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Top law firms and schools join Ethereum Alliance
 Will “smart,” automatically executing contracts have a place in the nation’s legal system?

The Enterprise Ethereum Alliance (EEA) announced earlier this week that a group of 14 law firms and academic institutions signed on to join a new wing of the organization called the EEA Legal Industry Working Group.

“Lawyers are the ones who are going to be able to take this to the next level and do it in a mature and measured way,” explained Aaron Wright, a professor at Cardozo School of Law and the chairman of the working group, by phone this week.

Honored to be chairing this important new initiative from the EEA. https://t.co/7webemc3xv — Aaron Wright (@awrigh01) August 14, 2017

The Enterprise Ethereum Alliance is a group of finance and consulting companies, many of them on the Fortune 500 list, which are looking for ways to incorporate the Ethereum blockchain into the business world.

Representatives hail from top law firms and schools, including: Debevoise & Plimpton, Perkins Coie, Cooley, Latham & Watkins, the Department of Legal Studies and Business Ethics at the University of Pennsylvania’s Wharton School and the Duke Center on Law & Technology. They’ll work together on adapting the blockchain to the legal profession.

“We’re going to bring them together in a neutral place to set standards and start thinking about legal agreements,” Wright said. “There’s a number of regulatory issues with blockchain also so we’ll try to weigh in on that.”

Because of the open and decentralized nature of the blockchain, Wright sees promise in its ability to broker transactions. Where parties now need a trusted third party to handle a transaction, the blockchain could take the place of the third party, and eliminate the fees that go along with it. Wright sees potential for this in several kinds of law, including real estate and intellectual property.

“Instead of using eBay, we could rely on the blockchain to facilitate that transfer,” he said, as an example of eliminating third parties.

Wright expects more firms and schools will join the working group in the coming months, as the Ethereum blockchain matures.

The Enterprise Ethereum Alliance is led by Bushwick blockchain startup ConsenSys, which is founded by Joseph Lubin, the cocreator of the Ethereum blockchain.

Technically Media

Output: Fourteen leading US law firms and university law departments have signed up to a new initiative by the Enterprise Ethereum Alliance (EEA) to examine how the Ethereum blockchain platform can be used by the legal profession. Companies involved in the new EEA Legal Industry Working Group include Debevoise & Plimpton, Perkins Coie, and Latham & Watkins, whilst Duke University School of Law and the University of Pennslyvania are among the academic participants. They will examine the potential for blockchain to be used in brokering of transactions in areas of law including real estate and intellectual property.


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Infosys partners with Purdue University for employee training
 Dive Brief:

Inside Higher Ed reports Purdue University recently announced that it has signed a 5-year deal with India-based technology outsourcing firm Infosys to provide on-demand virtual training and research support for its employees. This occurs just months after Purdue acquired the former Kaplan University.

The purpose of this partnership is to reshape existing curriculum and professional development efforts to increase the skillset of candidates, as there are major technology skill shortages in Indiana and around the country. This also addresses Infosys's commitment to hire 10,000 American workers at four corporate hubs by 2019.

Infosys generates $9.5 billion on revenue yearly and has over 200,000 employees, including 27,000 in America. Indiana is the proposed headquarters for this new venture, which represents around $31 million in conditional tax credits and training grants offered by the state.

Dive Insight:

The move by Indiana's Purdue University to partner with Infosys is not unexpected, given that Infosys has a solid reputation for supporting the development of corporate universities. This gives Purdue University a chance to evaluate the massive amount of curriculum and resources that their purchase of Kaplan University provided, then maximize this learning content for future efforts. It's more cost-effective to build on an already strong foundation.

In the past, HR Dive has highlighted the efforts the Indiana state government has made to ensure talent gaps will be filled. Indiana and the surrounding region provide examples of the types of talent challenges facing the U.S. right now — be it automating out certain jobs or finding proper talent for tech-heavy, high-skilled jobs. The Midwest has become somewhat of a hub for these university deals, likely due to that conflict.

Output: Purdue University in Indiana, USA has agreed a five-year deal with India-based technology outsourcing firm Infosys to offer virtual training and research support to university employees. The partnership is intended to address the major technology skills shortages in Indiana and across the US. The partnership confirms Infosys's commitment to hiring 10,000 US workers at four corporate hubs by 2019. It will also assist Purdue in exploiting resources that it acquired when it bought Kaplan University.


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London’s Borough Market to ban sale of bottled water
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London’s Borough Market is to introduce free drinking water fountains as part of a new pledge to phase out sales of all single-use plastic bottles over the next six months.

The renowned foodie haven – the only fully independent market in the capital – is aiming to become the UK’s biggest food shopping destination that is entirely plastic-free.

The market aims to make all other packaging used by its 114 traders over the 51,272 sq ft site near London Bridge biodegradable and compostable, helping it to achieve zero waste to landfill. Its overall mission is to put every leftover piece of food or packaging to the best possible use.

The market will also announce it is phasing out the sale of water in single-use plastic bottles – for sale at the market as well as in cafes and chains on its fringes – and offering free drinking water from newly installed fountains instead.

A recent Guardian campaign revealed that 38.5m plastic bottles are bought in the UK every day, of which just over half are recycled. At the same time, 16m are put into landfill, burned or otherwise leak into the environment and oceans each day. Plastic bottles can take up to 450 years to break down once they reach the sea.

“It’s great that people are increasingly aware of the health benefits of keeping hydrated, but we’ve been troubled to see increasing numbers of plastic bottles used every day, which damage the environment and add to litter,” said Darren Henaghan, managing director of Borough Market.

“By using the new Borough fountains our visitors will be able to refill and refresh without having to buy a plastic bottle each time. We are proud to take this significant step forward as part of our ongoing commitment to making Borough Market Britain’s greenest place to shop and hope that others will follow suit.”

The fountains placed around the market will mean that visitors are never more than a short walk away from free drinking water. Each has two streams of water to drink from and one to refill reusable water bottles. Plans are currently in place to produce Borough Market refillable bottles made from recycled plastic that can be purchased from stalls around the market.

Borough Market is known as the hub of London’s world-class food scene although its history goes back centuries. In June it resumed trading 11 days after three men mounted an attack in and around the market’s bars and restaurants which killed eight people.

Thousands of tourists flow through the market every day, sampling gourmet food from the UK and around the globe at more than 100 shops, stalls and restaurants, alongside a handful of traditional market traders still selling fruit and veg.

The amount of waste from single-use plastic bottles in London has risen out of control, according to a recent report from the London assembly environment committee. It is calling on the mayor to consider introducing a deposit return scheme and provide free tap water as an alternative.

Output: Borough Market in London, the capital’s only independent market, is to phase out the sale of single-use plastic bottles at the market and in nearby cafes over the next six months and will introduce free drinking fountains as an alternative. The market is also committing to making all packaging used by its 114 traders biodegradable and compostable as part of its goal of zero waste going to landfill. Each day 38.5 million plastic bottles are purchased in the UK with just over 50% being recycled and 16 million sent to landfill, burned or otherwise released into the environment and oceans.


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Solar capacity to overtake nuclear energy in 2018
 Sign up to the Independent Climate email for the latest advice on saving the planet Get our free Climate email Please enter a valid email address Please enter a valid email address SIGN UP I would like to be emailed about offers, events and updates from The Independent. Read our privacy notice Thanks for signing up to the

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Solar panel capacity is set to overtake nuclear worldwide for the first time within the next few months, according to expert predictions.

The total capacity of nuclear power is currently about 391.5 gigawatts but the total capacity of photovoltaic cells is expected to hit 390 gigawatts by the end of this year with demand growing at up to eight per cent per year, according to GTM Research.

While this would be a landmark moment for renewable energy, nuclear still generates much more electricity than solar – nearly 2.5 million gigawatt-hours a year compared to the latter’s 375,000 gigawatt-hours.

Stephen Lacey, writing on GTM’s website, said: “It’s still going to be a record-breaking year for new solar capacity additions – yet again.

“The 81 gigawatts expected this year are more than double the amount of solar capacity installed in 2014. And it’s 32 times more solar deployed a decade ago. (In the year 2000, global installations totaled 150 megawatts.)

“One of the most telling statistics: By 2022, global capacity will likely reach 871 gigawatts. That’s about 43 gigawatts more than expected cumulative wind installs by that date. And it’s more than double today’s nuclear capacity.”

While solar accounts for about 1.8 per cent of global electricity generation today, the International Energy Agency has predicted this could rise to 16 per cent by 2050 under a “high-growth scenario”, which would make it the largest source of energy in the world.

And Mr Lacy said: “In the last three years, growth rates and cost reductions for solar have far exceeded projections. Meanwhile, high costs, slow construction and competitive renewable alternatives are causing the global nuclear industry to falter.

“The trend lines are becoming clearer every year.”

The Sun delivers enough energy to the Earth in an hour to provide humans with everything they need for an entire year.

Output: Solar power will soon overtake nuclear power in terms of output, according to energy researchers GTM Research, with demand for photovoltaic cells rising up to 8% this year alone. At present, nuclear power pumps out around 391.5 GW, where photovoltaic capacity is due to reach 390 gigawatts by the end of 2017. The International Energy Agency believes that solar will generate 16% of all electricity by 2050, making it the largest energy source across the globe.


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Chinese start-up Aha School offers VR museum tours to kids
 HONG KONG — Last weekend: the Uffizi Gallery in Florence and the Musée d’Orsay in Paris. By Wednesday: the National Air and Space Museum in Washington, the Museum of Modern Art in New York and the German Historical Museum in Berlin.

And that’s just the half of it.

Children from more than 180,000 Chinese households are on a virtual tour this week of 10 famous museums. The two-hour daily broadcasts combine slick animations, clips from Chinese presenters’ recent trips to the museums and live-streamed commentary from Chinese academics in a Shanghai studio.

The families each paid Aha School, an education start-up based in Shanghai that produced the shows, the equivalent of $2.85 to watch, and the company is donating the broadcast feed to 174 rural classrooms as a public service.

“The children here don’t have access to any museums, let alone famous ones,” Ma Xiaoyan, a teacher at the Akeli Center School in a rural corner of the southwestern province of Sichuan, said by telephone. “For many of them, even going to the closest town is difficult because their families don’t have money for travel.”

Output: Edtech start-up Aha School has produced a VR broadcast that offers Chinese children a tour of ten world-famous museums. The feed includes live-streamed commentary from Chinese academics, animations, and clips from Chinese presenters' visits to the museums. The families of 180,000 children each paid Aha School the equivalent of $2.85 to watch the broadcast. The company will also donate the footage to 174 rural classrooms as a public service.


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Chinese K-12 language-learning service Vipkid wins $200m funding
 Sequoia Capital China has led a US$200 million series D round in Vipkid, a Chinese K-12 online education platform, in what the company calls the largest funding round to date in the nation’s K-12 online education sector. Tencent Holdings Ltd., Matrix Partners China, Yunfeng Capital and Zhen Fund also participated in the round.

Output: Chinese K-12 educational platform Vipkid has gained $200m in a series D funding round led by Sequoia Capital China. Participants in what was reportedly the largest funding round in China's K-12 online sector included Yunfeng Capital, Matrix Partners China, Tencent Holdings and Zhen Fund. Tencent will work alongside Vipkid to develop cloud services, artificial intelligence and online education facilities, as well as cooperate with the Jack Ma Foundation to provide 100 schools in Chinese villages by the end of 2017. Vipkid offers one-to-one video sessions with US-based language teachers for Chinese children aged between five and 12.


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FDA Reauthorization Act aims to lower costs of ‘overpriced’ generic drugs
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FDA Reauthorization Act aims to lower costs of ‘overpriced’ generic drugs

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David Gortler

The long-term effects of the FDA Reauthorization Act of 2017 — signed into law by President Donald J. Trump on Monday — may include savings in drug-related Medicare expenses due to increased competition encouraged by the FDA by fast-tracking generic competitor approvals, according to an expert.

“All things considered, this bill is mostly a good thing,” David Gortler, PharmD, FCCP, a professor of pharmacology and biotechnology at the George Washington School of Medicine & Health Sciences and a pharmacology and drug safety expert with the consulting group FormerFDA.com told Healio.com. “It has been praised by several long time FDA officials and seems to give the FDA more power in several areas. Even President Trump's most vigilant detractors will be hard-pressed to find faults with the FDA Reauthorization Act.”

Passed by the U.S. House of Representatives by a voice vote in July and by the Senate in August, the FDA Reauthorization Act of 2017 (H.R. 2430) aims to reauthorize the Prescription Drug User Fee Act, the Medical Device User Fee Amendments, the Generic Drug User Fee Amendments and the Biosimilar User Fee Act and includes several provisions to improve the FDA’s drug review process.

The act would ensure the FDA has the tools to deliver safe and effective drugs, devices and treatments to patients more swiftly, according to a press release from the Energy and Commerce Committee.

In an interview with Healio.com, Dennis R. Cryer, MD, co-convener of the Biologics Prescribers Collaborative and chief medical officer at CryerHealth, said the Biologics Prescribers Collaborative commends the passage of the act, as well as the reauthorization of the Biosimilar User Fee Agreement.

“The Biosimilar User Fee Agreement provides needed resources for [the] FDA to accelerate patient access to safe and effective biosimilars,” he said. “This BsUFA reauthorization reinforces FDA’s role to advance treatment options, including biosimilars.”

One of the significant possible medium- and long-term benefits of the act is the savings in Medicare costs associated with generic drugs that do not have any market competition, according to Gortler.

“We have seen the prices of some of these historically inexpensive generic ‘niche’ drugs like pyrimethamine (Daraprim, Turing Pharmaceuticals) randomly go up quite high when they do not have competitors,” he said. “There are provisions in the FDA Reauthorization Act to give priority review status to generic drug applications to lower the costs of these overpriced drugs, devices or biosimilar compounds.”

Additionally, Gortler said that there is a “a well-needed provision [in the act] for collecting real-time clinical use data from patients earlier in the development and marketing of a new drug, as opposed to relying solely on clinical trial findings.”

However, Gortler noted that the act did little to address important positions still unfilled at the FDA.

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“The FDA has had a long history of not filling key scientific positions at the agency,” he said. “While this act did little, if anything, to address the FDA’s hiring problems, it does integrate a Merit System Based Incentive Payment System, which the FDA wants to hopefully maintain employment of its existing scientific staff. This might be my only critique of the act — FDA employees are already some of the best paid employees in the federal government, with perks [that include] flexible work hours and the ability to work from home up to 2 days per week. Although pharmaceutical industry jobs can pay considerably more, there is a huge risk in job security and a significant difference in quality of life with regards to available free time. I can personally attest to the same, having worked in both capacities.” – by Ryan McDonald

References:

https://energycommerce.house.gov/news-center/press-releases/senate-follows-house-passes-bipartisan-bill-reauthorize-fda-s-user-fee

Disclosures: Cryer and Gortler report no relevant financial disclosures.

Output: The long-term effects of the FDA Reauthorization Act of 2017 — signed into law by President Donald J. Trump on Monday — may include savings in drug-related Medicare expenses due to increased competition encouraged by the FDA by fast-tracking generic competitor approvals, according to an expert.


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When given the chance to pay less, patients choose cheaper prescription drugs
 Credit: Susan Buck Ms/Public Domain

As prescription drug spending continues to rise in the United States, along with prices for new and well-established drugs, insurers, employers and patients are searching for ways to cut costs. A new study led by UC Berkeley researchers found that a policy called reference pricing is effective at encouraging patients to spend significantly less on prescription drugs by choosing cheaper drugs over name brand options.

Under the reference pricing strategy, the insurer or employer establishes its maximum contribution towards the price of therapeutically similar drugs and then the patient must pay the remainder out of pocket. The insurer/employer contribution is based on the price of the lowest-priced drug in the therapeutic class, called the reference drug. In theory, this policy would encourage patients to save money by selecting cheaper drugs that work just as well as their name-brand counterparts.

Reference pricing has been implemented across the United States by self-insured employers such as CalPERS, the agency which manages the pension and health benefits accounts for California public employees. Yet little has been known about how the policy has influenced patient spending on drugs. The new study found that reference pricing was associated with significant changes in drug selection and spending for patients covered by employment-based insurance in the United States. In the first 18 months after implementation, employers' spending dropped $1.34 million and employees' cost sharing increased $120,000.

"With reference pricing, the employer or insurer will make a contribution towards paying for the prescription drug chosen by the patient, and the patient will pay the remainder," said lead author James C. Robinson, director of the Berkeley Center for Health Technology at the School of Public Health. "If the patient chooses a cheap or moderately priced option, the employer's contribution will cover most of the cost. However, if the patient insists on a particularly high-priced option, he or she will need to make a meaningful payment from personal resources."

The study was published in the August 17 edition of the New England Journal of Medicine. Previous studies of reference pricing by the Berkeley center examined the strategy's impact on consumer choices and on employer spending on surgical procedures, hospital procedures and tests. The current study was funded by the U.S. Agency for Healthcare Research and Quality and the Genentech Foundation.

The study analyzed changes in prescriptions and pricing for 1,302 drugs in 78 therapeutic classes in the United States, before and after an alliance of private employers began using reference pricing. The trends were compared to a cohort without reference pricing. The study's dataset included 1.1 million prescriptions reimbursed from 2010 to 2014.

Implementation of reference pricing was associated with a 7 percent increase in prescriptions filled for the low-price reference drug within its therapeutic class, a 14 percent decrease in average price paid, and a 5 percent increase in consumer cost sharing, the study found.

"Reference pricing changes are what we refer to as the 'choice architecture' of health care," Robinson said. "Patients will have access to health care, but will need to pay attention to the price. Consumer choices in health care will come to resemble consumer choices in other areas, where people will make decisions based on value, which includes both good quality and affordable price.?"

Future evaluations of reference pricing will need to assess health outcomes, especially if reference pricing is extended to complex specialty drug classes, the authors note.

The data suggest that reference pricing may be one instrument for influencing drug choices by patients and drug prices paid by employers and insurers. In the future, pharmaceutical firms that wish to charge premium prices may need to supply evidence of commensurately premium performance.

"There is huge and unjustified variation within and across geographic areas in the prices charged for almost every test and treatment, drug and device, office visit and hospitalization," Robinson said. "It's not a surprise when one considers that most patients are covered by health insurance and hence do not shop among competing providers on the basis of price. Some providers look at price-unconscious consumer demand and ask themselves, 'Why don't we raise our prices?'"

More information: James C. Robinson et al, Association of Reference Pricing with Drug Selection and Spending, New England Journal of Medicine (2017). DOI: 10.1056/NEJMsa1700087 Journal information: New England Journal of Medicine

Output: As prescription drug spending continues to rise in the United States, along with prices for new and well-established drugs, insurers, employers and patients are searching for ways to cut costs. A new study led by UC Berkeley researchers found that a policy called reference pricing is effective at encouraging patients to spend significantly less on prescription drugs by choosing cheaper drugs over name brand options.


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Cal State LA Receives $16.6M Dental Health Promotion Grant
 Cal State Los Angeles was awarded a $16.6 million grant Tuesday from the California Department of Health Care Services to promote dental health among low-income children and young adults.

The university was one of 15 recipients of Local Dental Pilot Project funding, which is part of the Medi-Cal 2020 Dental Transformation Initiative that aims to help those enrolled in Denti-Cal, which provides dental services under Medi-Cal to about 6 million children in California.

"This grant recognizes our long history of service and engagement in underserved communities," Cal State L.A. President William A. Covino said. "With this grant, we will be able to assist children who desperately need dental care. We're grateful for the opportunity to serve in new ways."

The four-year grant is believed to be the largest in the university's history.

"Oral health is directly connected with overall health status and well-being across the lifespan," said CSULA professor Rita Ledesma, who is a principal investigator on the grant.

"Oral health can affect academic achievement, self-esteem, relationships, income and quality of life,'' she said. "The grant provides a unique opportunity to build partnerships with community-based organizations and deliver oral health screening, oral health education and supplemental services to address dental health disparities that children and families experience in our community."

CSULA officials said the project will implement educational and intervention strategies for children and young adults in the Los Angeles region and include health screenings. It will also focus on continuity of care and interdisciplinary training of students, agency staff and community members.

The project will also develop outreach to families who have children with special needs, and American Indian and Alaska native families. CSULA will team with USC and Children's Hospital Los Angeles as partners in reaching out to families with children with special needs.

"We look forward to joining with USC to carry out this important work," said Jose A. Gomez, Cal State L.A.'s executive vice president. "The knowledge and expertise of our two institutions will serve Los Angeles well."

Output: Cal State Los Angeles was awarded a $16.6 million grant Tuesday from the California Department of Health Care Services to promote dental health among low-income children and young adults.


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Here's how expanding Medicare could set us on the path to universal health coverage
 Thank you for supporting our journalism. This article is available exclusively for our subscribers, who help fund our work at the Chicago Tribune.

With Republicans seeming to have abandoned their repeal-or-bust attack on the Affordable Care Act, the path to improving Americans' health coverage is wide open.

That has given the idea of single-payer a jump-start. But it hasn't done much to clarify the most important question: How do we get there from here?

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Several routes go through Medicare, an enormously popular program that currently covers Americans 65 and older, many dialysis patients, and the disabled. Indeed, "Medicare for All" is a common mantra among single-payer advocates. But expanding Medicare to take up the slack in our health coverage system will create almost as many problems as it solves. And those will have to be addressed. Let's see how.

"The political ground has shifted in two ways," observes political scientist Jacob Hacker of Yale, who outlined a universal healthcare proposal as long ago as 2002. "During the course of the debate, there was pressure on Democrats to outline a vision of where they wanted to go." The result was "a non-trivial boomlet for Medicare-for-all." That concept is at the heart of healthcare plans from Rep. John Conyers (D-Mich.) and Sen. Bernie Sanders (I-Vt.).

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But by leaving the ACA in place, the end of the GOP repeal campaign encouraged Democrats to build on the existing law for the next phase of health coverage expansion. "If the ACA had been completely wiped out," Hacker says, "there would have been more pressure on Democrats to go for single-payer completely." Medicare-for-all and the expansion of the ACA, he says, aren't entirely compatible with one another.

Most countries fund healthcare from public, private and out-of-pocket sources, but the U.S. system relies less on public money and much more on private money. (Nation)

Before going further, a couple of general points: "Single-payer" and "universal coverage" are often used interchangeably, but that wrong. It's possible to have the latter without the former — indeed, every major country with universal coverage has multiple payers to some extent, though payments to doctors and hospitals for services typically are much more centrally regulated than in the U.S.

Almost every industrialized country finances its health coverage through a combination of public, private (typically employer-paid), and out-of-pocket spending. The key difference among them is the share of each category. As the accompanying chart from the Nation shows, the United States funds far more than any other country privately — at 40% of all healthcare spending, that's nearly three times the share of the runners-up, Ireland (15%), Canada (15%) and France (14%).

The public share of healthcare spending in the U.S., meanwhile, is well below that of other industrialized countries — 49% — even though Medicaid and Medicare are two of our biggest government programs. No other country contributes less than 64% of health spending from public funds. That's Switzerland. Countries known for their universal health coverage, such as Britain, France, Japan and the Scandinavian countries, all contribute at least 80% of healthcare costs from the public till.

Medicare isn't as comprehensive as many people believe: That's why a third of enrollees have joined more inclusive Medicare Advantage plans. (Kaiser Family Foundation)

"In most countries, they basically say, 'You're covered,' and then they figure out how to get money from you or your employer or anybody else to finance your care," Hacker says. "But they don't make your coverage contingent on your ability to hunt down the money and pay for it in advance."

That brings us back to Medicare, which resembles a single-payer program in that reimbursements to doctors and hospitals, along with mandated benefits, are centrally regulated. Part A, which covers hospitalization, is premium-free for most Americans who have paid payroll taxes during their working years. But Part B, which covers physicians, requires a monthly premium based on income, as does prescription coverage under Part D.

A and B charge enrollees deductibles and co-pays, as do some Part D plans. And Parts A and B don't have caps on out-of-pocket spending. That's why about one-third of enrollees choose Medicare Advantage plans, which cap out-of-pocket expenses and offer enhanced benefits, and others buy "Medigap" plans, which are offered by private insurers to fill in Medicare's blanks. Both are offered by private insurers.

The U.S. is roughly in the middle of the pack when it comes to out-of-pocket spending as a share of the total. But it's proper to keep in mind that U.S. healthcare costs are grossly out of line compared with other countries — at more than $9,000 per capita, its roughly twice the average among members of the Organization for Economic Cooperation and Development, OECD. That means that American pocketbooks are disproportionately affected by out-of-pocket spending, even at average ratios.

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So the goal really is universal coverage. Single-payer, in which the government pays all healthcare costs for everyone, is one way to get there, but not the only way. As we wrote in May, when a single-payer plan was before the California Legislature (it failed), "single-payer almost certainly would be cheaper and simpler than the ridiculous contraption we have now, a mishmash of employer, government and private plans all with different rules and standards" and is "favored by a clear majority of Americans in opinion polls, at least in theory." But covering everyone is Job One, and figuring out how to pay for it is Job Two.

In most countries, they basically say, ‘You’re covered.'...They don’t make your coverage contingent on your ability to hunt down the money to pay for it. — Jacob Hacker, Yale University

So traditional Medicare isn't as good as the typical large-employer plan or even ACA plans, which cap out-of-pocket spending. For a non-elderly population, Medicare benefits would have to be expanded to cover such services as pediatric care, maternity and birth control.

That suggests that replacing existing health coverage with Medicare for all without a lengthy transition period would be a heavy political lift, as Paul Starr of Princeton observed in March, during the heat of the GOP attack on the ACA. "Medicare-for-all faces two enormous obstacles," he wrote. "Moving everyone under age 65 into Medicare would require a huge increase in taxes; employees who now receive health care as a fringe benefit would inevitably look at those taxes as an additional burden, even if reformers try to assure them that their wages would rise once health care was financed by taxes." The second obstacle is seniors' fear that "extending the program to others will jeopardize their coverage."

Overcoming these obstacles would require lengthy political debates over the breadth of coverage and how to distribute costs, especially to the extent that it would involve raising taxes on the rich — very similar to the debate about those issues during the drafting of the Affordable Care Act and in the seven years since its enactment.

Yet some intermediate steps suggest themselves. In an essay published this month in Health Affairs, Hacker, Starr, and Gerard Anderson of Johns Hopkins University suggest making Medicare available on the ACA exchanges, say in any county or region with two or fewer competing private insurers. That would turn Medicare into a sort of public option of the sort that was initially contemplated for the ACA. They also propose that private insurers offering Medicare Advantage plans in any region be "required to offer such plans within the exchanges as well" — a trade-off using the insurers' desire for the profits they reap from Medicare Advantage, which are substantial, to goad them into improving the offerings in the individual exchanges. (We've recommended a similar arrangement that would require insurers bidding for desirable Medicaid expansion contracts in a state to participate in the exchanges.)

"We know that Medicare Advantage plans already operate in counties where there are no private insurers," Hacker says. "We know how to do this." Over time, the Medicare offerings could be expanded into counties with more competing insurers, and eventually nationwide. "A lot of questions would remain and this is not going to happen overnight be any means, but you can see how it works in discrete steps and moves us in the direction of Medicare for all."

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Hacker would couple that arrangement with a pay-or-play requirement for employers — not a mere tax on those that don't offer coverage to their workers, as exists under the ACA's employer mandate, but a requirement that they actually contribute to the cost of their coverage within a Medicare-like system. For small businesses this could be a modest charge, but as Hacker argued in a 2007 version of his "Health Care for America" plan, it would ensure that "no one with a direct or family tie to the workforce would remain uninsured."

Other proposals for gradually extending Medicare include lowering the eligibility age from the current 65 in stages — say to 60 or 55 in the near term. (Starr called this "midlife Medicare.") This has the virtue of guaranteeing coverage to a segment of the uninsured population most at risk of heavy medical expenses, since on average they have greater medical needs than younger Americans and even under the ACA can be charged higher premiums. On the downside, they're expensive to cover, which means finding new funding for their care.

The most important political shift resulting from the failed GOP repeal effort may be the assumption that everyone should be covered. That's implied bythe Congressional Budget Office's determination that the GOP's repeal plans would deprive more than 20 million Americans of their coverage — a finding that arguably delivered the death blow to the GOP's repeal dream. That shift may finally have put the U.S. on the path to universal coverage, and all we're really arguing about now is how to pay for it.

Keep up to date with Michael Hiltzik. Follow @hiltzikm on Twitter, see his Facebook page, or email michael.hiltzik@latimes.com.

Return to Michael Hiltzik's blog.

Output: With Republicans seeming to have abandoned their repeal-or-bust attack on the Affordable Care Act, the path to improving Americans' health coverage is wide open. That has given the idea of single-payer a jump-start. But it hasn’t done much to clarify the most important question: How do we get there from here?


Instruction: create a high quality summary of the given input

Input:
Governors Preparing Bipartisan Health Care Plan For Congress To Consider
 In the wake of congressional Republicans' failure to pass a health care bill, two governors from different parties are going to bring their own ideas to Washington.

Staff for Colorado Gov. John Hickenlooper, a Democrat, and Ohio Gov. John Kasich, a Republican, are working on a joint plan to stabilize the country's health insurance markets. Kasich told Colorado Public Radio's Colorado Matters that they expect to release it ahead of September hearings in the U.S. Senate. They also intend to get other governors from both parties to sign onto the plan, to show support at the state level.

"We're getting very close. I just talked to my guys today, men and women who are working on this with [Hickenlooper's] people, and we think we'll have some specifics here, I actually think we could have it within a week," Kasich said in a joint interview with Hickenlooper that aired Tuesday.

The plan will flesh out a set of principles the two men wrote about in an op-ed in The Washington Post, in which they said another one-party health care plan is "doomed to fail," just like the Republican plans considered this year. In the op-ed, they asserted that the best place to start reform efforts is "to restore stability to our nation's health insurance system."

Bipartisan health care hearings, including the one the governors will appear at, are set to begin just after Labor Day when Congress returns from its August recess. Lawmakers will be consumed with a number of deadlines involving government funding, though — sending health care to the back burner.

"I'm not going to get into specifics with you until we have it all ironed out, but it's not going to be some pie-in-the-sky, way-up-there kind of stuff. There will be things that we will address that will have specific solutions. And one of the things we're finding out is the states do have some power to do some things unique to them, as long as these insurance markets are going to be stabilized," Kasich said.

One specific they agree on and would discuss: changing the Affordable Care Act mandate that employers with 50 or more employees provide insurance coverage. The governors say that number is too low, which deters hiring at small companies.

They also agree that the possibility of national single-payer coverage is not on the table in their discussions.

In recent months, Hickenlooper and Kasich have appeared on national television shows to advocate for bipartisan health care reform that includes keeping the Medicaid expansion intact, with both took advantage of in their states. The two governors have even entertained running for the White House on a split ticket.

Interview Highlights With Govs. Hickenlooper And Kasich

On whether they think health care should be a "right"

John Hickenlooper: I come from the school that I think it is a right. I'm not sure how much health care is included in that right, but some basic coverage.

John Kasich: I don't think that's that important in this. I mean we want everybody to have health insurance. I mean that's how I feel. Is it a right or is it a privilege or whatever? I don't know why that declaration is important ... The question is how do you do it, and that's what we're working on ... Primary care is important. Catastrophic coverage is important. We don't want anybody to get bankrupted because they get sick.

On what to change about the Affordable Care Act first

Hickenlooper: There are several important things, but the probably top one on our list would be this notion of having some sort of reinsurance [using public money to help insure the sickest people] to make sure the high-cost pool is not causing higher rates for all the people seeking insurance on the private markets ... You use reinsurance in almost every type of insurance program to cut off those "hilltops" as we say.

On why this joint effort may gain traction

Hickenlooper: "[The Senate's health committee] is now holding hearings [starting Sept. 5], and hopefully in those hearings we'll get a chance to present, hopefully, what by that point a number of both Republican and Democratic governors think look like good ideas."

The Colorado Matters website has the full transcript.

This story is part of a reporting partnership with NPR, Colorado Public Radio and Kaiser Health News.

Copyright 2017 CPR News. To see more, visit CPR News.

Output: In the wake of congressional Republicans' failure to pass a health care bill, two governors from different parties are going to bring their own ideas to Washington. Staff for Colorado Gov. John Hickenlooper, a Democrat, and Ohio Gov. John Kasich, a Republican, are working on a joint plan to stabilize the country's health insurance markets.


Instruction: create a high quality summary of the given input

Input:
Why state-level single-payer health care efforts are doomed
 With members of Congress spending the month of August in their home districts, Republican efforts to do away with President Obama’s signature legislative achievement, the Affordable Care Act (ACA), appear stalled, at least temporarily.

However, the Trump administration still appears committed to unraveling the ACA. Most prominent are the threats to withhold cost-sharing reductions, which reduce out-of-pocket payments for low-income consumers on the insurance marketplaces. According to the Congressional Budget Office, cutting these payments would drive up health insurance premiums by 20 percent while costing the federal government close to US$200 billion over a decade.

Ultimately, the future of the ACA remains murky at best, leaving blue states scrambling for alternatives. One of progressives’ favorite solutions was floated by the California legislature at the height of Republican efforts to repeal the ACA: a plan to develop a single-payer health insurance system. Enthusiastic progressives, reeling from a series of defeats since the election of President Trump, quickly hailed the efforts as a path forward in Trump’s America.

Policy experts like me were not surprised when efforts in California petered out, not the least due to the massive price tag of $400 billion annually. Californians had been subjected to similar experiences over the decades, going back to the 1910s. Time and time again, efforts at comprehensive health reform have failed in the Golden State and elsewhere, such as Washington and Kentucky.

To the dismay of progressives, future efforts are likely equally doomed to failure. While states have been innovators with regards to many policies, fiscal issues and regulatory limitations will most likely preclude states from pursuing sweeping health reform. Here is why.

Financing health reform is challenging

Providing insurance to those who cannot afford it is a costly endeavor, particularly in the United States. Without the financial support from the ACA, which currently provides subsidies in the individual marketplaces and pays for well over 90 percent of the Medicaid expansions, states would be required to allocate funds for this purpose. This would be undeniably challenging.

For one, many states are still recovering from the Great Recession. Moreover, other important state functions like K-12 and higher education and criminal justice are taking up large parts of states’ budgets.

Perhaps most crucially, unlike the federal government, states are generally not allowed to carry a deficit so budgets need to be balanced in any given year.

This leaves tax increases as the only solution for states seeking to get more of their residents insured. From an institutional perspective, increasing taxes is a significant obstacle because in most cases this would require a supermajority of the legislature, as well as a willing governor to accomplish. With Republicans by and large unwilling to go this route, this seems exceedingly unlikely in the foreseeable future.

Yet even for those states finding a path to increasing taxes, significant obstacles remain. Unlike for health reform at the federal level, residents and businesses have a degree of mobility that allows them to select their location of residency. So increasing state taxes to fund health care expansion could prompt businesses and individuals to locate to other states with lower taxes.

It would likely also mean that poorer and sicker individuals seeking access to health coverage, particularly from neighboring states, would relocate to these states.

Over time, health reform would thus be financially unsustainable.

Health reform in a federal system is complex

Finances aside, there are also significant intergovernmental regulatory realities preventing states from moving forward on health reform on their own. Two issues stand out.

For one, a little-known law called the Employee Retirement Income Security Act of 1974, commonly referred to as ERISA, poses the most crucial obstacle. While mostly intended to address retirement and pensions, ERISA also preempts states from regulating companies that choose to self-insure with regard to health care.

Self-insurance refers to arrangements where companies, instead of relying on insurance company like Blue Cross or Cigna, pay their employees’ medical claims directly. While companies generally contract for the administration of these arrangements, the employing company bears the entire risk. A striking 50 million employees, particularly in large companies, are subject to these arrangements.

Second, states also do not have full regulatory authority over individuals obtaining coverage through Medicaid and Medicare. States are virtually excluded from regulation for the latter and require the cooperation of the federal government for the former.

Combined, this puts more than 50 percent of insurance markets out of reach for state-based health reform efforts, making it inherently unviable.

So how did Massachusetts do it?

Given these limitations, how was Massachusetts able to implement state-based health reform? It took a confluence of fortuitous circumstances.

First, there was bipartisan cooperation at both the state and federal level.

Massachusetts Gov. Mitt Romney, President George Bush and Secretary of Health and Human Services Mike Leavitt, all Republicans, were able to come to an agreement with Sen. Ted Kennedy (Democrat of Masachusetts) and Democrats in the state legislature.

Bipartisanship also meant that everyone was invested in the project, at the state and federal level, and sought to make a success.

Second, the federal government was willing to foot most of the bill and provided regulatory support for the state’s effort.

Third, Massachusetts is a relatively wealthy state that already covered a large percentage of its population.

A confluence like this appears highly unlikely under current political realities.

Moving forward with GOP health reform

States have a long history of developing sound policy solutions. For example, Wisconsin pioneered both unemployment insurance and pension schemes that laid the foundation for federal policies during the New Deal.

Yet states are not equally well-equipped to address all policy issues. Comprehensive health reform is one of those issues.

Current GOP proposals would do little to overcome the financial and regulatory barriers to state-based reform.

Indeed, states would be further inhibited by significant cuts to the Medicaid program. Moreover, waivers included in the various proposal, in a marked contrast to the ACA, are focused on allowing states to provide less coverage and fewer benefits.

Allowing policies to be sold across state lines, if successful, would further restrict the sovereignty of states to regulate their insurance markets.

Republican efforts to repeal and potentially replace the ACA may not be dormant for long. The Democratic victory in the Senate in July was a shaky one that could be quickly undone, for example, if Sen. Joe Manchin (Democrat of West Virginia) or Sen. John McCain (Republican of Arizona) choose to leave the Senate. The 2018 election for the Senate also puts Democrats at a significant disadvantage and Republicans may further enlarge their majority.

Unquestionably, progressive legislators will continue to introduce bills aimed at comprehensive reforms. Yet, history and economics tell us that these efforts are unlikely to make much headway. The structural limitations of states in a federal system may confine their efforts to filling in the gaps until the federal government further extends coverage.

Simon Haeder, Assistant Professor of Political Science, West Virginia University

Output: With members of Congress spending the month of August in their home districts, Republican efforts to do away with President Obama’s signature legislative achievement, the Affordable Care Act (ACA), appear stalled, at least temporarily.


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Input:
Conflict in South China Sea would have widespread impact on trade
 watch now

Several industries are trying to assess what open confrontation in the South China Sea would cost them, and a lot of them don't like what they're finding. The world's second-largest economy is getting more wary — and more vocal in its opposition — about increased U.S. naval patrols along the vast body of water, which holds some of the world's busiest trade routes. The U.S. Navy has sailed close to South China Sea reefs, atolls and other areas claimed by Beijing several times in recent months, under the pretext of freedom of navigation operations. In late May, the USS Dewey sailed within 12 miles of the Chinese artificial island Mischief Reef. In July, the USS Stethem passed by the Chinese-administered Triton Island. Then last week, the USS John S. McCain traveled close to Mischief Reef.

A U.S. Navy MH-60R Sea Hawk helicopter from the "Blue Hawks" of Helicopter Maritime Strike Squadron 78 fires chaff flares during a training exercise near the aircraft carrier USS Carl Vinson (CVN 70) in the Philippine Sea April 24, 2017. Sean M. Castellano | US Navy | Reuters

Watch out for these companies

With more than $5 trillion of trade flowing through the area every year, any hostility between would hit numerous business sectors, including commodities, logistics, and insurance. "Conflict between the U.S. and China in the South China Sea would be less about the physical things that can be produced, but more about controlling physical access and the key choke-points around it," Stratfor analyst Matthew Bey told CNBC earlier this year.

Satellite image of the Scarborough Shoal in the South China Sea, a fishing-rich area claimed by both Manila and Beijing, on 12 January 2017. USGS/NASA Landsat data/Orbital Horizon/Gallo Images/Getty Images

Almost every major container shipping company sends vessels through the South China Sea, making all of them vulnerable if Washington and Beijing butt heads, said Bey. "The ports that would be adversely impacted are the Straits of Malacca, East China straits, straits of Sunda and Lombok." Should Trump increase patrols by China's artificial islands as part of his new policy, that could particularly hurt the China National Offshore Oil , one of the the mainland's biggest crude producers, Bey added. Also known as CNOOC, the firm has commercial drilling platforms in the South China Sea and drew international attention in 2014 after placing an oil rig near the Paracel Islands that triggered a major spat between Beijing and Hanoi. CNOOC offered no comment on the matter.

Paying a premium for protection

Maritime insurance rates may spike if insurers identify parts of the South China Sea as a war risk. That means vessels would have to pay a premium to transit the area — or avoid the area completely, explained Andrew Booker, founding partner of marine specialist Latitude Brokers. However, that scenario remains highly unlikely at present, he added.

watch now

It's impossible to estimate how high rates could rise but because there is no premium for transiting the area at present, anything would be an increase, he said.

If that were the case, trade routes would change and freight costs for each voyage would rise, which could be good news for ship-owners but bad for charterers who pay freight, Booker continued.

Currencies will depreciate

Geopolitical strains could also weaken the Korean won and the . Financial markets in those countries have a large number of foreign equity investors, and those traders tend to sell shares in the wake of political tensions, explained Khoon Goh, head of Asia research at Australian bank ANZ. When those stock markets take a beating, so do their currencies. If that's the case, Goh predicts the won will fall to 1180 per dollar from 1130 presently, and the Taiwan dollar to hit 31.6 from current levels of 30.2. But the safe-haven Japanese yen would likely benefit amid the overall risk-averse mood, Goh added.

Oil climbs

The South China Sea holds around seven billion barrels of oil and 900 trillion cubic feet of natural gas, but in the event of hostilities, those reserves won't be first in the firing line. The more immediate impact may be a rally in global crude prices. Any conflict could disrupt the movement of energy resources, thus curbing overall supply and pushing Brent crude to around $65 per barrel, said Jonathan Chan, investment analyst at Phillip Futures. Oil futures trade hands at about $52 currently.

Nov 2016: A close-up of Chinese construction activities on the Cuarteron Reef, located at the east end of the London Reefs in the Spratly Islands of the South China Sea. DigitalGlobe via Getty Images.

Air freight is considerably more expensive than maritime shipping, and even within countries, overland networks are often not as well-developed. Maritime routes remain the most popular for the transportation of resources, he said.

Metals and minerals to bounce

Beijing imports massive quantities of copper and iron ore, so any blockage or disturbance to transport routes would cause prices of both commodities to spike, according to Chan. "Iron ore on the SGX Asia Clear could hit $95 per metric ton in the event of escalation," Chan said, "while copper may soar to $6,480 per ton." Gold, may rally to $1,450 per ounce, Chan added. That would mark a sharp bounce from its present level of near $1,285.

Happier fish and fishermen

An estimated 12 percent of the world's fish harvest comes from the South China Sea, where more than 3,000 known species dwell. But fish stocks have been rapidly declining amid Beijing's island-building activities. If Washington can stop Chinese construction and protect the rights of regional fishermen — especially Vietnamese, Indonesians and Filipinos — that would be welcomed, said Greg Poling, director of the Asia Maritime Transparency Initiative, at the Center for Strategic and International Studies. The sand and silt plumes created by dredging sand and gravel can kill fish or drive them from the reefs — a major problem for Southeast Asian fishermen who rely on the creatures for their livelihood. The problem is further exacerbated by China's annual fishing ban, typically between mid-May to early August, in parts of the sea that it administers. "Chinese dominance has been bad news for Southeast Asian fishermen, as evidenced by the way the Chinese authorities treat Vietnamese fishermen during the 3-month ban," Poling said.

WATCH: Why Trump's foreign policy is on a collision course in the South China Sea

Output: Industries have been trying to assess the damage that an open confrontation in the South China Sea would cause, since, with over $5tn of trade flowing through the area annually, any outbreak of hostilities would affect numerous sectors. Ports at the Straits of Malacca, east China straits and the straits of Sunda and Lombok would be adversely affected, for example. Also, shipping firms and several Asian currencies would be hit, and maritime insurance rates and prices for oil, copper, gold and iron ore are predicted to rise. However, the Japanese yen would be expected to strengthen in more anxious times.


Instruction: create a high quality summary of the given input

Input:
WPP cuts growth forecast as second quarter sales slow
 Sir Martin Sorrell has warned of a global economic slowdown as WPP slashed its growth forecast for the second time, leaving the world’s largest advertising group facing its worst year in a decade.

Sorrell said the election results in the UK and US, combined with erratic economic conditions in faster-growth economies such as China, had affected the global advertising market.

“In the last year or so, growth has become even more difficult to find, perhaps due to increasing social, political and economic volatility,” he said. “For example with the rise of populism typified by surprise election results in the United Kingdom and the United States and bumpy growth in... Brazil, Russia and China.”

Advertising and marketing spend by multinational companies is viewed as a bellwether for the global economy, which has enhanced Sorrell’s reputation as a commentator on economic growth given the presence of the consumer goods group Unilever and carmaker Ford on the WPP client list. Sorrell, one of the UK’s best-paid chief executives with a £48m pay packet last year, said that next year is “unlikely to be much different” for a slowing global economy.

“There seems little reason for an upside breakout in growth in terms of worldwide GDP growth,” he said, adding that while interest rates were likely to rise, they would remain at relatively low levels for “longer than some think”.

Sorrell added that Donald Trump’s patchy performance as US president to date has not so far proved to be the boon to business that had been hoped.

“Trumponomics may well have resulted in an increase in the United States GDP growth rate … [but] the limitations of the new administration seem to be jeopardising the anti-regulatory, infrastructure and tax reduction programme that was promised,” he said.

WPP’s share price tumbled 11% to £14 on Wednesday after the company made a shock cut in revenue and net sales forecasts, which wiped almost £50m off Sorrell’s paper fortune as it fell from around £412m to £365m.

Sorrell was forced to cut WPP’s full-year forecasts for the second time this year after reporting a marked deterioration in the second quarter that missed City expectations by some distance. He started the year forecasting that WPP would see growth of 3% but cut this in March to 2% to reflect “tepid” economic growth and weak new business trends.

On Wednesday, he slashed that even further – to growth of between zero and 1% – after reporting that net sales in the first half had fallen by 0.5% to £6.3bn, missing analysts’ forecasts. The City expected growth in the second quarter of 0.5%, but WPP plummeted by 1.7% to £3.2bn.

“Following the pressure on client spending in the second quarter, particularly in the fast-moving consumer goods (FMCG) or packaged goods sector, the full-year revised forecast has been revised down further, with both like-for-like revenue and net sales forecast to be between zero and 1.0% growth,” the company said.

Sorrell said there were no major job cuts planned imminently to help to counter the worsening conditions, pointing out that WPP had shed more than 1,400 staff this year. The job losses, about 1% of its workforce of about 134,000, were largely due to IT changes. “We are controlling our headcount reasonably well,” he said.

WPP painted a bleak picture of performance beyond the first half with net sales growth running down by 2.6% in July and net sales for the first seven months of the year down 0.8%.

It means WPP is on track to record its worst year in growth terms since 2009, when the company reported a full-year fall of 8.1% during the depths of the credit crunch.

Sorrell said WPP was preparing for Brexit by increasing investment in operations in key European markets, adding that free movement of staff was imperative to maintaining UK growth.

“About 17% of the 14,000 to 15,000 people we have in the UK come from the European Union,” he said. “If there are severe restrictions on their movement inward or outward in the future that will obviously impact our business in the UK. Our response [to Brexit] is to increase investment in France, Germany, Italy and Spain. Those are four of our top 10 markets and we can’t afford to lose influence or position in those markets.”

Output: Advertising and PR giant WPP is shaping up for its worst year in a decade and has cut growth forecasts for this year for the second time. The firm has reduced its full-year growth forecast for revenue and net sales to zero to 1% after starting the year predicting 3% growth. WPP's share price fell 11% following the news. WPP founder and CEO Sir Martin Sorrell blamed the disappointing performance on the Trump administration's wavering on reform for taxes and regulation, as well as lower demand from FMCG clients and "bumpy growth in Brazil, Russia and China".


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Input:
People should be able to sue nursing homes for abuse of elderly patients, lawmakers and activists say
 Healthcare, tax reform and the debt ceiling probably will be among the highest-profile issues when Congress returns from a monthlong recess Sept. 5.

But Democratic lawmakers and consumer advocates already have served notice that they’re also going to keep a spotlight on protecting people’s right to sue nursing homes for neglect or abuse of elderly patients.

The Trump administration, through the Centers for Medicare and Medicaid Services, announced in June its intent to roll back legal rights for consumers put in place under the Obama administration.

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Those rights include prohibiting any nursing home that receives federal funding — which is most of them — from requiring that disputes be addressed through mandatory arbitration rather than the legal system.

Thirty-one senators have written to CMS Administrator Seema Verma during the August recess calling on her to abandon plans to once again allow nursing homes to include mandatory arbitration provisions in their contracts.

“Forced arbitration clauses in nursing home agreements stack the deck against residents and their families who face a wide range of potential harms, including physical abuse and neglect, sexual assault and even wrongful death at the hands of those working in and managing long-term care facilities,” the lawmakers said.

“These clauses prevent many of our country’s most vulnerable individuals from seeking justice in a court of law, and instead funnel all types of legal claims, no matter how egregious, into a privatized dispute resolution system that is often biased toward the nursing home.”

In a separate letter, three dozen consumer groups and social justice organizations called the proposed change “cruel” and said it was “a disturbing new direction for CMS, which should be protecting patients, not making it easier for facilities to harm them and cover it up.”

“Placing a parent or loved one in a nursing home is already one of the most difficult things anyone will ever have to do in life,” they said. “But forcing the patient or family member to then sign something that violates the resident’s legal rights should they suffer future abuse or serious neglect is a horrific thing to do to families.”

The attorneys general of California and 15 other states, along with the District of Columbia, also submitted opinions this month calling on CMS to maintain the right to sue as a crucial means of holding nursing homes accountable for the welfare of residents.

A CMS spokesman, requesting anonymity for no particularly good reason, told me the agency stopped accepting feedback on the matter as of Aug. 7 after receiving “over 1,000 public comments.”

He noted that, under federal law, CMS has three years from release of the proposed change in June to issue a final rule, though a decision could come at any time.

The nursing-home industry is by no means alone in preferring arbitration for dispute resolution and denying people their day in court. Mandatory arbitration is a routine feature of contracts for telecom companies, credit card issuers and numerous other businesses.

Companies argue that consumers benefit from faster, cheaper arbitration proceedings, rather than having cases tied up in courts for possibly years and sharing any monetary awards with lawyers.

Yet with exquisite irony, the American Health Care Assn., a nursing-home industry group, took its case to court before the Obama administration’s rule could take effect in November. A federal court granted the association’s request for an injunction so the industry’s lawyers could litigate the matter.

Mark Parkinson, chief executive of the association, said at the time that “study after study shows that arbitration is fair and speeds judgments in a cost-effective manner that benefits those injured more than anyone else.”

In fact, study after study shows that consumers typically get the short end of the stick in arbitration. The advocacy group Public Citizen found that over a four-year period, arbitrators ruled in favor of banks and credit card companies 94% of the time in disputes with California consumers.

A 2015 study by the Consumer Financial Protection Bureau found that in grievances with financial-services firms, “class actions provide a more effective means for consumers to challenge problematic practices by these companies.”

One key reason: Arbitrators’ fees usually are paid by the business, not the consumer. If an arbitrator wants more cases, he or she has a strong incentive to make the company happy.

You could argue that nursing homes are the last places you want to keep disputes under wraps. Such secrecy clearly does little to promote safety and accountability.

Just as important, litigation provides a public record that other families can use in making their own decisions. Ask yourself: Would you be comfortable placing your parent in a facility that settled a lawsuit over patient abuse?

As of 2014, there were nearly 16,000 nursing homes nationwide with 1.4 million residents, according to the Centers for Disease Control and Prevention.

A report that year by the Department of Health and Human Services found that 33% of nursing-home residents experienced “adverse events” or “temporary harm.” Investigators attributed much of the harm to “substandard treatment, inadequate resident monitoring, and failure or delay of necessary care.”

The Department of Justice determined that “most adverse events in nursing homes — due largely to inadequate treatment, care and understaffing — lead to preventable harm and $2.8 billion per year in Medicare hospital costs alone.”

Such shameful stats are why the nursing-home industry is fighting so aggressively to block residents and their families from being able to sue. It has spent about $8 million on lobbying activities over the last two years, according to the Center for Responsive Politics.

It’s also what the Trump administration is talking about when it says — as it did in June — that restoring mandatory arbitration would “reduce unnecessary provider burden.”

That’s a pretty cold-hearted way of saying you’re going to look after the financial interests of an industry that may be abusing hundreds of thousands of seniors annually.

I suspect most nursing-home residents and their kin would say this in response: These companies would have nothing to worry about if they did an adequate job of keeping people safe.

That’s not too much to ask.

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

Output: Healthcare, tax reform and the debt ceiling probably will be among the highest-profile issues when Congress returns from a monthlong recess Sept. 5. But Democratic lawmakers and consumer advocates already have served notice that they’re also going to keep a spotlight on protecting people’s right to sue nursing homes for neglect or abuse of elderly patients.


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Input:
Caregiving needs double as end of life nears
 (HealthDay)—Reliance on caregivers doubles as people near death, and half of those caregivers—typically unpaid family members—report having no time for themselves, a new study indicates.

The research used a nationally representative sample of about 2,400 older adults in the United States. The study authors found that caregivers provided nearly twice the number of hours of help each week to dying individuals than to those not at the end of life.

"We were certainly aware when dealing with end-of-life care that families are mostly involved, but we couldn't quantify that prior to this [research]," said study author Dr. Katherine Ornstein. She's an assistant professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai in New York City.

More than 34 million Americans provided unpaid care to an adult aged 50 or older in the past 12 months, according to 2015 figures from the National Alliance for Caregiving and AARP. Most caregivers are female.

Ornstein and her team drew from two nationally representative surveys in which caregivers in the United States reported their experiences caring for dying adults over age 65. The researchers contrasted this data with that of other caregivers providing ongoing care.

Older adults were classified as being at the end of life if they died within 12 months of the surveys' completion.

The study found that dying adults had an average of 2.5 caregivers assisting them. Those near the end of life received 61 hours of help per week compared to 35 hours of help per week for older adults who weren't at the end of life.

More than one-third of the end-of-life caregivers reported physical difficulty related to their duties. Just over half reported having no time for themselves. These figures were 21 percent and 40 percent, respectively, for other caregivers.

Nearly nine in 10 caregivers are unpaid, according to the study. For end-of-life caregivers who were spouses, nearly two-thirds reported receiving no help from family or friends.

"What we see now is, on average, there are 2.5 people helping someone at the end of life. You can imagine if they don't have that, it's much more difficult," Ornstein said. "When spouses are serving as caregivers, the majority are reporting doing it alone and have the [most challenging] consequences."

Barbara Coombs Lee is president of Compassion & Choices, a Washington, D.C.-based advocacy organization for patients' rights and end-of-life issues. She pointed out that the caregivers surveyed in the new study didn't necessarily know ahead of time that the person they were caring for was at the end of life.

This lack of awareness may have increased caregivers' stress levels, she said.

"This told me the caregivers were probably struggling, not knowing this was an end-of-life situation. Our [organization's] research indicates that uncertainty about decision-making is an inherent and extremely powerful source of stress," Lee said.

"I would guess that many of these people didn't know they were dying ... so they pursued heroic, torturous, futile treatment," she added. "Often the default decision [to continue treatment] increases the caregiver burden."

Ornstein said she hopes greater awareness of the family burden of caregiving, especially at the end of life, comes from her research.

"We need to think about expanding access to palliative care services, which can help facilitate the delivery of supportive services to families earlier," she added. "And we can see how we need to provide more paid family leave so families can provide the support we're pretty much expecting them to provide."

Lee agreed with the need for expanded access to hospice and palliative care.

"One of the big barriers to access to hospice is [an] information gap," Lee said. "People don't understand that hospice is appropriate to them in their journey in their illness. Palliative care utilization would go up if people had more candid conversations and were privy to information that physicians have but aren't sharing."

The study was published recently in the journal Health Affairs.

More information: Katherine Ornstein, Ph.D., M.P.H., assistant professor, geriatrics and palliative medicine, Icahn School of Medicine at Mount Sinai, New York City; Barbara Coombs Lee, president, Compassion & Choices, Washington, D.C.; July 2017, Health Affairs The Family Caregiver Alliance has helpful information for caregivers. Journal information: Health Affairs

Copyright © 2017 HealthDay. All rights reserved.

Output: Reliance on caregivers doubles as people near death, and half of those caregivers—typically unpaid family members—report having no time for themselves, a new study indicates. The research used a nationally representative sample of about 2,400 older adults in the United States. The study authors found that caregivers provided nearly twice the number of hours of help each week to dying individuals than to those not at the end of life.


Instruction: create a high quality summary of the given input

Input:
HCL Sir Andrew Morris to retire from Frimley Health NHS trust next year
 The chief executive of Frimley Health NHS Foundation Trust has declared he has ‘unfinished business’ despite announcing his decision to retire in February next year after 29 years in charge.

Sir Andrew Morris has worked in the NHS for 43 years and is one of the longest standing hospital chief executives in England.

The 62-year-old said: “It has been a privilege to work for our local hospitals.

“For me, healthcare is a people business and I have worked with some outstanding colleagues.

“I am proud of what we have achieved together over the years.”

Frimley Health NHS Foundation Trust is responsible for Wexham Park Hospital in Slough, Heatherwood Hospital in Ascot and Frimley Park Hospital close to Camberley.

Sir Andrew joined the NHS in 1974 aged 19, where he progressed through a number of roles in the Midlands and was appointed general manager of Frimley Park Hospital in February 1989 – becoming its chief executive in 1991.

He then led Frimley Park’s successful application to become one of the first foundation trusts in 2005.

Last year he led the creation of the Frimley Health and Care Accountable Care System (ACS) in an unpaid capacity and will continue to focus on the ACS in a part-time capacity.

An ACS aims to bring together GPs, hospitals, physical and mental health services , social care and the voluntary sector in the same area to provide a more coordinated care system.

On the ACS, he said: “The NHS has talked about integrated care for a long time but the way the system was set up made it hard to work collaboratively.

“Now we have a chance to make serious progress and we have to do it, not least for our growing older population.

“For me, this is unfinished business.

“We have already made great progress with the Frimley system and we have been identified as an area that can pioneer improvements the rest of the country can follow.

“I want to help make that happen.

“For our patients, it will mean more joined-up services and faster progress in areas that really matter - like making it easier to see a GP and getting faster access to mental health care.”

He also led the acquisition of Heatherwood and Wexham Park Hospitals NHS Foundation Trust to create Frimley Health NHS Foundation Trust in 2014 and was knighted in January 2015 for services to public health.

The trust’s chairman Pradip Patel said: “Sir Andrew will be a hard act to follow and I am determined to find the right person who can build on the legacy that he will leave behind.”

Jim Mackey, chief executive of NHS Improvement, added: “Sir Andrew is a great example of what NHS leadership should be.

“He cares deeply about patient care, the service generally and the staff he leads, and he displays NHS values in everything that he does.”

Output: Frimley Health NHS Foundation Trust's chief executive, Sir Andrew Morris, will retire in February 2018 after holding hospital leadership roles for nearly 30 years. Morris has been employed in the NHS for 43 years and is one of the longest standing hospital chief executives in England. The Frimley Health NHS Foundation Trust oversees Wexham Park Hospital in Slough, Heatherwood Hospital in Ascot and Frimley Park Hospital near Camberley.


Instruction: create a high quality summary of the given input

Input:
Non-employment in older age is associated with feeling isolated and under-utilised
 Credit: University of Glasgow

Compared to those who work, and in contrast to many popular perceptions, older people who are retired, home-makers, unemployed, or not working because of sickness or disability are more likely to feel that their status results in poorer social and mental engagement and lower self-esteem, according to a new study.

The research published today, from the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, explored attitudes towards employment and non-employment in over 1,500 men and women aged 55 to 70 and living in the West of Scotland.

The study found associations were particularly marked among unemployed and sick or disabled respondents, who also felt that their status was a source of worry and prevented them from feeling in control.

Lead author Dr Elise Whitley said: "There are many individual and societal benefits to extending working lives and the success of future pension systems may be highly reliant on increases in the older workforce and retirement ages. However, recent trends have been towards earlier exits from the workplace, not always through choice.

"As well as economic benefits, being employed has other advantages including social contact, daily structure, social identity, status, and regular activity and we wanted to understand whether these factors play a role in explaining known associations between not working and poor physical and mental health.

"Older people who are not working represent a high risk group and, while re-employment may not always be possible, interventions that decrease loneliness, social isolation and boredom, and improve self-esteem offer valuable opportunities to improve health outcomes and promote successful aging.

"For example, programmes promoting volunteering and community involvement, or widening access to public transport could help to reduce the negative impact not being in employment on the health of older adults."

Co-author Dr Frank Popham said: "By comparing people changing over time from employment to non-employment, our analysis strengthens the evidence of negative social impacts of certain types of non-employment."

The paper, 'Leaving the labour market later in life. How does it impact on mechanisms for health?', is published in Occupational and Environmental Medicine.

More information: Whitley E, Popham F Leaving the labour market later in life: how does it impact on mechanisms for health? Occup Environ Med, 21 August 2017. DOI: 10.1136/oemed-2016-104258 Journal information: Occupational and Environmental Medicine

Output: Compared to those who work, and in contrast to many popular perceptions, older people who are retired, home-makers, unemployed, or not working because of sickness or disability are more likely to feel that their status results in poorer social and mental engagement and lower self-esteem, according to a new study.


Instruction: create a high quality summary of the given input

Input:
Software bug at subprime loan provider Provident costs it dearly
 Peter Crook, CEO of Provident Financial, resigned in disgrace yesterday as the company's stocks crashed

Hundreds of thousands of struggling families have been left in limbo by a mounting crisis at doorstep lender Provident Financial.

Shares in the business crashed by 66 per cent yesterday after bosses admitted that a software bug has made it impossible to collect debts from customers.

It is believed to be the biggest ever one-day stock price fall for a firm in the blue chip FTSE 100 index, wiping £1.7billion off its value.

The company’s chief executive, Peter Crook, resigned in disgrace.

The firm was also forced to announce its door-to-door loan division would lose up to £120million this year, and it will be axing its dividend.

In a shock update to the stock market, Provident revealed it was being investigated over a potential mis-selling scandal which could ultimately cost up to £140million.

Analysts have been closely watching the 137-year-old company, which targets customers with poor credit history, because any problems with repayments are likely to be an early warning sign that Britain’s debt bubble is about to burst.

Most of its 2.5million customers are among the most vulnerable in society. Many do not qualify for standard bank loans and are categorised as ‘sub-prime’.

Bradford-based Provident’s woes began when it launched a £21.6million overhaul of its doorstep collection business – an operation with 801,000 customers who are typically charged annual interest rates of 535 per cent.

The company got rid of 4,500 freelance debt collectors and planned to hire 2,500 full-time staff to replace them.

However, a recruitment campaign initially fell flat and it was forced to warn two months ago that it had a shortage of staff.

A new computer system was also introduced to make it easier for appointments to be scheduled. But instead of improving efficiency, it has made things far worse because bugs mean meetings are arranged at the wrong time and employees are not sure when they are meant to meet clients.

In total £1.7billion was wiped off the value of the lender, which deals with some of the most vulnerable in society, marking the biggest one-day fall in a blue-chip FTSE 100 firm ever

The problem is so bad that only 57 per cent of debts are being collected on time, as opposed to the 90 per cent normally picked up.

It is also far more difficult to lend out new cash, with weekly lending £9million lower than it was this time last year.

Customers whose payments are late because of the disaster will not be charged extra interest or hit with any financial penalties.

However, many rely on regular visits from Provident staff for credit to tide them over – meaning the scheduling chaos could leave them dangerously short of cash.

Chairman Manjit Wolstenholme, who has taken over day-to-day running of the company after Mr Crook’s departure, said: ‘We’ve got people on the ground, but we have issues with the software being used by them. Agents are turning up at the wrong time when customers aren’t there.

‘It’s not behaving because the data that’s in there isn’t good enough for what we need to do. This is something we should be able to do something about.’ And in a second major bombshell, Provident also revealed that the Financial Conduct Authority is investigating possible mis-selling claims at its credit card business Vanquis Bank.

It has 1.6million customers, and in addition to letting them borrow money it offers a product called a repayment option plan.

This allows borrowers to pay a monthly fee so they can freeze their account without incurring extra interest if they run into financial difficulties.

About a third of Vanquis customers are believed to have bought the product and they typically pay almost £155 a year for it.

Output: About 800,000 UK families have been affected by a software bug at doorstep loan provider Provident Financial, which has stopped the company from being able to collect debts and severely restricted its ability to make new loans. Provident revealed its door-to-door loan division will lose up to £120m this year. Shares plummeted by 66% this week, wiping £1.7bn off the company's value. Provident is also being investigated over a potential mis-selling scandal. Provident targets customers with poor credit histories and most of its 2.5 million customers do not qualify for standard bank loans. CEO Peter Crook has resigned.


Instruction: create a high quality summary of the given input

Input:
Geneformics looking to make genomic data more accessible
 The human genome has been mapped, but the genomes of most humans have not – at least not yet. When individual genomes are mapped, the world will have a problem: there is simply not enough space in the world’s computer systems to store that data.

“The mere size of the genomic data” said Rafael Feitelberg, CEO of Petah Tikvah-based Geneformics, is “one of the main inhibitors for genomics to be really ubiquitous in the world.” A sequenced human genome might be 200 to 300 gigabytes of raw data, while an analyzed genome could take up a full terabyte of disk space. “If you want to create gene banks, the mere size of the data is going to be very, very prohibitive.”

Geneformics, he said, “is all about providing the tools and infrastructure to make genomics data accessible through compression,” Feitelberg said.

The point of mapping the human genome is not just to know how genes interact in general, but to be able to apply that mapping to individuals. With a mapped genome at one’s disposal, for example, the era of personalized medicine would flourish. Doctors would be able to develop customized medicines for patients, ensuring that the drug will be targeted specifically to deal with the problem without any side effects.

Geneformics now counts among its customers two of the biggest gene-sequencing organizations in the world, Massachusetts-based sequencing company WuXi NextCode and the Garvan Institute of Medical Research in Sydney.

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One of the issues in data compression is what happens when it gets decompressed to become functional again. “Data compression should be something which is really hidden from them in a lossless and transparent way,” Feitelberg said. “What that means from a compression and solution perspective is that we are capable of decompressing the data at high speeds and actually streaming it back to all of these applications in a lossless form. It is equivalent, bit for bit, to the original, uncompressed file.”

Geneformics grew out of the Weizmann Institute of Science in Rehovot, Israel, based on the data compression work of Weizmann computational biologist Eran Segal, who cofounded the company in 2014 with career technologist and current Geneformics chief technology officer Arik Keshet.

Funding has come from investors including Geneformics chairman Dov Moran, who created DiskOnKey, widely cited as the first USB flash drive. Moran and two private equity firms have put about $2.85 million into Geneformics, according to Crunchbase. The company recently released Geneformics D, its first purely cloud-based offering.

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How it works, said CTO Keshet, is a trade secret. “This being a young industry, there are really no compression standards as of now. You don’t have your equivalent of JPEG or MPEG” in genomics, he said

“Eventually, when this space matures, we expect the standards to be formed. At that point, we will have the technology and the [intellectual property] and the market presence to influence those.”

What the company will say, said Feitelberg, is that data savings can be significant. “With compression, we will reduce the footprint by up to 90 percent. In addition, by having an intelligent tiering at the granular level of the genomic data, then we can even increase those savings more,” he said.

With its deal with the Garvan Institute, which has one of the largest genomic datasets in the world, the firm is on its way to international success. “It was a very fruitful partnership in being able to build an infrastructure for them so that as much as they’ll grow, they’ll always grow in a compressed and efficient way,” said Feitelberg. “Our view is that researchers and bioinformaticians shouldn’t ever change the analysis that they’re doing because of data compression,” he said.

Output: Genome data management company Geneformics is developing tools and infrastructure to make genomics data accessible through compression. The Israeli start-up can compress genomic data by up to 90%, then quickly decompress and stream that data back to applications in a lossless form, it said. The process enables researchers to map individuals' genomes more quickly and at a lower cost, as well as drastically increasing storage capacity.


Instruction: create a high quality summary of the given input

Input:
5.2 million British adults own multiple properties
 There has been a 30% increase between 2002 and 2014 in the proportion of adults who own multiple properties, rising 1.6m to 5.2m people, according to new analysis published by the Resolution Foundation.

Combined with falling home ownership since the early 2000s, the rise of second home-owning in 21st Century Britain has underpinned the increasing concentration of property wealth within a declining proportion of families. In contrast to the one in ten adults with multiple sources of property wealth, four in ten (40%) adults have no property wealth at all, up from 35% in 2000-02.

The analysis found that alongside an increase in the number of people with additional property, the average value of assets held in these properties has increased by 20% in real terms between 2000-02 and 2012-14 – from £125,000 to £150,000. The wealth held in additional properties had a gross value of £760bn in 2012-14 – 15% of the £5.2 trn held in gross property wealth overall.

Laura Gardiner, senior policy analyst at the Resolution Foundation, explained: “Multiple property ownership is still a minority sport, but a growing one that represents a significant boost to the wealth pots of those lucky enough to own second homes. People with second homes not only have an investment that they can turn to in times of need, for instance in later life when care is required, but if the property is rented out they also see a boost to their incomes here and now.

“Contrary to the popular narrative, these second home owners are rarely your typical middle-income worker shoring up savings or ordinary retiree boosting pension income. They tend to be baby boomers who are very wealthy indeed relative to their peers, living in the South and East of England.

“With young people much less likely to own a home at all than their predecessors at the same age, the growing concentration of property wealth among fewer families raises concerns not just for their living standards but for wealth inequality of our country as a whole.

She added: “Recent steps to increase stamp duty on second homes and reduce tax relief on buy-to-let mortgage are attempts to address this challenge, but policy makers should consider what more can be done to ensure that home ownership doesn’t become the preserve of the wealthy for generations to come.”

Generational shift

Resolution states that there is a clear generational split in terms of who owns second homes, with those in prime age and the early stages of retirement having accumulated the most.

Multiple homeowners are most likely to be baby boomers, the group born between 1946 and 1965 and currently aged 52-71. Boomers account for half (52%) of all the wealth held in additional properties, with far higher additional property asset levels than those now in their seventies and eighties had at the same age. Generation X – born 1966 to 1980 and currently aged 37-51 – accounts for a further quarter (25%) of additional property wealth.

By contrast the millennials – born since 1981 – own just three per cent of the additional property assets and are the first group since records began to have less of it than predecessors at the same age had. For example, those born in the 1980s have less than half the additional property assets at age 26 than those born in the 1970s – an average of £2,600 across all adults born in the 1980s, against £5,500 for those born in the 1970s).

While owning an additional property is sometimes depicted as a common way for typical workers to shore up savings or for ordinary pensioners to boost retirement income by letting properties out, the analysis finds that those with a second home are overwhelmingly rich and wealthy.

It found 88% of additional property owners were in the top half of the wealth distribution, and 79% of adults who earned income from additional properties as landlords were in the top half of the income distribution. Second home owners continued to stand out even when just compared to their peers, for example 82% of baby boomer second home owners were in the wealthiest half of their generation.

Regional differences

There were also stark regional differences in those who earned income from a second home as a landlord. The majority of landlords (59%) were found in the South West, South East, East of England and London, which were also the areas where incomes and average wealth were highest.

The latest Rightmove House Price Index predicts annual average increases of 2% in 2018 and 3% in 2019.

Output: The proportion of UK adults who own multiple properties increased by 30% between 2002 and 2014, from 1.6 million to 5.2 million people, according to research by the Resolution Foundation. The think-tank found that the trend has been accompanied by a fall in overall home ownership since the early 2000s, leading to an increased concentration of property wealth in a smaller number of families. The majority of multiple property-owners are baby boomers, concentrated in London and the South East, the South West and East of England.