Art can be a powerful medicine against dementia – The Guardian

People living with dementia discuss art at a Royal Academy InMind session. Photograph: Roy Matthews

A few weeks ago, turning on the radio, I hear a voice saying that creative writing can help wounds heal faster. Startled, I turn the volume up. Volunteers were given small wounds; half were then asked to write about something distressing in their life, the other half about something mundane. The wounds of the confessional writers healed substantially more quickly. A thought or a feeling is felt on the skin. Our minds, which have power over our bodies, are in our bodies and are our bodies: we cannot separate the two. Words, self-expression, can tangibly help pain and suffering. Art can be medicine, for body and soul.

Over and over again, I am reminded of the transformative power of art. Answering the phone, I hear a deep and husky voice: Doe, a deer, a female deer. My mother, 85, frail, registered blind, bashed about by cancer and several strokes, is having singing lessons. At school, she was made to mouth the words of songs and she never sang again until now. Eighty years after being told she was tone deaf, her voice is being released. Me, a name I call myself

Or recently I found myself in a hall in London, holding hands with a tiny woman from Jamaica and a large man from Birmingham, we dance. Bit by bit, our self-consciousness falls away and we grin at each other, laugh. Dementia has robbed them of their verbal ability but there are many different languages, many different forms of embodied knowledge and ways that we can connect with each other.

Dementia can look like solitary confinement and solitary confinement is a torture that drives most people mad

Or sitting in a church in Essex on a Sunday in June, I look across at my friends mother. She is in her 90s and has dementia. There are days when she is wretched, chaotic and scared, but each Sunday she is soothed and even enraptured by singing the hymns that she sang when she was a girl. The music has worn grooves in her memory and while she may not be able to speak in full sentences any more, she can sing Abide With Me in a true voice and her face, lifted up, looks young, eager, washed clean of anxiety. My friend thinks that at these moments her mothers brain comes together, like a flower reviving when its being soaked in water. People with dementia, she says, need to be drenched in art.

And this is precisely what the report of an all-party parliamentary group inquiry into arts, health and wellbeing, to be launched on Wednesday 19 July, will say. After two years of evidence gathering, roundtables and discussions with service users, health and social care professionals, artists and arts organisations, academics, policy-makers and parliamentarians, its unambiguous findings are that the arts can help keep us well, aid our recovery and support longer lives better lived; they can help meet major challenges facing health and social care ageing, long-term conditions, loneliness and mental health; and they can help save money in the health service and in social care.

Dementia is an area where the arts can radically enhance quality of life by finding a common language and by focusing on everyday, in-the-moment creativity. As Lord Howarth of Newport, co-chair of the all-party parliamentary group, said: The arts have a vital role to play for people with dementia. Research demonstrates that visual arts, music, dance, digital creativity and other cultural activities can help to delay the onset of dementia and diminish its severity. This not only makes a huge difference to many individuals but also leads to cost savings. If the onset of Alzheimers disease (which accounts for 62% of dementias) could be delayed by five years, savings between 2020 and 2035 are estimated at 100bn. Those are powerful statistics, but this isnt just about money; the arts can play a powerfulrole in improving the quality of life for people with dementia and for their carers.

Its what Seb Crutch and his team are exploring in their inspiring project at the Wellcome Foundation. Its what is happening with Manchester Cameratas Music in Mind or with Music for a While, a project led by Arts and Health South West with the Bournemouth Symphony Orchestra, with Wigmore Halls participatory Music for Life, with the project A Choir in Every Home and Singing for the Brain; with dance classes in hospitals and residential homes; with art galleries and museums that encourage those with dementia to come and talk about art.

There are optimistic, imaginative endeavours going on all over the country, in theatres, galleries, cinemas, community centres, pubs, bookshops, peoples houses. Its happening at a macro- and a micro-level. At a conference run by the Creative Dementia Arts Network, where arts organisations and practitioners gathered to share experience, I met two young students from an Oxford school who with fellow students go into local old peoples homes to make art: not the young and healthy doing something for the old and the frail, but doing it with them, each helping the other: this is the kind of project that is springing up all over the country.

I attended one of the monthly sessions at the Royal Academy in London where people with dementia who have been art-lovers through their life and are art-lovers still come to talk about a particular work, led by two practising artists. We sat in front of an enigmatic painting by John Singer Sargent, and there was an air of calmness, patience and above all, time, and there were no wrong opinions. There are many ways of seeing. People with dementia are continually contradicted and corrected, their versions of reality denied: its Sunday not Friday; youve already eaten your breakfast; Im your wife not your mother; anyway, you are old and she is dead . In this humanising democratic space, people were encouraged to see, think, feel, remember and express themselves. Slowly at first, they began to talk. There was a sense of language returning and of thoughts feeding off each other. They were listened to with respect and were validated.

Validation is crucial. We are social beings and exist in dialogue; we need to be recognised. In health, we live in a world rich with meanings that we can call upon as a conductor calls upon the orchestra, and are linked to each other by a delicate web of communications. To be human is to have a voice that is heard (by voice I mean that which connects the inner self with the outer world). Sometimes, advanced dementia can look like a form of solitary confinement and solitary confinement is a torture that drives most people mad. To be trapped inside a brain that is failing, inside a body that is disintegrating, and to have no way of escaping. If evidence is needed, this report robustly demonstrates that the arts can come to our rescue when traditional language has failed: to sing, to dance, to put paint on paper, making a mark that says I am still here, to be touched again (rather than simply handled), to hear music or poems that you used to hear when you were a child, to be part of the great flow of life.

I think of the wonderful film Alive Inside, made about a project in a huge care home in America: an old man with advanced dementia sits slumped in a wheelchair. He drools; his eyes are half closed and its impossible to know if he is asleep or awake. A few times a day, soft food is pushed into his mouth. Then someone puts earphones on his head and suddenly the music that he loved when he was a strong young man is pouring into him. Appreciation of music is one of the last things to go. His head lifts. His eyes open and knowledge comes into them. His toothless mouth splits into a beatific grin. And now he is dancing in his chair, swaying. And then this man who doesnt speak any longer is actually singing. The music has reached him, found him, gladdened him and brought him back into life.

Its like a miracle but one that happens every day, in care homes, in community halls, in hospitals, wherever kind and imaginative people are realising that the everyday creativity is not an add-on to the basic essentials of life, but woven into its fabric. Oliver Sacks wrote the function of scientific medicine is to rectify the It. Medical intervention is costly, often short-term and in some cases can be like a wrecking ball swinging through the fragile structures of a life. But art calls upon the I. It is an existential medicine that allows us to be subjects once more.

Nicci Gerrard is a novelist and author and co-founder of Johns Campaign johnscampaign.org.uk

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Art can be a powerful medicine against dementia - The Guardian

Q&A with Paul L. DeAngelis: OU medicine professor doubles as biotech entrepreneur – NewsOK.com

Along with teaching at the University of Oklahoma Health Sciences Center, Paul DeAngelis serves as chief scientist for four biotech companies he founded. [PHOTOS BY STEVE SISNEY, THE OKLAHOMAN]

It was a tiny advertisement in the corner of a crowded bulletin board at Harvard College that fortuitously sent Paul DeAngelis, a professor and scientist at the University of Oklahoma, on his career path of studying sugar polymers and the now real potential for a much safer and more effective form of the blood-thinner heparin, better delivery methods for all drugs, and more.

The year was 1981 and DeAngelis was a sophomore looking for a work/study job when he spied the scrap of paper about research involving carbohydrate chemistry. Most of the other research was on proteins or DNA regulation.

That work/study job is what started me off in the sugar world, DeAngelis said. I figured it was a new frontier and I could blaze my own trail.

And blaze he has.

Along with teaching at OU, DeAngelis serves as chief scientist for four biotech companies including 15-year-old Heparinex, which produces a synthetic bacteria-based anticoagulant, after animal-based heparin caused nearly 100 deaths in China, and 8-year-old Caisson Biotech, which uses a precursor to heparin a sugar molecule native to the human body for a new drug delivery method that lengthens drugs' effectiveness and lessens their side effects.

From his eighth-floor lab in the OU Medicine tower, DeAngelis, 55, sat down on Tuesday to talk with The Oklahoman about his life and career. This is an edited transcript:

Q: Based on your surname, I'm guessing you have Italian roots?

A: Yes. My dad was 100 percent Italian. My mom is German and Irish. All of my grandparents were born in the U.S. Funny once when I was visiting Sorrento, Italy, three different people mistook me as a native, inviting me to go somewhere or asking for a ride. I don't speak Italian; only the Spanish I learned in high school.

Q: What did your parents do?

A: When they met, my mom was a jockey and my dad was a trainer. But when it was time for me to start school, my dad got a job in a brewery bottling plant in Baltimore and my mom took care of us kids. I'm the oldest of five. After we all graduated high school, my parents moved out of the city to raise thoroughbreds. My mom, who's in her 70s, rode horses on the training track until 10 years ago. She still lives in Maryland; we've lost my dad. My siblings are scattered, but we all got together this past Easter at my sister's house in Florida.

Q: When did you decide to become a scientist?

A: I always liked science. As a kid, I grew plants and did experiments. My mom would say Don't make that smelly stuff in my kitchen, but she was really supportive. My parents, so that we'd be physically fit, also encouraged sports. I played three or four a year, including football and wrestling. In the spring, I'd ride my bike from lacrosse practice to baseball practice.

Q: Did you get a full scholarship to Harvard?

A: Pretty much. Every year, I had to earn $1,000, my parents would pay $1,000, and I'd take out a $1,000 student loan. I'm sure my parents were happy, because I easily could've eaten more than 1,000 bucks of food a year.

Q: What brought you to Oklahoma?

A: I did postdoctoral work at the University of Texas medical branch in Galveston with Paul Weigel, who recruited me here after he became chair of the Biochemistry and Microbiology Department; he's now chair emeritus. I joined the faculty in December 1994 as an assistant professor with my own projects. I'd never even driven through Oklahoma, but I knew it was a good opportunity. There already was glycobiology experience in Oklahoma, OU was proactive with biotech ventures, and people here are nice and work hard.

Q: Tell us more about your promising pharmaceuticals.

A: We discovered an enzyme in bacteria and harnessed the ability to make new and different-sized sugar polymers with repeating chains. That's opened up all sorts of possibilities for biomaterials and drug delivery; much like plastics, which includes plastic bags, plastic tubes and more.

One of the biotech companies I founded, Hyalose LLC, is focused on the commercialization of unique recombinant technologies for producing Hyaluronic Acid, an important biomolecule for many health care and cosmetic applications. Everything still is under evaluation, but hopefully will get into humans some time. Carbohydrates are more invisible and harder to study than proteins and DNA, which are easier to watch. There are fewer tools in the field, but we're learning new stuff all the time.

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Q&A with Paul L. DeAngelis: OU medicine professor doubles as biotech entrepreneur - NewsOK.com

Creating the Google of medicine: meeting the human CEO behind the AI doctor – TechRadar

Weve all been in the situation where you know you should go to the doctor, but its only a minor complaint. So, you decide to check first, Googling your symptoms...within half an hour you convince yourself that youve got an incredibly rare and incurable blood disorder.

Obviously you'd be better off actually seeking the advice of a medical professional, but who has time or the energy to trudge all the way to the doctor's office? If only there was a way you could get accurate, personalized medical advice on your phone.

Thats the mission of Babylon Health. Babylon already has an artificially intelligent chatbot that is being used by the UKs National Health Service (NHS) that can help you to figure out which health care professional you need, and has a dedicated app that can connect you to a GP on your phone.

You can pay per consultation or subscribe, see counsellors, and even get prescribed medicine. And the next generation is promising a whole lot more.

Created four years ago, the app now has over a million users worldwide, as well as a clinical service in Rwanda called babyl that connects people to medical professionals through smartphones and dedicated booths equipped with digital tablets. In the first six months of the service existing, almost 10% of the adult population of Rwanda has registered with babyl.

We met with Dr Ali Parsa, CEO and founder of Babylon Health to talk about his plans for Babylon and the future of healthcare.

Dr Ali Parsa: "I built a chain of hospitals. I got lucky and it did incredibly well. The business went from nothing to a few thousand employees and a few hundred million dollars of revenue. I took it public and I sold it."

"The reason I [sold it] was because when you run hospitals, you very quickly understand that the vast majority of peoples healthcare needs have very little to do with hospitals."

"Hopefully you have to spend maximum one month of your life in hospital. And if you take one month out of your life, its [around] 0.1% of your life. Most your healthcare needs for the rest of your life have nothing to do with that month."

"Its got to do with everything else: How do [healthcare professionals] keep you healthy? How do we deal with you when youre ill? How do we deal with your primary care, everything our GPs do? How do we take care of your mental health?"

"And then how do we do that at prices that everybody in the world can afford?"

"It is unbelievable that five billion people in the world have very little access to healthcare. Half of the population of the world have almost no access to healthcare. And yet they all have phones. I think that we can give most people in the world, most of the healthcare they need on most of the devices that they already have."

AP: "[In the NHS] every GP is a paid service. Its a business. So thats fine, but theyre being paid by the National Health Service."

"If you register with a great GP, theyll see you within a few hours or days. But if you have a GP who isnt so great they see you within two or three weeks."

"If you went to Babylon right now, the next available appointment is in 12 minutes. Why couldnt the NHS pay Babylon to be your GP?"

"You can be anywhere in the country and [Babylon] can see you in 12 minutes. One in ten times I have to send you to an actual physical person."

"One in ten times I tell you to see a GP near you and I pay that person. Say you [currently] go to the GP two times a year, that means once every five years I need to send you to someone physical."

AP: "We see you on the phone. We prescribe, we know exactly whats wrong, we cure you. You need no physical examination, youre done."

"It's not just the app, remember. Its a clinical service. In Rwanda, the app is only used by 5% of our users, the rest just use our clinical service. But behind the service sits the intelligence that powers the app in Rwanda."

"The BBC recently put Babylon in the top 10 science and technology innovations they believe are going to change the world. On the BBC Horizon programme last week there was a machine versus a doctor, and the machine was diagnosing as well as a doctor."

This is an interesting claim. In the episode, a GP gives herself an imaginary syndrome (fibroids), gives the chatbot her symptoms, and it manages to correctly diagnose her. Not only that but the doctor agrees with the second and third diseases in the list of differentials the AI provides.

Its very impressive, but it isnt exactly what Ali seems to be claiming here.This feels important as the moment the machine works better than the doctor, seems to us to call into question the need for the doctor. We asked Babylon about this and a spokesperson said:

"What you are seeing is the back end of the machine, this is not what the end user (patient) would see. Please keep in mind that this technology is a work in progress and is being continually developed every day. Version 3 of the babylon app will assist our doctors with diagnosis, giving them more time to focus on their patients.

AP: "Imagine putting into the hands of every human being on Earth through their mobile phone, a doctor who can diagnose them. That, I think, is a phenomenal thing to be able to do."

AP: "Were there."

AP: "We will be releasing a product in the next few months that can diagnose 80% of all primary care diseases. Now."

That's 80% of diseases it can get right, not that it will be right in 80% of all cases.

"Weve solved the problem scientifically. Thats what the BBC was testing. We just need to put it into the product so that you can have it too. Obviously, we need test it rigorously, then put it into the product. But, were there."

"In the next few months were going to do something else which is really cool which is create an avatar of every human being that uses our apps."

At this point Ali opens up a prototype of the next generation of the Babylon app, and shows us a blue avatar of a man with all the organs represented, the heart is the only organ that isnt blue, in a soft yellow. Underneath the avatar are individual sections for each part of the body, with readings that relate to that body part. Under the heart category, the cholesterol reading is yellow.

"I think [with this app] we can put a diagnostic engine into everybodys pocket. We can start putting an understanding of your body into your pocket. Because what that allows [Babylon] to do is to start predicting your health. And then try to foresee issues. Because thats where the costs are."

"Most diseases by the time they present their symptom, a 10 problem has become a 1,000 solution. Everything we do in Babylon is about this. How do you predict a disease ahead of time? What I just showed you, that avatar of me; behind that sits a massive amount of predictive analytics to constantly see how Im doing."

We asked Babylon exactly how this diagnostic tool would work and the spokesperson told us: "The monitor feature will track users health with a variety of different tools including patient history & data (doctors notes, medication, test results, frequently asked questions to the symptom checker), input from other health apps (ie, step count, daily km, sleep patterns) and input from non-health apps (ie emails, calendar)."

AP: "Eventually it will. Courses of action need to be curated country by country, its much more complex. So I can tell you that youre prone to diabetes and thats fine. But what diet you should take in India, is very different to what diet you should take in Britain. To get into that level of detail takes time."

AP: "I'm not saying that a machine will replace a doctor. Diagnosis does not need a doctor or empathy. Diagnosis is a probabilistic graphical modeling event. Im telling you what the probability of you having a disease is. Machines can do probability analysis much better than a human brain can."

"Also, diagnosis is about correlating my knowledge with your symptoms to tell you what is wrong with you. But my knowledge is limited because as a doctor, at best I can have three, four, five million strings of knowledge in my head. Our machine already has 300 million strings of knowledge. So Im looking at a much bigger pool of knowledge, I can do significantly do more, faster."

"But can a machine put its hand on your shoulder and say Trust me, Im going to look after you? Thats a fundamentally different part, and I think that Babylon will bring empathy back into medicine."

"Go to your GP with a symptom now, and they will spend five, eight, ten minutes with you to diagnose, then say okay, thats your problem, go. Wheres the empathy in that? If you went in and said, Ive used Babylon, it said this is the disease I have. They ask you a few questions to make sure its right, then they have five minutes left."

"Lets spend that five minutes to see how youre feeling. See what else is bothering you. How many patients with mental health problems do we catch? Why are GPs not catching people with mental health issues? Because they are focussing on the disease, not the full picture."

AP: "We have a whole list of restricted drugs that we never give. Our GPs work in the NHS. Why would they make a mistake and give you a drug here that they wouldnt give there? We have no interest in your drugs, we dont make money on your drugs."

We asked Babylon for further clarification on its policy and got this response: "All our doctors prescribe medication according to national guidelines for safe prescribing, in addition to following our own medication management policy which further safeguards our patients."

"When it comes to high risk medication, including drugs that people may misuse, babylon has extremely stringent policies to ensure safe prescribing. Furthermore, babylon has implemented mandatory photo identification for controlled medication which exceeds the requirements of the regulator (CQC). This is an example of our relentless pursuit of safe prescribing through a digital channel.

While discussing the potential dangers associated with the service Ali referenced internet banking, and the parallel between digital healthcare and digital banking. Undoubtedly there was a time when people were hesitant about using internet banking because they were worried about its safety, but we wonder whether the risks associated with medicine are greater than those with banking.

"I think weve got to be really careful. Everything that technology does, there are aspects that it will do better than existing, and there are elements that itll do worse. And its a choice."

AP: "To create a company that serves the globe takes 20 years. Thats just the reality. Even Uber, who is growing so fast, how old is it? Six, seven years old, and thats probably the fastest globalized company. And theyre in a tiny part of the globe still. Were in the business of creating the Google of medicine."

"I think that the software part of our business; the fact that we can put a diagnostic tool in the pocket of anyone in the world who wants it, we can create the avatar that I showed you for every human being on Earth. We can globalize that bit a lot faster."

"Putting doctors that can consult with you in every country; that takes longer. We have spent the last three years creating a product that is truly world beating. There is no product in the world that does what we do."

"You and I have the same access via mobile phone that Bill Gates has, and the cleaner in our office has. That is true democratization because it doesnt really matter how rich you are."

"Healthcare isnt like this. Even in the NHS, a lot of doctors do private work and in the private work they are much more accessible than in the public work. Even in the NHS we havent got democratized healthcare. There is no such thing as democratization of healthcare if I have to wait three weeks for it."

"Thats why I think we, or someone else like us, will fundamentally change that game. And that is brilliant for humanity. I hope somebody does it for education too and then well be a long way towards a better place."

It's difficult not to be intoxicated by the message behind Babylon. The idea of its service is very alluring, and of course it would be amazing to see a world where everyone has access to healthcare, but we feel it would be remiss of us not to consider the issues too.

As with all AI developments, if it takes away some of the work of the human currently doing the job, there is the risk that the human will just end up paid less, or working less, rather than freed by the development. And specifically with healthcare, does a paid service risk creating a world where only the wealthy can be healthy?

Scepticism aside, the ability to have an appointment with a doctor in minutes is a brilliant service, and that is reflected in the overwhelmingly positive reviews on the Google Play Store and App Store for the app. It will be interesting to see what form the diagnostic tools take in the next generation. Needless to say, we will be keeping a close eye on Babylon as it develops.

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Creating the Google of medicine: meeting the human CEO behind the AI doctor - TechRadar

Women’s League of Science and Medicine hosts awards luncheon – News 12 Brooklyn

BROOKLYN -

The Women's League of Science and Medicine awarded 21 scholarships Saturday to deserving students at a ceremony in the Flatlands.

The event was the organization's 57th annual awards luncheon. It has provided nearly 800 scholarships so far.

This year's theme was education.

Founded in 1960, the Women's League of Science and Medicine provides scholarships to students all over the tristate area.

Over the past five and a half decades, the organization has grown in size and continues encouraging the next generation of thinkers. The awards are given to high school, college and graduate students who have excelled in academics and are seeking to pursue their careers in fields ranging from medicine to science technology, law and more.

"They helped me through my transition into college. They definitely call me and my mother to make sure that I am OK and that I am accomplishing all that I need to," says three-time scholarship recipient Olivia Okeke. "They are definitely very supportive and they are a very big part of my support team and I am grateful."

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Women's League of Science and Medicine hosts awards luncheon - News 12 Brooklyn

Ellis Medicine stays solo despite partnerships all around – The Daily Gazette

Ellis Medicine on Nott Street in Schenectady.

Ellis Medicine is working with several other medical facilities to improve quality and reduce costs of government-subsidized careand will judge the results to see how to shape future collaborations.

Its a process that could lead to formal affiliations or a merger, though none is yet planned, proposed or even a concept at this point. After a decade of agreements announced by other area health care facilities, Ellis is one of the few left in this region without a formal partnership with another hospital.

It will remain that way for the short or even long term, said CEO Paul Milton.

The board is doing its homeworkand educating themselves on whats going on in health care and seeing if we need to do anything, he said. Theres no preconceived ideas that we have to do something.

In recent years:

In the wake of all this, rumors sometimes surface about an Ellis merger, but Milton said those rumors are unfounded.

What needs to happen, for Ellis and every other hospital, is to find ways to keep the patient population more healthy for less money, Milton said. If they dont, the cost of health care will rise at an unsustainably high rate.

To that end, Ellis has formed two alliances: one at federal direction to improve treatment provided through Medicare, the other at state direction to improve treatment provided through Medicaid.

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In a nutshell, what the Medicaid program is trying to do is say, Here's 100,000 lives, help us to manage them better. Try to keep them out of the ER for inappropriate ER visits and try to reduce the re-admittance ... in the next 30 days.

Its loosely referred to as 'managing population health' we're learning to do that, Milton said.

The group working to improve care and reduce costs for Medicare patients comprises Ellis, St. Peters and St. Marys Healthcare in Amsterdam. The three also are working together toward the same goal with Medicaid, joined by Hometown Health Centers in Schenectady and Whitney Young Health in Albany.

One thing that quickly became apparent through this process is how important it is for the partners to share data, and how complicated that is thanks to the differences in their computer systems, Milton said.

Its manageable but not perfect by any means, he said.

The two affiliations provide a sort of test run to see how collaboration works for Ellisand what it wants to get out of future partnerships.

It also gives Ellis a look at what Milton said will be the coming model of reimbursement for medical care, in which both government agencies and commercial insurers incentivize health care providers to keep people healthy, rather than heal those who get sick.

"Ellis looks at these changes that are coming from the insurance side, he said. Making a reasonable assumption that, in the future, theres going to be fewer health care dollars whether theyre government dollars or commercial insurance dollars and were going through the education now. Can we stay alone, and continue to be alone and independent doing this? And (can we) continue to affiliate in these kind of arrangements, or do we need to go through and do a more formal type of merger?

Ellis is looking at the mergers and affiliations that have occurred locally, as well as in other states, to see how the process has worked.

The thought process is playing out now rather than later, Milton added, because theres the luxury of time now: Were in a good position now with the services we provide and our financials;were not in a position of weakness. You really want to have this education while youre in a position of strength.

A key administrator of one of the regions largest hospital affiliations is Dr. Steven Frisch, senior vice president for integrated delivery systems at Albany Medical Center. He works closely with leaders at Saratoga Hospital and Columbia Memorial, and they have a combined service area that stretches 100 miles from north to south, through the heart of the Capital Region and beyond.

He said mergers and affiliations are a national industry trend.

Do you need to affiliate? I think its increasingly challenging to stand by yourself regardless of what size you are, he said.

External factors beyond any hospitals control federal policy changes, cost of medicine, cyberthreats, technology upgrades are evolving faster than hospitals' ability to implement programs to provide better care more efficiently at lower cost.

Is it better for us to share those costs, or is better for each of us to re-create them? Frisch said.

Albany-based health insurer CDPHP said the trend is not a positive one for its 420,000 subscribersbecause hospitals that merge or affiliate have more bargaining power and are able to negotiate higher payments for services. Insurers then pass along those higher payments to subscribers in the form of higher premiums. About 33 cents of each premium dollar goes to hospitals, CDPHP spokeswoman Ali Skinner said.

Thats always sort of the front-end messaging, she said, referring to the promise of increased efficiency and quality of care when hospitals join forces.We think thats a great thing.

"While the intentions are good, the consequences are not: Patients wind up paying more money. The literature is clear, Skinner said, citing a Robert Wood Johnson Foundation study that showed cost increases have sometimes exceeded 20 percent in markets where hospitals merged.

Its a fair statement on their part, Frisch acknowledged. He added, though, that hospital costs might well have increased even more without consolidation.

Whether or not systems are consolidating, yes, theres this phase where costs will go up. Its frustrating because we are taking costs out.

Dr. William Streck, chief medical and innovation officer at the Healthcare Association of New York State, said evidence so far indicates gains in quality and efficiency of care after mergers or affiliations, but not reductions in costs. I think it is a work in progress, he said.

HANYS is an industry group that represents 500 health care organizations across New York state, including all hospitals.

There has been a clear impetus toward consolidation, Streck said. Its been driven by both market forces and state policy.

This wont change, he added.

There are a number of financial imperatives.

One step the hospital industry is taking to respond to the changing health care market is building urgent care facilities. These can range from storefront clinics to large standalone facilities open 24/7 and offering a wide range of services. Ellis Medicine in 2012 opened its 38,000-square-foot Medical Center of Clifton Park near Northway Exit 9, which is staffed by nurses and physicians around the clock.

Ellis said the facility fulfills several purposes: Foremost, it keeps people out of the emergency department, one of the most expensive places to provide medical care. Also, it diversifies the patient mix to increase revenue for Ellis so it can remain viable and serve its whole patient population. Finally, it provides a measure of convenience by meeting patients where they are.

Louis Lecce stands in front of the Albany Medical Center Urgent Care building at 1769 Union St. in Niskayuna on Feb. 2, 2017. (Peter R. Barber)

The move into Clifton Park brought Ellis closer to Saratoga Hospitals service area. Around the same time, Saratoga Hospital and Albany Medical Center, which were not affiliated at the time, collaborated to build an urgent care center of their own Malta Med Emergent Care near Northway Exit 12.

Albany Med also built one of its EmUrgentCare facilities in Glenville, a 4-mile drive from Ellis Hospital, and then another on Union Street in Niskayuna, not even 2 miles from the headquarters of Ellis Medicine.

Ellis leadership expresses no annoyance at thisnearby competition, which it said is happening with increasing frequency in the industry.

Ellis said this is good from the patient's standpoint, as it increases choices, and it is good from Ellis perspective, as its a reminder it must provide quality care with compassion. Doing so, it said, will keep patients coming to Ellis.

By one industry estimate, there are about 10,000 urgent care clinics nationwide and nearly 400 in New York state.

Milton said Ellis Medicine has a few factors working against it as it maps its future: Some of its facilities are decades old; it provides a significant amount of mental health care, on which it makes little profit; and it provides a significant amount of indigent and Medicaid care, on which it makes no profit.

Faced with this, and the need to move to a population health model, Ellis would consider affiliating with an entity that has developed an expertise needed in the region, rather than reinventing the wheel, Milton said.

Can a place this size do that well, or does it need to scale up to get expertise to do it? Access to capital comes up. Ive got old facilities here that are going to need some investments. And based on the scale we are on now, are we going to have access to the capital we need?

Milton joined what was then Ellis Hospital in 2008 as its chief operating officer, just as the state Berger Commission ordered a number of closures and mergers among New York hospitals. Ellis Hospital was directed to merge with St. Clares Hospital, nearby in Schenectady, and with Bellevue Womans Center, a few miles away in Niskayuna, to become Ellis Medicine.

St. Clares was renamed the McClellan Street Health Center and was converted to an outpatient care, short-term rehab and nursing home. Bellevue retained its name and its mission as a maternity hospital. Ellis Hospital is still known by that nameand is home to a wide range of services, as well as the Capital Regions second-busiest emergency department.

The process was not painless, but Ellis Medicine is better off for it, and importantly, so are its patients, Milton said: I think it was very successful for this community.

Benefit to the community will be a guiding consideration in any future affiliations Ellis contemplates, Milton said.

Were only going to do something that improves the situation in this community, he said. When we go through our education with the board, one of the things were looking at is, what can we do with a partner? Lets say if it was a full merger: What is a partner bringing here thats going to make the care in this community better for the people in Schenectady? Thats the main criterion.

Id want to be very careful that this community doesnt lose anything that it has in any kind of merger or affiliation, he said.

Streck, at HANYS, said an optimum result of any affiliation or merger is increased revenue for the larger hospital involved; increased access to technology infrastructure and patient treatment options for the smaller hospital; and improved efficiency and reduced costs for both.

Frisch, at Albany Med, said the goal with the Albany-Hudson-Saratoga Springs affiliation was first to expand the medical offerings in the three communities and second to understand how to deliver care to the 100-mile long region as a whole, more efficiently and effectively.

The three entities have more than 100 locations, he noted.

What should the right distribution be across that region? he said. Thats going to be years in figuring out.

Since the affiliation, Columbia Memorial Hospital has increased its cardiology staff, added an ear, nose and throat specialist, and begun offering foot and ankle surgery. Saratoga Hospital was able to recruit an invasive cardiologist and gain access to Albany Medical Centers analytic tools; an information technology team from Albany Med was in Saratoga on Monday morning doing demonstrations.

I think our existing affiliations are working very well, Frisch said, adding that there will likely be more partnerships in the future, perhaps involving Albany Med.

Acute care is consolidating industrywide.

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Ellis Medicine stays solo despite partnerships all around - The Daily Gazette

Leadership void hangs over first day of class for UNLV Medical School – Las Vegas Review-Journal

A major health scare will keep the key leader and visionary behind the new UNLV School of Medicine from being on hand for a monumental moment Monday the first day of class for the first class of students.

Founding Dean Barbara Atkinson, who has ushered the school through countless deadlines and challenges to arrive at this point, recently suffered a ruptured intestine that triggered a serious infection. She remains hospitalized at University Medical Center in Las Vegas as UNLV officials weigh their options for an interim replacement to oversee the schools first weeks or months of operation.

Schools do face this on occasion, when the leader of the academic institution falls ill, or theres some sort of serious event that has occurred, and theyre no longer able to fulfill their duties, said Dr. John Prescott, chief academic officer for the Association of American Medical Colleges, who has reached out to school leadership to offer assistance. In most cases, theres been a succession plan that has been worked out. But since shes been with it since the founding, I dont know if thats happened.

Silence from UNLV

While university officials said this week that they are discussing the potential of hiring an acting dean to lead the fledgling school in Atkinsons absence, who that may be and when that person might step in are unclear. The university has communicated nothing to the Board of Regents, according to Regent Trevor Hayes, and has not responded to requests from the Review-Journal for interviews and information.

According to Prescott, its common in situations where a leader suddenly departs for university leaders to assess internal leaders to see if someone could temporarily step in.

Other times, he said, a school will tap a recently retired dean who can assist in the time of transition. He said schools typically seek someone with the same skill set as the person they are replacing, in this case someone who understands academic medicine.

Dr. Mark Doubrava, a physician and a member of the Board of Regents, who also chairs the Health Sciences System Committee, agreed that will be a key consideration.

It should be an individual who is in the field of medicine, and preferably has experience in medical education, Doubrava said.

Regardless of who is chosen, he or she will have big shoes to fill.

Atkinson is an accomplished educational leader, clinician and researcher who, after being appointed as planning dean in 2014, created the vision and education program for the school, while also garnering regional and legislative support. Prior to arriving in Las Vegas, she was elected to the prestigious Institute of Medicine of the National Academy of Sciences in 1997, and also served as dean of the University of Kansas School of Medicine, where she refocused the school to better serve regional needs.

Potential candidates in the ranks

The UNLV Medical Schools senior leadership includes several members who could potentially be tabbed to temporarily fill in, including:

Senior Associate Dean Dr. Parvesh Kumar, whose background includes experience as a researcher, clinician and academic. He has experience in building academic departments of radiation oncology and clinical research programs.

Vice Dean Dr. Ellen Cosgrove, an academic whose expertise lies in shaping and forming medical school programs.

Senior Associate Dean Dr. Samuel Parrish, whose background is primarily academic.

A clue on the succession could come as soon as Monday.

Since the dean usually greets medical students on their first day of classes, Prescott said UNLV will likely have someone step into Atkinsons place to provide reassurances to students.

But Regent Jason Geddes indicated that will not happen, saying he believes UNLV President Len Jessup will be on hand to greet the students.

At this time, student Sarah Grimley is feeling only excitement not nerves or concern about Atkinsons absence about the first day.

She set up everything perfectly for us, Grimley, 22, of Las Vegas said of Atkinson. Dr. Parrish and all of those people who worked right alongside her, they know everything that she wanted to happen.

They know what they have to do

Doubrava said that while Atkinson will miss the historic moment, UNLV supporters can take some comfort in the fact that she did not have teaching on her to-do list.

The curriculum, schedule has been set, he said. They know what they have to do on Monday, Tuesday, Wednesday.

In addition to providing reassurances, the acting dean will have to help address any issues that come up with the new students coming on board; continue faculty recruitment and fundraising efforts; and handle day-to-day operations and budgeting.

Over and above those duties, however, Prescott said the replacement should understand the schools mission, and commit to following it.

I have great faith the right leader will be found soon to assist until Dean Atkinson comes back, he said.

Jannah Hodges, president and managing partner of Hodges Partners Executive Search in Dallas said it is critical that a school of medicine have a strong, permanent leader at the helm. In the event Atkinsons return is delayed for some reason, UNLV could be forced to quickly mount a search for a permanent successor.

While a search for a new dean often takes up to a year, Hodges holds the Baylor College of Medicine in Texas as a shining example of how the process can be accelerated. By establishing a search committee led by a strong chairman, seeking help from an executive search firm and following a strict timeline, she said the school was able to name a new president after a relatively quick five-month search in 2010.

It was do or die for Baylor, said Hodges, whose firm assisted the school in its search. They are where they are today because of the CEO and excellent departmental leadership. You have to have someone with a vision, who carries it forward into the future.

Contact Natalie Bruzda at nbruzda@reviewjournal.com or 702-477-3897. Follow @NatalieBruzda on Twitter.

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Leadership void hangs over first day of class for UNLV Medical School - Las Vegas Review-Journal

Prestigious medical school hosts Tomah High School grad – La Crosse Tribune

Over the course of 10 days, Josh Adamczak, a 2017 Tomah High School graduate, got to experience what it would be like to attend medical school.

Adamczak was part of the National Youth Leadership Forum in Advanced Medicine & Health Care at Johns Hopkins University in Baltimore.

It was a busy 10 days, Adamczak said, but worth it.

It was really a really cool experience, but also kind of like intense, he said. It was non-stop from eight in the morning until about 10 at night, every night for 10 days. I got the schedule beforehand, and I realized it was a packed schedule, but I didnt really realize how in-depth or how much we would really be doing.

The program, which ran from July 2-11, is for students seriously considering a career in the medical field. They got to visit a medical training facility, take part in a simulated patient encounter, created a public awareness campaign and a social media campaign centered around a current topic in public health.

Participants got to attend lectures and speaking events, apprentice doctor workshops, real-life simulations and virtual reality surgery. They also went behind the scenes at medical institutions to interact with university faculty and professionals in the medical field.

It was like being enrolled in a mini medical school, Adamczak said. Participants received a considerable amount of information and learned a lot from a variety of sources.

We had lectures often about a variety of topics. We learned suturing, we did a thing about orthopedic surgery, he said. We did a virtual reality surgery, and we visited the shock-trauma center in Baltimore, which is like one of the biggest and most widely used. We visited the medical school in Marylands School of Medicine just tons of things.

The most memorable activity, Adamczak said, was a simulated patient encounter in which the patients are professional actors and actresses.

Its like a routine doctor visit, and you have so many questions and stuff that you have to ask, he said. Its one of the tests to become board certified like if you dont wash your hands youll fail, but with us they made it where it was a case study. (It) was really cool, because ... theyre trained to help teach med students. Then we used it in our groups to try to figure out, to diagnose what they had.

The experience that left the biggest impression on Adamczak was a lecture about medical ethics.

We spent like an entire afternoon talking about ethics, and I thought it was really interesting because we basically got different scenarios, and we had to argue our point of why, he said.

I found it really interesting because with medical ethics, if a patient has the decision-making capabilities, they can refuse whatever treatment they want and you can do nothing about it.

The lecture made Adamczak, who first became interested in a medical career after taking anatomy in high school, think about changing his career path.

I went to this camp, kind of hesitant if I really wanted to do medicine or not. But before I really wanted to do it, then I started to kind of doubt it, like, do I really want to do medicine? Do I really understand what it is that I would be doing? he said. This actually made me think more toward medical law, because we did a thing on ethics, it was really interesting. So Im thinking about possibly pursuing that instead.

Overall, it was a fun trip, Adamczak said, especially meeting new people.

The best parts was, other than just getting to be able to do all of those things that a majority of kids my age dont get to do, is that I made amazing friends from across the nation, he said. I had a group of probably like five friends that were in my group, and we were inseparable doing all this stuff together. ... I now have friends all over the place.

Starting this fall, Adamczak will attend Roosevelt University in Chicago, where he will major in bio-chemistry.

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Prestigious medical school hosts Tomah High School grad - La Crosse Tribune

Liberty County commissioner involved in accidental shooting – Chron.com

By Vanesa Brashier, vbrashier@hcnonline.com

Liberty County commissioner involved in accidental shooting

A Liberty County official is recovering from an injury he received July 6 when his firearm accidentally discharged.

Pct. 2 Commissioner Greg Arthur, former sheriff of Liberty County, was on a brief holiday with his wife and family at Garner State Park in Uvalde County when the accident occurred.

"We were at the pavilion and I was wearing my concealed handgun. It was shifting around a little bit so I stepped out into the parking lot to readjust," Arthur said.

While making adjustments, Arthur says he accidentally hit the trigger, causing the gun to fire downward toward the ground. The bullet grazed Arthur's leg, entering the skin and creating a gash before it exited and hit the ground. As it hit the ground, fragments of concrete and the bullet reportedly scattered, hitting two other nearby people including a 6-year-old boy.

"The boy was hit by either a piece of concrete or a fragment. It hit him in the foot. He was taken to a hospital for treatment. The other guy was treated on the scene. He also was hit in the foot," Arthur said.

In his 40 years of law enforcement as sheriff and a sergeant for the Texas Department of Public Safety, Arthur said he never accidentally discharged his handgun before now or had to shoot at anyone. He says he is extremely remorseful for any injuries his actions caused.

"The worse thing is that little boy was injured. That bothers me more than anything," he said. "It was just an accident."

The incident is the second time a firearm owned by Arthur has accidentally discharged. Several years ago, a Liberty business owner and a friend of Arthur's accidentally shot himself with Arthur's handgun. The business owner sustained non-life threatening injuries.

"He was in his car by himself when that happened," Arthur said. "I was outside of the car talking to someone else."

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Liberty County commissioner involved in accidental shooting - Chron.com

Kiah Stokes’ play has been enigmatic, emblematic of Liberty’s season – Summitt Hoops

PHOENIX, AZ - MAY 23: Kiah Stokes

Injury Report: Brittney Griner out with knee, ankle injuries by Arielle Chambers

No team, even one comprised of mostly the sameplayers, is identical from one year to the next. Players improve and regress. Injuries happen. The rest of the league changes around them.

The 2017 New York Liberty are no exception. They have the same core as last years 21-13 group, led by newly crowned franchise rebounding champion Tina Charles. Sugar Rogers and Shavonte Zellous are still consistent backcourt threats. Though they lost Brittany Boyd to an early season-ending injury, they also brought in Kia Vaughn for some needed front court depth.

Yet the Liberty are struggling. At 8-9, theyve lost five out of six games. And perhaps no player is as emblematic of the concerning, confusing downturn as Kiah Stokes.

Head coach Bill Laimbeer was honest after the Libertys 78-68 loss Friday to the Chicago Sky, saying Stokes role on the team has been significantly diminished. She is no longer a part of the identity of the team like she was last year, he says.

The reasons why are open for debate, he said in his postgame press conference Friday. The impact on the game just hasnt quite happened this year.

Over 27 games in 2016, Stokes was inarguably a vital part of the Libertys success. Her seven points and seven rebounds per night off the bench were made even more impressive by her ranking third in the WNBA in rebound percentage (18.3) and second in effective field goal percentage (64.1).

This season, its been a roller coaster with more lows than highs. After Laimbeer called Stokes out for being out of shape in the postgame press conference following the Libertys lackluster season-opening win over the Stars, Stokes refocused. She struggled through the next few games before breaking out against the Wings on June 2 to the tune of 13 points and 15 rebounds. Two days later, she dropped 23 on the Mercury and tallied 14 rebounds.

Stokes, we thought, was back.

She then posted her third straight double-digit rebound game a 17-board effort against the Dream. Stokes shot just 1-3 from the field in that game, but it didnt matter; her role isnt to be the leading scorer. The next game was the Libertys fourth win in a row, and Stokes was strong again, with a quiet eight points and six rebounds.

Since then, its been downhill for her and her team. The Liberty are just 2-6 since that point and Stokes minutes have dropped significantly from 24.0 per game in their first nine games to 14.6 in their past eight. Remove a 12-rebound tease last week in Phoenix and she has not had a game with more than four in that span. And while shes not the go-to option on offense, she has been nearly non-existent, making multiple field goals just once and never attempting more than four.

In the locker room, Stokes appears to be her same old self, taking time to thoughtfully answer questions after a tough loss in which she only played nine minutes, all with a smile on her face. Shes honest and forthright, not mincing words about her own performance, but staying relatively upbeat and optimistic about the road ahead.

The league keeps getting better and better, she told The Summitt. I have to do what they drafted me for. Defense, rebounding, blocking shots, being a presence in the paint. Just provide some energy off the bench.

When thats not working out, she has to find other ways to contribute. Stokes, who knows she is a good defender, has taken it upon herself to keep challenging Vaughn in practice, as Vaughn continues to make an impact. Vaughn has played five consecutive strong games, averaging 8.6 points and 7.2 rebounds in that span. Unsurprisingly, her minutes have increased as well.

I think that helps her confidence, keeps her motivated and gets her working hard, Stokes said of her concerted effort to makeVaughn work each day.

As for her own playing time, Stokes knows the minutes are still there if she earns them. She just has to keep doing what everyone already knows she can do. From there, more playing time will follow.

I just have to do that, whether its 5 minutes or 25 minutes, she said.

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Kiah Stokes' play has been enigmatic, emblematic of Liberty's season - Summitt Hoops

Liberty Hill football will stay old school and proud to do it – Austin American-Statesman

LIBERTY HILL

One of the most successful football programs in Central Texas will rush into a new era this fall with old-school swagger.

Jeff Walker has grabbed the reins as head coach and athletic director at Liberty Hill, taking over for Jerry Vance, who retired. Walker knows the lay of the land at the high school in western Williamson County. He served as Vances offensive coordinator in 2001-07, helping the Panthers win Class 3A state championships in the final two years.

Walker, a 48-year-old Texas State alum, makes it abundantly clear he remains fully committed to the slot T, an offensive relic of yesteryear, a ground-bound attack rarer than rain in July in this era of froufrou spread offenses.

Preparing for us in three days is a nightmare, Walker said Thursday while giving a tour of the schools shiny purple-hued facilities, which include a 5,000-seat stadium that opened in 2013. All your outside linebackers have been in coverage, and now theyre having to take on guards and sweeps and engage in the physical side of football.

I believe in the slot T. We do something different from anybody else. We dont spread it out, throw it all over; were a run-oriented offense, which has gone the way of the dinosaur. We do it from Pop Warner on up. We are different, and we pride ourselves on that. Well run the slot T and maybe add a few wrinkles.

For those whove never seen it, the slot T involves a lot of fakes and misdirection in the backfield and complicated blocking schemes up front.

We try to hide the ball, Walker said. We tell our quarterbacks were not going to pass for 4,000 yards, but were going to make the ball disappear. Its 11 guys selling out on every play. I like the toughness it brings. We dont have that wideout who can just stand there like in the spread. If we have a kid just standing, he doesnt play.

Vance rolled up a 155-46 record in Liberty Hill with that ancient offense. Walker has a 131-25 record running the slot T as an OC with the Panthers and as the head coach at Rogers, where his teams were 59-13 and averaged more than 50 points per game from 2008 to 2014.

We have a system from the ground up, Walker said. We know what we do and how we do it. Its a lot of little things. Our water breaks are even different from most schools. Everything we do is scripted. Theres no guessing. We have a proven plan.

Yet for all of Liberty Hills success, some question whether the slot T will work in Class 5A, which is where the 4A Panthers are likely to land in February when the UIL announces the results of its latest biennial realignment. Liberty Hill never has had a wealth of NCAA Division I athletes, and the Panthers advantages in size and depth the burgeoning program has about 160 players available for its freshman to varsity squads will be tested by a move up in class.

I like to hear those doubters. We will prove them wrong, Walker said.

He noted that Phil Danaher at Corpus Christi Calallen, Walkers alma mater, is the all-time winningest coach in Texas high school football, and he uses the wing T, a close cousin of the slot T. A year ago, Calallen reached the Class 5A, Division II state title game, losing to Aledo 24-16.

Liberty Hill already has beaten several 5A teams in recent years, including Brenham in 2014, the year after the Cubs played for a state title. Walker also was part of a coaching staff that won big with the slot T at then-Class 5A San Marcos.

People are so caught up in the spread, they think there is no other way, he said. We have something that works. Our kids have confidence; they believe in what we do. Well be successful wherever we go. I really, truly believe we wont miss a beat. I think the slot T can win a state championship in 6A.

While he insists the Panthers future is bright regardless of their UIL classification, Walker is still sorting through the 2017 roster, as only five starters return from an 8-4 team that won a playoff game.

Fullback Hunter Oncken, a 1,200-yard rusher, looks to be the headliner, along with offensive tackle Matthew Carter and cornerback Bryce McCatty. Yet they all must prove themselves to their new coach.

We can go look at the board right now, but every position is up for grabs, including quarterback, Walker said.

Heres what I can tell you: The cupboard is not bare. We have lots of good kids coming up. We expect big things, and so do they.

Walker spent the past two years away from football as he dealt with a medical issue and spent more time with his wife, Miranda, and their 13-year-old twins, Madison and Regan. As part of his return to coaching, he hired his younger brother Kent as Liberty Hills defensive coordinator, and the Panthers will shift to a 3-4 base defense.

Kents got a lot of passion for the game, and he knows defense, Walker said. Its always great to have someone in your corner with whom you have the ultimate trust. Hes got a track record at Round Rock and elsewhere.

My last game as a head coach, we lost 73-72 (to Refugio) in the playoffs. I dont want to get in any more shootouts like that.

At Liberty Hill, Walker will preside over a highly successful athletic program. The school recently finished third in the Lone Star Cup Class 4A standings for the 2016-17 school year, when the girls basketball and softball teams reached state title game. The volleyball team also reached the final four, and the boys basketball and soccer squads joined the baseball team in earning postseason bids, too.

Everybody around here makes the playoffs, Walker said. Weve got smart, hard-nosed kids who are very coachable. When we arrived in 2001, we started raising expectations. We keep setting the bar higher. I dont think youve seen it all yet.

MAKING ITS DEBUT, THE BREAZEALE CUP

Today, we unveil the inaugural Breazeale Cup rankings, which are topped by Liberty Hill, followed by Westlake and Dripping Springs.

Compiled by American-Statesman sports writer Thomas Jones, the rankings recognize the most succcessful high school athletics programs in our coverage area, regardless of their UIL classifications. The Breazeale Cup follows a formula similar to the one University Interscholastic League officials use to settle on Lone Star Cup winners, except that the Breazeale Cup does not factor in extracurricular activities beyond athletics.

Youll find the top-20 finishers and details about the Breazeale Cups namesake on Page C7. The complete rankings are listed online at mystatesman.com/sports/high-school.

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Liberty Hill football will stay old school and proud to do it - Austin American-Statesman

Liberty search for offense against Mystics (Jul 15, 2017) – FOXSports.com

New York Liberty head coach Bill Laimbeer has been left to scratching his head as he wonders what has happened to his teams offense.

Just a little over two weeks ago, Washington defeated the Liberty in a game that saw New York score 54 points the lowest output of any team this season. Since that loss on June 29, New York has lost three of four and averaged only 72 points in those four games.

Laimbeer might be making some lineup changes come Sunday when the Liberty play host to the Mystics at Madison Square Garden.

Overall, our defense is keeping ourselves in games, Laimbeer told nysportsday.com. Its the offensive part is whats struggling now. We are not getting consistent bench scoring. I might have to move a starter there to get us a boost when everyone is tired.

The Libertys struggles are especially surprising considering New York is led by five-time All-Star Tina Charles. Her 20.9 points per game are second-best behind Phoenixs Brittney Griner (22.3). Charles also is averaging 9.6 rebounds per game.

Shavonte Zellous and Kia Vaughn have been steady as of late, with Vaughn earning kudos from her coach.

Vaughn is playing well right now, Laimbeer said. Shes a physical presence out there and she demands the basketball on the inside. She sets the best screens on the team, so shes going to play her fair share of minutes.

The Libertys task might be made a lot easier depending on the status of Washingtons All-Star forward Elena Delle Donne, who sprained an ankle on Friday and left the game after only four minutes with no points and one turnover.

Delle Donne was to be evaluated on Saturday, leaving her status for Sundays game in doubt. And as of late Saturday afternoon, there was no word on her availability.

Without Delle Donne in the lineup, Emma Meesseman scored 15 points and pulled down five rebounds to lead the Mystics to their first win since beating the Liberty in June.

Meesseman averaged 15.2 points last season for the Mystics and has played in only eight games this season after playing for Belgium at the 2017 FIBA EuroBasket Championships.

The best part of this is we can get a lot better, Mystics coach Mike Thibault told the Washington Post before Meeseemans return. Weve got a lot of upside, and that feels good.

After holding Indiana to 58 points on Friday, even without Delle Donne, Washington has reasons to feel good. The Mystics won for the first time in four games in July and improved and got solid efforts from Krystal Thomas (14 points) and Tianna Hawkins (11 points).

Some of the enthusiasm is tempered because of Delle Donnes situation and because of an injury to guard Tayler Hill, whose status is also in limbo.

Hill (13.3 points per game) landed awkwardly on her right knee after attempting a layup and had to be carried off the court on Friday. She left the arena in a wheelchair.

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Liberty search for offense against Mystics (Jul 15, 2017) - FOXSports.com

A Case for Centrism – Being Libertarian – Being Libertarian

Libertarians must cast off their niche-party shackles and embrace more moderate stances to compete in the political arena.

The plight of third-party presidential bids in recent United States history have been, to put it in blunt terms, a series of major disappointments. The current Democratic-Republican two-party alignment has been extremely resilient to challenges from any alternative perspectives. Many of the ideological shifts in the American electorate have caused not a new political party to emerge, but rather strategic shifting of the two-party oligopoly to accommodate these new ideals.

Libertarians should observe the current shifting of the Democratic and Republican parties with concern, perhaps even fright. The days of the Reagan coalition, where conservative leaders like William F. Buckley gave a voice at the table (though not a full endorsement) to libertarian thinkers like FA Hayek and Milton Friedman, is long over. Modern right-wing politics now shares no more in common with the ideals of classical liberalism than does the progressive wing. From the neoconservative interventionism of George W. Bush, to the anti-market, anti-civil rights populist-nationalist Trump presidency, any tentative alliance between Republicans and libertarians that may have existed is now dead and buried.

Should libertarians consider a shift to the left? The outlook there is getting more and more concerning as well. An avowed socialist, Bernie Sanders, came within inches of earning the Democratic nomination in 2016. On the horizon, far-left Elizabeth Warren has her crosshairs aimed at the 2020 election. If either of these two candidates grabs the agenda of the Democratic Party away from the more reasonable Clinton-era members, it will represent a major underlying shift in the economic philosophy of the party. No longer will government intervention be deemed a necessary step to correct for perceived market failures or inequities. These far-left ideologues believe, rather, that the government actually does a better job in managing goods and services than does a private market.

Advocates of free markets and personal liberty face a potential political future in which the only two established political choices are between a pseudo-authoritarian and pseudo-socialist party. Neither could be further from the ideals of this countrys founders, save a true shift to pure fascism or communism. What should the only remaining US political party with access to the ballot on all 50 states do? The only strategic answer that makes sense is to flank from the center.

While Gary Johnsons failed 2016 presidential bid was a disappointment given his polling numbers earlier in the campaign season, a quick look at the voters who supported the Libertarian ticket explains a great deal about where the support was coming from. The ANES 2016 survey reveals that voters who went for Johnson identified politically as more moderate than Trump or Clinton supporters. They take more centrist stances on trade, the environment, and many other partisan issues. The 4 million+ people who were drawn to the Johnson-Weld candidacy were not libertarian ideologues, driven by the writings of Murray Rothbard and David Friedman. Rather, they were primarily moderates; dissatisfied with both Clinton and Trumps candidacies and voting in protest of the two major parties. In a time of increasing political polarization, a possible revolt of moderate voters ostracized by the far-left and far-right seems very possibly on the horizon. This opportunity for vote gathering cannot and should not be ignored by the only other US party with the resources and organization to achieve electoral success.

If the Libertarian Party wants to gain relevance and bargaining power in 2020 and perhaps beyond, participants and party members must drop some of more unpopular and radical party positions. Arguments for legalizing all drugs (not just marijuana), a complete elimination of minimum wage laws and regulations, and the complete abolition of Medicare, Medicaid, and Social Security are without a doubt well-principled, and in keeping with an ideal libertarian vision of society, but they are not yet supported by enough of the population to be realistic campaign promises. For too long, ideological purity has superseded more pragmatic, measured goals for the Libertarian Party. They have been acting as a niche party, and this needs to change.

I propose that a center-libertarian party one that espouses the ideas of moderately limited government, social progress, and globalization is the best chance true libertarians have in order to push back against the radicalization of the Democratic and Republican parties. By positioning as the reasoned middle-ground, the party can work to advance some ideological interests that are largely popular (free trade, LGBT rights, lower taxes, reasoned budget cuts, school choice, and a restrained foreign policy to name a few) while offering a solid option to so many moderate voters within the US that while perhaps not true card-holding libertarians are concerned about either the growing authoritarian tendencies of the Republican party or the rapid expansion of economic interventionism and massive budget deficits offered by the left-Democrats.

Many of my libertarian friends will no doubt argue that what I am asking for is a step too far. For too long, I have heard, libertarians have had to choose between the lesser of two evils. A centrist party with only a classical liberal bent would be a return in their eyes to choosing a distant compromise over their preferred ideal ends. But this kind of thinking ignores reality and the pragmatic constraints of an electoral system, and the nature of strategic political bargaining. There are simply not yet enough true believers in minarchist policy for a presidential ticket espousing elimination of nearly 85% of government services to be electable. As political entrepreneurs, the libertarians must act pragmatically: not only is a centrist platform preferable to the options currently tabled by the Republicans and Democrats, but it is where many of the undecided or ostracized voters are likely to lie in 2020.

If libertarians continue to exist on fighting from the fringe of politics, there will be no opportunity to pose any political threat to the rise in statism that we see in the current political climate. The Libertarian Party and its donors must seize this opportunity, and work towards electoral success. The war against tyranny must be fought from the middle, not from the fringe. If we cannot make the adjustments and decisions necessary to compete electorally in a system already so stacked against third party challengers, then we too are equally culpable in the horrifying direction that the American political parties are heading.

* Colin French is a PhD student of political science at the Maxwell School of Citizenship and Public Affairs. He has taught economics, history, and politics at both the secondary and post-secondary levels.

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A Case for Centrism - Being Libertarian - Being Libertarian

Today’s Libertarians Got the Border Debate Wrong The Lowdown on Liberty – Being Libertarian (satire)

For libertarians in modern day politics, there has been more commotion regarding the proper stance on borders than ever before. This confusion has focused on the debate between whether we should be proponents of open or closed borders, and depending on who you ask, you get completely conflicting answers.

Why this topic causes so much confusion among libertarians is a complete mystery, as the debate regarding the proper stance on borders has been self-evident for almost 50 years now. So self-evident in fact, that Murray Rothbard barely even addressed it in For a New Liberty: The Libertarian Manifesto, spending less than a handful of its few hundred pages discussing it. Why it has been so prominent lately though can be attributed to a few things.

Lets start with the overall increase in skepticism shown towards immigration, as it will certainly be brought up as a criticism later.

Nationalism has always been something promoted by the state, with an irrational fear of foreigners likewise trailing close behind. Immigration, however, has always been and still is an overall net benefit to an economy. For starters, immigrants do not steal peoples jobs, because unless you own the company, you do not own your job. Instead, they fill in the gaps left by most natives. In America, immigrants tend to be either exceedingly high or low skilled, complementing the majority of American workers who fall somewhere in the middle. Not only are immigrants less likely to commit crimes than natives, but research also shows that in America, immigrants are assimilating better than ever before. And although we can agree that we have a massively overblown welfare state, immigrants as a whole pay more in then they receive.

Part of the reason this illogical cynicism has been exacerbated in libertarian circles is due to the influx of both Democrats and Republicans abandoning their respective party, choosing to identify as libertarian with no real knowledge of its specifics.

These individuals, ranging from members of the alt-right all the way to full-blown communists, have caused the focus of the issue to be distorted. The open and closed borders distinction serves only to confuse most people through their subjective definitions, misleading many into arguing over inconsequential details. They have in essence academized libertarianism unnecessarily, much like what modern progressives have done with inequality and racism. Thus, taking a settled debate and adding excessive details, oftentimes complicating it to the point of arriving at the opposite answers.

Ironically, Rothbard predicted this would happen, and in For a New Liberty no less. In it, he refers to these groups through the borrowed Marxist terms of left-wing sectarians and right-wing opportunists, and wrote the following:

The critics of libertarian extremist principles are the analog of the Marxian right-wing opportunists. The major problem with the opportunists is that by confining themselves strictly to gradual and practical programs, programs that stand a good chance of immediate adoption, they are in grave danger of completely losing sight of the ultimate objective, the libertarian goal. He who confines himself to calling for a two percent reduction in taxes helps to bury the ultimate goal of abolition of taxation altogether. By concentrating on the immediate means, he helps liquidate the ultimate goal, and therefore the point of being libertarian in the first place. if libertarians refuse to hold aloft the banner of the pure principle, of the ultimate goal, who will? The answer is no one.

With that in mind, we can better understand the libertarian stance on borders, which is the complete abolition of state-owned property, followed by a strict adherence to private property rights. There is no adaptation of government involvement in any issue surrounding libertarianism, and borders are no different. Every issue brought up by the sectarians and opportunists to muddy the waters does not hold water themselves. Claiming the need for government to close borders to combat a problem brought on by the state requires the abandonment of the libertarian foundation. Wed no sooner advocate for the government to nationalize our health industry to solve the current insurance death spiral, brought about through a previous intrusion of government.

Likewise, the idea of handing the state more power to solve a state-sponsored problem is antithetical to libertarianism. It disregards both the truth that government cannot perform even the most menial tasks as efficiently as the market can, as well as the key argument that any authority the state is granted is never willingly given back. Instead, we should combat the states expansion and advocate its dissolution, specifically the policies aggravating the problems at hand, as aggressively as possible at each turn. For example, we may agree that the state is currently subsidizing immigration to the detriment of its citizens well-being, however, giving more authority to the state to solve this matter for reasons of pragmatism only further incentivizes the state to cause crises in other sectors so that it may usurp more authority in its resolution.

But, even the great Murray Rothbard fought vigorously with himself over this, going back and forth later in life. If this tells us nothing else, it means that until such a time where it is the individual property owners choice, the border debate is done a gross injustice when reduced to the polarizing false dichotomy of open or closed.

What solutions can we advocate in the meantime then?

Rather than fall prey to the circular logic of initial state expansion as a means of reaching the goal of abolition, we should spend our time calling out the problems the state is guilty of promoting and educating those we can of the discernable solutions the market provides. With regard to borders, this means calling for the immediate end to all the things currently being provided at the federal level possessing negative incentives. These include subsidized and preferential immigration policies, tax-funded border walls, and above all else, the welfare-warfare state. Similarly, the focus should also be put on decentralization, until the point where the authority resides in each private property owner, as mentioned earlier. We can fight to accomplish these things simultaneously.

Now, to some that are too entrenched in the debate to digest this truth, this may sound contradictory. But we must be vigilant not to allow the aforementioned opportunists to usher in more state power, so that they may wield it for their own ends. We can think of this in simpler terms through another analogy borrowed from Rothbard. We all believe in freedom of speech, yet we know from his teachings that this does not include the ability to yell fire in a theater, or disrupt a service in a private hall. While we want these rights upheld, surely, we would not advocate for the state to establish a Ministry of Speech to achieve that end, as we know it would end up being a complete contradiction of its intended purpose. Likewise, we want private property rights, however, advocating that the state undertakes its implementation through monopolistic tactics should be seen as clearly self-defeating at this point.

The recent election process, however, has shown us that people are yearning for a change from the traditional solutions put forth by government. If we could reunite behind this foundational principle instead of tearing one another down through petty infighting, theres no doubt we could crush any misconception or delusion the left or right throws at us, while simultaneously influencing an untold number of people toward our cause as they witness the veracity of our arguments when put up against the current status quo.

Featured image: http://www.tapwires.com

This post was written by Thomas J. Eckert.

The views expressed here belong to the author and do not necessarily reflect our views and opinions.

Thomas J. Eckert is college grad with an interest in politics. He studies economics and history and writes in his spare time on political and economic current events.

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Today's Libertarians Got the Border Debate Wrong The Lowdown on Liberty - Being Libertarian (satire)

Libertarian Party of Arkansas Set to Appear on 2018 Ballot – Stor – KARK

LITTLE ROCK, Ark. (News release) - After receiving the required number of signatures, the Libertarian Party of Arkansas (LPAR) has received the green light to appear on the 2018 ballot in Arkansas.

Monday, Arkansas Secretary of State Mark Martin declared the Libertarian Party a New Political Party for the fourth consecutive time.

Now that the LPAR is officially on the ballot for 2018, candidate recruitment will be the partys next major task.

The Party had submitted 15,108 signatures to the Elections Division of the Secretary of States office on June 12. After spending almost three weeks verifying the submitted signatures, the Secretary of State notified the party that its new political party petition was sufficient. Leslie Bellamy, the Director of Elections, informed the party that 12,749 of the signatures were valid.

In accordance with Arkansas Code, new political parties are required to file a petition with the Secretary of State. The party has 90 days to collect signatures from at least 10,000 registered Arkansas voters. To retain ballot access, the partys candidate for Governor will have to receive 3% of the votes cast for Governor.

According to Stephen Wait, the partys Treasurer, Petitioning to become a new political party again cost over $25,000 and a lot of volunteer hours. Despite the obstacles the old parties put in our way, we are happy to provide freedom loving Arkansans the opportunity to vote for candidates who will represent their views.

The Libertarian Party of Arkansas is currently seeking liberty minded individuals who are interested in running for office. The LPARs elections committee has already been contacted by numerous people interested in seeking the partys nomination for various positions.

Vice-chairman, Chris Olson, said It's an important election with all constitutional officers up for election. We are committed to providing the people of Arkansas with a strong set of pro-liberty candidates. We will not shirk from our commitment to providing a consistent voice for limited responsible government. He urged those who are interested in running for office as a Libertarian to contact elections@lpar.org for more information.

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Libertarian Party of Arkansas Set to Appear on 2018 Ballot - Stor - KARK

Chinese coast guard ships confirmed in waters off northwest Kyushu islands for first time – The Japan Times

FUKUOKA Two Chinese coast guard ships briefly entered Japanese waters Saturday around two islands off Kyushu, in the first confirmed entry by Chinese government vessels into the area, the Japan Coast Guard said.

Under the U.N. Convention on the Law of the Sea, vessels of every country have the right to sail through territorial seas as long as they do not harm the safety of the countries concerned.

The Japan Coast Guard requested the ships exit from the territorial waters, though it has not made it clear whether it considered their presence an intrusion into territorial waters.

According to the coast guard, it was notified by the Defense Ministry that one Chinese coast guard ship entered territorial waters near the southern tip of Tsushima Island around 11:50 a.m.

The ship exited the waters around 12:20 p.m. after the coast guard contacted the ship by radio and asked it to leave.

But the coast guard confirmed this ship and another Chinese vessel entered waters some 19 km north of Okinoshima Island around 3:50 p.m. The two exited the waters by shortly after 5 p.m., the coast guard said.

Tsushima Island is located about halfway between the southern tip of the Korean Peninsula and the northwest coast of Kyushu.

Chinese ships often enter Japanese territorial waters around the Senkaku Islands, in the East China Sea, a group of uninhabited islets controlled by Japan but claimed by Beijing.

Earlier this month, Okinoshima Island was added to UNESCOs World Heritage list. The whole area belongs to Munakata Taisha Shrine, and entrance by general citizens is tightly restricted.

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Chinese coast guard ships confirmed in waters off northwest Kyushu islands for first time - The Japan Times

Oklahoma mediucal briefs, July 16 – NewsOK.com

From Staff Reports Published: July 16, 2017 5:00 AM CDT Updated: July 16, 2017 5:00 AM CDT

John Mulvihill, M.D., at The Children's Hospital at OU Medical Center, has won a mentorship award from theAmerican Society of Human Genetics. [Photo provided]

Geneticist wins national recognition

John Mulvihill, an geneticist at The Children's Hospital at OU Medical Center, has been awarded the American Society of Human Genetics mentorship award. The award recognizes those with records of accomplishments as mentors. He will receive the $10,000 award at the national group's annual meeting on Oct. 20 in Orlando, Florida.

Back-to-school shots available

The Oklahoma City-County Health Department is offering back-to-school immunizations for students at three locations across Oklahoma City. Immunizations will be offered Monday through Thursday from 8 a.m. to 4 p.m. and 8 a.m. to noon on Friday. A copy of the students immunization records is required. Immunization services will be offered at:

Gary Cox Partner Building, 2700 NE 63

South Wellness Campus, 2149 SW 59, Suite 104

West Clinic, 4330 NW 10

Birth certificates needed for school

The Oklahoma State Department of Health is urging families to begin requesting birth certificates as they prepare to send their children back to school. The busiest month of the year for requests is August and long lines are normal. The cost is $15 for a copy. Information can be found online at http://vr.health.ok.gov.

Mumps still a problem in state

Kristy Bradley, state epidemiologist, confirmed that the state is still facing a problem with mumps. Oklahoma and Garfield counties are still seeing cases of mumps transmission. The state has had 152 cases since January.

From staff reports

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Oklahoma mediucal briefs, July 16 - NewsOK.com

Decimal Points: Adventures in DNA – Greensboro News & Record

Though I have to admit my background in the hard sciences is very limited, the use of DNA to unravel the mysteries of the past especially human evolution and genealogy is something I find absolutely fascinating. A couple of years ago, I finally gave in to the urge and paid a genetic testing company to test my Y chromosome line. Thats the line of your paternal ancestry thats passed down from one father to another.

Since traditional documentary sources on my fathers family peter out in the late 18th century, Id hoped this would help me tie in with another more distant line of Coles.

DNA testing didnt really help much with my Cole genealogy, but I still havent given up on what it might tell me about my past. Just recently I tried autosomal testing, which examines the 22 pairs of chromosomes we have in addition to our X and Y sex chromosomes.

One of the things autosomal testing will give you is a pretty good idea of your national and ethnic ancestry. Since Cole is an English surname, I wasnt surprised to see an autosomal finding of 49 percent UK ancestry, but I was a bit surprised that I was 32 percent Scandinavian (though my prior Y chromosome test had indeed also revealed some Scandinavian matches). The rest of my other autosomal origins (Celtiberian, Sephardic Jew and other European) came in at 5-9 percent each.

When I received the autosomal findings, I remembered Bryan Sykes Saxons, Vikings, and Celts: The Genetic Roots of Britain and Ireland (2006) and thought it might shed some light on the Scandinavian result or at least, suggest a theory to explain it. Sykes, who is a professor of human genetics at Oxford, also is author of the popular The Seven Daughters of Eve (2001), which explores how virtually everyone of European descent can trace his or her ancestry back to one of seven women.

As most everyone knows who is familiar with U.K. history, between the eighth and 11th centuries AD Vikings, mainly from modern-day Norway and Denmark, raided and invaded the coasts of the British Isles. In 866 AD, they even captured York, one of the largest cities in England at the time.

Though Sykes was working with Y and X chromosome matches rather than autosomal DNA, his research identified especially high concentrations of Viking DNA (37 to 42 percent) in the Northern Isles (Shetland and Orkney). Perhaps these and other areas of old U.K. Viking settlements are places I should look for my own ancestry assuming Im interpreting all this right.

The complexity of all this DNA stuff reminds me that I used to kid around about being a low-browed Neanderthal, the ancient Eurasian humanoid species, extinct since about 30,000 B.C., which is genetically closest to Homo sapiens. In his investigations in the U.K., Sykes wrote about a story hed heard of alleged living Neanderthals in the mountains of Wales near Plynlimmon. Though Sykes didnt take this seriously of course, he did hope one day to find just one person with Neanderthal DNA.

Turns out he probably did in fact, Sykes has probably tested lots of them. DNA research has advanced since he wrote Saxons, Vikings, and Celts,and in 2010 Dr. Svante Pbo and his team at the Max Planck Institute for Evolutionary Anthropology in Leipzig, Germany, succeeded in mapping the entire Neanderthal genome.

This led to a stunning finding: When they compared the Neanderthal genome to Europeans, Asians and Africans, the Max Planck scientists found just a little bit of Neanderthal DNA in modern humans of European and Asian ancestry. This meant that there must have been gene flow between Homo sapiens and Homo neanderthalensis, i.e., they interbred. The institutes work on Neanderthal DNA, detailed in Pbos Neanderthal Man: In Search of Lost Genomes (2014), set off a human evolutionary firestorm of sorts among scholars because it didnt neatly conform to the Out of Africa model, which holds that modern humans are descended from Homo sapiens and originated in Africa. I suppose all this means that Ive actually got a little Neanderthal in me, as well as Viking.

The work of Pbo and his colleagues is certainly wonderful stuff, but if you simply want a great read about DNA research, I cannot fail to mention James D. Watsons The Double Helix: A Personal Account of the Discovery of the Structure of DNA (1968). It was of course the work of Watson and Francis Crick in the early 1950s at Cambridge which led to the discovery of the structure of DNA.

The Double Helix is an enthralling story of scientific discovery written in a very witty and lucid style. I believe Ive read this book three times and now that I think of it, I think Ill read it again.

As for my own adventures in DNA, I still have at least one thing left to test my X chromosome or mothers line. Like my paternal ancestry, the paper trail gets fuzzy in the late 18th century. Who knows what surprises might be in store?

After that, maybe Neanderthal testing?

Tim Cole is a reference librarian with the Greensboro Public Library. Decimal Points is a regular feature provided by the library.

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Decimal Points: Adventures in DNA - Greensboro News & Record

Health Care Bill: Insurance Groups Call Parts "Unworkable …

(WASHINGTON) Two of the insurance industry's most powerful organizations say a crucial provision in the Senate Republican health care bill allowing the sale of bare-bones policies is "unworkable in any form," delivering a blow to party leaders' efforts to win support for their legislation.

The language was crafted by conservative Sen. Ted Cruz, R-Texas, and leaders have included it in the overall bill in hopes of winning votes from other congressional conservatives. But moderates have worried it will cause people with serious illnesses to lose coverage, and some conservatives say it doesn't go far enough.

Two of the 52 GOP senators have already said they will oppose the legislation. Senate Majority Leader Mitch McConnell cannot lose any others for the legislation to survive a showdown vote expected next week.

The overall measure represents the Senate GOP's attempt to deliver on the party's promise to repeal President Barack Obama's health care law, which they've been pledging to do since its 2010 enactment.

The criticism of Cruz's provision was lodged in a rare joint statement by America's Health Care Plans and the BlueCross BlueShield Association. The two groups released it late Friday in the form of a letter to McConnell, R-Ky.

"It is simply unworkable in any form," the letter said. They said it would "undermine protections for those with pre-existing medical conditions," increase premiums and lead many to lose coverage.

The provision would let insurers sell low-cost policies with skimpy coverage, as long as they also sell policies that meet a stringent list of services they're required to provide under Obama's law, like mental health counseling and prescription drugs.

Cruz says the proposal would drive down premiums and give people the option of buying the coverage they feel they need.

Critics say the measure would encourage healthy people to buy the skimpy, low-cost plans, leaving sicker consumers who need more comprehensive coverage confronting unaffordable costs. The insurers' statement backs up that assertion, lending credence to wary senators' worries and complicating McConnell's task of winning them over.

The two groups say premiums would "skyrocket" for people with preexisting conditions, especially for middle-income families who don't qualify for the bill's tax credit. They also say the plan would leave consumers with fewer insurance options, so "millions of more individuals will become uninsured."

The bill provides $70 billion for states to use to help contain rising costs for people with serious conditions. But the insurance groups' statement says that amount "is insufficient and additional funding will not make the provision workable for consumers or taxpayers."

The Cruz provision language in the bill is not final. McConnell and other Republicans are considering ways to revise it in hopes of winning broader support.

McConnell and top Trump administration officials plan to spend the next few days cajoling senators and home-state governors in an effort to nail down support for the bill.

The nonpartisan Congressional Budget Office is expected to release its analysis of McConnell's revised bill early next week, including an assessment of Cruz's plan.

The office estimated that McConnell's initial bill would have caused 22 million additional people to be uninsured.

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Health Care Bill: Insurance Groups Call Parts "Unworkable ...

McCain’s Surgery Will Delay Senate Votes on Health Care Bill – New York Times

The announcements, first by Mr. McCain, then by Mr. McConnell, dealt another setback to the effort to repeal the Affordable Care Act, which once seemed inevitable after years of promises by congressional Republican leaders that they would dismantle it.

With control of the White House and both houses of Congress, Republican leaders foresaw a quick strike coming as soon as January or February. But the House struggled to pass its version of the bill, and the Senate has had even more troubles. Mr. McConnell had to postpone the first votes before the July 4 recess when it was clear he did not have enough support for a procedural motion to take up the bill.

A revised measure unveiled last week was supposed to win over more Republicans, but it was greeted quickly with two Republican defections: Senators Susan Collins of Maine, a moderate, and Rand Paul of Kentucky, a conservative. Both have said they oppose the bill in its current form, for very different reasons, and will not vote even to begin debate.

That left Mr. McConnell without a vote to spare. Mr. McCains ailment cost him the final vote at least for now.

Mr. McCains absence will give the forces of opposition which include scores of health care provider organizations and patient advocacy groups more time to mobilize.

On Friday, in a joint letter, the insurance industry lobby and the association that represents Blue Cross Blue Shield plans came out strongly against one of the innovations in the latest draft. They joined consumer groups, patient advocates and organizations representing doctors, hospitals, drug abuse treatment centers and religious leaders who have expressed opposition to the bill.

With Mr. McCain missing, Senate Republicans would have only 49 potential votes to move ahead with the legislation because all Senate Democrats and the two independent senators oppose it.

Mr. McCain, 80, announced Saturday night that he had the surgery at Mayo Clinic Hospital in Phoenix. He is at home with his family and, on the advice of his doctors, will be recovering in Arizona this week, a spokeswoman said.

Mr. McConnell said that while John is recovering, the Senate will continue our work on legislative items and nominations.

But congressional aides, lobbyists and state officials said Saturday night that Senate leaders should rethink their strategy after being forced to postpone consideration of the repeal bill, which opinion polls show to be highly unpopular.

The House passed a repeal bill, broadly similar to the Senate measure, by a vote of 217 to 213 in early May. Mr. McConnell has had a more difficult time rounding up support in the Senate.

Mr. McCain has been decidedly noncommittal in his comments on the bill. Asked last month about the chances for a quick agreement among Republican senators on a bill, he said that pigs could fly.

A number of other Republicans have expressed serious reservations about the bill in its current form. They include Senators Shelley Moore Capito of West Virginia, Dean Heller of Nevada, Lisa Murkowski of Alaska and Rob Portman of Ohio.

Governors from both parties have sharply criticized the Senate bill, drafted mainly by Mr. McConnell. Trump administration officials are frantically trying to win over state officials gathered in Providence, R.I., this weekend for a meeting of the National Governors Association.

The administration is trying to discredit estimates by the Congressional Budget Office that more than 20 million people would lose insurance coverage by 2026 as a result of the Senate and House bills.

When Senate Republican leaders unveiled a revised version of their health care bill on Thursday, Mr. McCain said it did not include the measures he had been seeking to protect the people of Arizona and newly eligible Medicaid beneficiaries, in particular.

Tens of thousands of people in Arizona have gained coverage through the expansion of Medicaid under the Affordable Care Act, and Mr. McCain was planning to propose amendments to the bill to protect his constituents.

In all, 20 Republican senators come from states that have expanded Medicaid.

Mr. McCain also criticized the unusual process by which the bill was developed: in the majority leaders office, without the benefit of public hearings or the expertise of Senate committees.

Have no doubt, Mr. McCain said in a statement. Congress must replace Obamacare, which has hit Arizonans with some of the highest premium increases in the nation and left 14 of Arizonas 15 counties with only one provider option on the exchanges this year.

But if we are not able to reach a consensus, he continued, the Senate should return to regular order, hold hearings and receive input from senators of both parties, and produce a bill that finally provides Americans with access to affordable and quality health care.

A version of this article appears in print on July 16, 2017, on Page A1 of the New York edition with the headline: McCain Out, Senate Puts Off Health Care Votes.

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McCain's Surgery Will Delay Senate Votes on Health Care Bill - New York Times

Focus on Russia or health care, Dems divided on message – ABC News

House Democratic Caucus Chairman Joe Crowley hesitated when asked about his party's core message to voters.

"That message is being worked on," the New York congressman said in an interview this past week. "We're doing everything we can to simplify it, but at the same time provide the meat behind it as well. So that's coming together now."

The admission from the No. 4 House Democrat that his party lacks a clear, core message even amid Republican disarray highlights the Democrats' dilemma eight months after President Donald Trump and the GOP dominated last fall's elections, in part, because Democrats lacked a consistent message.

The soul-searching comes as Democrats look to flip at least 24 GOP-held seats necessary for a House majority and cut into Republican advantages in U.S. statehouses in the 2018 midterm elections. Yet with a Russia scandal engulfing the White House, a historically unpopular health-care plan wrenching Capitol Hill and no major GOP legislative achievement, Democrats are still struggling to tell voters what their party stands for.

Some want to rally behind calls to impeach the Republican president as new evidence indicates possible collusion between Trump's campaign and the Russian government. Democratic leaders are reluctant to pursue that approach as it only energizes the GOP base. Others want Democrats to focus on the GOP's plans to strip health insurance from millions of Americans. And still others say those arguments can be fashioned into a simplified brand.

"The Democratic Party needs to up its game," national Party Chairman Tom Perez said in a speech this week. "What I hear most from people is, 'Tom, we not only need to organize, but we need to articulate clearly what we stand for.'"

For now, at least, Democrats are waging a tug-of-war largely between the Russia investigation and the GOP's attempts to gut the 2010 Affordable Care Act.

Several liberal groups that had been laser-focused on health care have intensified calls for impeachment in recent weeks, including MoveOn.org, Indivisible and Ultraviolet.

"We need to be talking about impeachment constantly," said Scott Dworkin, co-founder of the recently formed Democratic Coalition Against Trump. He warned on Twitter, "If you're an elected Dem & you're not talking impeachment or 25th amendment then find a new party."

Yet one of the left's favorites, Vermont Sen. Bernie Sanders, is focusing almost exclusively on health care.

Sanders, an independent who caucuses with Senate Democrats, said in an interview that "there should not be a rush to judgment" after emails released by Donald Trump's son this week revealed that Trump's top advisers held a meeting with a lawyer they were told represented the Russian government.

Sanders sidestepped questions about impeachment, warning instead that "many, many thousands of Americans" will die every year if the GOP health care plan becomes law. Sanders has hosted swing state rallies focused on health care in West Virginia, Kentucky, Pennsylvania and Ohio in recent weeks and was in Iowa on Saturday.

Democratic operative Zac Petkanas, who led Hillary Clinton's campaign war room, agrees that this week's developments in the Russia investigation shouldn't change the party's focus heading into 2018.

"Candidates need to be saying the word 'health care' five times for every time they say the word 'Russia,'" Petkanas said. He added, "I think it's a fundamental mistake to make this election a referendum on impeachment."

It's not that easy for some elected officials, like Rep. Joe Kennedy III, D-Mass., who says concerns about Russia have caught up to health care as a priority among his constituents. He described the Russian developments as "a threat to our foundation of democracy" that demands attention.

"Congress has to be able to walk and chew gum. We have to be able to do both," Kennedy said.

Democrats are naturally playing defense given generations of victories that expanded the role of government, from the social safety net of Franklin Roosevelt's New Deal to Lyndon Johnson's landmark civil rights legislation to Obama's health care law.

But many Democrats outside Washington insist they must go beyond opposing Trump and his policies if they expect to make major gains in 2018 and beyond.

"Democrats would make a mistake if we thought pounding Trump and not having an authentic message of our own is a winning strategy," said Ohio Democratic Party Chairman David Pepper. "The message of Democrats has to be about issues that matter to people at their kitchen table."

In South Bend, Indiana, Mayor Pete Buttigieg said Democrats don't have to retreat from their opposition to Trump, including talking about Russia, but they must tie it all together with a consistent theme that goes beyond day-to-day news cycles.

"It's very simple," he said. "We exist to help people go about their lives, to protect their rights and freedoms and opportunities."

Jason Crow, a Democrat running for Congress in a Colorado swing district, said voters regularly ask him about the Russia story, which "goes to the core of our institutions and our faith in government." But he's anchoring his pitch on issues that "are real and immediate to people's lives: going to college, paying the bills, financing a house, whether they can go and get the health care they need right now in an affordable and accessible way."

Meanwhile, Crowley said voters may have to wait a few more months before they hear national Democrats' new message.

"We're all working on that," Crowley said. "We're hoping to have this up and running and out by this fall."

Barrow reported from Atlanta.

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Focus on Russia or health care, Dems divided on message - ABC News