In keeping with Arcosantis traditional eventnigh

first_imgIn keeping with Arcosanti’s traditional event-night experience, the evening began at 5 pm with an after-hours tour of Arcosanti, this time led by Arcosanti’s ecotourism coordinator, naturalist Anne-Marie Vaduva. [photo: Steven Bochinski, text: Kate Bemesderfer] At 6 pm, attendees gathered in the Cafe at Arcosanti for a sold-out 6-course meal created by Chef M. Ali Sadiqi and his team of dedicated staff and volunteers.  With a menu of such culinary delights as classic Caprese sald with Arcosanti basil, fresh trout, roast potatoes with truffle oil, and a sweet polenta souffle with chocolate-hazelnut sauce, it was a full house of satisfied palettes![photo: Conrad Strano-Mcanany, text: Kate Bemesderfer] This year’s Vivaldi Festival brought together a wonderful array of performers and artists: soprano Eileen Mager, pianist GayNell Cronin, violist Nokuthula Ngwenyama, painter Jim Covarrubius, Terpiscore Dance Company, Zona Flamenca with Bernadette Gaxiola, and glass artists Joshua Dopp and Brigid O’Malley.[photo: Conrad Strano-Mcanany, text: Kate Bemesderfer] May 21, 2014On Saturday, May 17th, Arcosanti hosted the 17th edition of the Arizona Vivaldi Festival, an annual event presented by Arts Renaissance Initiative.  The festival began earlier this month with events in Phoenix, is a celebration of “the maestro’s magic in song, dance, dinner and glass.” [photo: Sue Kirsch, text: Kate Bemesderfer] Following dinner, guests had the opportunity to see a live Venetian glassblowing demonstration (and a rare glimpse inside the Arcosanti Lab Building) with Joshua Dopp and his Highway Hotshop, a portable glass studio.  Josh’s demonstration highlighted a weekend of glass-working activities at Arcosanti that included his 3-day workshop and fellow glass artist Brigid O’Malley’s afternoon presentation on architectural glass–keep an eye out for a glass workshop with Brigid at Arcosanti this fall.  As part of the evening, one of Joshua’s pieces was raffled off to raise funds for the Arcosanti community–the lucky winner turned out to be one of the stars of the festival, Eileen Mager! More about the glass workshop in Friday, 5/23/2014 report.[photo: Conrad Strano-Mcanany, text: Kate Bemesderfer]Around 7:30, the audience settled into the Colly Soleri Music Center Amphitheater for the concert itself, which began with a tribute to Paolo Soleri from festival organizer and ARI founder Michel Sarda. With great humor and scholarship, Eileen Mager guided the audience through a selection of Vivaldi arias, Terpiscore Dance Company transformed orchestral pieces into modern movement, Thula Ngwenyama enchanted us with her Stradivarius renditions of several works, Zona Flamenca infused classical music with the energy and passion of flamenco, and Jim Covarrubius created an original painting (also raffled off to a lucky audience member at the end of the night) live onstage as the concert unfolded.[photo: Steven Bochinski, text: Kate Bemesderfer]With its unique constellation of inter-disciplinary, cross-cultural and trans-historical interpretations of one of the world’s great composers, the Arizona Vivaldi Festival remains one of Arcosanti’s premiere events–we look forward to next year’s iteration![photo: Steven Bochinski, text: Kate Bemesderfer]last_img read more

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When I hear about strategies that purport to legal

first_imgWhen I hear about strategies that purport to legally allow US citizens to avoid having to pay income taxes, the first thing that usually comes to mind is that it is some sort of dodgy cockamamie scheme. This is because the US government is no slouch when it comes to shaking down its citizens for every penny it can get away with. The mind-boggling spending on welfare and warfare policies necessitates this. It would be dangerously foolish in the extreme to think you could slip one past them. There really was no sure way to legally escape the suffocating grip of US taxes besides death and renouncing your US citizenship… until recently. Every other country in the world (besides the US and Eritrea) practices a system of residence-based taxation. This means that citizens are not liable for paying income taxes to their home country if they become a legal resident of another country and earn their income there. Take, for example, an American expat and a Canadian expat who both live and earn income in Singapore. The Canadian would only be responsible for paying the much lower Singapore income taxes, while the American would be responsible for paying Singapore income taxes AND American income taxes (though the IRS does allow for around $100k of foreign earned income to be excluded from income taxes if certain conditions are met). This is because the US taxes its citizens by virtue of their citizenship (citizenship-based taxation), regardless of where they live and earn their money. Even leaving the US permanently does not absolve you from paying US income taxes. Though Eritrea also practices citizenship-based taxation, it is an impoverished African country and has no ability to effectively enforce it. That’s the key difference. The US government can effectively enforce its citizenship-based taxation policies thanks to its massive economic, political, and military weight and the fact that it does not recognize any limit to its jurisdiction (consider FATCA and Edward Snowden). American expats are therefore in the uniquely unfavorable position of having arguably the worst tax policies and a government that can effectively enforce them. For many, it is a tight and suffocating tax leash. It is no wonder, then, that a record number of Americans gave up their citizenship last quarter to escape these onerous requirements. (You can find more about citizenship-based taxation versus residence-based taxation in this article.) There is, however, another way besides death and renunciation to legally escape US income taxes, thanks to the Caribbean island of Puerto Rico. Of course, the US government could always pressure Puerto Rico to change its policies, but people in the know view that as unlikely. For now, Puerto Rico and its special tax situation definitely deserve consideration for Americans. Puerto Rico may be the best internationalization option for Americans at present, but its conditions may be unworkable for many. Fortunately, many other options exist for internationalizing at least part of your wealth—and your life, should you want to leave your home country and live elsewhere. And honestly, with the global economy in the state it’s in, just about everyone would benefit from internationalizing… it isn’t just for Americans. But how to get started? What are the best ways to move wealth offshore, and what are the best destinations for it? Should you internationalize in the same countries that you move your wealth to? All these questions, and many more, can be answered in one convenient, trustworthy resource. This resource has its roots deeply intertwined with the original “International Man”—legendary contrarian and speculator Doug Casey himself. So you can be confident that every detail has been thoroughly vetted, to not just maintain your wealth and lifestyle… but in many cases, to improve them. Get all the details and get started on your path to internationalization right now. Puerto Rico is an unincorporated territory (commonwealth) of the US, and this allows it to have a special tax arrangement. Namely, legal residents of Puerto Rico who earn their income in Puerto Rico do not pay US federal income taxes (though they still have to file a federal tax return). All Puerto Ricans are already US citizens, and since it is a commonwealth of the US, Americans are generally free to stay on the island without restriction and do not even need a passport to travel there. In order to obtain legal residency status in Puerto Rico and the associated tax benefits, one would have to be physically present on the island for at least 183 days a year. While US citizens who become legal Puerto Rican residents do not have to pay US federal income taxes on income earned on the island, they still have to pay local Puerto Rican taxes. This only amounts to 4% in certain cases, a pittance in comparison to combined US federal, state, and sometimes city income taxes. This low 4% rate only applies if the services are performed in Puerto Rico for clients outside of Puerto Rico—otherwise a local income tax of as much as 33% is applicable. For example, an investment manager based in Puerto Rico who performs services for US-based clients would be eligible for the lower income tax rate. Consult a tax expert to discuss individual cases and circumstances. In addition, Puerto Rico recently slashed its taxes on dividends and interest to ZERO, and capital gains taxes to as low as zero (maximum of 10%).This is part of a recent program over the past year or so in which Puerto Rico has been promoting itself as a tax-friendly jurisdiction open to Americans, in order to compete with its better-known Caribbean neighbors like the Cayman Islands. Taken together, Puerto Rico is an attractive destination for American companies and individuals who have portable incomes, such as software developers, writers, Internet businesses, and especially those dealing with investments, like hedge funds, in which the majority of the earnings are derived from investment income like dividends, interest, or capital gains. Spending half the year in Puerto Rico, with its beautiful white sand beaches, Caribbean climate, and close proximity to the US is not a bad proposition.center_img In short, thanks to a system of citizenship-based taxation, becoming a legal resident of Puerto Rico is the only way for Americans to keep their US citizenship and legally avoid US federal income taxes. There have been at least 40 Americans who have taken advantage of this special arrangement with Puerto Rico and moved there during the past year. Earlier this year billionaire hedge fund manager John Paulson was said to have been exploring this option. Check out the short clip below from Bloomberg about an American who has moved to Puerto Rico for exactly these reasons.last_img read more

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And what about their greatgrandparents who were s

first_imgAnd what about their great-grandparents who were slaves? They were militarily protected, after all. And their local oppressors operated fully under the rule of law. The  Supreme Court approved. Did that make them free? On one side of this “xenophobia coin,” we have outsiders whom we need to keep beneath us. The people of Eastern Europe were protected by a Soviet arsenal that included thousands of atomic bombs. They were further protected by constitutions and courts, all of which were locally administered. Were they free? I could go on, but I think the point is made: The vast majority of human oppression comes at the hands of locals, not foreigners. That’s a fact, whether or not it works as a movie plot. I know that many good men and women have spent time in various military capacities, but the fact is this: Foreign invaders abuse far, far fewer people than do local bosses. And here’s another fact: Once a foreign invader takes control of a new place, he usually tries very hard to keep the populace happy. The foreigner does not murder civilians by the millions… but local rulers do. (Think of Mao, Pol Pot, Stalin, etc. They each killed millions of locals.) The Flip Side of Xenophobia Xenophobia is fear of the foreigner and usually applies to things like hating immigrants. But it’s not always “fear.” It’s more often a need to keep the foreigner beneath us. In any case, classic expressions of xenophobia involve punishing immigrants, Jews, or some other outsiders (justified by whatever facts can be conveniently assembled). It seems to me that the myth we mentioned above, “military power equals freedom,” is the flip side of this xenophobia phenomenon: On the other side, we have outsiders whom we must prevent from putting us beneath them. No people suffered more to defeat Hitler than the Russians. So did killing the foreign invader make them free? Hardly – it kept Stalin, who killed far more people than Hitler ever did, in power.center_img Both of these fears come from a dominance instinct: We must allow no one above us. As I was finishing up my liberty entertainment article a few weeks ago, I checked lists that other people had made, just to see if I had forgotten something. As I did, I was dismayed to find that in most of these lists, pro-liberty really meant pro-military. So I think it’s time to take a quick look at the myth that military power gives us liberty. The Fantasy of the Foreign Oppressor There is a plot that lies behind this “military power equals freedom” belief. It says that the enemy of liberty is a foreign invader. So, if the outsider is afraid to approach, we are free. It implies that “local rule equals freedom.” This is simply a lie. But it’s a lie that works very well in fiction. Back in the real world, the hometown of an oppressor – whether it be near or far – makes him no better or worse. Are we free because the people who rule us reside within local borders? Does that remain true even when it’s the “inside our lines” people who oppress us? May only foreigners be oppressors? Consider these recent cases: What about Southern blacks in 1950? Almost everything done to them was “under the law,” and they were protected by a massive military and a nuclear arsenal capable of reducing any invader to ashes. Were they free? We must keep those below us in place. Both of these impulses are irrational, and they tend to travel together. Perhaps I’m missing something, but my experience tells me this: The people who love the “military equals freedom” fantasy are the same people who oppose immigrants. That’s not just an American thing, by the way. You see it more or less everywhere. I know that there are many exceptions to this statement (we’re talking about millions of individuals, after all, many of whom DO analyze their own minds), but I think this statement holds up: “Military equals freedom” grows from the same impulse as xenophobia.The Case of America Since the majority of my readers seem to be Americans, I’ll devote a minute to the US’s fear of the “foreign devil.” Should Americans really take an “alien invasion” seriously? Even when surrounded by two huge oceans and friendly people to the north and south? (The trouble in Mexico exists largely because the US government created it.) There is no potential invader who takes invasion seriously. Here’s what Japan’s Admiral Yamamoto said during the hostilities of World War II: You cannot invade mainland United States. There would be a rifle behind each blade of grass. No foreign power would seriously consider invading America, where there are 270 million guns in the hands of ordinary people. Everyone, not just boys in uniforms, would be a deadly threat. The US can be taken by stealth, but not by an open invasion. If the American people ever paid attention to what was being done to them, no oppressor would survive it. To close this discussion, here’s a quote from General Douglas MacArthur, who knew something about America and war: Our country is now geared to an arms economy which was bred in an artificially induced psychosis of war hysteria and nurtured upon an incessant propaganda of fear. We need to let go of fear and think rationally. Very seldom do foreigners oppress us. The vast majority of oppression comes from within. Paul Rosenberg FreemansPerspective.comlast_img read more

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Another huge corporation just went bankrupt It wa

first_imgAnother huge corporation just went bankrupt.It was one of the biggest bankruptcies of the year. But it certainly won’t be the last. In fact, we think this is a trend that could soon level the global economy…Some folks will call us alarmists for saying this. But, as you’ll discover by the end of today’s Dispatch, this prediction isn’t as bold as it sounds.Today, we’ll take a deeper look into this growing crisis…and we’ll show you what you can do today to protect your wealth.•  On Monday, Brazilian telecom giant Oi SA filed bankruptcy…The company went bankrupt after its $19.3 billion debt became too much to bear. It was the largest bankruptcy in Brazil’s history.Like many companies these days, it borrowed too much money. MarketWatch reported yesterday:Since 2009, Brazil’s fourth-largest telecom company has accumulated a huge amount of debt to complete two mergers, first with Brasil Telecom and later with Portuguese company Portugal Telecom. Those deals failed to generate enough cash flow to fund the company’s investment needs.Last week, the company said it was burning through cash. It warned that it desperately needed to restructure its debt. But, according to Fortune, it “ran out of time.”•  Many folks thought Oi SA would become one of the world’s top telecom companies…That’s because Brazil was a rising star of the global economy not that long ago.From 2000 to 2011, its economy more than quadrupled in size. Brazil was even the “B” in “BRICS,” a Wall Street acronym for five emerging markets with big growth potential.It didn’t live up to the promise.•  Brazil is in its worst downturn since the Great Depression…Its economy has been shrinking for two straight years.Unemployment and inflation are both at their highest levels in years and climbing. The country’s main stock market index, the Bovespa, has plunged 70% since 2010. And Brazil’s currency, the real, has lost 34% of its value over the past two years.•  Thousands of Brazilian companies have failed…Last year, 1,287 Brazilian companies went bankrupt. That was a record high, but it might not stand long.According to Reuters, 571 Brazilian companies filed bankruptcy between January and April. That’s twice as many filings as there were over the first four months of last year.•  Brazil’s government is a big reason why the country’s economy is unraveling…This won’t surprise longtime readers. As we’ve shown you countless times, almost every major financial crisis begins because of bad government policies. That’s because governments don’t create economic value. They only steal, hurt, and destroy it.Brazil’s socialist president, Dilma Rousseff, has destroyed the economy. She took the country from a 2.3% government surplus to a 10.3% deficit in just five years.Rousseff is still running the show right now. But she may not be for long. She’s currently standing trial for impeachment. Many folks believe a new government could turn things around.•  Nick Giambruno, editor of Crisis Investing, is watching Brazil’s economic crisis closely…Nick says it will take more than a new government to fix Brazil. In the April issue of Crisis Investing, he said things will get worse in Brazil before they get better:Replacing one corrupt government with another is not going to fix these problems. The worst is yet to come in Brazil. It’s shaping up to be a lovely train wreck.I believe soon, one (or a combination) of these things will trigger a full-blown crisis in Brazil. It will thrust Brazil onto the front pages of First World newspapers…and get Wall Street to say, “Sell anything Brazilian.”•  Nick thinks Brazil’s currency will collapse…Brazil’s had five currency crises over the past 75 years. That’s one every 15 years. Its last one was in 1994.If Brazil’s currency collapses, its stock market will collapse too…Nick says this would create one of the best buying opportunities in years.You see, most folks don’t realize that a crisis is actually an opportunity. In some cases, a crisis will give you the chance to buy a dollar’s worth of assets for a dime. That’s why we’ve called buying during crises “the world’s most powerful wealth-building secret.”Legendary investors like Warren Buffett and Sir John Templeton used it to become some of the richest men on the planet. Casey Research founder Doug Casey also used this strategy to make millions.Nick is an experienced crisis investor. In 2013, he made huge gains crisis investing in the tiny European island of Cyprus. The country just had a horrible banking crisis. Its stock market was down 98%. It was one of the world’s most hated markets.Nick recommended eight dirt-cheap Cyprus stocks to his readers. Three of those stocks more than doubled in under two years. Another gained 97%. Just one of the eight picks lost money, and the loss was small.•  Nick says Brazil’s economic crisis presents a similar opportunity…But he’s not ready to buy Brazilian stocks yet. He’s waiting for the crisis to become the front-page story on newspapers around the world.That’s when he’ll invest in the world-class Brazilian company he’s been “stalking.”This company dominates its industry. It’s highly efficient. And it’s been steadily growing its profits despite Brazil’s economic struggles. Nick will let his Crisis Investing readers know when it’s time to pull the trigger.You can learn how to access Nick’s best investing ideas by watching this free presentation. We encourage you to watch this video even if you don’t plan on investing in Brazil. That’s because you’ll learn about a much bigger crisis that will affect you no matter where you live in the world…•  The global financial system is more fragile today than it was in 2008…International Business Times reported last month:Corporate debt across the world has reached extreme levels, warned the Institute of International Finance (IIF), a trade group of financial institutions. The global banking watchdog added that it far exceeded the pre-Lehman financial bubble.According to International Business Times, it’s not just countries like Brazil that you need to be worried about. The entire global economy is drowning in debt:It said there was a double threat. While emerging markets had seen a five-fold increase in corporate debt to $25tn (£17.32tn, €21.91tn) over the last 10 years, developed markets such as the US and Europe were seeing record junk bond issuance.Referring to the US, the IIF said companies were borrowing as if there was no tomorrow even though their profits began to decline in 2014. It said the ratio of net debt to earnings (EBITDA) for companies was at 1.4. This had doubled since the 2007 subprime bubble.A rising debt-to-EBITDA ratio is a serious problem. It means companies have borrowed more money than they’re making.•  If you’re nervous about the global financial system, we encourage you to take action today…We recommend you start by owning physical gold.As we often say, gold is real money. It’s held its value for centuries because it has a rare set of qualities: It’s durable, easy to transport, and easily divisible. No matter where you go in the world, folks recognize its intrinsic value.Unlike many paper currencies, gold has survived every stock market meltdown, economic depression, and currency collapse in history. During many periods of economic turmoil, gold’s value skyrocketed.You can learn other ways to protect your wealth by watching this short presentation. We encourage all Casey readers to watch it.As you’ll see, an implosion of the debt market will likely spark a crisis that could impact every person on the planet. It won’t matter where you’ve put your money.You’ll also learn how to turn the global debt crisis into a money-making opportunity. Click here to watch this free video.Chart of the DayU.S. corporations are light on cash and high on debt…Today’s chart shows the cash-to-debt ratio for 2,000 nonfinancial U.S. corporations. A cash-to-debt ratio measures how much cash a company has compared to its debt. The higher the ratio, the better.You can see this key ratio has been plunging since 2013. It’s now at the lowest level since the 2008 financial crisis.It only gets worse when you dive into the details. As we recently explained, U.S. corporations have a record $1.84 trillion cash on their books. But more than half of that cash belongs to just 25 companies, or 1% of Corporate America.When you remove these cash-rich companies from the equation, the cash-to-debt ratio plunges to 12%. In other words, the bottom 99% of U.S. corporations have just $0.12 of cash for every dollar of debt.U.S. corporate balance sheets are weaker today than they were before the last financial crisis. And they continue to weaken.Again, you can learn how to protect yourself by watching this free presentation.Regards,Justin SpittlerDelray Beach, FloridaJune 22, 2016last_img read more

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As billions in tax dollars flow to private Medicaid plans Whos minding

first_imgReviewed by James Ives, M.Psych. (Editor)Oct 19 2018With no insurance through his job, Jose Nuñez relied on Medicaid, the nation’s public insurance program that assists 75 million low-income Americans.Like most people on Medicaid, the Los Angeles trucker was assigned to a private insurance company that coordinated his medical visits and treatment in exchange for receiving a set fee per month — an arrangement known as managed care.But in 2016, when Nuñez’s retina became damaged from diabetes, the country’s largest Medicaid insurer, Centene, let him down, he said. After months of denials, delays and erroneous referrals, he claimed in a lawsuit, the 62-year-old was left nearly blind in one eye. As a result, he lost his driver’s license and his livelihood.”They betrayed my trust,” Nuñez said, sitting at his kitchen table with his thick forearms folded across his chest.The current political debate over Medicaid centers on putting patients to work so they can earn their government benefits. Yet some experts say the country would be better served by asking this question instead: Are insurance companies — now receiving hundreds of billions in public money — earning their Medicaid checks?More than two-thirds of Medicaid recipients are enrolled in such programs, a type of public-private arrangement that has grown rapidly since 2014, boosted by the influx of new beneficiaries under the Affordable Care Act.States have eagerly tapped into the services of insurers as one way to cope with the expansion of Medicaid under the ACA, which has added 12 million people to the rolls. This fall, voters in three more states may pass ballot measures backing expansion. Outsourcing this public program to insurers has become the preferred method for running Medicaid in 38 states.Yet the evidence is thin that these contractors improve patient care or save government money. When auditors, lawmakers and regulators bother to look, many conclude that Medicaid insurers fail to account for the dollars spent, deliver necessary care or provide access to a sufficient number of doctors. Oversight is sorely lacking and lawmakers in a number of states have raised alarms even as they continue to shell out money.”We haven’t been holding plans to the level of scrutiny they need,” said Dr. Andrew Bindman, former director of the federal Agency for Healthcare Research and Quality and now a professor at the University of California-San Francisco. “This system is ripe for profit taking, and there is virtually no penalty for performing badly.”In return for their fixed fees, the private insurers dole out treatment within a limited network, in theory allowing for more judicious, cheaper care. States contract with health plans as a way to lock in some predictability in their annual budgets.More than 54 million Medicaid recipients are now covered by managed-care plans, up from fewer than 20 million people in 2000. (In traditional Medicaid, states pay doctors and hospitals directly for each visit or procedure — an approach that can encourage unnecessary or excessive treatment.)Already, states funnel nearly $300 billion annually to Medicaid insurers. That’s up from $60 billion a decade ago. Today’s spending is approaching what Pentagon awards annually to contractors.Medicaid is good for business: The stock price of Nuñez’s insurer, Centene, has soared 400 percent since the ACA expanded Medicaid eligibility. The company’s chief executive took in $25 million last year, the highest pay for any CEO in the health insurance industry. In California, the largest Medicaid managed-care market with nearly 11 million enrollees, Centene and other insurers made $5.4 billion in profits from 2014 to 2016, according to a Kaiser Health News analysis.Plans get to keep what they don’t spend. That means profits can flow from greater efficiency — or from skimping on care and taking in excess government payments.”States are just giving insurers the keys to the car and a gas card,” said Dave Mosley, a managing director at Navigant Consulting and former finance director at the North Carolina Medicaid program. “Most states haven’t pressed insurers for the information needed to determine if there’s any return on their investment.”Two of California’s most profitable insurers, Centene and Anthem, ran some of California’s worst-performing Medicaid plans, state quality scores and complaints in government records show. California officials have been clawing back billions of dollars from health plans after the fact.For nearly two decades, federal officials have tried building a national Medicaid database that would track medical care and spending across states and insurers. It’s still unfinished, hampered by differing state reporting methods and refusals by some health plans to turn over data they deem trade secrets.In July, a federal inspector general’s report accused Medicaid insurers of purposefully ignoring fraud and overpayments to doctors because inflated costs can lead to higher rates in the future.In a report last month, the U.S. Government Accountability Office disclosed that California’s Medicaid program is unable to electronically send records justifying billions of dollars in spending, forcing federal officials to sift through thousands of documents by hand. California said it can’t share key files electronically because it uses 92 separate computer systems to run the program.”You simply cannot run a program this large when you can’t tell where the money is going and where it has been,” said Carolyn Yocom, a health care director at the GAO.Related StoriesObese patients with Type 1 diabetes could safely receive robotic pancreas transplantResearch sheds light on sun-induced DNA damage and repairDiabetes medications mask euglycemic ketoacidosis at the time of surgeryToday, Medicaid consumes the single-largest share of state budgets nationwide at nearly 30 percent — up from less than 21 percent a decade ago — crowding out funding for education, roads and other key priorities.”If anything, our results suggest that the shift to Medicaid managed care increased Medicaid spending,” researchers at the Congressional Budget Office and the University of Pennsylvania concluded in 2013, based on a nationwide analysis.Industry officials insist that managed care saves money and improves care. Medicaid Health Plans of America, an industry trade group, points to a study showing that health plans nationally saved the Medicaid program $7.1 billion in 2016.Health plans also say they can help modernize the program, created more than a half century ago, by upgrading technology and adopting fresh approaches to managing complex patients.Getting it right has big implications for patients and taxpayers alike, but the results in many states aren’t reassuring.State lawmakers in Mississippi, both Republicans and Democrats, criticized their Medicaid program last year for ignoring the poor performance of two insurers, UnitedHealthcare and Centene, even as the state awarded the companies new billion-dollar contracts.In Illinois, auditors said the state didn’t properly monitor $7 billion paid to Medicaid plans in 2016, leaving the program unable to determine what percentage of money went to medical care as opposed to administrative costs or profit.In April, Iowa’s state ombudsman said Medicaid insurers there had denied or reduced services to disabled patients in a “stubborn and absurd” way. In one case, an insurer had cut a quadriplegic’s in-home care by 71 percent. Without the help of an aide to assist him with bathing, dressing and changing out his catheter he had to move to a nursing home, according to the ombudsman, Kristie Hirschman.”We are not talking about widgets here,” Hirschman said. “In some cases, we are talking about life-or-death situations.”Meanwhile, the Trump administration has sent mixed signals on Medicaid oversight. Seema Verma, administrator for the Centers for Medicare & Medicaid Services, has promoted a new, nationwide scorecard and vowed to ramp up audits targeting states and health plans.”We need to do better,” Verma said in a Sept. 27 speech to the Medicaid managed-care industry. “Medicaid has never developed a cohesive system of accountability that allows the public to easily measure and check our results.”But consumer advocates also are concerned that Verma’s efforts to roll back “burdensome regulations” will weaken accountability overall. Many also disagree with her support of Medicaid work requirements.Nuñez, the truck driver who lost much of his sight, is suing a unit of Centene for negligence and breach of contract. The company has denied the allegations in court filings and declined to comment further, citing the pending litigation.Talk of requiring Medicaid recipients to work is hard for him to take. “I need my health to work,” he said. “They took that away from me.”This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation. This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.last_img read more

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PET imaging better detects coronary artery disease than SPECT scans

first_img Using PET scans instead of SPECT scans resulted in increased rates of diagnosis of severe obstructive coronary artery disease from 70 percent to 79 percent. PET scans were associated with a lower incidence of invasive catheterization without identification of severe coronary artery disease (43% vs 55%). Overall, PET more successfully identified patients with severe obstructive CAD and need for revascularization; compared to SPECT, PET scans increased true positives and reduced false positives for severe coronary artery disease. Related StoriesMathematical model helps quantify metastatic cell behaviorDeep learning analysis of SPECT MPI can improve diagnosis of coronary artery diseaseDetecting fungal disease in crops with multispectral imaging systemResults of the study will be presented at the American College of Cardiology Scientific Session in Orlando on March 10 at 10 a.m., ET. More than 13,000 cardiologists and cardiovascular clinicians from throughout the world are attending the four-day meeting.”Since Intermountain Medical Center made the switch from SPECT to PET in 2013, we thought it would be valuable to look at the differences in clinical outcomes since then,” said Kirk Knowlton, MD, director of cardiovascular research at the Intermountain Medical Center Heart Institute. “In order to understand the differences between the two-year period of SPECT utilization immediately before the PET program began and the two years after PET was fully implemented, we conducted a retrospective analysis of catheterization outcomes 60 days after heart patients received various treatments.””This study involves one of the largest number of PET patients studied to date,” Dr. Min added. “What we now know is that PET more successfully identifies patient who have high-grade coronary artery disease and may benefit from revascularization. Similarly, PET better identified patients who did not need an invasive procedure. This has broad implications as physicians consider what test best serves their individual patients and institutions consider the advantages and disadvantages of SPECT and PET as well as downstream resource utilization.'” Source:https://intermountainhealthcare.org/center_img Reviewed by Kate Anderton, B.Sc. (Editor)Mar 12 2019Patients who receive cardiac positron emission testing (PET) imaging instead of single photon emission computed tomography (SPECT) scan experienced a significant increase in the detection of severe obstructive coronary artery disease, according to researchers at the Intermountain Medical Center Heart Institute in Salt Lake City.Both, PET and SPECT scans are nuclear imaging techniques that provide metabolic and functional information of the heart. PET scans provide better image resolution and quality, but have not yet gotten widespread adaptation compared to SPECT. The study is one of the largest of its kind involving PET patients.For the study, researchers examined Intermountain Healthcare’s Enterprise Data Warehouse, which is one of the nation’s largest depositories of clinical data, and identified 3,394 patients who underwent a pharmacologic SPECT from 2011-2012 and 7,478 patients who underwent PET in 2014-2015 at Intermountain Medical Center. The average age of the patients was 65 years, and 47 percent of patients were female.”The benefit of the study is that it helps us better identify a patient’s risk for adverse events affecting the heart and their need for further care,” said David Min, MD, a cardiologist specializing in cardiac imaging at the Intermountain Medical Center Heart Institute, and lead author of the study.Researchers looked at pharmacologic SPECT so the comparison with PET scans was more accurate. Both scans involve injecting a small dose of radioactive chemical, called a radiotracer, into the vein of the arm. The tracer travels through the body and is absorbed by the organs doctors examine.Key findings of the study:last_img read more

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Study offers new insights for vaccine development to prevent RSV disease

first_img Source:https://www.lsu.edu/mediacenter/news/2019/03/26vetmed_cormier_rsv.php Reviewed by James Ives, M.Psych. (Editor)Mar 27 2019In healthy adults, RSV, or respiratory syncytial virus, feels like the common cold with a runny nose, chest congestion and cough. However, it is the second leading cause of death in infants. In fact, nearly 40 percent of infants who contract this widespread virus develop severe bronchiolitis or pneumonia, with 1 to 3 percent hospitalized. Each year, there are about 64 million cases and about 160,000 deaths due to RSV worldwide. Contracting RSV within the first few months of life can make a child more susceptible to developing asthma later in life. The elderly and immune compromised populations, including cancer patients undergoing chemotherapy treatment, also suffer substantial morbidity and mortality. A new publication in Frontiers in Immunology by Stephania Cormier, the LSU Department of Biological Sciences Wiener Chair professor, and colleagues offers new insights for vaccine development, both active and passive, to prevent this deadly disease. This study is of particular interest following the recent failure of ResVax, an RSV vaccine by Novavax, to prevent RSV disease in infants via maternal immunization.”Because an infant’s immune system develops gradually within the first six months of life, the immune system does not respond and fight back in the same way as an adult would when infected by RSV. Since there are currently no effective RSV vaccines available, infants are essentially defenseless against this common virus,” Cormier said.The paper reviews the existing data demonstrating the importance of a family of small proteins called type 1 interferons, which are released by cells in response to viruses and are key to the body’s immune response. For example, when an infant is exposed to the influenza virus, its body launches an interferon response that fights back against the virus. However, infants who develop severe RSV bronchiolitis or pneumonia do not launch an interferon response when exposed to RSV. The scientists urge pharmaceutical companies to consider strategies for enhancing type 1 interferon responses to aid in combating RSV in infants.Related Stories$3.1 million NIH funding awarded to develop universal flu vaccineResearchers develop improved vaccine for meningitis and bloodstream infectionsNew shingles vaccine reduces outbreaks of painful rash among stem cell transplant patients”Vaccine developers need to look at how infants are responding immunologically to a vaccine at the site of infection. Our research shows that simply increasing circulating neutralizing antibodies is not enough to prevent disease in infants; it is also important to induce type 1 interferons,” Cormier said.She suggests approaches to restore a normal interferon response to a vaccine, which enhances the body’s immune response providing protection from disease.Since development of active vaccines is a long and costly endeavor, pharmaceutical companies are also interested in passively administering antibodies manufactured in the lab. For the past 20 years, the leading product of this type called Synagis has been used to reduce disease severity in the high risk population of premature birth infants. The new understanding of the host immune response to RSV suggests that improvements on Synagis need to provide both the antiviral activity and a countermeasure to the viral distortion of the host immune response.”Because Synagis has been a useful drug, most pharmaceutical efforts have targeted the same viral protein, called the F protein, as this approved drug. However, a different viral protein, called the G protein, has been implicated as a key driver of the immune system’s weak response. Antibodies against the G protein provide antiviral activity that is as good as those targeting the F protein, while also normalizing the host immune response,” said co-author Lawrence Kauvar, chief scientific officer of Trellis Bioscience, which is close to being ready to begin testing an antibody against the G protein in human clinical trials.In developing a new RSV vaccine for infants, the scientists urge the vaccine developers to think outside of the box.”If we can unlock infants’ type 1 interferon response, it could potentially change vaccines for all infants. It’s exciting,” Cormier said.last_img read more

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Papua New Guinea mulls temporary ban on Facebook

first_img Explore further The proposal, which Communications Minister Sam Basil said could lead to replacing Facebook with a locally developed social networking platform, was ridiculed as ill-timed and unworkable by opponents.Basil floated the idea of a one-month shutdown on Tuesday, saying it would “allow information to be collected” on fake accounts and users who upload pornography and defamatory information so that they could be removed from the platform.”This will allow genuine people with real identities to use the social network responsibly,” he said.Basil also said PNG could create a local alternative to Facebook, which has been rocked by revelations that it improperly shared the personal data of 87 million users with British consultancy firm Cambridge Analytica.”If there need be then we can gather our local applications developers to create a site that is more conducive for Papua New Guineans to communicate within the country and abroad as well,” he was quoted as saying by local media.No timeframe was given on the potential shutdown, although some reports suggested it could coincide with Port Moresby hosting the APEC (Asia-Pacific Economic Cooperation) summit later this year.A spokesperson for Facebook in Sydney said they had reached out to PNG authorities and were “working to address their concerns”.Basil issued a follow-up statement Wednesday acknowledging that “Facebook use in PNG is not limited to personal chats and blogs” but also serves as a forum for legitimate commercial and information services.But he stood firm on pursuing a study of “the advantages and disadvantages of use of Facebook” and of “vulnerabilities” linked to personal data use and cybercrime. PNG Institute of National Affairs executive director Paul Barker said shutting down Facebook would make a mockery of the nation during the 21-member APEC summit, expected to be attended by US President Donald Trump.”The APEC meeting is all about promoting the digital era to assist business, develop economies, and improve citizen welfare in member countries,” he told the PNG Post Courier newspaper Wednesday.”It would be a travesty if PNG sought to close down Facebook during the APEC month, making PNG seem rather foolish.”Facebook is widely used in PNG to discuss politics and expose corruption and MPs and officials have shown a high degree of sensitivity to posts in the past, according to the Australian Broadcasting Corporation, one of the few foreign media groups based in the country.Basil denied the proposed ban was a threat to freedom of speech.”I don’t think so because MPs are open to criticism,” he said. Opposition MP Bryan Kramer, who has a large following on Facebook, called the proposal ridiculous.”The reason the word dumb comes to mind is because how does one shut down a platform to carry out research on it,” he said Wednesday. “It would be equivalent to saying we are carrying out research on the negative effects of TV so we are turning it off so we can study a blank screen.” © 2018 AFP Communications Minister Sam Basil said Papua New Guinea was mulling a one-month shutdown of Facebook and the possible development of an alternative social networking platform for its citizens UK regulator investigating Facebook over political campaigningcenter_img Citation: Papua New Guinea mulls ‘temporary’ ban on Facebook (2018, May 30) retrieved 18 July 2019 from https://phys.org/news/2018-05-papua-guinea-mulls-temporary-facebook.html Papua New Guinea said Wednesday it was mulling a temporary shutdown of Facebook to uncover false accounts and block fake news in the Pacific nation, which hosts a major global summit later this year. This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.last_img read more

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