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Electric vehicle manufacturers may start buying into lithium mines
 "If you think about the investment required downstream in battery making and car making capacity the capital being deployed is huge – billions and billions of dollars.

"So the idea they might spend a couple of hundred million at the raw material end to assist in security of supply makes a lot of sense."

Mr Rule said the companies were keen to diversify the supply chain away from China, secure production from about 2025 and be able to deal directly with the miners, rather than the lithium chemical converters or battery companies.

"They are very active right now and they have been for the past couple of months," he said.

"We are talking to them about an offtake agreement for Sal de Vida – 10 years and a pre-payment. Then we don't have to go and debt fund anything... they may come in for a small portion of equity. That is how we are hoping to do it and then they have guaranteed supply."

The adoption of electric vehicles and energy storage systems, which use lithium-ion batteries, has boosted demand and pricing for lithium over the last couple of years.

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A string of Australian companies are racing to get projects into production to meet the spike in demand but some analysts forecast, even with the new production, demand will exceed supply into next decade.

Galaxy already operates the Mt Cattlin mine in Western Australia. Pilbara Minerals is developing the Pilgangoora lithium project in Western Australia, which it expects to commence production in the second quarter of 2018.

Mr Brinsden said the Perth-based company already had a "healthy level of engagement" with large upstream players keen to discuss the security of future supply.

"They do genuinely want to talk about the supply base and where it is going to come from," he said.

"They are paying a lot more attention to it than they might have historically. I think the worm has turned and there is an issue in the industry with respect to that supply base and I wouldn't mind betting that you start to see some of those bigger organisations try and get a seat."

Much of Pilgangoora's production is already covered by offtake contracts, a trend which Mr Rule said was making the manufacturers anxious.

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Of about 200 lithium producers and developers globally, Mr Rule said one car manufacturer said only 10 companies met its supply criteria - including production quality, availability, management team and balance sheet strength.

"They are concerned because it is such a long lead time for them to get the electric vehicle process happening they don't want to get caught without access to that so they want to lock away enough supply of LCE to give them all the batteries that they need," Mr Rule said.

"They are really concerned."

Supply chain integration has already begun to emerge at the other end of the lithium industry. Producers of lithium chemicals have teamed up with Australian miners to get new operations into production and integrate them with the plants that convert the spodumene concentrate produced at West Australian mines into the lithium chemicals used in the batteries.

Elsewhere at the Diggers and Dealers conference, Roy Hill Holdings chief executive Barry Fitzgerald said the company's namesake iron ore project was close to achieving its nameplate production rate of 55 million tonnes a year, after being set back by challenges during the ramp-up.

In the month of July, Roy Hill, which is majority-owned by Gina Rinehart, said the project ran at an annualised rate of about 53 million tonnes.

"We are comfortable we are well on the path to overcoming the issues," Mr Fitzgerald said.

"As we get closer we will find perhaps one or two other smaller ones but we are far more comfortable [that] we know the beast."

Mr Fitzgerald said the Pilbara iron ore project had been selling a product, which met its targeted ore grade of about 61 per cent iron. Despite the slower than targeted ramp-up the company's relationships with its customers and financiers remained strong, he said.

Output: Investments in lithium mines from electric vehicle and battery manufacturers seeking to secure their supply chain will be the lithium sector's next catalyst, said Ken Brinsden, managing director at mining company Pilbara Minerals. Manufacturers are "really concerned" that they will be caught without access to lithium as demand for electric vehicles grows, said Alan Rule, CFO of lithium miner Galaxy Resources. Rule has already discussed selling a portion of equity for its Sal de Vida mine with several manufacturers.


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Rental car woes worsen as used-auto values fall, ride-hailing rises
 One line item on Hertz Global Holdings Inc.’s second-quarter results may hold the key to understanding one of the main reasons for car-rental stocks’ deep, longstanding underperformance.

Hertz’s net depreciation per vehicle per month rose to $353 in the U.S. in the second quarter, or 27% higher than the $278 in net depreciation in the second quarter of 2016.

The company pinned that, in part, to declining residual values.

Companies such as Hertz HTZ, +3.39% and rival Avis Budget Group Inc. CAR, +2.56% , which reported late Monday, also missing expectations, have to offload thousands of cars they retire from their rental fleets every year.

The used-car market is oversupplied in the U.S., mostly due to an uptick of new-car leases, and those cars ending in the used-car market after their leases end.

Worse-than-expected first-quarter results in May brought Hertz shares to their lowest in seven years at the time, and at the heart of the share underperformance were concerns about the depreciation of its cars as well as broader worries about ride-hailing companies denting rental-car demand.

Hertz late Tuesday reported an adjusted net loss of $52 million, or 63 cents a share, in the second quarter, versus a net income of $35 million, or 41 cents a share, in the same period last year.

Revenues for the second quarter reached $2.2 billion, compared with $2.3 billion in the second quarter of 2016. Analysts polled by FactSet had expected an adjusted per-share loss of 20 cents on sales of $2.2 billion.

Hertz said in a statement it had made “significant progress” in the first half of 2017 with its turnaround plan, but “the hard work always comes before” a payoff as reflected on the quarterly results, which also showed increased spending.

Despite that decrease in residual values, Hertz said it “stayed on course with its fleet optimization plan, selling 35% more vehicles year-over-year and onboarding a richer mix of model year 2017 vehicles,” the company said in the statement.

Hertz shares rallied nearly 4% after hours Tuesday, after falling 6.3% during regular trading.

Output: Full-year profit for Avis may be as low as $2.40 a share, down on its previous estimate of $3.50 a share, the car rental company said. The announcement comes as the rising popularity of ride-hailing companies and falling used-vehicle prices cut into revenues across the car-rental market. Rival car rental company Hertz posted its third straight quarterly loss of $158m.


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Facebook aims to reduce unintentional clicks on mobile ads
 With research suggesting that over half of all clicks on mobile ads are mistaken, Facebook has today (8 August) announced an initiative designed to limit the likelihood of users clicking on ad units unintentionally.

The update to its Facebook Audience Network includes policy clarifications on unintentional clicks, product changes to invalidate them, and proactively pausing implementations that exhibit abnormal click behavior, according to the online giant.

Brett Vogel, Facebook, product marketing manager, made the announcement in a blog post where he outlined some of the activities he had planned, adding that “ad placements that are built to drive unintentional clicks run counter” to its goal of creating a healthy advertising ecosystem.

For instance, Facebook will measure the amount of time a user spends on an ad unit – or “drop off rates” – to assess whether-or-not a user has intentionally clicked on that ad.

“We found that people who click on an Audience Network ad and spend less than two-seconds on a destination page almost always clicked accidentally. Moving forward, we will no longer count clicks categorized as unintentional. We will continually refine and adjust this threshold as we gather more data and signals,” reads the post.

The transparency initiative will also include using its analytics systems to detect “inflated clickthrough rates” to assess if publishers have created ad placements that deliver value to advertisers.

“When we see abnormal behavior, such as an inflated (CTR), we'll automatically pause placements to protect people and advertisers. We'll also inform publishers so they can make necessary changes,” added Vogel.

To clarify the updates in its policies, Facebook has provided a best practice guide where publishers using its third-party ad network (Facebook Audience Network) to sell their inventory can keep abreast of the updates.

“Going forward, we'll be experimenting with more ways to reduce the number of unintentional clicks by looking further into bounce rates, additional metrics, and trying to prevent users from accidentally clicking in the first place,” reads the post.

Research published last year claimed that over 60% of clicks on mobile display ads are accidental, with 'fat thumbs' identified as the prime culprit.

The study, polled 500 adult mobile users across the US between January 18 to 25, 2016, and focused on several aspects of mobile banner ad engagement. 69% of those surveyed identified at least one occasion where they had clicked on a mobile banner ad (within mobile web or app).

Meanwhile, 60% said that they typically click on banner ads while on a smartphone or tablet, and 'it’s usually by accident' due to the device’s small screen size. A mere 16% claimed they click on mobile banner ads because they 'like the company, product or service being promoted'. The research also found that even less of those surveyed (13%) said they do so because 'the ads are interesting.'

Output: Facebook has announced updates to its Facebook Audience Network, which aim to cut down on the number of unintentional ad clicks. To achieve this, the company will time how long a user spends on an advertisement, which will determine whether the click was intentional or otherwise. Facebook product marketing manager Brett Vogel said in a blog post that people who click on an advert and spend "less than two seconds on a destination page almost always clicked accidentally".


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Findel Sports Direct boss increases stake in Goals Soccer Centres
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Newcastle United owner Mike Ashley has continued to build on his retail empire by snapping up more shares in Goals Soccer Centres.

The billionaire entrepreneur and Sports Direct boss, has increased his holding in the five-a-side football pitch chain, which has North East sites, to around 4.7%, up from 3.8% – and shares in both firms rose following the announcement.

The shares deal was confirmed to shareholders in stock market announcements by both Sports Direct and Goals Soccer Centres, in the form of a notification of major holdings.

Shares in Goals Soccer Centres rose 8% in early trading.

Last month Mike Ashley’s retail empire Sports Direct continued to build up holdings in fellow high street names after picking up a 26% stake in struggling Game Digital.

The shares purchase came a month after Game issued a profit warning, having bemoaned a challenging high street trading period and the poor stock availability of Nintendo Switch.

The billionaire has a history of snapping up stakes in struggling high street firms.

He also now has stakes in Debenhams, French Connection and Findel, as well as 10 Agent Provocateur stores.

In April it was also announced that Sports Direct had seized control of US retailers Bob’s Stores and Eastern Mountain Sports in a $101m (£78m) debt deal. The billionaire tycoon acquired the chains by buying up the debts of their parent firm Eastern Outfitters, which filed for Chapter 11 bankruptcy protection in February.

The deal will see Mr Ashley take charge of around 50 retail stores in the US under the Bob’s Stores and Eastern Mountain Sports fascias, which sell clothing, sportswear and camping equipment.

The company also upped stakes in Umbro-owned Iconix Brand Group and doubled its stake in Indiana-based footwear retailer Finish Line in June – the second time the firm boosted its stakes in the businesses. The firm has 13.25% of the issued common stock of Iconix and 18.85% of the stock of Finish Line Inc.

Meawhile, Mr Ashley has declared Sports Direct to be on track to become the ‘Selfridges of sport’, through its new generation of stores.

The business has ploughed £300m into property in the last year, acquired stores and new brands in the UK and overseas and opened several flagship stores, including one in Sunderland.

Output: Sports Direct boss Mike Ashley has increased his stake in Goals Soccer Centres, the five-a-side football pitch chain, from 3.8% to 4.7%. Shares in both firms rose on the announcement. Ashley also has stakes in Findel, Game Digital, Debenhams, French Connection and Agent Provocateur, plus US retailers Bob’s Stores and Eastern Mountain Sports, after buying the debts of their parent firm Eastern Outfitters, which filed for Chapter 11 in February.


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Designer brands put their names to luxury Miami towers
 Designers have long been drawn to Miami, with Gianni Versace, Calvin Klein and Tommy Hilfiger all having owned homes there over the years.

But today, the Miami real estate market is hotter than ever among the fashion set — especially in a business sense. Fendi, Armani and Missoni are plastering their names on superluxury residential towers springing up across the city after having dabbled in the hotel world. Meanwhile, hard-core fashion followers (or in some cases their generous spouses looking for an original gift) appear willing to drop millions of dollars on apartments in the designer-branded buildings.

Setting the trend is Armani, which has partnered with developers Dezer Development and The Related Group on Residences by Armani/Casa in Sunny Isles Beach. The 56-story César Pelli-designed building, comprising 308 apartments priced between $2 million and $15 million each, isn’t due for completion until 2019, but already 72 percent of the apartments have been sold.

Gil Dezer of Dezer Development is no stranger to branded buildings, having worked on six with Donald Trump (before he became President, of course). He recently completed the Porsche Tower in Miami, the world’s first condominiums to have elevators that take residents directly to their apartments while sitting in their cars. “I was in Dubai when I stayed at the Armani Hotel and I said, ‘This is wow. We need to bring this to America,’” he said.

However, he admitted that it was a challenge to convince the famed Italian fashion house to take part. “It was not easy. They do their homework very well. We can do more damage than good as Armani is doing $9 billion a year in sales. They don’t need the few bucks that I’m going to give them. This is more about that they want to have a real strong presence and it helps their brand and it also helps sell [their] furniture.”

Dezer finally succeeded in persuading the Italian company to license their brand to him and today Armani is designing all the communal areas and for an additional cost to the buyer can also offer interior design, at about $300 a square foot. For the largest apartments, that works out at just over $1 million.

Armani has complete control of the interior design of the wider building, with Dezer admitting he has had to become “opinionless” on it. And, as with everything his company does, Giorgio Armani is personally involved. “He’s actually very involved, which is good and bad,” admitted Dezer. “It’s good because we get his stamp of approval, so we really know it’s an Armani thing and not just slapping a brand on. But we have to wait for him to get off his boat to approve something and we have to wait for him to fly here and fly there. Even if we need to approve an ad, he approves everything.”

Three blocks south of Bal Harbour, Fendi Château Residences, a 12-story, 58-unit boutique building, has attracted a range of buyers since it was completed last year (only four apartments are left), including some devoted Fendi shoppers. “We have some buyers that are truly, truly Fendi lovers who normally furnish everything Fendi. We had somebody who purchased a unit for his wife as a gift for their anniversary and he designed everything in Fendi because she loves the brand,” said Helen Ashford of the Château Group, the developer.

At $6.5 million for a three-bedroom apartment, these pads — which come with a use of a communal indoor spa, private chef, cinema and children’s room — have the highest starting prices of all the fashion-branded residences in Miami, with a penthouse setting buyers back as much as $25 million.

Meanwhile at the budget end of the market (if one can call half-a-million dollars budget), is Missoni Baia, a partnership between the Italian fashion family and OKO Group, the Miami-based property development firm founded by Russian billionaire real estate mogul Vladislav Doronin, in the up-and-coming Edgewater neighborhood.

Prices at the 57-story, 249-unit building overlooking Biscayne Bay, which is yet to break ground but is due for completion in the summer of 2020, range from $500,000 to $3.5 million. When it is ready, the communal areas will be decked out in Missoni’s trademark colorful designs, while residents will have access to five pools. Like Armani and Fendi, Missoni will decorate apartments at an additional cost.

And finally, also jumping in on the trend to join the apartment fray in Sunshine City is Karl Lagerfeld. The couturier has designed a lobby in The Estates at Acqualina, twin, 50-story luxury towers with 245 units that come complete with an ice rink and traders’ room where apartments cost between $4 million and $9 million.

Much like Armani, Lagerfeld has complete design control and is very hands-on. “The guy is legendary. He has come up with enormous creative solutions for our lobbies. Everything in the lobby will be his touch,” said South African-born developer Jules Trump of The Trump Group (no relation to the President). “Karl’s aesthetic, in particular, will be appreciated and valued by our guests, who desire an incomparable level of opulence, luxury, design and style.”

Why Miami?

Dubai, Beijing and London are among other cities that are home — or soon will be — to residential buildings with interiors designed by famous fashion houses. But Miami is at the heart of this booming trend, partly a result of slowing luxury residential sales and political and economic uncertainty. Combined, these trends have made competition tougher and Miami developers more determined than ever to make their projects stand out.

“I see it as a way that developers are trying to differentiate themselves among all the competition in new development. Before this, it was cars with the Porsche Tower and the Aston Martin Residences and then the use of ‘star-chitects’ and famous interior designers,” said Jonathan Miller, chief executive officer of appraisal firm Miller Samuel.

“It’s not enough to say that I have the most beautiful building, the best views or the most welcoming lobby. They have to differentiate and they have to go to another level. We haven’t seen much of that in other U.S. markets. If it proves to be an effective branding mechanism, we will absolutely see it elsewhere.”

Yet its effectiveness is still uncertain. While sales figures seem healthy (not all buildings have released data), satisfaction levels remain to be seen — and won’t be until the new owners have settled in.

Jay Parker, ceo of Douglas Elliman Real Estate Florida, said while Armani, Fendi and Missoni are recognizable and influential brands synonymous with luxury, what remains unclear is whether the quality of the fashion houses’ products will carry over into all aspects of the residential developments from the food to service.

“When people buy in Ritz-Carlton, the level of service is established. We don’t know that yet with Armani or the others,” he said. “After all, fashion houses are not expected to influence the service element as much as the design element.”

As for why these big fashion houses want a slice of residential real estate, Robert Burke, the chairman and ceo of retail consultancy Robert Burke Associates, said one of the biggest desires of any label is to be a lifestyle brand and “this just allows them to be even more of a lifestyle brand because ultimately that’s what people are living.”

Output: Designer brands Fendi, Armani and Missoni have each given their name to luxury towers in Miami. Armani partnered with Dezer Development and the Related Group to build a 56-storey building that houses 308 apartments priced between $2m and $15m. Meanwhile, Fendi Château Residences, a 12-storey, 58-unit boutique building, was completed last year. The apartment block offers apartments at $6.5m and penthouses at $25m. In partnership with Miami-based property development firm OKO Group, Missoni is developing a 57-storey, 249-unit building that will offer apartments priced from $500,000 to $3.5m.


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GS Yuasa claims new battery will double electric vehicle range
 OSAKA -- Japan's GS Yuasa will begin mass producing as early as 2020 lithium-ion batteries that double the driving range of small electric vehicles.

Lithium Energy Japan, a joint venture with trading house Mitsubishi Corp. and carmaker Mitsubishi Motors, will develop the cells, which will be produced at its plant in Shiga Prefecture and supplied to automakers in Japan and Europe.

Output: GS Yuasa will start mass production of lithium-ion batteries that it said will double small electric vehicle (EV) driving ranges by 2020. The batteries will be developed by Lithium Energy Japan, a joint venture between trading house Mitsubishi Corp. and Mitsubishi Motors, and be supplied to car makers in Japan and Europe. The battery would extend the driving range of the Mitsubishi i-MiEV compact from 170 km (106 miles) per charge to some 340 km, comparable to that of a larger car with a bigger battery.


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FDA moves to stop genetic editing technique for embryos
 On Friday, the FDA sent Zhang a strongly worded letter saying he must stop marketing the technique in the U.S. The move is a sign that the federal government is taking a hard line against the development of technologies to make genetically altered babies, even in cases where doing so would prevent severe disease.

According to the FDA, Zhang then requested a meeting with the agency to ask permission to carry out a clinical trial using the technique in the U.S. The agency subsequently denied the meeting. Zhang has since been marketing his fertility procedure to women with certain genetic diseases and older women having trouble conceiving through a new company called Darwin Life. The creation of the company was first reported by MIT Technology Review.

Modifying embryos in a lab is not illegal under U.S. law as long as federal funds are not used to carry out the work. But implanting one in a woman’s womb so that a baby can develop is prohibited. Since December 2015, Congress has barred the FDA from accepting research applications that involve a human embryo that has been "intentionally created or modified to include a heritable genetic modification." The FDA letter also says Zhang did not have permission to export the embryo. New Hope Fertility Center did not respond to a request for comment.

Zhang’s technology, called "spindle nuclear transfer," was initially performed on the eggs of a Jordanian woman to prevent her from passing on a serious neurological disease to her children. The woman and her husband previously had two children who died from the condition, called Leigh syndrome, which is caused by faulty mitochondria.

As a result of the procedure, the woman gave birth to a child that technically has three genetic parents, since healthy mitochondria in the hollowed-out donor egg has its own DNA. The baby wasn’t the first to be born with three genetic parents—more than a dozen babies were born with an older three-person IVF technique in the 1990s before the FDA intervened and decided to regulate the procedure like a new drug. The treatment was never approved.

Some evidence suggests that malfunctioning mitochondria are one reason why older women can’t easily produce viable eggs, which is why Zhang thinks using a young egg will help. The idea is controversial, though, since it’s unknown whether children born using this method will have long-term side effects. Zhang told MIT Technology Review in June that he was in the process of assessing a handful of women over 40 who may be able to benefit, but that he would have to go outside the U.S. to do the procedure.

A similar treatment was approved in the U.K. late last year, but only when a couple is at very high risk of having a child with a life-threatening genetic disease. Clinics wishing to perform the procedure must first obtain a license from the U.K. government.

Leigh Turner, a bioethicist at the University of Minnesota who first called attention to the FDA letter to Zhang, says prohibitions on this kind of research encourage rogue scientists to "look for settings with lower regulatory standards."

Output: The US Food and Drug Administration (FDA) has told a New York-based doctor that clinical trials to test a genetic modification technique must not go ahead. Dr. John Zhang's method, which involves using three people's DNA to genetically edit embryos, helped a couple have a healthy child last year. The technique made use of in-vitro fertilisation, transferring DNA from the mother's egg into a second hollowed-out egg, donated by a younger woman. The embryo was then fertilised with the father's sperm and inserted into the womb. The FDA has warned Zhang to stop marketing the method in the US.


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Regus Regus signs 11-year lease on 10,200 sq ft at Pinnacle Leeds
 The Leeds office of global property consultancy Knight Frank has advised on the leasing of the 10,200 sq ft of quality space to Regus at Pinnacle Leeds, the city centre’s tallest office tower.

Regus, the leading UK serviced office provider, is taking floors 17 and 18 on an 11-year lease.

Eamon Fox, head of Knight Frank’s office agency team in Leeds, who are marketing the building, commented: “We are delighted to have concluded this letting at one of the city’s most popular office buildings. Prominently located at the heart of Leeds city centre in Albion Street, the Pinnacle is a landmark building, which is perfectly located between the city’s historic professional core and the retail quarter.

“The building has recently undergone a comprehensive refurbishment and offers high quality, flexible and open plan office space boasting breath-taking panoramic views over Leeds city centre. We are delighted to welcome a well-known name like Regus to the Pinnacle in one of the most significant deals in the Albion Street corridor this year.”

Speaking on behalf of Regus, CEO Richard Morris said: “Our decision was simple to move here and reflects our strong endorsement of the qualities of the Pinnacle. The building is home to a dynamic mix of businesses and is recognised as the prime location within Leeds city centre, providing ideal working space, value and excellent amenities.

“We expect our new Leeds facility to be popular with a wide range of users including local small businesses, start-ups and remote workers, as well as national firms opening regional offices and global businesses establishing a footprint in the city.

“The new site will offer a range of flexible working options for businesses and professionals including co-working space, virtual office services, meeting rooms which are bookable by the hour, and a wide range of private offices of varying sizes,” said Mr Morris.

Among other Pinnacle office occupiers are Barnett Waddingham LLP, Optimisa Research, Schlumberger, FRP Advisory, Steer Davis Gleave and Blue Fin Insurance.

Retail and leisure tenants in the Pinnacle Podium include Joy, Superdrug, Nourish, Next, Pret a Manger, Greggs, Roxy Lanes and Tesco Express.

Nigel Doherty of property consultancy Doherty Baines, who advised Regus, added: “It is the perfect location for both staff convenience and client entertainment, Pinnacle is right next door to the flourishing Trinity Leeds shopping centre and is also surrounded by many of the city’s finest bars, restaurants and high street retail stores.”

Output: Regus has signed an 11-year lease on 10,200 sq ft of space at the Pinnacle building on Albion Street, Leeds. The serviced office provider will occupy the 17th and 18th floors of the city centre's tallest office tower, which recently underwent a comprehensive refurbishment. In addition to a number of retailers, other occupants in the Pinnacle include Barnett Waddingham LLP, Optimisa Research, Schlumberger, FRP Advisory, Steer Davis Gleave and Blue Fin Insurance.


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Most global oil trade uses eight vulnerable maritime chokepoints
 Photo: STR/AFP/Getty Images

About 61 percent of the world’s oil supply moves through a handful of vulnerable maritime chokepoints, according to the U.S. Energy Information Administration (EIA).

Some of these eight chokepoints are so narrow that restrictions are placed on the size of the vessel allowed to navigate through them. Most chokepoints can be circumvented by using other routes, but in some cases no practical alternatives are available, the EIA said. Rerouting to avoid chokepoints can result in substantial disruption, often requiring ships to detour by thousands of miles and adding significantly to transit time.

The world’s energy markets rise and fall on reliable transport routes. “Blocking a chokepoint, even temporarily, can lead to substantial increases in total energy costs and world energy prices,” the EIA said. “Chokepoints also leave oil tankers vulnerable to theft from pirates, terrorist attacks, political unrest in the form of wars or hostilities, and shipping accidents that can lead to disastrous oil spills.”

Here’s a brief look at the eight chokepoints:

The Strait of Hormuz

This is the world’s most important chokepoint. In 2015 about 30 percent—17 million barrels a day (b/d)—of all seaborne-traded crude oil and other petroleum liquids flow through this strait. In 2016 that figure jumped to a record high of 18.5 million b/d.

About 80 percent of the crude oil moved through this chokepoint went to Asia markets, the EIA estimates. The strait can handle the largest oil tankers in the world, but it could be subject to geopolitical uncertainty at any time. Iran has previously made noise about disrupting traffic in the strait; at one point Tehran threatened to mine the waterway. And in 2015 it blew up a full-size model of a U.S. aircraft carrier in the strait.

There are bypass options, but most aren’t operational. Only Saudi Arabia and the United Arab Emirates have pipelines that can ship crude outside of the Persian Gulf and have the additional capacity needed to bypass the strait, the EIA said.

Strait of Malacca

This is the shortest passageway, connecting the Indian Ocean to the South China Sea and the Pacific Ocean. This route supplies oil to China and Indonesia, two of the fastest growing economies in the world, and is the primary chokepoint in Asia. Some 16 million b/d flowed through here in 2016, making it the second most important energy passageway.

The Strait of Malacca is among the most narrow chokepoints in the world, measuring only 1.7 miles at its widest point. “If the Strait of Malacca were blocked, nearly half of the world’s fleet would be required to reroute around the Indonesian archipelago,” the EIA said. “Rerouting would tie up global shipping capacity, add to shipping costs, and potentially affect energy prices.”

Complicating matters, the region is now a hotspot for piracy and maritime kidnappings.

The Suez Canal

This passageway accounted for about 9 percent of the world’s maritime oil trade in 2015 or 5.5 million b/d.

The canal was expanded in 2010 to allow 60 percent of all tankers in the world to pass through, the EIA said. Although the region is subject to political unrest, the fall of Hosni Mubarak in 2011 hardly deterred shipping. Still, security remains an issue. A planned rocket attack on cargo ships passing through region was thwarted in 2013.

Bab el-Mandeb Strait

If the Bab el-Mandeb Strait were closed, it could keep tankers in the Persian Gulf from reaching the Suez Canal, diverting them around the Cape of Good Hope, another of the world’s chokepoints. An estimated 4.8 million b/d flow through this strait en route to Europe, the United States and Asia, the EIA said.

The strait is another restricted passageway, only 18 miles wide at its narrowest point, which limits tanker traffic to two, 2-mile-wide channels, the EIA said.

Turkish Straits

The Turkish Straits are important for shipping oil from the Caspian Sea region; however, the straits have seen declining volumes since 2011, falling to 2.4 million b/d in 2016. Oil moving through these straits supplies Western and Southern Europe.

The straits are only a half mile wide at the narrowest point, making them among the most difficult waterways to navigate larger vessels.

The Panama Canal

Ironically, the canal isn’t a significant route for U.S. oil, and its recent expansion is unlikely to significantly change crude oil and petroleum product flows, the EIA said. Only about .9 million b/d flow through the canal.

The narrowest point of the canal is only 110 feet wide, which means larger super-tankers have to avoid it entirely.

The Danish Straits

This passageway is a crucial one for Russian-based oil exports to Europe, connecting the Baltic Sea to the North Sea. An estimated 3.2 million b/d of crude flowed through here in 2016.

Cape of Good Hope

The cape isn’t technically a chokepoint, but its status as a major global trade route qualifies it as chokepoint as it’s responsible for about 9 percent, or 5.8 million b/d, of all the maritime oil trade.

The cape is also a standard alternate route for ships traveling westward wanting to bypass the Bab el-Mandeb Straits or the Suez Canal. However, diverting around the cape increases cost and shipping time—as much as 15 added days in transit to Europe and 10 days to the U.S.

Output: Nearly two-thirds (61%) of the global oil trade passes through eight vulnerable maritime chokepoints, the US Energy Information Administration (EIA) has said. Some of these are so narrow that restrictions are placed on the size of vessel permitted to navigate through them, it added. And while some chokepoints can be circumvented by rerouting, others cannot, leading to substantial disruption to shipping time and increases to energy prices, the EIA warned. Chokepoints listed in the report include the Strait of Hormuz, the most significant one, the Suez Canal and associated pipeline, the Strait of Malacca and the Panama Canal.


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Viome applies machine learning to microbiome management
 Viome, which has developed technology aimed at balancing microorganisms in the gut, has landed $15 million in capital.

The funds will go towards the launch of the company’s at-home health kit, which targets the microbiome. Microbiome refers to microorganisms, such as bacteria, fungi, and viruses, in the human body.

Viome is led by CEO Naveen Jain, innovator, philanthropist and founder of Moon Express, Intelius, TalentWise and InfoSpace. It was founded by Jain and a group of entrepreneurs.

The company is currently operating as an early beta program with several thousand customers using the product.

Viome uses proprietary technology licensed through the Los Alamos National Laboratory. Viome identifies and quantifies all microorganisms in the gut – and analyzes what they are doing. By applying machine learning to this analysis, the produ then recommends personalized nutritional recommendations to balance the gut microbiome inside the body.

These results offer the users a view into their health and the nutrition they need to prevent many of today's chronic illnesses, company executives say.

Viome has 45 employees located in Cupertino, Los Alamos, and New York. The company was founded by a group of entrepreneurs in science and technology that includes innovator, philanthropist and founder of Moon Express, Intelius, TalentWise and InfoSpace, Naveen Jain.

The series A funding takes Viome's total funding to $21 million, led by Khosla Ventures with participation from Bold Capital Partners. Khosla Ventures, led by managing partner Vinod Khosla, which will receive one seat on the Viome board.

Output: US healthtech firm Viome has raised $15m in a series A funding round, led by Khosla Ventures with participation from Bold Capital Partners, which takes its valuation to $21m. The cash injection will be used to help launch Viome's at-home health kit, currently in beta testing with several thousand people using it. The proprietary technology, backed by artificial intelligence, analyses all the bacteria in the human gut before recommending personalised nutritional changes to balance the micro-organisms' environment and help to prevent illnesses.


Instruction: create a high quality summary of the given input

Input:
City and property push UK wealth past £10tn
 New report proposes ways to encourage savers to invest and put their money to work, along with new 'Britannia Bonds' and giving all fifteen year olds £1500 to invest for their future

Over 14 million working age adults in Britain are not saving at all, and over 26 million British adults do not hold adequate rainy day or pension savings, according to a new report from the Social Market Foundation think tank.

The report, called ‘Saving Better’, also found that savers are holding more than £200 billion in cash above and beyond the ‘rainy day’ level – which is defined as three months’ worth of income. This means that over the last five years they have lost out on £94 billion of returns if they had invested this money in the FTSE 100, or £40 billion of returns if they had invested in peer to peer loans.

The report, which is supported by peer to peer lender, RateSetter, recommends several measures to address the tendency for people to hold their savings in cash, rather than invest it for potentially higher returns:

The policy framework for saving and investing should be fully reviewed by the government and reformed to better encourage people to diversify how they save and invest.

The government should allow for up to 25% of its Future Britain Funds and National Productivity Investment funds to be held by British retail investors. The investments should be renamed “Britannia Bonds” and should be actively marketed to the public as an opportunity to invest in the future of the UK. This could lead to investment worth at least £30 billion over the next five years, delivering greater funding for infrastructure.

The Government should create a ‘Fund at Fifteen’ scheme, using money saved by reducing ISA allowances to give all 15 year olds £1,500 to invest in a range of asset classes, supplemented with real life financial education.

The report’s author, SMF senior researcher Matthew Oakley, said:

“Despite the best attempts of policy makers, regulators and consumer groups, UK households do not save enough – and those who do save are losing out on billions of pounds in interest by keeping their money in cash.

“There is are clear links between saving, wellbeing, living standards and economic growth and the UK’s poor saving performance is a major social policy concern.

“The Government should act to make saving wisely second nature. Marketing its Future Britain and National Productivity Investment Funds to retail investors as Britannia Bonds could give savers access to £30 billion worth of assets over the course of the Parliament.

“Giving each 15 year-old £1500 to invest from 2020 would ensure all young people have at least some financial assets, and would teach them the value of saving and investing wisely.”

Rydian Lewis, RateSetter CEO and founder, commented:

“It is clear that an alarming number of people are not saving at all, but in addition, even those that are diligently putting money away are being short changed by holding their money in close-to-zero return cash accounts.

Moving surplus cash into investments like peer to peer loans, and accepting some risk in exchange for the prospect of better returns, could have added tens of billions of pounds to people’s wallets and purses over the last 5 years, which might in turn have spurred them on to put even more money away.

The government should make sure the savings and investment policy framework itself is not acting against the best interests of savers by discouraging them from putting their money to work in assets such as equities, bonds and peer to peer lending.”

ENDS

Notes to editors

The report can be read here: https://www.smf.co.uk/publications/saving-better/

About the Social Market Foundation

The Social Market Foundation (SMF) is an independent, non-partisan think tank. We believe that fair markets, complemented by open public services, increase prosperity and help people to live well. We conduct research and run events looking at a wide range of economic and social policy areas, focusing on economic prosperity, public services and consumer markets. The SMF is resolutely independent, and the range of backgrounds and opinions among our staff, trustees and advisory board reflects this. https://www.smf.co.uk

About RateSetter

RateSetter has grown from start-up in 2010 to a platform that has originated more than £2bn of loans to individuals and businesses across the UK. It has over 250,000 active investors and borrowers, making it one of the largest FinTech business in the UK. RateSetter pioneered many firsts in peer-to-peer lending, including the Provision Fund model.

All borrowers pay a risk-adjusted premium into the Provision Fund, which reimburses investors in the event of a borrower default. The Provision Fund has a 100% track record to date, but capital is at risk and RateSetter is not covered by the Financial Services Compensation Scheme.

Another innovative feature of RateSetter is that the interest rate on the platform is set by the supply and demand of money, not by the platform itself. The aspiration is that this rate will become a benchmark rate for money.

In 2014, RateSetter became the first peer-to-peer lender to launch with a retail licence in Australia. In November 2016, the platform won Best Peer-to-Peer Lender in the FT and Investors Chronicle Wealth Management Awards for the third year running. RateSetter was the highest-rated platform by Which? readers in 2015, 2016 and 2017. RateSetter is regulated by the Financial Conduct Authority.

More info is available at www.ratesetter.com. Follow us on Twitter @RateSetter.

Interviews/media enquiries

For interviews with SMF experts, please contact SMF communications manager Mercedes Broadbent on mercedes@smf.co.uk // 020 7222 7060

Output: The UK’s wealth has passed £10tn ($13tn) due to increasing house prices and a City boom, according to a survey by Lloyd’s Bank’s private banking division. The research shows that the country’s total household wealth increased by £892bn last year, with half of that increase coming from the property and financial markets. The disclosure will fuel the debate about inequality within the country. A report from thinktank the Social Market Foundation on Tuesday revealed that 14 million working age adults in the UK were not saving and over 26 million adults had insufficient rainy day or pension savings.


Instruction: create a high quality summary of the given input

Input:
City and property push UK wealth past £10tn
 A booming City and rising house prices provided a double boost to Britons holding assets in 2016 as they pushed the nation’s wealth through the £10tn mark, according to a new survey.

Lloyds Bank’s private banking arm said total household wealth in the UK increased by £892bn last year – with the property and financial markets each responsible for half the rise.

News of the 9% jump in the value of the assets from £9.6tn to £10.5tn during 2016 is likely to rekindle the debate about the UK’s wealth inequality. Previous surveys have shown that a tenth of adults own half the nation’s wealth, while 15% own nothing or have negative wealth.

The Bank of England has acknowledged that the richest 10% of Britons gained most from the money creation programme known as quantitative easing, since the increase in the supply of credit boosted demand for financial assets. Since the better off held a greater proportion of these assets, 40% of the gains of rising share and bond prices went to the richest 5% of households.

In a separate report released on Tuesday, the Social Market Foundation said more than 14 million working age adults were not saving at all, and more than 26 million adults did not hold adequate rainy day or pension savings.

Lloyds said the value of assets had risen far faster than prices or incomes over the past decade. The £3.9tn increase in the value of residential property and financial assets owned by UK residents represented a 59% rise, whereas prices rose by 39% and gross household income was up 37%.

Other surveys have come up with higher estimates of total household wealth, but Lloyds said its figure excluded non-residential property and assets held by charities and other non-profit institutions.

The survey said average house prices rose by 4.9% during 2016 and an additional 183,000 homes were added to the stock of private properties to buy and rent. This resulted in housing wealth contributing an estimated £431bn to the overall increase in wealth. The total value of financial assets – such as bank and building society deposits, government bonds, shares in companies, life assurance and pensions held by households – increased by a £461bn, or 8%.

Sarah Deaves, private banking director at Lloyds Bank, said: “For many people, their overall wealth is locked up in assets that they hold for the longer term like their homes, their pensions, ISAs and investments. With rising house and equity prices, net worth has increased substantially in the past decade, growing by £143,000 per household on average.

“Increasing levels of wealth are clearly positive for households, but with recent changes, like pensions freedoms, it also highlights the increasing importance of proper financial planning, especially as people approach and move into retirement.”

The Halifax, an arm of Lloyds Bank, said in its monthly snapshot of the property market that house price inflation had eased since the turn of the year. Prices in January were 5.7% higher than a year earlier but by July the annual rate of increase had fallen to 2.1%.

In the three months to July, the Halifax said prices fell by 0.2%. It added that this was the fourth month in succession that prices had been dropping on a quarterly basis – the first time this had happened in five years.

Russell Galley, the managing director of the Halifax bank, said the annual house price increase was the lowest seen since April 2013.

“The rise in the employment level by 175,000 in the three months to May helped push the unemployment rate down to 4.5%, the lowest since June 1975. However, this improvement in the jobs market has not, as yet, boosted wage growth, resulting in earnings rising at a slower rate than consumer prices,” he said.

“This squeeze on spending power, together with the impact on property transactions of the stamp duty changes in 2016 now being realised, along with affordability concerns, appear to have contributed to weaker housing demand.

“However, a continued low mortgage rate environment, combined with an ongoing shortage of properties for sale, should help continue to support house prices over the coming months.”

Output: The UK’s wealth has passed £10tn ($13tn) due to increasing house prices and a City boom, according to a survey by Lloyd’s Bank’s private banking division. The research shows that the country’s total household wealth increased by £892bn last year, with half of that increase coming from the property and financial markets. The disclosure will fuel the debate about inequality within the country. A report from thinktank the Social Market Foundation on Tuesday revealed that 14 million working age adults in the UK were not saving and over 26 million adults had insufficient rainy day or pension savings.


Instruction: create a high quality summary of the given input

Input:
Off-exchange trade pools pose threat to UK equities market: FCA
 By Richard Crump (August 4, 2017, 2:46 PM BST) -- Trading in controversial off-exchange venues known as dark pools could damage the U.K.'s equity market if the value of orders exceeds 17 percent of total trading, according to a research paper published by Britain's financial services watchdog....

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Output: Off-exchange trading, or "dark pools", poses a threat to the UK's equities market, according to a research paper by the Financial Conduct Authority (FCA). The financial services watchdog warned that market quality starts to deteriorate when the value of orders in dark pools reaches between 11% and 17% of total trading. The overall value of dark trading will not be allowed to overstep 8% for each stock after EU financial securities rules, known as Mifid II, come into effect next year.


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Young adult premature death on rise in northern England
 We examined long-term trends in mortality in the North and South of England, focusing on the age groups most affected by northern excess mortality. Between 1965 and 2010, national mortality declined while the northern excess remained consistent for most age groups. Among adults aged 25–44, however, northern excess mortality increased sharply from the mid-1990s onwards due to a stall in the North of the long-term decline in mortality. By 2012, following the Great Recession of 2008–2009, four decades of declining premature mortality in both North and South England had stalled, a pattern not seen following earlier recessions.

This study analysed mortality data over five decades for England's population, enabling differences in long-term trends between North and South to be examined in full. Measuring inequalities between two large, meaningful geographies of around 25 million people each allowed us to minimise the effects of errors in population estimates, and more precisely to examine age group specific mortality. While the classification of smaller geographies into North or South is to some extent arbitrary, it reflects boundaries of administration and political responsibility, as well as established social, economic and cultural divisions. This dichotomous approach does not, however, allow us to account for heterogeneity within each region. Within the South for example, London concentrates political and economic resources. We have not examined causes of death, which limits the conclusions we can draw about the underlying drivers of the disparities, although the relative ranking of causes of death for different age groups is the same across all regions of the country. 21 We also have not measured the changes over time in potential social, economic, behavioural and demographic determinants (eg, migration, smoking rates and unemployment), as this was beyond the scope of the study. Finally, in our analysis of recessionary periods we have not examined other periods of economic or social insecurity.

Interpretation of findings

In common with other advanced industrial nations, mortality rates consistently fell across all regions of England in the second half of the 20th century and the first decade of the 21st. Premature mortality rates in the North steadily converged on—but remained substantially higher than—rates in the South throughout a period that included three recessions and multiple changes in political administration, with a total of 23 years of Labour and 22 years of Conservative government. However, the same uniform pattern of converging mortality was not apparent in all age groups. For the 25–34 and 35–44 age groups there were distinct phases: between 1965 and 1985, mortality rates fell more quickly (from a higher baseline) in the North, closing the North-South gap to 12% in the 35–44 age group and completely in the 25–34 age group. This was followed by a decade when the long-term decline in mortality rates among young adults halted nationwide, with little change in regional disparities. However, from the mid-1990s northern excess mortality increased by 25 percentage points in the 25–34 age group and by 23 percentage points in the 35–44 age group. Underlying this rapid divergence was an increase (ages 25–34) or plateauing (ages 35–44) of mortality rates in the North at the same time as mortality rates in the South started to decline again. Because deaths in the under 45s are relatively uncommon, these patterns are concealed in whole population mortality rates, which are dominated by older age groups. However, the consequences for the population, in terms of years of life lost, are grave.

Prior to the Great Recession of 2008–2009 there were no obvious effects of recessionary periods on either long-term trends in mortality or on inequalities in mortality between North and South, even in the working age population. For example, the divergence in mortality rates for young adults between North and South began in 1995, 4 years after the 1990–1991 recession, and continued for another decade through a period of sustained economic growth. It is possible, however, that overall mortality figures conceal different trends for specific causes of death; analyses of previous economic crises found that increases in cardiac deaths were counterbalanced by reductions in respiratory deaths.22

During the 2008–2009 recession, there was again no obvious change in underlying trends in mortality, but from 2012 the historical decline in under 75 mortality rates plateaued in both the North and the South. Within the under 75s, this overall pattern is reflected equally in North and South England for the 25–34 and 45–54 age groups; however, for the 35–44 age group the gap is widening due to a decline in mortality post-2012 not seen in the North. It remains to be seen whether the overall plateauing is a transient phenomenon, or whether years of improving premature mortality are fading and existing wide regional disparities are persisting or worsening.

The extended period of austerity following the 2008–2009 recession has raised concerns about detrimental impacts on population health,23 particularly the health of disadvantaged socioeconomic groups and more economically precarious regions.18 However, the divergent trends in mortality we noted in the 1990s and early 2000s suggest that inequalities can increase rapidly during periods of sustained economic growth. Similar patterns have emerged in the USA (and have been similarly concealed by overall mortality patterns), where mortality rates in white non-Hispanic women aged 45–54 started to increase in the late 1990s.24

Explaining the rapidly widening divide in young adult mortality between North and South over the past two decades will require detailed analysis of specific causes of death and the plausible explanations, including epidemiological, social, economic and migratory factors. The most common causes of death in this age group are suicide, poisoning, land transport accidents and liver disease. Over the age of 40, other causes become increasingly common; ischaemic heart disease in men and breast cancer in women.21 The recent rises in mortality rates noted above in the USA were driven by rapid increases in suicide, poisonings and chronic liver disease—increases that were heavily concentrated in less educated populations.24 In the UK, suicide rates declined nationally throughout the 1990s and 2000s, but this general fall may have concealed different regional and socioeconomic trends. The rapid increase in suicides from 2008, and its concentration in areas of high unemployment, suggests that already wide health inequalities affecting England are worsening.18 The age-standardised rate for alcohol-related deaths in the UK has increased since 1994. Although the rate peaked in 2008 and has subsequently fallen, the 2014 rate is still higher than that observed in 1994.25

Some commentators on the nation's growing inequalities conclude that the transition from premature mortality driven by infectious diseases in the Victorian era to chronic diseases today means that the era of effective state intervention—which included the great public works of sanitation, housing reform, immunisation and universal healthcare—is past, and that responsibility for addressing current disparities now lies with the individual.26 Following this logic, the government would do no more than provide education and some behavioural nudges, particularly in the case of the violent and self-destructive causes of premature mortality that afflict young and middle-aged adults. However, the strong social and geographical patterning of trends in premature mortality points to structural defects that lie beyond the control of the individual, demanding collective action and a strong policy response.

Future policies may be distracted from addressing inequalities due to the pan-regional nature of the apparent plateau in declining premature mortality and the reversal of declining elderly mortality.27 Doing so would ignore the persistent North-South divide and the potential population health gain from addressing it effectively.

Output: More young adults are dying prematurely in the north than the south of England, and the gap is increasing, according to a study from the Universities of Manchester and York. In 1965, there were 8% more deaths amongst 25-34 year olds in the north than in the south. This gap fell to 2.2% in 1995, but rose to 29.3% in 2015. For those aged 35-44, the gap was 21% in 1965, 3.3% in 1995 and almost 50% in 2015. The reasons for the trend are unclear, but the authors of the study are calling for greater investment in the north.


Instruction: create a high quality summary of the given input

Input:
Young adult premature death on rise in northern England
 More young adults are dying before their time in the north of England than the south – and the gap is widening, a study has revealed.

Researchers say that since 1965, about 1.2 million more people have died before the age of 75 in the north of England than in the south, taking into account differences in population.

And the team warns that the gap in premature deaths is growing larger – revealing a particularly “alarming growth” among younger adults and those nearing middle-age.

“Between the ages of 25 and 44 there have been rising inequalities,” said Iain Buchan, professor in public health informatics at the University of Manchester and a co-author of the study.

While it is not clear what is behind the trend, Buchan said the findings highlight the need for policies to increase investment in the north of England

“There is higher attainable health in the north, as shown by the higher attained health in the south – therefore invest in the north,” he said.

Published in the Journal of Epidemiology and Community Health by Buchan and colleagues at the University of Manchester and the University of York, the latest study built on previous work by the group, which looked at trends between 1965 and 2008. The new study extended the findings to 2015, to cover the period since the recent recession.

To investigate the north-south divide, the team split England into “north” and “south”, with the latter comprised of the East, South East, South West and London. Using data from the Office for National Statistics, they then combined figures on the numbers of deaths in each region with population estimates.

Overall, premature deaths fell in both the north and the south in the second half of the 20th century. However the study revealed that the decline has levelled off for both since 2010 – the same year at which the rate of increase in life expectancy in the UK began to stall, according to recent research.

“[It is a] stagnation of five decades of improving mortality,” said Buchan.

By drilling down into the figures by age group, the team then revealed the widening of the gap among younger adults.

Once factors including age, population size and sex were taken into account, there were 8% more deaths among those aged 25-34 in the north in 1965 but just 2.2% more in 1995. However in 2015, 29.3% more 25-34-year-olds died in the north than the south.

For those aged 35-44, the number of deaths was almost 21% higher in the north in 1965, falling to just 3.3% higher in 1995 before rising to almost 50% higher than the south in 2015.

That, said Buchan, suggested the south was doing better at tackling common chronic disease deaths that typically start to become more common from the age of 40.While the authors do not explore the reasons behind the deaths, they note that the most common causes of death among young adults include suicide, poisoning, traffic accidents and liver disease.

And although the research did not find any obvious effects of economic recession on the trends, Buchan said investment in the north was of paramount importance.

“A sticking plaster might be education, improvement of interventions around alcohol misuse and the other common causes associated with young people’s deaths – but that doesn’t tackle the root cause of the social and economic environment,” he said.

Sir Michael Marmot, professor of epidemiology at University College London who was not involved in the study, said that the research showed the north-south divide has been amazingly persistent. “It is really astonishing how long it has gone on for,” he said, adding that other research has shown that the divide is worse for those of lower socio-economic status.

While Marmot said that it was difficult to link changes in mortality to changes in government policy – not least because it is not known what the lag times might be – he said it was highly likely that the disadvantage in the north was social and economic. He added that the 2010 Marmot review laid out a six-point strategy for combating inequality that including better early childhood development, better working conditions and education.

Richard Wilkinson, co-founder of the Equality Trust and emeritus professor of social epidemiology at the University of Nottingham, said he was not surprised by the results, pointing out that inequalities rose during the 1980s, and added that austerity was making the north-south divide worse. “The main cuts are to the cities, the labour areas, which need [money] most,” he said.

A government spokeswoman said: “The causes of health inequalities are highly complex but we are taking action by addressing the root social causes, promoting healthier lifestyles and improving the consistency of NHS services etc.

“This government is committed to creating a society where everybody gets the opportunity to make a success of their hard work - regardless of where they are from.”

Output: More young adults are dying prematurely in the north than the south of England, and the gap is increasing, according to a study from the Universities of Manchester and York. In 1965, there were 8% more deaths amongst 25-34 year olds in the north than in the south. This gap fell to 2.2% in 1995, but rose to 29.3% in 2015. For those aged 35-44, the gap was 21% in 1965, 3.3% in 1995 and almost 50% in 2015. The reasons for the trend are unclear, but the authors of the study are calling for greater investment in the north.


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New study shows how to account for social disparities in health care costs
 Credit: CC0 Public Domain

A first-of-its kind payment formula developed at the University of Massachusetts Medical School recommends allocating some health insurance dollars for patients in vulnerable communities and for those subject to social risks, in addition to their medical issues. Adjusting for these risk factors redistributes funds in the health system, which can be used in community settings to address underlying causes that often lead to costly hospitalizations and visits to the emergency room.

"A payment formula that accounts for medical problems but ignores social risk will underpay for treating vulnerable populations, potentially exacerbating already existing inequalities," said Arlene S. Ash, PhD, professor of quantitative health sciences and the study's author. "We describe a model to ensure that plans get more money for enrolling patients with greater medical and social needs.

"These reallocated funds could be used to support innovations, such as purchasing a home air conditioner for someone at high risk of hospitalization for breathing problems, or providing culturally appropriate cooking classes so families can prepare diabetes friendly meals."

MassHealth, the combined Medicaid and State Children's Health Insurance Program (CHIP) in Massachusetts providing access to care for the state's most vulnerable residents, is the first to implement a model that adjusts payments to managed care organizations for socially vulnerable patients. Although data for measuring social risk is limited, MassHealth's model now recognizes the additional resources needed for patients with unstable housing, those living in highly stressed neighborhoods, and those with various kinds of disabilities whose needs are not fully captured by their medical diagnoses. MassHealth's current payment model uses existing Medicaid data and reproducible methods to improve payment equity and support care for vulnerable beneficiaries.

"As people put their hopes in alternative payment methods to handle rising health care costs, it's important to have a conceptual framework that does not exacerbate current inequalities," said Ash. "Just as we started adjusting for medical complexity thirty years ago, so that the sickest patients would have access to the care they needed, this study shows how to account for social disparities in health care costs."

Using 2013 data from MassHealth for over 800,000 members, Ash and colleagues scanned enrollment and insurance claims looking for variables such as ethnicity, housing issues, mental health, substance use, disability, and English language limitations, which might be useful for predicting medical costs. A key finding was that people who moved more than once in a year used over $500 more health care dollars than formulas that only accounted for medical risk. The researchers also mapped enrollee addresses to US Census data to calculate a neighborhood-level score that summarizes the prevalence - among near-neighbors - of social risk factors such as very low incomes, no access to a car, single parent households, public assistance and unemployment.

The study found that health costs for residents in the most stressed neighborhoods were about 23 percent higher than those in the least stressed neighborhoods - a differential that was mostly accounted for greater medical risk. However, Ash and colleagues were only able to eliminate the last 5 percent of underpayment for those living in the most-stressed neighborhoods by including the neighborhood stress score in the payment formula.

"We need to build a health system that recognizes and pays for these and other social risks, so as to encourage and enable networks of medical and community-based practitioners to work together to help socially-vulnerable people become more healthy," said Ash. "This study is a first step in that direction."

More information: Arlene S. Ash et al. Social Determinants of Health in Managed Care Payment Formulas, JAMA Internal Medicine (2017). DOI: 10.1001/jamainternmed.2017.3317 Journal information: JAMA Internal Medicine

Output: A first-of-its kind payment formula developed at the University of Massachusetts Medical School recommends allocating some health insurance dollars for patients in vulnerable communities and for those subject to social risks, in addition to their medical issues.


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Input:
Pinterest jumps on the video advertising bandwagon
 A year after tests with advertisers began, Pinterest is rolling out video ads to all advertisers targeted for both search results and feeds.

Pinterest joins a growing number of companies including Facebook, YouTube, Twitter and Snapchat that are gunning for lucrative video dollars. But while marketers have scrutinized measurement and inaccurate stats and platforms have rushed to keep pace, Pinterest is hoping to side-step at least some of the initial measurement issues by inking deals with Moat and Nielsen that allow marketers to vet metrics through third parties.

Pinterest

Output: Pinterest is following in Facebook, YouTube, Twitter and Snapchat's footsteps by launching video ads for advertisers, with third-party metrics available as standard. Pinterest has signed deals with Moat and Nielsen to offer transparency, although it has yet to undergo a full-blown audit from the Media Rating Council. Internal data from the San Francisco-based site revealed 75% of consumers say they’re likely to watch videos with topics that interest them, while 80% of users watching Pinterest videos said they helped teach them something.


Instruction: create a high quality summary of the given input

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Getting patients to shop for health care is a tough sell
 Americans extol price shopping for health care as a prudent idea, yet few actually do it even when given the means to, according to the findings of two separate studies led by investigators at Harvard Medical School.

Results of the two analyses, published in the August issue of Health Affairs, cast doubt on the increasingly popular notion that empowering consumers to price shop could help stem the tide of rising healthcare spending, the research team said.

"The idea is that if you give consumers good information about prices—and make sure they have 'skin in the game' through high deductibles or co-pays—they will choose lower-priced providers and services, and market forces will drive spending and prices down," said Ateev Mehrotra, a health care economist and physician in the HMS Department of Health Care Policy. "That's the theory. We wanted to see how it works in reality. Turns out, reality is a bit more complicated than that."

One study, which analyzed utilization of a comparison shopping tool by consumers, revealed that few used the tool to choose lower-cost options. Offering the tool resulted in no difference in the net cost of care at the population level.

The other study, a national survey of people's attitudes toward comparison shopping for health services and their shopping behaviors, showed that while the majority favored price shopping, a mere 3 percent actually compared prices across providers.

Policy makers have shown growing interest in the idea that unleashing the power of market competition through price shopping can rein in rising health care costs. Many policies have been designed to use price shopping as the engine of change, such as insurance policies designed to include high deductibles and large co-pays or mandates in more than half of U.S. states that require insurance companies, providers, and employers to give consumers transparent pricing information so that potential shoppers can compare costs.

Mehrotra, who is an associate professor of health care policy at Harvard Medical School and HMS associate professor of medicine at Beth Israel Deaconess Medical Center, worked with colleagues at Harvard Medical School, the Harvard T.H. Chan School of Public Health and the University of Southern California to conduct a nationwide survey of 3,000 people who had recent out-of-pocket health expenses.

Only 13 percent of respondents had sought information about their expected spending before receiving care, and just 3 percent had compared costs across providers before receiving care. Notably, the research found, the low rates of price shopping do not appear to be driven by opposition to the idea of comparison shopping: The majority of respondents said they believed price shopping for care was important and did not believe that more expensive providers necessarily offered higher quality of care. The most common reason for avoiding price shopping was reluctance to switch physicians, with 77 percent of respondents citing this as a factor. Additionally, 75 percent of people in the survey said they did not know of a price comparison resource. This is despite many efforts by states to make prices more easily accessible.

Would the situation be different if people were offered a price transparency resource?

Unlikely, according to the results of the second study, which looked at whether access to a price comparison tool could spark change in consumer behavior among a group of California public employees. For that study, Mehrotra teamed up with Sunita Desai, a Marshall J. Seidman Fellow in Health Care Policy at HMS and colleagues at Harvard Medical School, the Harvard Chan School, the Center for Innovation at the California Public Employees' Retirement System and HealthCore.

The researchers focused on employee spending for a set of services, including lab tests, office visits, and advanced imaging services, that were more "shoppable" on the price comparison tool. A mere 12 percent of employees who were offered the tool used it at least once in the 15 months after it was introduced. Use of the tool did not result in lower overall prices for lab tests or office visits. While patients who shopped were able to purchase less expensive services, overall, so few consumers shopped that access to the tool didn't make a dent in lowering outpatient spending.

The results echo and expand on an earlier study by the same team published in JAMA last May, which found that access to a similar price transparency tool was not associated with lower health care spending.

Taken together, the researchers said, the results of the two new studies add to growing evidence that it may be more difficult than believed to use "consumerism" to drive down health care costs. The researchers noted that future efforts to encourage price shopping will likely require different benefit designs other than deductibles along with tools that are both easier to use and easier to access.

"Tweaking health plan benefits to give people more incentive to shop for lower-priced care options and making the price comparison tools easier to use might encourage more people to price shop," said Desai, the lead author of the latter study.

"As it stands now, our findings suggest that the current set of transparency laws and online tools have a limited impact on health care price shopping, and even less impact on overall spending or prices," Mehrotra said. "The evidence we've found doesn't support the enthusiasm that policy makers have had for these tools."

Output: Americans extol price shopping for health care as a prudent idea, yet few actually do it even when given the means to, according to the findings of two separate studies led by investigators at Harvard Medical School.


Instruction: create a high quality summary of the given input

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Facing Trump Subsidy Cuts, Health Insurance Officials Seek a Backup Plan
 J. P. Wieske, the deputy insurance commissioner in Wisconsin, said that two companies, Anthem and Molina Healthcare, were leaving the state’s marketplace in 2018 and that two others, Humana and UnitedHealth, exited in previous years. As a result, he said, more people will be enrolled in smaller local health plans that could be more affected by a termination of federal subsidy payments.

“Carriers left in the Wisconsin market are smaller, local plans,” Mr. Wieske said. “Particular carriers could have huge surges in population, going from 7 or 8 percent of their business in the individual market to 30 or 40 percent. If that’s the case, if it’s 30 or 40 percent of their business in the individual market, that’s obviously a gargantuan risk.”

The risks for consumers are also high, Mr. Wieske said. “Consumers,” he said, “could be stuck in a zombie plan, an insurer that is essentially no longer able to do business in the worst-case scenario, or consumers may have to move to another insurer with different health care providers.”

Officials in many states must decide this month on insurance rates for next year.

“We are holding off making those decisions until the very last possible minute,” said Julie Mix McPeak, the Tennessee insurance commissioner. “In doing so, we are really making it difficult for consumers who need information about open enrollment — who’s participating in the market and what the rates might be. We don’t know the answers to any of those questions.”

The uncertainty stems not only from the White House and Congress, but also from federal courts.

House Republicans challenged the cost-sharing payments in a lawsuit in 2014. A federal judge ruled last year that the Obama administration had been illegally making the payments, in the absence of a law explicitly providing money for the purpose. The case is pending before the United States Court of Appeals for the District of Columbia Circuit, which has held it “in abeyance” at the request of House Republicans and the Trump administration.

Output: Congress is on vacation, but state insurance commissioners have no time off. They have spent the past three days debating what to do if President Trump stops subsidies paid to insurance companies on behalf of millions of low-income people.


Instruction: create a high quality summary of the given input

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Medicare Advantage Spends Less on Care, So Why Is It Costing So Much?
 The Medicare Advantage program was supposed to save taxpayers money by allowing insurers to offer older Americans private alternatives to Medicare. The plans now cover 19 million people, a third of all those who qualify for Medicare. Enrollee satisfaction is generally high, and studies show that plans offer higher quality than traditional Medicare. But the government pays insurers more than they pay out for patient care — in some years, it turns out, a great deal more.

Concern about Medicare Advantage’s cost has found sharp expression in a recent suit brought by the Justice Department charging UnitedHealth with excessive billing of the government. While that suit plays out, research published by the National Bureau of Economic Research provides context.

The study, released in January, found that the revenue Medicare Advantage plans received in 2010 exceeded the amount they paid out for medical care by a hefty 30 percent. At more than $2,000 per enrollee per year, that probably topped $20 billion dollars, nearly all from federal payments, not enrollee premiums. The study relied on Medicare Advantage billing data obtained from three large insurers across 36 states, a type of data the government doesn’t yet release.

Paradoxically, even though Medicare Advantage plans cost taxpayers more than traditional Medicare, they spend less on care. In fact, one of the motivations of the program is to capture that lower spending as savings for taxpayers. It hasn’t worked out that way.

Output: The Medicare Advantage program was supposed to save taxpayers money by allowing insurers to offer older Americans private alternatives to Medicare. The plans now cover 19 million people, a third of all those who qualify for Medicare. Enrollee satisfaction is generally high, and studies show that plans offer higher quality than traditional Medicare.


Instruction: create a high quality summary of the given input

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To Cut or to Reform Medicaid?
 The GOP’s attempt to repeal and replace the Affordable Care Act has generated intense opposition and run into repeated roadblocks on Capitol Hill, despite advancing many worthy reforms. The proposals are right to allow individuals without pre-existing conditions to obtain insurance from a freely-competitive market, right to shift able-bodied individuals from Medicaid to the exchanges, and right to restructure Medicaid so that the largest share of its funds is not captured by the wealthiest states that need it least.

Yet, the $904 billion in aggregate spending cuts incorporated in the most recent bill have fueled bitter opposition to the proposed reforms. The GOP has long struggled to balance its objectives of enhancing competition and personal responsibility with a desire to immediately save money. Well-designed institutions save money over the long-term, but a haste for savings has ensured that the main thing many states, providers, and individuals see in the GOP’s reform proposals is the prospect of having to make do with less.

The blueprint for the GOP’s 2017 attempt to repeal and replace the Affordable Care Act was laid out by Speaker Paul Ryan in his June 2016 proposal, “A Better Way.” That white paper proposed “more choices, lower costs, greater flexibility” in health insurance, set out the case for reforming Medicaid into a per capita allotments for states, and argued for transforming Medicare into a “fully-competitive market-based model”.

Following President Donald Trump’s election, the “premium support” proposal to cut funding for Medicare was dropped — but a core tension remained between the belief that reforms could improve the structure of health insurance, and the desire to generate immediate savings for taxpayers.

There was much merit in the Senate GOP’s proposal to repurpose the exchanges into a dedicated safety-net for low-income individuals and those with pre-existing conditions, allowing a competitive market provide affordably-priced insurance to most individuals at premiums priced in proportion to their health care needs. But combining this reform with $46 billion of cuts from the $86 billion expected to be spent in 2026 on premium and cost-sharing subsidies for these plans raised legitimate concerns (only partially allayed by $19 billion in proposed stabilization funding) about whether the exchange would retain much appeal for the 81 percent of enrollees who currently receive subsidies. It also undermined the argument that exchange plans could serve as a satisfactory replacement for the expansion of Medicaid to able-bodied adults earning less than 138 percent of the poverty line.

It is hard to justify the system established by the ACA, by which the federal government pays for 90 percent of the cost of providing Medicaid services to able-bodied childless adults, but only 50 to 75 percent for disabled, the elderly, and pregnant women. Similarly, it makes little sense to finance the provision of health care for the poor through a system of matching funds which distributes the most money to the wealthiest states. But the coupling of fixes to these issues with aggregate funding cuts meant that GOP proposals to establish a more deliberate allocation of resources were easily beaten back by an alliance of hospitals, physicians, and state politicians who stood to lose money, without being counterbalanced by others who stood to gain.

The competing priorities of structural reform and fiscal retrenchment have long struggled for supremacy in conservative health policy proposals. The 2003 Medicare Modernization Act was perceived by many conservatives as showing the danger of paying too much for reform, and did much to foster the Tea Party insurgency within the GOP.

In the 2000 presidential election, Vice President Al Gore had pledged 50 percent federal assistance for a standalone drug benefit as a Part D to Medicare. George W. Bush responded with a proposal to subsidize 25 percent of the cost for private Medicare plans to add drug coverage, as a means of enticing beneficiaries into capitated plans. In order to avoid a Democratic filibuster, the Republican-led Congress eventually adopted the structure of Gore’s proposal, to be administered privately, with a 75 percent subsidy.

The MMA nonetheless succeeded in its core reform goals (slowing the cost of employer-sponsored insurance premiums and making private plans the most attractive choice for a growing section of Medicare enrollees), but the $100 billion annual cost of adding prescription drugs to Medicare was high.

Attempting health care reform through reconciliation, Republicans need not spend billions to secure Democrats’ support, but this time they have erred in the other direction. The health care reform proposed by the House GOP was scored as reducing federal spending by $119 billion over 10 years. Congressional budget rules required the Senate bill’s cuts to exceed that amount.

The most recent version of the Senate bill was estimated to reduce the deficit by $420 billion over 10 years, but if it fails to pass into law, it will save taxpayers $0. It was reported that Senator Mitch McConnell (R-Ky.) was looking to spend $200 billion of this as “candy”, to secure support for the bill. That effort, financed by a reduction of the tax cuts included in the bill from $701 billion to $484 billon, appears to have failed. Yet, much room remains to reinstitute subsidies withdrawn by the Senate bill, to ensure that the bill’s worthy structural reforms are not overwhelmed by the cuts they threaten to impose.

The experience of MMA may suggest that it is possible to do too much to sweeten a pill; but the experience of this year reminds us that it is also possible to do too little.

Chris Pope is a senior fellow in health policy at the Manhattan Institute.

Morning Consult welcomes op-ed submissions on policy, politics and business strategy in our coverage areas. Updated submission guidelines can be found here.

Output: The GOP’s attempt to repeal and replace the Affordable Care Act has generated intense opposition and run into repeated roadblocks on Capitol Hill, despite advancing many worthy reforms.


Instruction: create a high quality summary of the given input

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Republicans on recess hold town halls, are met with constituents angry about health care
 As lawmakers head back to their districts for the August congressional recess, many of them are bracing to hear earfuls from their constituents over national healthcare policy during their latest round of town hall meetings.

With the Republicans’ failure to repeal the Affordable Care Act this summer and with the cost of healthcare continuing to rise (as it has been for decades), lawmakers will struggle to pivot attention away from healthcare and to the next item on their agenda: tax cuts.

In Durango, Colorado on Friday, Republican Sen. Cory Gardner was thrown off his guard at a town hall meeting that was supposed to focus on environmental policy. Instead, he faced a packed room of frustrated constituents who shouted at him for his support of his party’s efforts to repeal the ACA.

“Why on Earth did you vote for the Republican [health] care bill when the vast majority of your constituents opposed it?” one man asked the first-term senator as the crowd cheered, according to The Denver Post.

In his first in-person town hall meeting in more than a year, Gardner replied that he won on the promise he would vote to repeal and replace President Barack Obama’s signature piece of legislation. Gardner voted in favor of every Republican attempt to pass some form of ACA repeal, including one that would have repealed the law without providing a replacement.

During a telephone town hall meeting on Aug. 2, Gardner faced a barrage of questions that were critical of his voting record, including from some participants who supported ACA repeal but were angry that the Republicans couldn’t get it done.

On Saturday, Tennessee Democratic Congressman Steve Cohen faced a packed auditorium in Memphis where constituents raised their concerns about tax reform, immigration and healthcare.

“I would like to see the Democrats and the Republicans reach across the aisle and work out a workable, efficient health insurance system,” one man in attendance said, according to WHBQ-TV in Memphis.

During a town hall meeting last week, supporters and detractors of the Affordable Care Act kept the issue front and center with Colorado Republican Rep. Mike Coffman, showing just how much the issue is on voters’ minds.

“How do you address a problem when you don’t know what it feels like?” one woman said at the meeting, according to The Wall Street Journal, underscoring the point that members of Congress who are much wealthier than the average American enjoy taxpayer-subsidized health care. Members of Congress and congressional staffers are qualified for taxpayer subsidized gold-level health insurance through an exchange in Washington D.C. that is used by local small businesses. They also benefit from low-cost subsidized routine care through the Attending Physician of the United States Congress, which is staffed by U.S. Navy officers and personnel.

As Congress attempts to move on to tax cuts and the 2018 fiscal year budget, critics and supporters of ACA don’t appear to be willing to follow.

Output: As lawmakers head back to their districts for the August congressional recess, many of them are bracing to hear earfuls from their constituents over national healthcare policy during their latest round of town hall meetings.


Instruction: create a high quality summary of the given input

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How to get long-term care at home without busting the bank
 The vast majority of older adults receive long-term care at home, not in nursing homes. But few people plan for this expense.

Nor do they see long-term care insurance as a viable option because it's expensive and is often seen as protection against the cost of nursing home care.

That should change, some experts contend. If the long-term care insurance industry focused more on helping people cover home-based services, they argue, policies would be more affordable, and potentially appealing.

"Long-term care, for most people, is a home care problem," said Bill Comfort, who owns Comfort Long Term Care, a brokerage based in St. Louis and Durham, N.C.

"It makes sense to insure people for the likelihood of where care is going to be needed first which is at home," agreed Deb Newman, president of Newman Long Term Care in Richfield, Minn., outside Minneapolis.

Genworth, one of the nation's leading long-term care insurers, acknowledged that this position is supported by industry claims data.

"Primarily, we are seeing people utilizing home care and a smaller and smaller percentage using nursing home care," said Beth Ludden, Genworth's senior vice president for long-term care insurance products.

"People think, 'While I might start out needing care at home, eventually I'll need to be in a facility,'" Ludden continued. "But that's not something we see in our data. For the most part, people are able to stay at home for the whole time."

Currently, more than 6 million older Americans are thought to have a "high need" for long-term care, according to a report from the U.S. Department of Health and Human Services. That's defined as requiring daily assistance with two activities (eating, bathing, toileting, dressing, continence or transferring from a bed to a chair) that lasts at least 90 days or a need for substantial assistance due to severe cognitive impairment.

About 52 percent of adults reaching age 65 today will need these services 26 percent for two years or less; 12 percent for two to four years; and 14 percent for more than five years, the HHS report projected.

Yet fewer than 10 percent of older adults have purchased long-term care insurance, which has declined in popularity as premiums skyrocketed and insurers exited the market over the past decade. Whether the industry can fix its major problem affordability remains to be seen.

From a consumer's perspective, if your goal is covering several years of home-based care, not nursing home care, you can purchase a less expensive policy without all the bells and whistles that drive up costs, Newman suggested.

A 55-year-old couple buying a policy of this kind say, $4,000 a month in benefits for each person, for a maxiumum of three years, with a 1 percent compounded annual inflation protection provision from Mutual of Omaha would pay $2,380.05 a year in premiums, according to a quote from Minnesota that her firm provided. It's common for policyholders to pay premiums for 10 or 20 years before claiming benefits. Terms are similar in many other states.

How much help in the home might this policy provide?

According to 2016 data compiled by Genworth, the average annual cost for care provided by a home health aide was $46,332, compared with $82,128 for a semiprivate room in a nursing home. That translates into $3,861 a month, for 44 hours of home care a week the equivalent of slightly more than six hours of care, seven days a week.

That might not be enough for seniors with serious, disabling illnesses, but it can provide much-needed relief to unpaid family caregivers who could otherwise be on call nonstop.

What happens if someone ends up needing nursing home care?

You might consider what's known as a "qualified long-term care partnership policy" a plan available in every state except Alaska, Hawaii, Illinois (where a program has been approved but policies aren't available yet), Massachusetts, Mississippi, New Mexico, Vermont and Washington, D.C. (The Mutual of Omaha quote above is for a partnership policy.)

These little-known insurance products are designed to help consumers preserve their assets if they become seriously ill, need nursing home care and seek to become eligible for Medicaid, which pays for nearly half of nursing home costs in the U.S.

To qualify for Medicaid, most states require that an individual have no more than $2,000 in assets; couples are allowed to have up to about $120,000, so that a well spouse doesn't become impoverished. With a partnership policy, every dollar received in long-term care benefits is exempted from Medicaid's asset test and protected from seizure by the state.

In other words, if you get $200,000 in benefits from a partnership policy and your state has an asset limit of $2,000 for Medicaid, you can keep $200,000 in assets plus the $2,000 allowed and still meet your state's asset test, said Scott Olson, co-founder of the LTCShop.com, a brokerage based in Camano Island, Wash.

He noted that partnership policies don't guarantee Medicaid eligibility and you'll still have to meet whatever income standards your state sets for Medicaid. (Many, but not all states, allow people to "spend down" to qualify, using their income to pay for institutional care.)

Bill Nickerson, 63, of Las Vegas, one of Olson's clients, purchased a partnership policy three years ago because it lets him "retain control of my financial assets, even if I have to be cared for." Another plus: The policy "permits me, if I decide to stay home, to take a certain amount of the monthly amount and give it to someone who I choose to provide care for me, even if that person is a family member."

There's no reliable national data about how many people with partnership policies end up going on Medicaid to cover nursing home care. Nor is there good data about the number of these policies that have been sold or the benefits paid out to date.

David Guttchen, who directs the Connecticut Partnership for Long-Term Care, the first such program in the country, is skeptical about policies with benefits that will cover only a portion of expected costs. (Four states, including Connecticut, were the first to launch partnership programs and have special rules.)

"You absolutely need to know what the average home care and nursing home costs are for your state, to get a sense of what your exposure might be," he said. "If you don't buy meaningful benefits, you're wasting your premium."

If you've been able to cover a good amount of home care but your policy won't cover nursing home care, you've gained some protection, for a while, but you could still pay an enormous amount out-of-pocket going forward, if Medicaid isn't an option.

It's a gamble because people can't be sure what kind of care they'll need in the future, or for how long, or what the future of Medicaid will look like, said Michael McDonnell, an insurance broker in Petaluma, Calif. Before buying any policy, consult with an elder law attorney or independent financial adviser, he recommended.

We're eager to hear from readers about questions you'd like answered, problems you've been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.

KHN's coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation and coverage of aging and long-term care issues is supported by The SCAN Foundation.

Output: The vast majority of older adults receive long-term care at home, not in nursing homes. But few people plan for this expense. Nor do they see long-term care insurance as a viable option because it's expensive and is often seen as protection against the cost of nursing home care.