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Robotic sensor-laden 'eel' helps detect water pollution
 The robotics researchers at Switzerland's École Polytechnique Fédérale de Lausanne (EPFL) have produced some truly impressive (and creepy) animal-inspired droids over the years. Following in the footsteps of the team's robotic turtles, grasshoppers and crocodiles comes the Envirobot, a robotic eel built to snake through contaminated water to find the source of pollution.

Envirobot can be controlled remotely or swim on its own, measures 1.5 meters long (5 ft) and is made up of individual modules that each house a small electric motor. These motors are what changes the robot's curvature, enabling it to snake smoothly through the water without stirring up mud or annoying aquatic life.

Meanwhile, some of these modules contain sensors to measure things like conductivity and temperature, while others contain chambers designed to fill up with water. Those that fill up with water also house bacteria, small crustaceans and fish cells, which work as biological sensors.

Envirobot measures 1.5 meters long (5 ft) EPFL

By watching how these organisms respond to the water as it enters the chamber, the operators can get a read on what kind of pollutants are in the water and its toxicity in general. For now, the team has only tried this out in the lab, where it says it was shown to be highly effective.

"For example, we developed bacteria that generate light when exposed to very low concentrations of mercury," says Jan Roelof van der Meer, Project Coordinator and Head of the Department of Fundamental Microbiology at the University of Lausanne. "We can detect those changes using luminometers and then transmit the data in the form of electrical signals."

Another example of these biological sensors involves the use of Daphnia, which are tiny crustaceans less than 5 mm (0.20 in) whose movement is affected by water toxicity. Two of Envirobot's modules contain the Daphnia, one in clean water and one in water taken in while it swims around. By tracking the movement of the creatures in each tank, the team can gain an indication of the water's toxicity.

Envirobot has been trialed in Lake Geneva, where one recent exercise was designed to test its ability to track changes in water conductivity. The team did this by pumping salt into a specific area close to the shore and setting Envirobot free, where it successfully mapped the variations in conductivity resulting from the salt and created a temperature map of the area.

Envirobot has been trialed in Lake Geneva EPFL

That is as far as the team has got for now, with further tests involving the biological sensors and real contaminants still a little ways off. But eventually, it imagines the Envirobot either following a preprogrammed path or following the direction of increasing water toxicity to autonomously zero in on the source of pollution.

"We obviously can't contaminate a lake like we do the test water in our lab," says van der Meer. "For now, we will continue using salt as the contaminant until the robot can easily find the source of the contamination. Then we will add biological sensors to the robot and carry out tests with toxic compounds."

You can hear from van der Meer and see Envirobot in action in the video below.

Source: EPFL

Output: Researchers at École Polytechnique Fédérale de Lausanne (EPFL) in Switzerland have developed the Envirobot, which is able to find the source of pollution in contaminated water. The robot measures 1.5 metres in length and does not disturb mud or local aquatic life. The robot has chambers designed to fill with water that can be analysed for levels of toxicity, using biological sensors. One example of these biological sensors is Daphnia, tiny crustaceans whose movement are affected by water toxicity.


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Healthcare transportation service Circulation raises $10.5m
 Circulation, a Boston, MA-based on-demand provider of non-emergency healthcare transportation has raised $10.5 million in Series A funding co-led by Flare Capital Partners and The Providence Service Corporation. The round also includes participation from Boston Children’s Hospital, Echo Health Ventures (a strategic collaboration of Cambia Health Solutions and Mosaic Health Solutions), Intermountain Healthcare Innovation Fund (a strategic investment vehicle of Intermountain Healthcare, managed by Healthbox), Humana, NextGen Venture Partners and the world’s leading healthcare diagnostics company.

According to the Transportation Research Board, up to $3 billion is spent annually by Medicaid on non-emergency medical transportation. It is estimated that 33 percent of non-emergency medical transportation rides are funded inappropriately.

Founded in 2016 by John Brownstein, PhD and Robin Heffernan, PhD, CEO of Epidemico, Circulation provides patients, caregivers and hospital staff a seamless, superior overall experience. Hospital transportation coordinators can schedule and manage on-demand rides that are affordable and tailored around patients – all from one convenient interface. Coordinators can update patient information files with transportation scheduling information, ensure physicians, nurses and caregivers are notified when patients arrive for appointments, and receive alerts on Circulation’s centralized multi-patient dashboard – all in real-time.

Initially piloting at Boston Children’s Hospital, Mercy Health System’s three acute-care hospitals and all-inclusive care program for the elderly in Pennsylvania, and Nemours Children’s Health System in Wilmington, Delaware, Circulation’s service has almost 50 clients across 1,000 top-tier hospitals, clinics, community health centers, and other healthcare facilities nationwide. It has also reported major industry advancements in cost savings, patient satisfaction ratings, and appointment adherence improvements. The company recently signed a partnership with Uber to become their preferred healthcare platform partner.

“Our focus on improving critical access to healthcare services and better patient outcomes is stronger than ever,” said Robin Heffernan, Ph.D., Circulation CEO in a statement. “We’ve proven how Circulation can significantly increase patient satisfaction rates while simultaneously cutting ride costs by up to 70% – a clear benefit for our healthcare clients and their populations served.”

The startup plans to utilize the latest round of funding to accelerate Circulation’s on-demand transportation expansion and growth across the country.

Output: Boston-based start-up Circulation has raised $10.5m in a series A funding round, co-led by Flare Capital Partners and the Providence Service Corporation. Founded in 2016, Circulation provides non-emergency healthcare transportation and has built up almost 50 clients across 1,000 hospitals by helping transport coordinators to schedule and manage affordable and tailored transportation for patients. The new funds will be used to speed up Circulation's national expansion.


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Metromile launches Ava, an AI-powered claims processing assistant
 Utilizing Metromile Pulse sensor data, AVA can reconstruct the accident scene and instantly determine if claim details are accurate. If verified, the claim can be approved within seconds and AVA notifies the customer of the expedited claim. Depending on the method chosen by the customer, payment can be in their bank account within days of filing. Behind the scenes, Metromile has a team of data scientists utilizing machine learning capabilities and continuously teaching AVA new skills to further expedite the claims process.

"We strive to provide a fair, accurate and seamless claims experience. Instead of relying on traditionally complex processes to handle customers' claims, our machine learning platform removes the friction associated with getting your car back as soon as possible. The future of insurance is frictionless and fairly priced, which is all enabled by smart use of data." said Dan Preston, CEO at Metromile. "AVA enables us to automate traditional claims handling tasks, allowing our adjusters to do what they do best, service our customers."

When AVA does flag details that need to be further reviewed, Metromile's in-house claims team is equipped with internally developed software that helps them investigate and close the claim quickly and fairly.

At launch, AVA will only be available for certain claim types, with expanded eligibility and advanced automated features rolling out in the coming months.

In September 2016, Metromile announced their series D funding of $192 million and acquisition of Mosaic Insurance enabling them to underwrite policies and transform their entire claims process. In addition, the company has:

Transferred their book of business to be underwritten by Metromile (from NGIC) and brought claims handling in-house.

Released first-of-its-kind dynamic online "first notice of loss." Customers can file their entire claim from their mobile phone, without needing to call an adjuster.

Metromile's pay-per-mile car insurance saves low mileage drivers $500 on average each year. In addition, Metromile's smart driving app and in-car telematics device give customers visibility into their car's general health and usage, as well as pinpoint their car's exact location via the vehicle locator, and help customers avoid parking tickets via the app's street sweeping alerts (in select cities). Metromile's pay-per-mile insurance is currently available in seven states, including Calif., Ill., N.J., Ore., Pa., Va., and Wash., and the company is focused on offering pay-per-mile insurance nationwide.

For more information about Metromile, visit metromile.com or follow Metromile on Facebook, Twitter, and LinkedIn.

About Metromile

Metromile is revolutionizing car insurance through technology with its pay-per-mile insurance model. By offering affordable car insurance, transparent pricing based on the miles you actually drive, data to optimize how you use your car, and instant access to detailed vehicle diagnostics via the driving app, Metromile is transforming car insurance — and car ownership — to be more intelligent, seamless, and accessible than ever before.

SOURCE Metromile

Related Links

http://metromile.com

Output: US pay-per-mile insurance company Metromile has launched an artificial intelligence claims assistant called Ava, a machine learning-backed automated system that the company said will provide a "fair, accurate and seamless claims experience". Using Metromile's sensor data, Ava will determine the veracity of a claim by reconstructing the accident scene, with successful claims approved in seconds. Initially Ava covers only certain claim types, but the company expects to expand and roll out more features in the coming months, including instant payments and assisting with arranging repairs.


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KPMG Australia hires Lisa Bora for marketing advisory business
 KPMG Australia has announced the appointment of Lisa Bora (pictured above) to lead the sales transformation for its new specialist customer, brand and marketing advisory business.

Bora joins KPMG from Google, where she has worked as a senior executive for the past five years, most recently leading Google Australia and New Zealand’s new business division.

Furthermore, Bora has more than 20 years’ experience leading marketing for organisations including News Corp, Voyages Hotels & Resorts and Village roadshow.

As the partner leading KPMG’s sales transformation consulting, Lisa will work with the firm’s clients to ensure all their customer touch points are delivering and delighting customers’ expectations; that distribution channels are effective and future-proofed for digital disruption; and that they are building new business partnerships and marketing and sales operations for future-oriented consumer behaviours.

Bora will be responsible for building a sales transformation team focusing on areas such as technology choices, data integration, full marketing and sales supply chain reviews, loyalty program and customer service and packaging reviews, and driving alignment of chief marketing officer), chief technology officer and chief sales officer disciplines within business which are often operating in silos.

Paul Howes, partner in charge of KPMG’s customer, brand and marketing advisory, said: “Lisa specialises in adapting organisations’ sales and marketing strategies though digital disruption and organisational change.

“She has a strong history of successfully driving new ways of business, new partnerships, new revenue and new distribution channels, which is exactly what our clients are looking for from our new business.”

Commenting on her new role, Bora said sales transformation is about putting the customer at the centre of your business by ensuring marketing, sales and distribution are aligned for profit building.

“It’s about making marketing operate as a profit and insight centre for a business, rather than a cost centre,” she explained.

“Being at the heart of driving this change across marketing, sales and distribution channels is what attracted me to KPMG.

“The opportunity to build a business and new practice that is heavily integrated into an overall business transformation journey, which is KPMG’s strength, is exhilarating.

Bora commences her new role with KPMG on Monday 28 August.

Launched last month, KPMG’s new practice now has a combined team of 46 specialists, including seven partners.

Its suite of services include customer experience strategy, customer experience design, customer journey, sales and channel transformation, marketing and product transformation, service transformation and customer insights.

Output: Former Google Australia senior executive Lisa Bora has been confirmed as KPMG Australia's leader of sales transformation consulting for its new customer, brand and marketing advisory business. Bora will be responsible for developing a sales transformation team and facilitating closer working between the chief marketing officer, chief technology officer and chief sales officer. The sales transformation team will focus on technology choices, data integration, marketing and sales supply chain reviews and loyalty programmes. She takes up the position on 28 August.


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How much are health IT groups spending on lobbying efforts?
 The number of groups lobbying Congress on the Medicare Access and CHIP Reauthorization Act has decreased to 58 in the second quarter, compared to 81 from the same period in 2016, according to the Politico Morning eHealth newsletter.

Organizations have spent just over $18 million in the past three months on lobbying efforts for MACRA, compared to more than $27 million in the same period last year.

Here are 12 notable lobbying contributions from health IT groups in the second quarter, as reported by the Politico Morning eHealth newsletter.

1. Munich, Germany-based Siemens: $1,010,000

2. San Francisco-based McKesson: $212,000

3. Watertown, Mass.-based athenahealth: $180,000

4. Euless, Texas-based Federation of State Medical Boards: $150,000

5. Washington, D.C.-based Alliance for Connected Care: $75,000

6. Purchase, N.Y.-based Teladoc: $50,000

7. Chicago-based Allscripts: $46,800

8. Washington, D.C.-based Health IT Now: $40,000

9. Verona, Wis.-based Epic: $36,000

10. North Kansas City, Mo.-based Cerner: $30,000

11. La Jolla, Calif.-based West Health Institute: $20,000

12. Ann Arbor, Mich.-based College of Healthcare Information Management Executives: $15,000

More articles on health IT:

GAO: 3 reasons patients don't like EHRs, portals

Nebraska, Nevada, Utah connect HIEs for Patient Centered Data Home

House bill would reorganize DHS, create Cybersecurity and Infrastructure Security Agency

Output: The number of groups lobbying Congress on the Medicare Access and CHIP Reauthorization Act has decreased to 58 in the second quarter, compared to 81 from the same period in 2016, according to the Politico Morning eHealth newsletter.


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Yes, we can lower sky-high drug prices — other countries have done it
 Scott Gottlieb, head of the Food and Drug Administration, wasted no time in his opening remarks at a forum last week on high drug prices.

“The fact is that too many people can’t afford the medicines that they need,” he declared.

On that, I hope, we can all agree.

The trouble is doing something about it.

In all other developed countries, patients are protected by government authorities overseeing the market for prescription meds, ensuring that prices are reasonable while still allowing drug companies a fair profit.

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In the United States, profit comes before public interest. There are no limits to how much can be charged for a prescription drug, particularly specialty drugs intended for the costliest illnesses.

As a result, the U.S. is by far the world’s biggest spender on pharmaceutical products, shelling out more than $1,026 annually per person, according to a 2015 report from the Organization for Economic Cooperation and Development.

That’s double the OECD average of $515 and considerably more than economic peers such as Germany ($678), France ($596) and Australia ($590).

Total U.S. spending on prescription drugs reached $450 billion last year, according to the research firm QuintilesIMS. It could be as high as $610 billion by 2021.

The FDA has no power to dictate pricing to drug companies. So Gottlieb said last week that the agency will focus on speeding up the approval process for generic meds so consumers have cheaper alternatives to branded drugs. It also wants to encourage greater competition among drug companies to lower prices.

“These moves would help,” said Peter Hilsenrath, a healthcare economist at the University of the Pacific. “But I wouldn’t expect really big things to come of it.”

He pointed out to me that generics already account for about 80% of U.S. drug sales, meaning that faster approval of generic meds wouldn’t exactly be a game changer for the marketplace.

“The big problem continues to be the prices of patented drugs,” Hilsenrath said.

Case in point: The same day that Gottlieb, a doctor when not running a federal agency, was calling for more affordable drug prices, the FDA gave its blessing to a new hepatitis C medication called Vosevi.

It’s the latest such drug from Gilead Sciences, which says Vosevi is for people who may not have seen strong results from the company’s other blockbuster hepatitis C pills, Harvoni and Epclusa.

The San Francisco Bay Area company plans to sell Vosevi for nearly $25,000 a bottle, with three bottles required for 12 weeks of treatment — a total cost of about $75,000.

The company is no stranger to envelope pushing when it comes to the cost of its drugs. In 2013, it introduced its first hepatitis C drug, Sovaldi, at a price of $1,000 a pill.

Gilead execs argued at the time that the drug cured 98% of hep C patients who took it, so a thousand bucks a pill was still cheaper than treatment for expensive complications the virus can cause, such as liver failure and cancer.

That may be true. But it’s important to remember that Gilead didn’t do the bulk of the research on Sovaldi. That was done by a pharmaceutical company called Pharmasset, which estimated in 2011 that a 12-week treatment regimen of its hep C drug would cost patients about $36,000.

Gilead paid $11.2 billion to acquire Pharmasset in 2012 and immediately decided $36,000 was much too cheap for a hepatitis cure. So it raised the price of a 12-week regimen to $84,000.

That’s the American way of drug pricing: Whatever the market will bear. Even if patients are treated as hostages.

The International Federation of Health Plans said last year that a one-month supply of Gilead’s Harvoni pill cost $32,114 on average in the United States. The same amount of the same drug cost $22,554 in Britain, $18,165 in Spain and $16,861 in Switzerland.

How do other countries do it? Simple, said Jason Doctor, an associate professor at USC’s School of Pharmacy. “Developed countries keep their drug prices down through price controls,” he said.

First and foremost, other nations offer their citizens universal health coverage, achieved through variations of single-payer insurance systems. Basically, that’s Medicare for everyone, not just seniors.

This allows the government to keep rising drug prices in check by using its market clout as the biggest buyer of prescription meds.

Incredibly, Medicare has no such negotiating power. The government-run program is forbidden by law from haggling with drug companies over prices.

Other nations also keep a close eye on what pharmaceutical companies charge in drugstores. In Canada, for example, the Patented Medicine Prices Review Board ensures that drug costs “are not excessive,” which means companies can’t gouge patients just because they can.

Canada also has a law requiring that breakthrough new drugs like Sovaldi can’t be priced higher than the median price around the world, ensuring that the price for Canadians is fair relative to what people elsewhere are paying.

Researchers have found that U.S. patients can pay as much as 16 times what people in other countries pay for the same drugs.

Free-market types will counter that price controls stifle innovation.

“If the revenue potential is not there, the company will not take the risk of spending $1 billion getting an early promising molecule to market,” said Patrick Sullivan, a pharmaceutical economist at Regis University in Denver.

There’s something to that. Then again, how much innovation are big drug companies really responsible for? Pharmasset took most of the risk developing a promising hepatitis C drug. It was only after Gilead acquired the company that corporate greed became the driving force in pricing.

Also, why should we rely so heavily on innovation by the private sector? Why not restore public-sector science to prominence with a boost in grant-making by the National Institutes of Health?

Such grants could be funded via potentially billions of dollars in savings from allowing Medicare to negotiate public-sector drug prices.

Consider this: The discovery of insulin in the early 20th century was one of the most important moments in modern medicine. It wasn’t done by a private company. It was primarily the work of a Canadian scientist, Frederick Banting, who would go on to share the Nobel Prize in 1923.

Banting and two colleagues subsequently sold the patent for insulin to the University of Toronto for just $3. The university in turn allowed drug companies to manufacture insulin royalty-free.

It wasn’t about profit. It was about what was best for society.

Today, drug companies see the global diabetes epidemic as an enormous business opportunity. Insulin prices have more than tripled in recent years.

It’s not about what’s best for society. It’s about profit.

There’s our problem.

David Lazarus’ column runs Tuesdays and Fridays. He also can be seen daily on KTLA-TV Channel 5 and followed on Twitter @Davidlaz. Send your tips or feedback to david.lazarus@latimes.com.

MORE FROM DAVID LAZARUS

Revised GOP healthcare bill succeeds at making things even worse

If you’re on a spouse’s health plan, what happens if the worst should happen?

Chiropractic treatment, a $15-billion industry, has its roots in a ghost story

Output: Scott Gottlieb, head of the Food and Drug Administration, wasted no time in his opening remarks at a forum last week on high drug prices. “The fact is that too many people can’t afford the medicines that they need,” he declared.


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Drug prices: how generics changed the game
 For a time, high drug prices made headlines, and it looked like the issue could be tackled by the Trump administration. But as we all know, efforts to repeal Obamacare have consumed Republicans much of this year.

The drug problem hasn’t gone away; it’s just lingering in the background. Even the cost of some generic drugs are rising.

For more than 30 years, Americans have relied on these drugs to give us low-cost options. In the late 1970s, the generic drug scene was sketchy. While generics were legal, proving them safe and effective was tough, and getting them to the consumer was even tougher.

“There would be sales reps showing up in the summertime at an independent drug store in Anytown, USA,” said pharmacist George Zorich. “They’d be selling bottles of penicillin out of the trunks of their cars in 100 degree heat.”

Regulation of generics began taking shape in the 1960s, but that wasn’t much help to manufacturers.

Bob Billings, a consultant with the generic manufacturer’s trade group, said into the 1980s, companies weren’t sure how long it would take to get approval or even what exactly had to be submitted to get that approval.

“It’s like going on a trip and you don’t have a road map,” Billings said. “You just have to sort of hope you choose the right roads. You may end up choosing a wrong path, and it could take a long time to get there.”

The trouble getting generics to market at that time helped explain why only about a third of top-selling brand-name drugs had any generic competition, even though their patents had expired.

To do something about the growing price of drugs, Congress passed a bill, now known at the Hatch-Waxman Act, that laid out exactly what companies needed for approval and that this process would take the Food and Drug Administration just six months.

President Ronald Reagan hailed the legislation as a winner, especially for older Americans.

“Senior citizens require more medication than any other segment of our society. I speak with some authority on that,” joked Reagan. Turning serious, he added, “With this bill, elderly Americans will have access to safe and effective drugs at the lowest possible cost.”

The bill shook up the industry immediately. Billings said within a year of passage, generic manufacturers submitted 1,000 applications. Branded companies got longer patent protections for their new drugs, a benefit he said they’ve maximized.

“Some [extensions] were 30 days, some were 40 days,” he said. “Many were three or four years. I just did a real quick adding up of that and got over 1,100 years of patent-term extensions for brand products since Hatch-Waxman came into being.”

Back in 1984, Reagan predicted the bill would save $1 billion over the next decade. In June, the FDA reported generics saved the U.S. more than $1.5 trillion since 2007. As designed, Hatch-Waxman created pharmaceutical competition like we’ve never seen.

Output: For a time, high drug prices made headlines, and it looked like the issue could be tackled by the Trump administration. But as we all know, efforts to repeal Obamacare have consumed Republicans much of this year.


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Pharmacy group ASHP opposes proposed cuts to Medicare payment rates for drugs
 Proposed cuts to the Medicare payment rates for drugs that hospitals acquire under the 340B Drug Pricing Program, if enacted, could have devastating consequences for the low-income and uninsured patients that receive care from the nation's safety net hospitals, according to ASHP (American Society of Health-System Pharmacists).

The new rule on outpatient payment rates for hospitals and ambulatory surgical centers, proposed by the Centers for Medicare & Medicaid Services, would reduce the reimbursement for drugs acquired through the federal 340B program from average sales price (ASP) plus 6 percent to ASP minus 22.5 percent.

"The CMS proposal to reduce reimbursement of 340B-purchased drugs has the potential to be very harmful to the sickest and most vulnerable patients by endangering their access to essential healthcare services," said ASHP Chief Operating Office and Senior Vice President Kasey K. Thompson, Pharm.D., M.S., M.B.A. "These changes run counter to the statutory intent of the federal 340B program and will incur a steep cost to the people and the organizations that can least afford it."

The 340B drug-discount program allows community safety net providers -; organizations that serve low-income patients, including critical access, children's, and cancer hospitals -; to provide care for tens of millions of uninsured and underinsured people every year. The discounts allow 340B-eligible entities to provide free or low-cost medications, establish programs to increase medication adherence, and provide additional screening and preventive care services.

ASHP is currently gathering member feedback on how this reimbursement change will impact covered entities. ASHP will submit detailed comments outlining the impact of the proposal on ASHP members and their patients and organizations in advance of CMS' September 11 deadline.

Output: Proposed cuts to the Medicare payment rates for drugs that hospitals acquire under the 340B Drug Pricing Program, if enacted, could have devastating consequences for the low-income and uninsured patients that receive care from the nation's safety net hospitals, according to ASHP (American Society of Health-System Pharmacists).


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Single payer can't happen in California. At least, not right away
 Given the dismal state of healthcare reform in Washington, liberal Californians have rallied around the idea that the state should establish a single-payer program. Although in the future such a system would be workable and desirable, the reality is that at the moment a single-payer bill cannot pass. Fighting for one in the immediate term is a waste of time.

Financing, first of all, is a heavy lift. In addition to higher state taxes, California would need to channel Medicare and other federal healthcare funding into the single-payer system. Before it can do that, Congress must pass a waiver and the president must sign it — which isn’t going to happen while Donald Trump is in office.

The challenge of local political support is just as difficult to meet. Californians need to elect a governor who will sign the legislation. The current one will not do so. So-called “moderate” or “corporate” Democrats in the Assembly and state Senate who oppose single payer need to be persuaded that it is in their interest to vote for it. Millions of California voters with relatively good insurance coverage and those on Medicare are fearful of a radical change in their protections.

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Another problem is that the most recent version of the single-payer bill mandates an “overnight” approach — it would put for-profit insurance companies out of business from one year to the next and force all existing public safety net programs to rapidly combine their administrative structures and processes. The prospect of such sudden change will encourage insurance companies to ramp up their already vehement and well-funded opposition. The bureaucratic complexities of the Medi-Cal program, moreover, put into doubt that California could effectively administer a single-payer program on such a short time frame.

Some activists propose placing a single-payer initiative on the next state ballot, but this would be catastrophic.

Overcoming these three difficulties will require advocates to develop broader, deeper and more diverse (in every sense of the word) coalitions, alliances and legislative relationships. It will also require convincing millions of skeptical California voters that state government can run an efficient health insurance system.

Meanwhile, at the national level, Democrats have the daunting task of winning back the House, Senate and the White House. But by 2020, California might just be ready for single payer — if advocates achieve a string of smaller but important legislative victories to build power.

Such steps might include: a state individual mandate; a state employer mandate that also covers part-time workers and their dependents; continued guaranteed coverage for children in the country illegally; giving the state insurance commissioner the power to regulate insurance premiums; setting a process to negotiate drug and medical device pricing; administrative reforms to streamline Medi-Cal so that there is less waste and better coordination and continuity of care; engaging the state’s tech sector to assist with such streamlining; advancing nonprofit delivery systems and moving away from fee-for-service practice; and opening up Medi-Cal to everyone, which would effectively create a state public option robust enough to compete on a level playing field against private insurers.

As to the problem of persuading “corporate” Democrats to support single payer, one strategy would be to run pro-single-payer candidates in key primaries. The resources of the entire state movement would be concentrated in these campaigns and a movement victory in even one such race would cause deep reflection and rethinking of positions.

Some activists propose placing a single-payer initiative on the next state ballot, but this would be catastrophic. There is no evidence that such an initiative could win in California. The preconditions for a ballot victory simply do not yet exist.

Proposition 61 on drug price controls was badly defeated despite a high-profile endorsement from Sen. Bernie Sanders (I-Vt.). The initiative to have the state insurance commissioner regulate premiums was also badly defeated. And then there’s the historic 1994 defeat of Proposition 186, which proposed establishing a single-payer system in California. That went down by a 3-to-1 margin. Insurance companies and Pharma would see a single-payer proposition as an existential threat and spend the money needed to crush yet another health reform initiative. So far, they’ve got a 1.000 batting average.

We do not need yet another devastating loss. Time, treasure and effort would be better spent winning the series of smaller victories that create the pathway to single payer. And in four years, a substantially stronger single-payer movement could successfully lobby a new Congress and president for federal waivers.

The fight over the role of government in medical care is not something new. It goes back to the founding of our republic, with passage of the Merchant Marine Act in 1798. More than a century ago, Theodore Roosevelt called for a system of national health insurance. Single-payer advocates have been working for decades. They’ll have to work a few years more.

Steve Tarzynski is a physician and president of California Physicians Alliance.

Follow the Opinion section on Twitter @latimesopinion or Facebook

Output: Given the dismal state of healthcare reform in Washington, liberal Californians have rallied around the idea that the state should establish a single-payer program. Although in the future such a system would be workable and desirable, the reality is that at the moment a single-payer bill cannot pass. Fighting for one in the immediate term is a waste of time.


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San Diegans Share Concerns Over Healthcare Coverage
 Covered California is warning that under the Republican-proposed Better Care Reconciliation Act, deductibles would skyrocket and instability in the national health care arena could threaten rates in the state.

Though some experts say it is still too early to tell what will happen going forward, many San Diegans are concerned about their health care coverage.

One woman, who did not want to be identified, told NBC 7 that she only has health care coverage because of the Affordable Care Act.

Her message to lawmakers: “Keep us healthy and safe."

In San Diego's East County, Sen. Joel Anderson (R-38th District) told NBC 7 that many of his constituents are concerned about the cost of health care.

Some who had insurance in the past cannot afford it anymore under Obamacare, he said.

"Of course, I think we should have access to health care," Anderson said. "But it's got to be in a balanced way that lifts everybody -- it's not just focused on taking from the middle class to give to the poor."

In the wake of the possible instability, health facilities, like City Heights' La Maestra Health Center, are stepping up as much as possible to try and help residents. The center provides medical, dental and mental health services for anyone in need, regardless of their health care coverage.

Director of Development Corrine Knutson told NBC 7 that the center is preparing to double their capacity.

"Because we can see such a need in our community, so we can't turn a blind eye to our patients," Knutson said.

In the meantime, all eyes are on the nation's capitol to see what lawmakers will do as they move forward to repeal and possibly replace Obamacare.

Output: Covered California is warning that under the Republican-proposed Better Care Reconciliation Act, deductibles would skyrocket and instability in the national healthcare arena could threaten rates in the state.


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Uncertainty Over Obamacare Leaves 2018 Rates In Limbo
 California’s Obamacare exchange scrubbed its annual rate announcement this week, the latest sign of how the ongoing political drama over the Affordable Care Act is roiling insurance markets nationwide.

The exchange, Covered California, might not wrap up negotiations with insurers and announce 2018 premiums for its 1.4 million customers until mid-August — about a month later than usual. Similar scenarios are playing out across the country as state officials and insurers demand clarity on health care rules and funding, with deadlines fast approaching for the start of open enrollment this fall.

“It’s insane,” says John Baackes, CEO of L.A. Care Health Plan, which has about 26,000 customers on the California exchange. “Here we are in the middle of July, and we don’t even know what rules we will be operating under for open enrollment. It is not how you want to run a business.”

Individuals could face sharply higher premiums and fewer choices if more health insurers leave the insurance marketplaces because of lingering uncertainty. State and industry officials around the United States are concerned that the federal government could stop funding so-called cost-sharing subsidies that reduce out-of-pocket costs for people with lower incomes. And they worry the Trump administration won’t enforce the individual mandate that requires people to purchase health coverage or pay a penalty.

Amid those concerns, there was a sense of relief Tuesday among many exchange officials and insurers after the U.S. Senate’s latest attempt to replace the Affordable Care Act failed.

Two large insurer trade groups bluntly warned last week that parts of the Senate plan were “unworkable” and could plunge the market into chaos. In a letter to the Senate, America’s Health Insurance Plans and the Blue Cross Blue Shield Association particularly objected to an amendment by Sen. Ted Cruz, R-Texas, that would have allowed insurers to sell bare-bones health plans to people who wanted cheaper premiums. That provision, the insurers said, would split the market between the healthy and the sick, driving up costs for people with pre-existing conditions.

In the Florida exchange market, health insurers have sought an average rate increase of nearly 18 percent. But Florida Blue, the state’s largest health insurer, said those rates would go even higher if the cost-sharing reduction payments disappeared.

“If cost-share reductions are not approved, then we know that our rates are going to increase probably 20 percent above whatever our submitted rates are going to be,” said Tony Jenkins,

Florida Blue will stop offering adult dental and vision coverage next year on plans sold to individuals through the Affordable Care Act.

The actual rate increase for health insurance bought on Obamacare exchanges is considered a trade secret in Florida. But we know the six companies selling individual plans are asking for an average rate increase of 17.8 percent.

Florida Blue, the state’s largest insurer, will also start telling customers in writing what happens if federal subsidies for their plan go away. Florida Blue may switch you to a different plan, and you would be responsible for the full costs if you keep it. While that’s always been true, it’s now such an actual risk they want to put it in writing for consumers buying a plan.

“As we prepare for the upcoming Marketplace Open Enrollment season, our goal is be a trusted resource for our members and keep them educated and informed as best we can on their health plans and factors that may affect them,” Florida Blue said in a statement. “Our Marketplace plans that include dental and vision coverage have a very low participation rate across the state and represent less than 0.25 percent of our Marketplace membership. Our decision to discontinue these plans for 2018 was based on the lack of interest in them by our members.”

The federal government next month is expected to release detailed info on health insurance companies raising their rates by more than 10 percent – which analysts expect to be most insurance companies across the country.

The Republicans’ failure to pass that replacement plan did not resolve questions swirling around the current health law.

Tuesday, President Trump expressed disappointment in the outcome in the Senate, telling reporters, “We’ll let Obamacare fail and then the Democrats are going to come to us and they’re going to say, ‘How do we fix it?’ ”

Some Senate Republicans struck a more conciliatory tone, suggesting that lawmakers should work on a bipartisan measure that would help stabilize the individual insurance markets.

Sen. Lamar Alexander, R-Tenn., chairman of the Senate Committee on Health, Education, Labor and Pensions, says he plans to hold hearings in the coming weeks on ways to shore up the individual insurance market. Lawmakers may look at creating a new stabilization fund that helps compensate insurers for higher-cost patients. Such a fund would be similar to one that existed during the first three years of the Affordable Care Act exchanges.

Some insurance industry executives welcomed the talk of bipartisanship, but they said action must be taken quickly to resolve key issues affecting consumers.

“We are running out of time, and we need a resolution on what we are charging for 2018,” says Gary Cohen, vice president of public affairs at Blue Shield of California in San Francisco, the largest Covered California insurer by enrollment.

Cohen, who helped launch the exchanges in 2014 as an official in the Obama administration, noted that the Republican bills in both the House and Senate included money for reinsurance that can help lower premiums industrywide. Those provisions are among the “immediate steps Congress and the Trump administration need to take in order for markets to provide coverage that is affordable,” Cohen says.

Lawmakers could also appropriate federal funds for the cost-sharing subsidies, which have a price tag of about $7 billion a year. Those payments, made directly to insurers, help reduce deductibles and other out-of-pocket costs for policyholders who earn up to 250 percent of the federal poverty level. This year, that’s up to about $29,000 for an individual or around $61,000 for a family of four. More than half of the people enrolled in exchanges nationwide qualify for this financial assistance.

Without it, many people would face annual deductibles of $2,000 or more when visiting the doctor or undergoing medical tests. That would make people far less likely to sign up with participating insurers.

Conservatives generally oppose the subsidies, calling them a bailout of the insurance industry and arguing that the Obama administration didn’t have the authority to pay them. Trump has repeatedly threatened to cut off those cost-sharing subsidies as well.

With the future of cost-sharing subsidies up in the air, some states, including California and Pennsylvania, have allowed insurers to submit two sets of proposed premiums. One filing reflects continued federal funding of those subsidies, and a separate one assumes they are eliminated and their cost is included in health plan premiums.

In Pennsylvania, premiums next year without the subsidies would increase by an average of 20 percent, compared with 9 percent if they remain intact.

Pennsylvania Insurance Commissioner Teresa Miller says the market in her state would be in good shape were it not for the uncertainty over federal policy.

“The only thing right now keeping everyone on edge is what’s going to happen in Washington, D.C.,” Miller says. “If things calm down in D.C. and if we don’t see further changes, then Pennsylvania’s market really is stabilizing.”

On Tuesday, Covered California officials said the two different rate filings its health plans submitted will be released Aug. 1. The exchange may announce that same day what the final premiums are, or it could postpone the decision for several more weeks if Congress has begun to pursue fixes to the ACA.

“This decision is based on the ongoing federal uncertainty around the repeal and replacement attempts of the Affordable Care Act and the dramatic potential impacts such uncertainty has on the rates and on California consumers,” exchange officials said in a statement.

A recent analysis commissioned by Covered California estimated that premiums for silver-tier plans would jump by 16.6 percent if the federal government stopped paying cost-sharing subsidies. That would be in addition to normal increases meant to cover rising medical costs. An exchange spokeswoman declined to comment further Tuesday, citing the ongoing developments in Washington.

Robert Laszewski, an industry consultant in Virginia and a frequent ACA critic, said the exchange markets aren’t imploding, despite what the Trump administration has often said. But their premiums will continue to rise unless more young and healthy people are persuaded to buy coverage, he said.

“I think most insurance companies will at least break even, or even make a profit, in 2018,” Laszewski says. “Coverage will be ‘stable,’ but it will stabilize at a horrific premium rate level.”

Copyright 2017 Health News Florida

Output: California’s Obamacare exchange scrubbed its annual rate announcement this week, the latest sign of how the ongoing political drama over the Affordable Care Act is roiling insurance markets nationwide.


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Republicans’ wrong approach to tackling Medicaid
 The high decibel fight in the Senate over Medicaid is one more example—did we need more?—of why lasting changes in social programs require thoughtful legislative deliberation leading to bipartisan consensus. There should be hearings to gather input from all sides and serious debate in committees as well as on the floor. If one party rams through big changes in any program as important as Medicaid, the other party will demonize the result. In the case of Medicaid cuts, arousing public outrage won’t be hard. Individuals and families, state governments, rural hospitals and other health providers will all be vocal about their plight. One wonders why either party would seek such opprobrium when they could be working together on sensible Medicaid reform.

In defending their Medicaid cuts, Republicans invoke two valid points with which most Democrats agree. First, federal entitlements, especially the big health entitlements, Medicaid and Medicare, are on an unsustainable path. They drive projected growth in federal spending as the population ages and health care becomes more expensive. Policies to reduce the future growth of Medicare and Medicaid—along with Social Security and tax reform—have to be part of any effective effort to keep the debt from growing faster than the economy and contain the burden of debt service as interest rates rise.

Second, Medicaid is a particularly complex web of federal subsidies that serve multiple purposes and diverse populations. It dominates state budgets, often driving out other needed spending. It has complex, restrictive rules. Its joint state-federal responsibility clouds accountability and federal matching of state spending arguably reduces incentives for state efficiency. In short, Medicaid badly needs rethinking and restructuring.

So, if Medicaid has to be part of entitlement reform and needs restructuring, aren’t Republicans taking a good first step in replacing the Affordable Care Act (ACA) with a law that makes drastic cuts in Medicaid? No, they are taking the worst possible step, both politically and substantively.

Senator Pat Toomey (R-PA) describes Medicaid growth as “out of control,” noting that Medicaid spending has grown twice as fast as the economy since its creation in the mid-1960s. It is true that Medicaid has gone from .49 percent of GDP to 3.02 percent between 1970 and 2015. In the same period, Medicare spending has grown from .71 percent to 3.58 percent of GDP, and private health spending from 1.44 percent to 5.94 percent.

Medicaid is not out of control; it is health spending, which now accounts for about 18 percent of all spending. Americans are devoting increasing portions of our total resources to health care because medical interventions help patients more than they did in the old days. We all want care, but we have a costly, wasteful, fragmented system for delivering it. We need to accelerate efforts to produce care more efficiently and change our behavior to stay healthier, but cutting care for the neediest is a terrible place to start.

We need to accelerate efforts to produce care more efficiently and change our behavior to stay healthier, but cutting care for the neediest is a terrible place to start.

Medicaid actually serves comparable patients less expensively than private coverage, because of Medicaid’s low reimbursement to providers and increasing use of managed care. In recent decades, Medicaid spending growth has resulted almost entirely from efforts to increase insurance coverage by expanding Medicaid to new groups—pregnant women and children in the 1990’s and most recently low-income adults without dependents under the ACA. In general, Medicaid’s costs per enrollee have grown more slowly than Medicare or private payers. The ACA expansion population surprised the estimators with higher than expected need for services, but this need is expected to decrease over time. If the objective is to rein in health spending growth (or entitlement growth), Medicaid should be part of the conversation, but not the lead focus.

There are plenty of sensible Medicaid reforms that could attract both Republicans and Democrats. One approach would be to recognize that Medicaid is actually two programs. One provides long-term care and support services for the elderly and disabled. These enrollees represented about 21 percent of the Medicaid population in 2014, but generate 61 percent of total program costs. Increasingly Medicaid pays for services that allow elderly and disabled people to stay in their own homes for greater satisfaction at less cost. It could make sense to relieve states of part or all of the cost of serving the elderly and disabled by shifting them to Medicare, which serves many of the same people, but such a shift would greatly increase Medicare costs.

The rest of Medicaid beneficiaries are low-income children and adults, including adults without dependents now covered as a result of expansion under the ACA. Many low-income adults now on Medicaid are employed but not in steady jobs with health benefits. Their incomes fluctuate so that they are sometimes eligible for Medicaid and sometimes when they are doing well, for subsidies to buy private health insurance. It would make sense to consider combining Medicaid spending for low-income adults and their children with subsidies for buying private health insurance, creating a single program that would ensure continuity of coverage and be simpler to administer—or at least to allow states try the combination.

Indeed, the most basic question about Medicaid is what role it should play in expanding health insurance coverage to the uninsured. Expanding eligibility for Medicaid, as the ACA did, is a relatively inexpensive option for increasing health insurance coverage quickly (Republicans admit this aspect of the ACA worked as intended). The market-oriented approach of subsidizing low-income households to purchase private insurance can also work, but it is more expensive, because providers demand higher compensation, and it is challenging to find a way to induce young, healthy people to buy into the insurance pool without a mandate.

Reaching a consensus on the role of Medicaid in financing health care requires thoughtful deliberation, bipartisan negotiation and two-party buy-in not possible in the context of a go-it-alone scramble to pass a reconciliation bill. With any luck, Republicans will fail to pass their one-party solution and be forced to seek common ground with Democrats in crafting a more durable Medicaid reform. If so, vulnerable Republican candidates may be glad they have constructive health reform to defend—and faith in our democracy will be strengthened by a demonstration that the policymaking process is not totally broken.

Output: The high decibel fight in the Senate over Medicaid is one more example—did we need more?—of why lasting changes in social programs require thoughtful legislative deliberation leading to bipartisan consensus.


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Moving All Medicaid to Managed Care Could Save Billions
 Managed care models already are saving more than $7 billion this year in Medicaid. Moving all Medicaid fee-for-service to managed care could save $63 billion over a decade, a study concludes.

Moving all Medicaid fee-for-service spending to a capitated managed-care model could produce total savings of $63 billion over 10 years, including $35 billion in federal savings, according to a newly released analysis.

A report from the Association for Community Affiliated Plans (ACAP) analyzes the current and potential savings to Medicaid programs around the country from the adoption of the managed care model.

The report estimates that in 2016, Medicaid managed care already results in nationwide savings of $7.1 billion, and it projects savings from these existing managed care programs to total $94.4 billion over the next 10 years.

Managed care is poised to become the dominant payment model for Medicaid, the report notes. As recently as 2010, capitated managed care represented only a quarter of total Medicaid spending nationwide. That figure rose to 48.9% of national Medicaid expenditures by 2016, and this percentage will likely continue to increase, the report says.

ACAP CEO Margaret A. Murray says the report "puts in black and white the fact that managed care can save precious Medicaid resources while at the same time maintaining a high level of access and quality care. Should Congress continue to turn to managed care's predictable budgeting and quality management tools to effect further savings, they must assure that Medicaid managed care plans are reimbursed in an actuarially sound manner."

Legislators should be pushing states to adopt the manage care model more extensively, the report suggests, targeting the potential savings of transitioning remaining Medicaid fee-for-service expenditures and beneficiary subgroups into the capitated model.

"These costs currently represent roughly half of the nation's Medicaid spending. Transitioning these fee-for-service costs to the capitated setting to the fullest extent possible is estimated to yield care coordination savings of $63.2 billion across the 2017 to 2026 10-year timeframe," the report says."

The majority of these 10-year savings ($35.7 billion or 56.5% of the total) are estimated to accrue to the federal government. The savings potential for remaining non-capitated costs is lower than for existing capitation programs because some Medicaid costs—such as [disproportionate share hospital] and [graduate medical education] payments and coverage of retrospective eligibility periods—are not 'impactable' by managed care techniques."

Managed care organizations (MCOs) bring improved quality along with the savings, the report says.

"MCO and provider performance on these access and quality fronts is being measured with ever-increasing sophistication, and these measurements are increasingly tied to performance-based payments both in state contracts with MCOs and in MCO contracts with their front-line providers," the report says.

"The results of these efforts are evident in the ongoing improvement in Medicaid MCOs' quality scores across time, both at the individual plan level and program-wide."

Murray notes that further adoption of the managed care model could save significant sums without the nearly $800 billion in cuts to Medicaid spending currently under consideration on Capitol Hill.

"There are ways to improve the efficiency of the Medicaid program, to be sure," Murray says. "$800 billion in budget cuts are simply a different order of magnitude than what innovation and system reform can provide. These cuts aren't just trimming fat from the Medicaid program. They get at muscle and bone."

Output: Managed care models already are saving more than $7 billion this year in Medicaid. Moving all Medicaid fee-for-service to managed care could save $63 billion over a decade, a study concludes.


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The Great Health Care Coverup
 Like many people, I have a sick sense of anger over what just happened in the Senate, which just voted to proceed on a health care bill without any information on what will be in the bill. There’s still hope that in the next few hours, moderates who just caved in will balk at the horrible things they’re being asked to vote for. And I do mean hours: there will be no time for reflection or serious debate.

But nobody should have any confidence that they will. And I think we can almost take it for granted that John McCain will first vote for something terrible, then give a grandstanding speech about making our politics better.

The important thing to realize is WHY the Senate is doing this — rushing to pass legislation that will have a vast impact on American lives, the economy, and more without a single hearing, without time for a proper analysis of the bill, and with crucial votes taken on behalf of legislation yet to be determined. It’s not some arbitrary failure of procedure: it’s a coverup.

The fact is that Republicans have no good ideas on health; everything they want to do will make huge numbers of people worse off, to the benefit of a wealthy few. And they know this. They know that the campaign against Obamacare was based on lies from the beginning, that all their complaints about things like high deductibles were hypocritical. They know that what they’re about to do is terrible. But they’re trying to do it anyway — and the only way they have a chance is by breaking every rule of good governance, by making the process so rushed and secretive that nobody has a chance to say “Wait a minute– what are we doing?”

At a deep level McConnell’s determination to pass a health bill by breaking all norms is quite similar to Trump’s determination to shut down an investigation into his own corruption and possible collusion. Both men are trying to cover up what they know would outrage voters if they knew about it, and they don’t care what rules get broken along the way.

And the Senators who caved on health today are pretty much the same people who are enabling Trump’s abuse of his office. The moral rot in the Republican party runs wide as well as deep. All we need to save America is a few good men — but apparently all we have are two decent women. And that’s not enough.

Output: Like many people, I have a sick sense of anger over what just happened in the Senate, which just voted to proceed on a health care bill without any information on what will be in the bill. There’s still hope that in the next few hours, moderates who just caved in will balk at the horrible things they’re being asked to vote for.


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The Senate’s Health Care Travesty
 In a moment Tuesday that was almost surreal, Senator John McCain, back from surgery and a brain cancer diagnosis, said that Republicans were making a big mistake with their partisan approach to health care, among other subjects. “We have been spinning our wheels on too many important issues because we keep trying to find a way to win without help from across the aisle,” he said. The substance of what he said accurately described the fecklessness of his party. What made it surreal was that only moments earlier he had voted along with almost every other member of his party to endorse Mr. McConnell’s obsession; Senators Susan Collins and Lisa Murkowski were the exceptions.

There are three main proposals before the Senate. On Tuesday night the Senate failed to muster enough votes to advance one of those: the Better Care Reconciliation Act. That bill would have gutted Medicaid and slashed insurance subsidies, taking coverage away from about 22 million people, according to the Congressional Budget Office. Another, the Obamacare Repeal Reconciliation Act, would eliminate important parts of the law without a replacement, stripping 32 million Americans of health insurance. The third option is called “skinny repeal” because it would leave much of the A.C.A. in place but eliminate one of the law’s taxes and the mandates that individuals buy insurance and that employers offer it to their workers. That plan could increase the uninsured population by up to 15 million. It would also cause insurance companies to raise premiums by 20 percent.

The details are complicated, but most Americans understand that these proposals would be incredibly cruel and needlessly devastating, which is why polls have shown that few people support the partisan repeal effort. A recent Kaiser Family Foundation poll found just 28 percent supported the Senate bill to repeal and replace the A.C.A., while 71 percent wanted Republicans and Democrats to work together to improve the law.

Republicans seem oblivious to those concerns, and to the danger that voters who lose access to health care could retaliate at the ballot box in the 2018 and 2020 elections. Some lawmakers may have decided that voters will in fact reward them for living up to their promises to repeal Obamacare, and that because actual repeal would be delayed two or more years, they will pay no price. Still others may have voted yes because they were afraid of losing primary elections to challengers further to the right than them.

Output: Ignoring overwhelming public opposition to legislation that would destroy the Affordable Care Act, Senate Republicans voted on Tuesday to begin repealing that law without having any workable plan to replace it.


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‘Skinny’ Obamacare Repeal Would Clash With Republicans’ Health Care Promises
 But, of course, there is a downside.

The individual mandate is unloved because no one likes being told what to do. But many independent analysts have concluded that, without a mandate, health insurance would become more expensive and cover fewer people. With the nudge of a mandate, more healthy people tend to buy insurance, reducing the average cost of coverage. Without one, the theory goes, mostly sick people buy insurance, and premiums rise to cover that sicker pool.

Fewer people would probably be covered under Medicaid, too. Over the last few years, signups for Medicaid have increased substantially, even among people who could have been covered before Obamacare expanded eligibility. Many of those people presumably didn’t realize they qualified for Medicaid and first tried to buy private insurance because of the mandate, before learning that they could get Medicaid and not have to pay a premium. Without a mandate, fewer people are likely to find their way into the program.

The Congressional Budget Office thinks that eliminating the individual mandate would have substantial negative effects on the insurance market, raising prices and reducing enrollment. It is hard to imagine that more insurers would wish to participate in this smaller, sicker market. The budget office still needs to evaluate a skinny repeal bill, but it seems likely that the reductions in coverage from a mandate repeal would save the federal government enough money for the bill to comply with budget instructions.

It is worth considering these effects in the context of Republicans’ criticisms of Obamacare itself. On the Senate floor Tuesday, Mr. McConnell assailed the health law as building unstable insurance markets and providing too little consumer choice. A skinny repeal would probably exacerbate those effects.

Output: If the current options for overhauling the health care system can’t get a majority of Senate votes, the majority leader, Mitch McConnell, has a new backup plan, according to senators and lobbyists: a simple bill that eliminates three of Obamacare’s least popular provisions.


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Lutein may counter cognitive aging, study finds
 Spinach and kale are favorites of those looking to stay physically fit, but they also could keep consumers cognitively fit, according to a new study from University of Illinois researchers.

The study, which included 60 adults aged 25 to 45, found that middle-aged participants with higher levels of lutein - a nutrient found in green leafy vegetables such as spinach and kale, as well as avocados and eggs—had neural responses that were more on par with younger individuals than with their peers. The findings were published in the journal Frontiers in Aging Neuroscience.

"Now there's an additional reason to eat nutrient-rich foods such as green leafy vegetables, eggs and avocados," said Naiman Khan, a professor of kinesiology and community health at Illinois. "We know these foods are related to other health benefits, but these data indicate that there may be cognitive benefits as well."

Most other studies have focused on older adults, after there has already been a period of decline. The Illinois researchers chose to focus on young to middle-aged adults to see whether there was a notable difference between those with higher and lower lutein levels.

"As people get older, they experience typical decline. However, research has shown that this process can start earlier than expected. You can even start to see some differences in the 30s," said Anne Walk, a postdoctoral scholar and first author of the paper. "We want to understand how diet impacts cognition throughout the lifespan. If lutein can protect against decline, we should encourage people to consume lutein-rich foods at a point in their lives when it has maximum benefit."

Lutein is a nutrient that the body can't make on its own, so it must be acquired through diet. Lutein accumulates in brain tissues, but also accumulates in the eye, which allows researchers to measure levels without relying on invasive techniques.

The Illinois researchers measured lutein in the study participants' eyes by having participants look into a scope and respond to a flickering light. Then, using electrodes on the scalp, the researchers measured neural activity in the brain while the participants performed a task that tested attention.

"The neuro-electrical signature of older participants with higher levels of lutein looked much more like their younger counterparts than their peers with less lutein," Walk said. "Lutein appears to have some protective role, since the data suggest that those with more lutein were able to engage more cognitive resources to complete the task."

Next, Khan's group is running intervention trials, aiming to understand how increased dietary consumption of lutein may increase lutein in the eye, and how closely the levels relate to changes in cognitive performance.

"In this study we focused on attention, but we also would like to understand the effects of lutein on learning and memory. There's a lot we are very curious about," Khan said.

More information: Anne M. Walk et al, The Role of Retinal Carotenoids and Age on Neuroelectric Indices of Attentional Control among Early to Middle-Aged Adults, Frontiers in Aging Neuroscience (2017). DOI: 10.3389/fnagi.2017.00183

Output: Spinach and kale are favorites of those looking to stay physically fit, but they also could keep consumers cognitively fit, according to a new study from University of Illinois researchers.


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Trying to stay young isn’t just futile: it’s also bad for you
 In the 20th century, thanks largely to clean water and antibiotics, the American lifespan increased by 30 years. Who doesn’t want even more, if new technologies like gene editing and nanomedicine can safely put them within our grasp? As Neo.life describes it, it’s the most important story today: “how biology and technology are coming together to help us all live healthier, happier, and longer lives.” But the challenge for all of us, no matter our age, is to not frame it as an “anti-aging” story. Here’s a pro-aging take on each of those modifiers—healthier, happier, and longer lives—starting with life extension itself.

Goal #1: longer lives

Aging isn’t something debilitating that bushwhacks us somewhere north of mid-life. Aging is living and living means aging. Nor is aging a disease; otherwise life, too, would be a disease. As British journalist Anne Karpf put it to NPR’s Brian Lehrer, “You can no more be anti-aging than anti-breathing.” Part of the distinction is semantic: make the target “age-related functional decline,” not “aging.” The “root cause of aging” is the passage of time, not cell senescence. At the end of all that living, we die. If the goal is to prevent death, whether by freezing ourselves in cryonic vats or by achieving what scientist Aubrey de Grey calls “longevity escape velocity,” let’s describe it accurately: not anti-aging but anti-dying.

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Don’t get me wrong. I’m intrigued by the regenerative potential of tissues and organs, and all in favor of more research into the biology of aging. Until we understand what happens to our cells and organ systems far better than we do now, no health promotion strategy will have much of an effect on average life expectancy and maximum lifespan. More years of healthy life would be wonderful. But just as the enemy is disease, not aging, the goal needs to be health, not youth.

Goal #2: healthier lives

I like the way bio-entrepreneur Craig Venter puts it in a Neo.life article called “The Anti-Aging Habits of Longevity Experts”: “I’m trying to use the best of scientific knowledge to be as healthy as I can for as long as I can.” Like all the experts quoted in that story, Venter is engaged in the most effective “anti-aging” behavior of all: pursuing a goal. Long-term studies show that even with brains full of plaques and tangles, some people stayed sharp to the end. What did they have in common? A sense of purpose. What’s the biggest obstacle to having a sense of purpose in late life? A culture that tells us that getting older means shuffling offstage. Aging with purpose means rewriting that script.

A growing body of fascinating research shows that attitudes toward aging have measurable effects on how our minds and bodies function. People who don’t equate aging with disability and decline walk faster, do better on memory tests, and are more likely to recover fully from severe disability. That’s why the World Health Organization is developing a global anti-ageism campaign: to extend not just lifespan but “healthspan.” Not coincidentally, people with positive feelings about getting older also live longer—and they live better.

How worried are you about getting older, and why? Has what you dreaded come to pass? Check your age bias. It segregates us, pits us against each other, and fuels needless fears—and it might be your biggest health risk.

Goal #3: happier lives

Even in Silicon Valley, tied with Hollywood as the most ageist place on the planet, people know that tans and Teslas aren’t what make us happy. What does? Aging itself. Study after study shows that people are happiest at the beginnings and the ends of their lives; Google “U shaped happiness curve.” You don’t have to be a Buddhist or a billionaire, because the curve is a function of the way aging itself affects the brain. We get better at dealing with negative emotions like anger, envy, and fear. The knowledge that time is short makes us focus on the present and spend our time more wisely—and living in the present is why the very young and very old enjoy life the most. That’s what the “mindfulness” mania is constantly reminding us, and why so many myths couple immortality and misery.

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As wise people across countries and cultures continue to remind us, there’s no present if there’s no ending. Not dealing with dying is a way of not dealing with living. Who wants more life, if it indeed becomes ours for the taking, if it comes without self-awareness or fulfillment or contentment? More reason to drop the anti-aging rhetoric, and the denial that fuels it. It keeps us from enjoying the present, and it feeds the narrative that aging well means looking and acting like younger versions of ourselves. Only the well-off can pursue that strategy, which is doubly discriminatory for women—and futile.

Imagine a new goal: age equality

Perhaps, not too long from now, we’ll be able to make the body of an octogenarian function as well as of that of a 30-year-old. That’ll be fantastic, especially if the advances become accessible to all. But 85 won’t be the new 30. It’ll be the new 85. And even the fittest octogenarians will be second-class citizens until we challenge the last socially sanctioned prejudice. Making the most of the new longevity means ending ageism.

Why does “anti-aging” sound normal and “pro-aging” sound weird? Because we’re brainwashed by a ruthless consumer culture. Who says wrinkles are ugly? The multi-billion-dollar skin care industry. Who says perimenopause and “Low T” and “mild cognitive impairment” are medical conditions? The trillion-dollar pharmaceutical industry. Unless you count sunscreen, no “anti-aging” remedies are effective, and many have proven harmful. Aging is not a disorder. Yes, it strips us of cartilage and shortens our telomeres, but it also confers confidence, contentment, even grace. You can’t live longer without getting older—and that’s a very good thing.

This post originally appeared in Neo.life, a new publication covering the ways that technology is helping us live longer, happier, and healthier lives.

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Sign up for the weekly email at www.neo.life. You can follow Ashton Applewhite at her blog This Chair Rocks.

Output: In the 20th century, thanks largely to clean water and antibiotics, the American lifespan increased by 30 years. Who doesn’t want even more, if new technologies like gene editing and nanomedicine can safely put them within our grasp? As Neo.life describes it, it’s the most important story today: “how biology and technology are coming together to help us all live healthier, happier, and longer lives.”


Instruction: create a high quality summary of the given input

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US cable TV conglomerate Charter invests in data partnerships
 Charter, the US cable conglomerate second only to Comcast in subscriber count, has made a strategic investment in 605 Group, the TV analytics startup founded by former Cablevision ad execs.

Although financial terms of the deal weren’t disclosed, Charter has struck a strategic data partnership with 605 to provide access to TV viewing data in aggregate across 26 million homes in 100 DMAs, including the former Time Warner Cable footprint.

In turn, 605 Group has helped Charter develop a TV planning and analytics tool for linear TV called AudienceApp, which will go into beta mid-August and become generally available to the market by mid-2018.

David Kline, EVP and president of Charter’s ad division, Spectrum Reach, and James Blackley, EVP of engineering and IT for Charter, have also joined 605’s board of directors.

Although Charter has previously formed data partnerships with Oracle, comScore and others, this is the first time it’s co-developed a data product with a partner and put it in the hands of 1,500 Spectrum salespeople.

For now, the tool will only be sold as a managed service through Charter, but once it’s generally available, Kline said Charter would consider a self-serve option for agencies to access via an API.

“One of the benefits of partnering with 605 Group is they’re accustomed to building audience-based applications that make it easier for advertisers to build highly optimized schedules for linear TV,” Kline told AdExchanger. “It really reduced our time to market to develop a product like this.”

Like other TV audience indexing tools, AudienceApp, at its most basic, is designed to identify pockets of inventory where an advertiser has the highest propensity of hitting their target audience.

Yet, because 605 has access to set-top box data representing about 40 million households and 1,500 buying attributes, combining it with first-party viewership data from Charter will help improve advertiser precision, said Kristin Dolan, founder and CEO of 605.

That access to additional cable and set-top box data, including from local market inventory, will also help Charter scale its local advertising opportunity.

“In our past life at Cablevision, in many cases, we found that a number of networks we inserted ads on weren’t measured by Nielsen,” Dolan explained.

To be fair, Nielsen has been modernizing its local measurement efforts in recent months. But the historic lack of measurement has meant that the vast majority of the 3 million spots sold by local cable operators each year go unsold. That’s one problem AudienceApp aims to solve, Kline said.

“Only about 20% to 25% of [local cable operators] today actually have measurement through Nielsen,” he added, “But we know from looking at our set-top boxes anonymously that there are a lot of people who may be watching some of the networks that may not be measured very well by Nielsen.”

Thus, a programmer or cable network’s opportunity to monetize local or “long-tail” inventory, which already sells at much lower CPMs, can be futile unless they can roll up more inventory for scale or apply data for precision.

If an advertiser wants to reach a specific demo or target like “auto intenders” through impression-based buying, their likely goal is to get the ad in front of the right person versus in as many places as possible.

A tool like AudienceApp could give the buyer the best of both worlds.

“If you’re not measuring or looking at viewership across every single network, you’re much more limited to only pricing and selling things that can be measured by Nielsen,” Dolan said. “Monetizing that inventory also benefits the viewer, who will see more relevant advertising – especially if you’re on a long-tail network where the consumer may be seeing the same ad over and over.”

Output: US cable conglomerate Charter has made an investment in TV analytics start-up 605 Group. Charter and 605 have worked together to develop AudienceApp, a TV planning and analytics tool, marking the first time the company has created a data product with a partner. The tool, initially sold via Charter, aims to help cable networks monetise local or “long-tail” inventory and offer viewers more relevant advertising.


Instruction: create a high quality summary of the given input

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Indian transport chief warns against autonomous vehicles
 The biggest names in tech and autos are racing to develop self-driving cars but one of the fastest growing markets in the world may not want them.

India's top transport official warned this week that the new technology would increase unemployment among a young population already struggling to find jobs.

"We will not allow driverless cars in India. We don't need it," Transport Minister Nitin Gadkari was quoted as telling reporters on Monday. "Each car gives a job to a driver. Driverless cars will take away those jobs," Gadkari added.

A ministry official confirmed the remarks to CNNMoney, but added that the minister was merely expressing his opinion about the technology. The Indian government has not yet received any proposals for self-driving cars.

Related: The backlash against self-driving cars officially begins

More than 20 million people -- around 5% of India's workforce -- are unemployed, according to government data, and the rate has risen since Prime Minister Narendra Modi took office in 2014.

Millions of Indians make a living behind the wheels of trucks and taxis, or as drivers for wealthy Indian families, hotels or other businesses. Uber and rival Ola have created jobs for tens of thousands more.

Self-driving technology is still relatively new but has already run into opposition in the U.S. and China, where tech giant Baidu's CEO recently upset the authorities by riding in a driverless car through Beijing.

There's a lot at stake. Ford invested $1 billion in its self-driving car program earlier this year, while French firm PSA -- the owner of Peugeot and Citroen that recently decided to re-enter India -- is testing driverless cars in Singapore.

Tech firms such as Google (GOOGL), Apple (AAPL), Uber and Tesla (TSLA) are forging ahead. Apple was recently granted a permit from the state of California to test self-driving cars.

Related: Samsung just got approval to start testing a self-driving car

Tata Group, one of India's biggest conglomerates and the owner of British carmaker Jaguar Land Rover, is also developing driverless technology through its design and tech arm Tata Elxsi.

Tata Elxsi did not respond to requests for comment on the minister's statement.

Gadkari is not alone in casting doubt on India's potential as a driverless car market. On a visit to the country last year, Travis Kalanick -- who has since resigned as Uber CEO -- said it would be "one of the last places" to get them, but for a different reason.

"Have you seen how people drive here?" he quipped.

Output: India's Union Road Transport and Highways Minister, Nitin Gadkari, has argued that autonomous vehicles would have a detrimental impact on employment in the country, going so far as to claim that they will not be allowed in India. "We don’t need it. Unemployment is a huge problem in our country. Each car gives job to a driver”, said Gadkari. Almost 5% of the Indian population are unemployed.


Instruction: create a high quality summary of the given input

Input:
Indian transport chief warns against autonomous vehicles
 “We will not allow driverless cars in India. We don’t need it. Unemployment is a huge problem in our country. Each car gives job to a driver,” said Gadkari on Monday, while responding to queries from reporters. “We will not allow driverless cars in India. We don’t need it. Unemployment is a huge problem in our country. Each car gives job to a driver,” said Gadkari on Monday, while responding to queries from reporters.

DRIVERLESS CARS, labelled as the future of automobiles with Google, Apple and Tesla racing to crack a potentially multi-billion-dollar market, will not be allowed in India because they will lead to more unemployment, according to Union Road Transport and Highways Minister Nitin Gadkari. “We will not allow driverless cars in India. We don’t need it. Unemployment is a huge problem in our country. Each car gives job to a driver,” said Gadkari on Monday, while responding to queries from reporters.

“I saw in Sweden a 70-year-old man was driving a taxi. There (Western countries), they have less people. Here, we have more people and they need jobs. Driverless cars will take away those jobs. I am certain on this issue,” he said. According to a study by Boston Consulting Group, the global autonomous cars market is expected to be worth $42 billion by 2025 and $77 billion by 2035. A quarter of all cars sold could be autonomous vehicles by then, the study has said.

According to current prototype versions, such cars navigate traffic with the help of multiple inputs from GPS, and laser, infra-red and computer-vision technologies. Technology experts say autonomous cars reduce chances of collision and increase traffic efficiency. Gadkari, a proponent of electric vehicles, said he has also told global automakers that India will not reduce import duty on e-vehicles or its parts. “I have told chiefs of the auto companies recently that world-class electric vehicles can very well be manufactured in India. They are welcome to make them here under Make in India, we will not reduce the import duties,” he said.

Output: India's Union Road Transport and Highways Minister, Nitin Gadkari, has argued that autonomous vehicles would have a detrimental impact on employment in the country, going so far as to claim that they will not be allowed in India. "We don’t need it. Unemployment is a huge problem in our country. Each car gives job to a driver”, said Gadkari. Almost 5% of the Indian population are unemployed.


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Grovo targets professional micro-learning with $10m funding
 Grovo announced the close of $11.3 million in financing from an undisclosed investor.

Grovo plans to reimagine on-the-job learning for enterprises. A pioneer in the “micro-learning” movement, it combines an elegant training platform with engaging 90-second video lessons, strong tracking, and an advisory service to help customers align learning strategy to their business goals. The company’s goal is to empower employees to make a lasting impact on their organizations by providing a curated curriculum that helps them quickly master everything from cloud applications to management techniques.

Founded in 2010 by Nick Narodny, Surag Mungekar, and Jeff Fernandez, Grovo has delivered more than 17 million “learning moments” at organizations in 190 countries, including such companies as Chevron, Capital One, WeWork, The Ritz-Carlton Company, and DDB. The company has received recognition as a “Best Place to Work” by Fortune Magazine, Entrepreneur Magazine, Crain’s, and Internet Week.

The company had previously raised $40 million in Series C funding, led by Accel with participation from Costanoa Venture Capital, SoftTech VC, Greg Waldorf and Vayner Capital.

Output: Edtech start-up Grovo has raised $11.3m in funding from an undisclosed backer. This comes on top of a $40m round of series C funding, led by Accel. Grovo, founded seven years ago by Nick Narodny, Surag Mungekar, and Jeff Fernandez, aims to help employees make an impression on their companies, providing a specialised curriculum on subjects including management techniques and cloud applications.


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Nielsen merging streaming and TV viewing figures for media buyers
 A not-so-simple question has plagued the TV and advertising industries for years: What is the value of TV programming that is no longer being watched on TV?

A partial answer has arrived. Nielsen said Tuesday it is now counting views of certain types of programming on Hulu’s live service and YouTube TV, which can then be used as currency in negotiations between TV networks and advertisers. The maneuver would place viewing from so-called “skinny bundles” of programming offered by subscription-video-on-demand players into the mix when Madison Avenue decides what types of content to support.

With the new technology, media companies “are able to measure their content as it flows across platforms, across devices, through whoever is distributing it, then roll it up and include it in their rating numbers,” said Megan Clarken, president of product leadership at Nielsen, in an interview.

The disclosure shows Nielsen attempting to find a solution to a growing problem in the media business. As consumers feel more comfortable with streaming video and mobile devices, monetizing their consumption of one-time couch-potato favorites ranging from AMC’s “The Walking Dead” to NBC’s “This Is Us” and CBS’ “The Big Bang Theory” is critical. Traditional TV ratings have continued to ebb, and there is no single solution at present that will tabulate every view of video on an emerging technology. Indeed, there is a growing concern among executives that the industry could face a breakdown in measurement, with advertisers in some cases devising their own standards for audience reach with specific outlets.

Nielsen will now be able to count what it calls “eligible” viewing of Hulu’s or Google’s YouTube’s live-streaming services and make it count as part of the industry’s commercial-ratings standards. Advertisers pay for commercial time based on rates set according to metrics known as “C3” and “C7,” or views of ads over the first three days or first week of availability of a new episode of a TV show. Nielsen said it could examine digital viewing of live, DVR and on-demand content on the two companies’ services and combine it with traditional linear audience measures. “With this inclusion, Nielsen measurement will provide media buyers and sellers with a more comprehensive and transparent view of audiences engaging with linear TV programming across digital devices,” the company said in an announcement.

To be certain, not all video from Hulu or YouTube will count. A Hulu user enjoying on-demand playback of the streaming-video hub’s critically praised series “The Handmaid’s Tale” or an old episode of the NBC cop drama “Hill Street Blues” would not count. To be part of the new measure, the programming has to “mirror” the commercial load of the original linear TV broadcast and be seen within the three-day or seven days windows.

Both live-streaming services are relatively nascent. Hulu in May unveiled a new live-TV service starting at $39.99 monthly for around 50 channels. The service includes ABC, CBS, Fox, NBC programming (the availability of local TV stations is subject to market)and cable nets including ESPN, CNN, Fox News, TBS, TNT and Disney Channel. Hulu is owned jointly by Comcast, 21st Century Fox, Walt Disney and Time Warner. Google in February said it would launch a 50-channel bundle priced at less than half the average cost of cable TV. YouTube TV includes live and VOD programming, an unlimited cloud-based DVR (which will store recordings for nine months), and access to the company’s ” YouTube Red” originals programs.

YouTube executives are “already seeing that live TV represents the majority of time spent watching on the service,” said Heather Moosnick, director of content partnerships for YouTube TV, in a statement. “Our network and advertising partners will benefit” from the new measure.

“Our goal is to make it possible for viewers to watch their favorite shows whenever and wherever they want – and be able to measure that viewership,” said Cindy Davis, executive vice president of consumer experience at Disney-ABC Television Group, in a statement. “We are pleased with Nielsen’s launch of this capability, and look forward to the new insights it enables.”

Nielsen has had the technology available for about two years, Clarken suggested, but had to work with TV networks to gain acceptance. The new measurement tools require media companies to sort of “tag” their content so it can be recognized and tabulated by software. But the company expects viewing of video in new venues to increase: “You have to imagine a world where digital platforms for linear TV is just going to grow,” she said.

Output: Data measurement company Nielsen will count what it calls "eligible" viewing on streaming services Hulu and YouTube TV, and incorporate the figures into its traditional ratings analyses. In order to be counted, Nielsen said a streamed programming must “mirror” the commercial load of the original linear TV broadcast and be viewed within a three-day or seven-day window. The aim is to provide marketers with "more comprehensive and transparent view of audiences engaging with linear TV programming across digital devices", according to a company statement.


Instruction: create a high quality summary of the given input

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Outbrain acquires DSP Zemanta in native ad format push
 Outbrain acquired native DSP Zemanta for an undisclosed sum Tuesday. The deal will bring together Outbrain’s scaled native supply with Zemanta’s demand, laying the groundwork for Outbrain to position itself as a leader in the still-nascent programmatic native ecosystem.

Outbrain bought the DSP because it expects native advertising to become larger than display advertising in the next five years, but that native advertising technology lags.

“Most of the media-buying tools used by marketers were made for a display world and are not optimal for native executions,” said Gilad de Vries, SVP for strategy at Outbrain. “With a platform like Zemanta, which has access to the largest native supply pool in the world, marketers will be able to scale their native efforts much more effectively at scale than anywhere else.”

Outbrain already works with Zemanta. The DSP bids on billions of Outbrain native impressions a day. The company became an Outbrain DSP partner last year.

Zemanta has raised just less than $9 million since it was founded in 2007, in contrast to Outbrain’s $194 million over the same period. Zemanta sold some of its publisher-focused technology to Sovrn last September for an undisclosed sum.

Zemanta buyers will continue to bid across more than 30 native supply platforms, including Outbrain. The company can optimize for reach, frequency and user engagement, and it was the latter capability that attracted Outbrain. Post-acquisition, Outbrain will connect its interest graph to Zemanta’s DSP, allowing for more unique targeting opportunities.

Outbrain will also bring Zemanta, which is based in Slovenia, into more countries, mirroring its own 15-country footprint.

Publishers using Outbrain will see unique demand due to the Zemanta acquisition. “More access to unique and premium demand … will help in increasing RPMs,” de Vries said.

Outbrain buying a DSP makes it look a bit more like Google, the display advertising leader that successfully unified a DSP with a SSP. Like Google, Outbrain said it envisions its growing programmatic business and ad network-style business living side by side.

“Just like Google enables buying AdWords through one CPC-based interface alongside programmatic buying on CPM through DBM [DoubleClick Bid Manager], we see programmatic and direct buying coexisting, serving different needs for the marketer,” de Vries said.

Those who value Outbrain’s capabilities around personalization, interest targeting and lookalike targeting can work with the company directly, while those embracing programmatic native can use their own data to buy via Zemanta’s DSP.

Output: Online advertising platform Outbrain has acquired native demand-side platform Zemanta for an undisclosed sum. Following completion, Outbrain will link its interest graph to Zemanta’s platform, and expand the firm into more countries. "Just like Google enables buying AdWords through one CPC-based interface alongside programmatic buying on CPM through DoubleClick Bid Manager, we see programmatic and direct buying coexisting, serving different needs for the marketer", said Gilad de Vries, SVP for strategy at Outbrain.