparing catalogs from the 1950s to today's data sets.

"Finding an actually vanishing star - or a star that appears out of nowhere! - would be a precious discovery and certainly would include new astrophysics beyond the one we know of today", said project leader Beatriz Villarroel, Stockholm University and Instituto de Astrofsica de Canarias, Spain.

When stars die they either become white dwarfs or supernovas. Stars that don't fit in either of these categories are considered "impossible phenomenon" that could be attributed either to new astrophysics or to alien activity.

Out of 15% of the 150,000 candidate objects in the available data, the researchers have spotted approximately a hundred red transients. "We are very excited about following up on the 100 red transients we have found", said Beatriz Villarroel.

Before you get too excited that these 100 objects may be due to alien activity it should be noted that the researchers discounted that possibility.

"But we are clear that none of these events have shown any direct signs of being ETI. We believe that they are natural, if somewhat extreme, astrophysical sources", said Martin Lpez Corredoira, co-author of the paper, Instituto de Astrofsica de Canarias, Spain.

Now, the researchers are seeking help to examine all150,000 candidate objects. Through acitizen science project, they hope to find more information on these anomalies. And who knows with a bit of luck they may actually detect some alien activity.

"We hope to get help from the community to look through the images as a part of a citizen science project," said Lars Mattsson, Stockholm University.

The rest is here:

Mysteriously Disappearing Stars Lead to Theories of New Astrophysics and Alien Technologies - Interesting Engineering

This drone will fly on one of Saturns moons. Heres the woman leading the mission – PBS NewsHour

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A billion miles sounds impossibly far, but in planetary terms, You can get there, said Elizabeth Turtle.

In Turtles lifetime, shes seen human technology reach Uranus and Neptune, quick flybys that completely transformed our understanding of the solar system.

Thats why she is leading the hunt for rocks on Titan one of Saturns moons that, surprisingly, could tell us a lot about Earths early days.

Turtle who goes by the nickname Zibi is the principal investigator for NASAs Dragonfly mission, a drone-like vehicle the space agency plans to launch toward Titan in 2026.

The Dragonfly rotorcraft will finally arrive on Titan in 2034, after an eight-year-long voyage from Earth. During its 2.7 year-long baseline mission, it will take advantage of Titans dense atmosphere to travel more than 100 miles almost double the distance traveled by all of the land-based Mars rovers combined. By flying to multiple locations, the mission hopes to collect organic samples from a variety of environments.

Zibi Turtle. Photo by Johns Hopkins University Applied Physics Laboratory

Titan is one of the many satellites in the outer solar system with an interior water ocean, making it an ideal place to search for elements necessary for the origin of life. Its much colder than our planet, but is chemically similar to early Earth, Turtle said.

Humans have probed Titan in the past. In 2005, the European Space Agency landed on the moon during the Cassini mission, parachuting a camera toward the terrain that took photos during its two-and-a-half-hour descent. With Dragonfly, scientists hope to measure the chemical composition of the moons surface. Theyll look at how Titans atmosphere could affect those chemical compounds to get a better picture of which might be biologically relevant to the development of life.

In an interview with the PBS NewsHour, Turtle, who is also a planetary scientist, discussed the mission and what scientists are hoping to find. (Spoiler alert, it may not be aliens.)

The conversation has been edited for length and clarity.

Ive always been really interested in astronomy. My dad majored in astronomy. I kind of grew up going out to look at comets and meteor showers and aurora and things like that. Id always had an interest in college. I took a bunch of astrophysics courses and then I started taking planetary science courses. The planets are a little more closer and tangible, you can get there.

At the time, Voyager was making its way out to the Neptune and just the idea of exploration and the sense of how much we were learning in such a short period of time with these Uranus and Neptune flybys, was very quick. The New Horizons flyby took a very short period of time, and yet it completely transforms the understanding of the system.

Zibi Turtle is seen here in front of Yasur Volcano during a 2014 trip to observe and study volcanoes in Vanuatu, an archipelago about 1,000 miles east of Australia. Photo by Zibi Turtle

Its a very exciting field, theres just so much we dont know, and so many things that we have opportunities to learn.

I ended up going to grad school in planetary science and worked with the Galileo mission, studying Io and Europa, both moons of Jupiter. Then I worked with the Cassini mission, studying Titan primarily and some of the other icy satellites in the Saturnian system.

Titan is unique in that its the only moon in the solar system to have a dense atmosphere. This atmosphere is mostly nitrogen, like Earths atmosphere, and then it has methane as its next major constituent. Its so much colder in the outer solar system that the compositions are different, so you get very complex organic molecules. This complex organic matter has had the availability of liquid water in the past. You have all the ingredients we know to be necessary for life on the surface of Titan.

We want to study the pre-biotic chemistry the chemical steps that occurred that may have supported the development of life.

Dragonfly will take samples of Titans surface materials for chemical analysis. Image by NASA

Titan in many ways chemically is similar to early Earth, and so by studying Titan we can get an understanding of what processes may have happened here.

Instead of driving across the surface the way we often do on Mars, we fly from place to place with a rotorcraft. This gives us the ability to get to places over 100 kilometers apart and measure compositions in different environments with different histories.

In the past on Titan, liquid water would have been in contact with this organic material, meaning theres great opportunity for all of this pre-biotic organic synthesis to occur. We really want to understand the results of these chemistry experiments that Titan has been doing for millions of years. Then we want to put that in the context of Titan as a system.

Titan has a much thicker ice crust, but it has this organic material and thats really where the connection to the early Earth comes in.

Titan has a much thicker ice crust, but it has this organic material and thats really where the connection to the early Earth comes in. Its about the only place in the solar system that has this level of chemical complexity in terms of just the size of the carbon molecules on Titan, so its really the only the only parallel to Earth in terms of the chemistry available.

The other thing thats similar to the Earth is that because theres an atmosphere interacting with the surface, the geology is very similar. Not only do you have these similar molecules, but they have processes, like wind and rain, transporting them across the surface and mixing them the same way we have here on earth. There are lakes and seas on Titan of liquid methane instead of water here on earth, Titan being made of water ice instead of silicate rock here on Earth.

*Laughs*

We dont have reason to believe life would have developed on Titan. We cant say that it didnt, but its certainly not necessarily something wed expect. The surface temperature on Titan is 94 Kelvin, -290 Fahrenheit. Thats certainly not conducive to life as we know it. Everything is frozen solid at the surface.

We have the capability to make the measurements to detect chemical bio signatures, things like the chiral preferences for the structure of molecules. We do know that water and organic material have been in contact for long periods, but we dont know how long it took life to develop on Earth. We dont even know how long you need.

At this point, given the conditions there, we would be remiss if we didnt if we didnt look.

Hundreds of people are working on all of these projects and coming up with ways to solve challenges, to make things work better. Its a lot of fun. But its more fun when it works. Those are some of the less fun moments of mission or instrument design when you hit challenges that there isnt a way to surmount. Thats where things can be on the more frustrating side.

The exploration is incredibly fun. I remember as a grad student and postdoctoral researcher coming in to work at night when the new images from Galileo of Io were coming back, theres something different every time you look at it. It was spectacular to rush in and pull up the images and see what had happened, what volcanoes had started erupting since the previous flyby.

Zibi Turtle (bottom row, center) poses with the rest of the team from the Dragonfly mission. Image by NASA

That had this human desire to explore, to see whats behind beyond the horizon. This is just looking at all the ways of learning whats beyond the horizon further out in the solar system. Part of the excitement is really learning whats new and seeing what what we havent seen before on other planets and then trying to figure out how it works.

We went from barely knowing what the surface of Titan was like to understanding the geography of Titan, geological processes and how they fit together and how Titan works as a system. Its a huge privilege to be able to participate in that journey. And well be doing the same with the Europa Clipper and with Dragonfly.

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This drone will fly on one of Saturns moons. Heres the woman leading the mission - PBS NewsHour