Global Security News from Michael_Novakhov (27 sites): 1. World from Michael_Novakhov (22 sites): Reuters: World News: U.S. imposes first new North Korea sanctions since failed summit

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The United States imposed sanctions on Thursday on two Chinese shipping companies it says helped North Korea evade sanctions over its nuclear weapons program, the first such steps since a U.S.-North Korean summit collapsed last month.

Reuters: World News

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1. World from Michael_Novakhov (22 sites): Reuters: World News: U.S. imposes first new North Korea sanctions since failed summit

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The United States imposed sanctions on Thursday on two Chinese shipping companies it says helped North Korea evade sanctions over its nuclear weapons program, the first such steps since a U.S.-North Korean summit collapsed last month.

Reuters: World News

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Global Security News from Michael_Novakhov (27 sites): 1. World from Michael_Novakhov (22 sites): FOX News: Gutfeld on the crushing of ISIS

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No one likes to say, “Mission Accomplished,” but Fox News has learned that the last ISIS stronghold, has been liberated– the repugnant empire that once terrorized over 8 million people is left with 800 yards of turf. For now.

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1. World from Michael_Novakhov (22 sites): FOX News: Gutfeld on the crushing of ISIS

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No one likes to say, “Mission Accomplished,” but Fox News has learned that the last ISIS stronghold, has been liberated– the repugnant empire that once terrorized over 8 million people is left with 800 yards of turf. For now.

FOX News

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1. World from Michael_Novakhov (22 sites): Reuters: World News: China birth rates fall in several regions in 2018: China Daily

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China’s birth rate in several regions, including the capital Beijing, fell again in 2018, the official China Daily said on Friday, despite government efforts to encourage couples to have more children.

Reuters: World News

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1. World from Michael_Novakhov (22 sites): FOX News: Reporter’s Notebook: Italy’s poised to breaks ranks with G-7, raising fears of a Chinese Trojan horse

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Chinese President Xi Jinping, in an editorial charm offensive published Wednesday in one of Italy’s leading newspapers, said Chinese youth love pizza and tiramisu. Meanwhile, the rest of Europe is not loving much at all about Xi’s visit to Italy.

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1. World from Michael_Novakhov (22 sites): Voice of America: At Least a Dozen Dead in China Chemical Plant Blast

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The death toll from a huge explosion at a chemical plant in eastern China rose to 12 Friday after rescuers pulled dozens of people from the area, state media said.

The blaze “has been controlled” by firefighters hours after Thursday’s blast left an industrial park burning into the night in Yancheng in Jiangsu province, according to broadcaster CCTV.

As of the early hours of Friday, a total of 88 people were “rescued” from the area, including 12 who died in the disaster, CCTV…

Voice of America

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The FBI News Review: “house judiciary committee” – Google News: Maryland House Judiciary Committee advances Johns Hopkins police legislation – Baltimore Sun

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Feedly Logo
March 21, 2019
“house judiciary committee” – Google News: Maryland House Judiciary Committee advances Johns Hopkins police legislation – Baltimore Sun
FBI seeks woman accused in multi-state drug trafficking ring – KOB
Deposition Reveals Late Sen. McCain’s Role in Spygate Scandal – The Epoch Times
White House personnel official described Trump GOP nomination as ‘end of the world’ – Washington Examiner
“fbi surveillance” – Google News: Only on 10: FBI, Fall River police search for fingerprints on vandalized graves – Turn to 10

“house judiciary committee” – Google News: Maryland House Judiciary Committee advances Johns Hopkins police legislation – Baltimore Sun

FBI from Michael_Novakhov (25 sites)
Maryland’s House of Delegates Judiciary Committee voted 13-8 Thursday night to advance legislation to authorize a police force for Johns Hopkins University. The committee voted for the bill after adding a series of amendments, including one that requires a member of the university’s Black Faculty and Staff Association to sit on the accountability board that will oversee the force; another that prohibits the force from using surplus military equipment; and a third that mandates officers are trained in the legal use of searches.
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FBI seeks woman accused in multi-state drug trafficking ring – KOB

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FBI seeks woman accused in multi-state drug trafficking ring KOBKOB Web Staff March 21, 2019 09:26 AM. ALBUQUERQUE, N.M. – The FBI is looking for a woman who allegedly played a part in a drug trafficking organization …
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Deposition Reveals Late Sen. McCain’s Role in Spygate Scandal – The Epoch Times

The Epoch Times
David Kramer, a longtime associate of the late Sen. John McCain (R-Ariz.), revealed in an unsealed deposition that he had contact with at least 14 members of the media regarding the Steele dossier—a collection of 17 memos containing unverified allegations against Donald Trump.
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White House personnel official described Trump GOP nomination as ‘end of the world’ – Washington Examiner

Washington Examiner
White House personnel official described Trump GOP nomination as ‘end of the world’ Washington ExaminerPresident Trump secured the Republican presidential nomination on May 3, 2016, when he crushed a final “Never Trump” effort to stop him in the Indiana …
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“fbi surveillance” – Google News: Only on 10: FBI, Fall River police search for fingerprints on vandalized graves – Turn to 10

FBI from Michael_Novakhov (25 sites)
FALL RIVER, Mass. (WJAR) — The FBI joined Fall River police Thursday to search for fingerprints on vandalized graves at Hebrew Cemetery. More than 50 gravestones were knocked over, written on or damaged in some way, police told NBC 10 News.
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Global Security News from Michael_Novakhov (27 sites): Top stories – Google News: Hands On: There’s More To Nintendo’s Labo VR Than Meets The Eye – Nintendo Life

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Global Security News from Michael_Novakhov (27 sites): News and Times from Michael_Novakhov (15 sites): Top stories – Google News: Hands On: There’s More To Nintendo’s Labo VR Than Meets The Eye – Nintendo Life

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Global Security News from Michael_Novakhov (27 sites): 1. World from Michael_Novakhov (22 sites): FOX News: Mexico launches plan to mark vaquita porpoise reserve

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The Mexican government says it will mark the reserve of the world’s most endangered marine mammal with buoys, in a bid to save the last remaining 10 or so vaquita porpoises.

FOX News

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1. World from Michael_Novakhov (22 sites): FOX News: John Legend joins viral ‘Florida Man’ challenge with headline from his birth date

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The infamous “Florida man” meme, inspired by outrageous headlines coming out of the Sunshine State is now turning into a viral trend. And even singer John Legend is joining in on the fun.

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Global Security News from Michael_Novakhov (27 sites): Counterintelligence from Michael_Novakhov (50 sites): Eurasia Review: Health Care Costs And The Budget – OpEd

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Introduction

Budget projections show the federal budget deficit
growing substantially in the next decade and beyond. A major part of
this story is high US health care costs. The United States pays roughly
twice as much per person for its health care with little to show in the
way of better outcomes. If US health care costs were in line with those
in other countries, the budget picture would be substantially improved.

I will make five main points in this discussion.
First, I show how the budget outlook would look if US health care costs
were comparable to those in other wealthy countries. Second, I point out
that US health care costs have actually slowed substantially over the
last decade. This fact has drawn remarkably little attention. Third, I
point out that we pay roughly twice as much for prescription drugs as
other wealthy countries and describe routes for bringing down drug
prices. Fourth, we also pay twice as much for our physicians as other
wealthy countries. Fifth, our administrative costs also vastly exceed
costs in other wealthy countries.

These areas are sources of massive waste. If we could
get these costs more in line with costs in other wealthy countries,
universal health care coverage in the United States would be affordable
and not be a major drain on the budget in the years ahead.

US Health Care Costs and the Budget Deficit

Figure 1 shows the Congressional Budget
Office’s (CBO) projection for the budget deficit as a share of GDP over
the next three decades. It also shows what the deficit would look like
if we paid the same amount per person for our health care as in Germany.[1]
While per person health care costs in Germany are just 56 percent of
those in the United States, it is actually a relatively high-cost
country among the OECD. Per person costs in France are less than 49
percent of those in the United States. In Japan, they are less than 47
percent while in the United Kingdom they are just over 42 percent.[2]

baker middlebury 2019 02 27 fig 1

As can be seen, the projected course for the budget
deficit looks hugely different in the scenario in which US health care
costs are the same as in Germany. The baseline projection shows a
sharply rising deficit. This is both due to projected increases in
government spending on health care over the next three decades and a
sharp rise in projected interest payments as the debt-to-GDP ratio is
projected to increase rapidly over this period.

The baseline projections show total government
spending on health care rising from 5.2 percent of GDP in 2018 to 9.2
percent of GDP in 2048. The biggest factor in this projected increase is
the aging of the population, with both a large percentage of the
population eligible for Medicare and also the average age of Medicare
beneficiaries rising substantially. Net interest on the debt is also
projected to increase, going from 1.6 percent of GDP in 2018 to 6.3
percent in 2048, as the ratio of public debt to GDP rises from 78
percent to 152 percent.

The story is quite different in the scenario where we
pay the same per person health care costs as in Germany. Instead of
rising over this period, the deficit is projected to fall and actually
turn into a surplus in 2041. The two big factors here are that the
savings from paying lower per person health care costs are much larger
as projected health care costs in the United States rise relative to
GDP. In 2018, the savings from paying German levels of health care costs
would be 2.3 percent of GDP, by 2048 they would be more than 4.0
percent of GDP.

While the baseline projections show the debt-to-GDP
ratio rising ever higher, the projections assuming German health care
costs show the debt to GDP ratio falling throughout the period. In fact,
the debt is projected to be paid off completely in 2044 and the US
government begins accumulating assets. This means that instead of paying
net interest of 6.3 percent of GDP in 2048, in the scenario with German
health care costs the government would be collecting interest on its
assets equal to 0.7 percent of GDP.

Of course, both the projections in the baseline and
my alternative scenarios are highly unrealistic. Our ability to project
health care costs has been very poor, as I’ll show in a moment. Also,
these projections are drawn assuming that current tax and spending
policy remains in place for the next three decades. One thing of which
we can be quite certain is that tax and spending policy in 2048 will
look very different than it does today.

The History of Health Care Spending Projections

Our ability to project the course of health care
spending has been notoriously bad. The problem is that we project the
past into the future, and that turns out not to be a very good predictor
of health care costs. In 1991, analysts at the Health Care Financing
Administration (the predecessor to the Centers for Medicare and Medicaid
Services [CMS]) projected that health care spending would rise to 26.1
percent of GDP by 2030.[3]
By 2020, costs were supposed to reach 22.7 percent of GDP. Spending was
equal to 18.0 percent of GDP for 2017, the most recent year for which
full data are available and is now projected to rise to 18.4 percent for
2020.[4]

The difference between the projection for 2020 from
1991 and the most recent projection is 4.3 percentage points of GDP.
That is equivalent to more than $860 billion annually in today’s
economy. Unless we see a very sharp pickup in health care cost growth,
the gap between the 1991 projection and actual spending in 2030 will be
considerably larger.

It wasn’t just the projections from the 1990s that
proved to be overly pessimistic. There has been a sharp slowing in
health care costs in just the last decade. In 2008, the CMS projections
were for national health care spending to be 19.5 percent of GDP by
2017, a full 1.5 percentage points higher than the actual figure.[5]
This can also be seen in the CBO projections for health care spending.
CBO only projects the government side of health care spending, which is
skewed by the expansion of Medicaid and the subsidies in the exchanges
which were part of the 2010 Affordable Care Act. But if we just look at
the Medicare projections, as shown in Figure 2, we can see that
costs have risen considerably less rapidly than projected. Net spending
for 2018 was 2.8 percentage points of GDP, nearly 0.5 percentage points
less than the 3.3 percent of GDP that had been projected in 2008.

baker middlebury 2019 02 27 fig 2

The reduction in Medicare cost growth can also be
seen in the projections for the program’s financial health by the
Medicare trustees. In the 2009 Medicare trustees report the projected
shortfall in the program’s funding over its 75-year planning horizon was
3.88 percent of payroll.[6] In the most recent trustees report (2018) it was projected at 0.82 percent of payroll over its 75-year planning horizon.[7]
Even this sharp reduction in the projected shortfall understates the
improvement in the finances of the program since the 75-year horizon
going forward from 2018 looks considerably worse demographically than
the 75-year horizon going forward from 2009. Remarkably, this sharp
improvement in the program’s finances has received little attention as
the Obama administration opted not to publicize it to any substantial
extent.

The Reason for High US Health Care Costs: We Pay Too Much

While the United States pays more than twice as much
per person for its health care that people in most other wealthy
countries, it is not because we get more or better health care. The
United States actually does poorly by measures like life expectancy and
infant mortality rates, but this is largely due to the fact that it has
more inequality and higher poverty rates than most other wealthy
countries. However, even when efforts are made to control for
socioeconomic factors that affect health, the US healthcare system does
not stand out as being an especially good system compared to those in
other wealthy countries.[8]
The basic story is that we pay twice as much for everything as other
countries. This is true for doctors and dentists, for our drugs and
medical equipment, and for the insurance industry that gets between
patients and providers.

Doctors

Doctors in the United States get paid twice as much
on average as physicians in other wealthy countries. This is not a
general pattern throughout the economy. Our autoworkers and retail
workers do not get paid twice as much as their counterparts in Germany
and France. In fact, our autoworkers are likely to get paid considerably
less than their counterparts in northern and western Europe.[9]By contrast, our doctors do get paid twice as much as their counterparts in Europe.

Our general practitioners get paid on average close
to $200,000 a year, while specialists average close to $300,000, with
the most highly paid getting $500,000 a year or more.[10]
Our pay for physicians is further inflated by the fact that two-thirds
of our doctors are specialists, while in most other countries the ratio
would be close to one-third. These means that we have many specialists
in the US who are doing tests and procedures that would be done by
general practitioners in other countries.

The most obvious way to get physicians’ pay more in
line with other wealthy countries is through increased competition, both
foreign and domestic. In terms of foreign competition, we have very
restrictive rules that largely prevent foreign-trained physicians from
practicing in the United States. We require that they complete a US
residency program in order to work as a physician in the United States.
This means that even highly accomplished doctors in countries like
France and Germany would be arrested if they practiced medicine in the
United States.[11]

The obvious route for more competition would be to
allow foreign doctors who have received comparable training to what US
doctors receive to practice in the United States. We could also work to
facilitate US patients going overseas to talk advantage of lower cost
care directly, by having major non-emergency surgeries performed in
other countries with lower costs. With the difference in price for major
procedures often coming to $100,000 or more, there could still be large
savings even if a patient traveled with a family member and stayed
overseas for a lengthy period of recovery. To substantially increase
medical travel, it would be necessary to have a reliable system of
accreditation which would allow patients to have confidence in the
quality of the facilities they are using. It would also be necessary to
have well-defined rules on legal liability so that patients would know
they have recourse in the event there is a mistake.

The potential gains from bringing the pay of US
doctors in line with the average for other wealthy countries are large,
in the neighborhood of $100 billion a year or roughly $700 per household
per year. There are issues of equity that would come up if the pay of
doctors were to fall sharply. Many have taken out large amounts of debt
to pay for their medical training. Medical school in most other wealthy
countries is mostly paid for by the government. It would be reasonable
to follow the same path here and to have some loan forgiveness program
to get doctors through the transition. However, it is worth noting in
this context that there was very little interest in policy circles in
measures that sought to compensate the millions of manufacturing workers
who were displaced in the last decade by the opening of trade,
especially to China. That is not a model we would want to emulate, but
it is striking that there seems to be so much more interest in ensuring
that our most highly educated workers are protected from the impact of
foreign competition than was the case with less-educated manufacturing
workers.

There also is an issue of increased domestic
competition. There are many tasks that are now performed by doctors that
can be performed equally well by less-highly trained and less-highly
paid health care professionals. One area that has drawn considerable
attention is prescribing drugs. In several states, nurse practitioners
are able to prescribe drugs without a doctor’s supervision. There is no
evidence that this leads to worse outcomes or increased incidence of
drug abuse. Laws defining the scope of practice for various
professionals should be based on medical evidence, not the desire of
more highly paid professionals to increase their income.

Prescription Drugs

According to the OECD, the United States paid more
than $1,200 per person for prescription drugs in 2017, whereas in other
wealthy countries drugs cost close to $600 per person.[12]
The basic story in the United States is that we give drug companies
patent monopolies and then allow them to charge whatever they want for
their drugs. In many cases, these drugs are necessary for people’s
health or even their life. This means that if there is any way that a
person or their family can pay the price demanded by the drug company,
they will do so. Since the payer is typically a third party, either an
insurer or the government, this means that they will spend their efforts
lobbying an insurer or the government to pick up the tab.

Other wealthy countries have some process of
negotiation whereby they restrict what drug companies can charge. This
can mean, in some cases, that expensive drugs that are available in the
United States, are not available in the United Kingdom or Australia,
because their governments were not able to reach an agreement on price
with the drug company. However, in most cases, the drugs are available
and the price is typically around 50 percent of the price in the United
States. (There is a similar story with medical equipment. Items like
MRIs typically cost around half as much in other wealthy countries as in
the United States.)

There are two routes to go to bring our prices in
line with those in other wealthy countries. The first is to adopt the
same sort of negotiation process used elsewhere. The pharmaceutical
industry will use all its power to prevent a reduction in prices in the
United States since the country is such a large source of profits for
the industry. However, if the political obstacles can be overcome, there
is no reason why people in the United States have to pay twice as much
for drugs as people in France and Germany.[13]

The other route is to look to replace the research
supported by patent monopolies with public funds. In this scenario, the
government would look to replace the roughly $70 billion a year that the
industry now spends on research with additional public funding. (The
government already spends roughly $40 billion a year on biomedical
research through the National Institutes of Health and other agencies.)

Ideally, the government would sign long-term
contracts with drug companies to conduct research in various areas. A
condition of getting a contract would be that all results are in the
public domain. This means both that all patents are placed in the public
domain and also that all results are posted on the Internet as soon as
possible so that they can be reviewed and critiqued by other
researchers.[14]

The potential savings from going this route are
enormous. In 2018, the United States spent almost $440 billion (2.2
percent of GDP) on prescription drugs. It is likely that these drugs
would have cost less than $80 billion (0.4 percent of GDP) in a free
market where all drugs are sold as generics. Drugs are rarely costly to
manufacture; their high prices stem from the protection the government
gives them.

In addition to drastically reducing the cost of
drugs, this route would also eliminate many of the perverse incentives
created by patent monopolies. Drug companies would no longer spend
billions of dollars on lobbying and legal fees trying to protect and
extend their patent monopolies because these monopolies would no longer
exist. They would also have much less reason to advertise and market
their drugs to doctors since their profit margins would be more
comparable to what companies get from selling paper cups rather than
street heroin. And, they would have much less reason to conceal evidence
that drugs are less effective than originally believed or that they
could be dangerous under some circumstances.

The same story would apply to all sorts of medical
equipment and tests. If an MRI were just a few hundred dollars, doctors
would have little concern about prescribing one for a patient if they
believe that it would be more effective than a less expensive scanning
device. As with drugs, the cost of researching the device has already
been paid. In almost all cases, the cost associated with additional use
is likely to be trivial.

Insurance Costs

We paid private insurers almost $230 billion (1.2
percent of GDP) in 2017 to administer insurance plans. Most of this
money was paid to administer private insurance plans either purchased by
employers or individuals.[15]
This means that administrative costs were more than 19 percent of the
$1,183 billion that insurers paid for services in that year.[16]
By comparison, Medicare’s administrative expenses are a bit more than
2.0 percent of what it pays out for services each year. Canada has
comparable administrative expenses for its universal Medicare program.

In addition to the direct expense of supporting the
insurance industry, the fact that we have multiple insurers with varying
policies on coverage, copays, and deductibles, means that hospitals and
doctors’ offices must have more staff to deal with billing. If we had a
single Medicare-type insurer, as in Canada and a number of other
countries, providers could get by with considerable less office staff to
deal with the financial aspects of health care.

This change would also likely be a big boon to
patients since insurers often make mistakes in not paying for covered
care. (They likely make some mistakes in the other direction as well,
but this would not be a major source of aggravation for people in bad
health or their families.) If the payment structure was simplified, it
would drastically reduce the amount of time wasted on all sides in
dealing with health care bills.

It is difficult to get a clear sense of what the
total savings would be from a simplified insurance system, but a figure
in the neighborhood of $140 billion a year (0.7 percent of GDP) would
likely be in the ballpark. Some of these savings could likely be
accomplished with an expanded Medicare-type system that people could buy
into voluntarily. Since getting to a universal Medicare system all at
once is likely a hurdle too big, we will almost certainly need some
intermediate steps if we are to go in this direction.

Conclusion: Health Care Costs and Budget Deficits Can Be Controlled

The projections of escalating budget deficits are
overwhelmingly a story of high US health care costs. If US health care
costs were comparable to those in other wealthy countries, our current
and projected future deficits would be easily manageable.

Even though we pay twice as much per person as
people in other wealthy countries, we do not get better health care for
our money. The problem is that we pay twice as much to our doctors, for
our drugs and medical equipment, and we waste a huge amount of money
administering private insurance. If we can get these costs more in line
with those in other wealthy countries, we will save an enormous amount
of money on our health care and we will not have deficit problems to
worry about.

Notes.


[1] This calculation assumes that the
ratio of spending in Germany to spending in the United States remains
constant over the next 30 years. The calculation also assumes that
interest rates will be the same in the lower health care cost scenario.
Interest payments will be lower in the lower health care cost scenario
only because debt is lower, the calculation does not assume that lower
debt and deficits result in lower interest rates. This assumption almost
certainly leads to an understatement of the savings from lower health
care costs. The calculation also understates the savings from lower
health care cost since it doesn’t pick up the additional tax revenue
that the government would realize as a result of private sector health
care spending. The health insurance premiums that employers pay for
their workers are not subject to income tax. If the savings from lower
health care costs showed up as higher wages, as is generally assumed, it
would increase tax revenue by roughly 1.0 percent of GDP or $200
billion in 2019.

[2] These data are taken from the OECD’s
data page for per capital health care spending, see: OECD. 2019. “Health
Spending (Indicator).” Paris, France: OECD. https://data.oecd.org/healthres/health-spending.htm#indicator-chart.

[3] “Exhibit 1: National Health
Expenditures, By Type of Service, Middle Scenario, Selected Calendar
Years 1980–2030” in Waldo, Daniel R., Sally T. Sonnefeld, Jeffrey A.
Lemieux, and David R. McKusick. 1991. “Health Spending Through 2030:
Three Scenarios.” Health Affairs, Vol. 10, No. 4, p. 234. https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.10.4.231.

[4] Centers for Medicare and Medicaid
Services. “Table 1: National Health Expenditures and Selected Economic
Indicators, Levels and Annual Percent Change: Calendar Years 2010–2026.”
Baltimore, MD: Centers for Medicare and Medicaid Services. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/Proj2017Tables.zip.

[5] Sean Keehan, Andrea Sisko, Christoper
Truffer, Sheila Smith, Cathy Cowan, John Poisal, and M. Kent Clemens.
2008. “Health Spending Projections through 2017: The Baby-Boom
Generation is Coming to Medicare.” Health Affairs, Vol.. 27, No. 2, pp. 145–155. https://www.ncbi.nlm.nih.gov/pubmed/18303038.

[6] OASDI Board of Trustees. 2009. “2009 OASDI Trustees Report.” Woodlawn, MD: Social Security Administration. https://www.ssa.gov/oact/tr/2009/VI_OASDHI_payroll.html#131183.

[7] Boards of Trustees of the Federal
Hospital Insurance and Federal Supplementary Medical Insurance Trust
Funds. 2018. “2018 Annual Report of the Boards of Trustees Of the
Federal Hospital Insurance and Federal Supplementary Medical Insurance
Trust Funds.” Baltimore, MD: Centers for Medicare and Medicaid Services.
https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/downloads/tr2018.pdf.

[8] For example, see: Schneider, Eric C.,
Dana O. Sarnak, David Squires, Arnav Shah, and Michelle M. Doty. 2017.
“Mirror, Mirror 2017: International Comparison Reflects Flaws and
Opportunities for Better US Health Care.” New York, NY: Commonwealth
Fund. https://interactives.commonwealthfund.org/2017/july/mirror-mirror/.

[9] Bureau of Labor Statistics. 2012.
“Table 1. Hourly compensation costs, US dollars and US = 100.”
Washington, DC: Bureau of Labor Statistics. https://www.bls.gov/news.release/ichcc.t01.htm.

[10] Knowles, Megan. 2017. “AMGA: 10 median salaries by medical specialty.” Becker’s Hospital Review, November 13.https://www.beckershospitalreview.com/compensation-issues/amga-10-median-salaries-by-medical-specialty.html.

[11] Doctors licensed in Canada are
exempted from the residency requirement, although other restrictions
still make it difficult for them to practice in the United States.

[12] OECD. 2019. “Pharmaceutical Spending (Indicator).” Paris, France: OECD. https://data.oecd.org/healthres/pharmaceutical-spending.htm.

[13] The industry will claim that this
will reduce their research spending. This is undoubtedly true to some
extent, but if we get slightly less research, and save $200 billion a
year on drugs, that might look like a pretty good trade-off.

[14] Copyleft patents may prove to be
more desirable than simply putting material in the public domain. In
principle, all countries would share in the cost of biomedical research
according to a formula based on their size and wealth. However, if some
countries refused to go along with such an agreement, then a copyleft
patent could deny them free access to the research.

[15] Insurers also play a role in administering Medicare, especially with Medicare Advantage plans.

[16] These are taken from Centers for Medicare and
Medicaid Services. 2019. “National Health Expenditures Projections,
Tables 1 and 3.” Baltimore, MD: Centers for Medicare and Medicaid
Services. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/Tables.zip.

This article is adapted from a presentation at the Middlebury Institute, Monterey, CA. It originally appeared on CEPR.

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Global Security News from Michael_Novakhov (27 sites): Trump Investigations from Michael_Novakhov (81 sites): “trump putin” – Google News: White House rejects Dem requests for info on Putin communications – CNN

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Global Security News from Michael_Novakhov (27 sites): Counterintelligence from Michael_Novakhov (50 sites): Eurasia Review: Elevation Shapes Species Survival In Changing Habitats

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Luke Frishkoff, University of Texas at Arlington assistant professor
of biology, explores how human land use expedites biodiversity loss in a
paper recently published in Nature Ecology & Evolution.

For a study conducted at the University of Toronto, Frishkoff, as a
postdoctoral fellow, and his collaborators traveled to the Dominican
Republic to take a census of the region’s Anolis lizard species along an
elevation gradient affected by deforestation. The species is a common
group of tropical lizards that are a model system in ecology and
evolutionary biology.

“This work uses elevation as a lens to understand the potential
implications of climate change,” Frishkoff said. “Temperature changes
along an elevation gradient, and general climate temperatures are
expected to continue warming. By comparing the highlands to the
lowlands, we can, in some sense, get a picture of how these biological
communities might look in the future.”

The lowlands along the gradient are warmer than the highlands due to
altitude, and a forest canopy blocks direct sunlight making the
vegetation-dense areas cooler than their agricultural surroundings at
any elevation. The study determined elevation plays a major role in
which species survive as humans modify the habitat.

“The takeaway message is that the lizard communities in the lowlands
are pretty good at coping with habitat conversion–they lose abundance,
but don’t go extinct,” Frishkoff said. “When the forest is cut down in
the highlands and the habitat warms, the pastures become filled with
species from the warmer lowlands. Unlike the lowland species, the
locally adapted forest lizards unique to the region’s mountaintops
cannot survive when the forest is cut down.”

Frishkoff points out that biodiverse animals in any habitat act as
“ecological players” to balance the ecosystem and often provide services
that benefit humans in a variety of different ways. In order to get the
most benefit from these ecological players, humans need to understand
and have mechanisms to predict which species will survive as the climate
warms and human land use changes, and Frishkoff’s research indicates
the effects of habitat conversion can change radically with elevation.

The Dominican Republic study is part of a larger project, Frishkoff
said. Since coming to UTA in September 2018, he has begun looking at
lizard populations throughout Jamaica, Puerto Rico, Central America and
Texas to understand the rules that govern species survival in a variety
of different climates and conditions.

“We need to be able to predict what species are going to do well in
what environmental contexts,” Frishkoff said. “The broader goal is to
lay that foundation to predict biological communities across climates,
across land uses. So that eventually policymakers can use that
information eventually to make decisions that integrate human wellbeing
and biological wellbeing.”

In his research, Frishkoff focuses mainly on reptiles and
amphibians. He said the placement of UTA offers a great wealth of
biological diversity to support his research, which is enriched by the
university’s Amphibian and Reptile Diversity Research Center. The ARDRC
is home to the largest herpetology collection in Texas with more than
200,000 specimens.

Using the collection, Frishkoff’s lab is beginning to study
morphological differences between species to understand whether certain
body shapes allow various species to do better in urban environments
like the one UTA lies at the center of.

“Luke’s ongoing and developing research endeavors to address
critical issues facing our global environment and support a sustainable
urban community – two driving themes of our university’s strategic
plan,” said Clay Clark, professor and chair of the Department of
Biology. “He will make contributions to our growing footprint as a
research enterprise.”

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Global Security News from Michael_Novakhov (27 sites): Counterintelligence from Michael_Novakhov (50 sites): Eurasia Review: Ancient Birds Out Of The Egg Running

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The ~125 million-year-old Early Cretaceous fossil beds of Los Hoyas, Spain have long been known for producing thousands of petrified fish and reptiles (Fig. 1). However, one special fossil stands unique and is one of the rarest of fossils — a nearly complete skeleton of a hatchling bird.

Using their own laser imaging technology, Dr Michael Pittman from the Department of Earth Sciences at The University of Hong Kong and Thomas G Kaye from the Foundation for Scientific Advancement in the USA determined the lifestyle of this ~3cm long hatchling bird by revealing the previously unknown feathering preserved in the fossil specimen.

Chickens and ducks are up and about within hours of hatching, they
are “precocial” (Fig. 3). Pigeons and eagles are “altricial”, they stay
in the nest and are looked after by their parents. How do you tell if a
hatchling came “out of the egg running” or was “naked and helpless in
the nest”? Feathers. When precocial birds hatch they have developed down
feathers and partly developed large feathers and can keep warm and get
around without mum’s help. “Previous studies searched for but failed to
find any hints of feathers on the Los Hoyas hatchling. This meant that
its original lifestyle was a mystery,” says Dr Pittman.

Michael Pittman and Thomas Kaye brought new technology to the study
of Los Hoyas fossils in the form of a high power laser. This made very
small chemical differences in the fossils become visible by fluorescing
them different colours, revealing previously unseen anatomical details.
They recently had tremendous success with the first discovered fossil
feather which they disassociated from the famous early bird
Archaeopteryx by recovering the chemical signature of its fossil quill, a
key part of the feather’s identification that had been previously
unverified for ~150 years. The new results on the hatchling bird finally
answered the question about its lifestyle as it did indeed have
feathers at birth (Figs. 2, 4) and was thus precocial and out of the egg
running. The feathers were made of carbon which has low fluorescence
using Laser-Stimulated Fluorescence (LSF), but the background matrix did
glow making the feathers stand out in dramatic dark silhouette (Fig.
2). “Previous attempts using UV lights and synchrotron beams failed to
detect the feathers, underscoring that the laser technology stands alone
as a new tool in palaeontology” added Tom Kaye, the study’s lead
author.

This discovery via new technology demonstrates that some early birds
adopted a precocial breeding strategy just like modern birds. Thus, in
the time of the dinosaurs, some enantiornithine bird babies had the
means to avoid the dangers of Mesozoic life perhaps by following their
parents or moving around themselves. “One of the feathers discovered was
of a substantial size and preserves features seen in other hatchlings.
It indicates that our hatchling had reasonably well-developed flight
feathers at the time of birth”, says Jesús Marugán-Lobón, a co-author
from the Universidad Autónoma of Madrid, Spain (Figs. 2B, 4). This and
other “illuminating” discoveries are adding to our knowledge of ancient
life with details surviving in the fossil record that were never thought
possible even a couple decades ago.

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Global Security News from Michael_Novakhov (27 sites): Counterintelligence from Michael_Novakhov (50 sites): Eurasia Review: Analyzing A Facebook-Fueled Anti-Vaccination Attack: ‘It’s Not All About Autism’

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Social media has given those espousing anti-vaccination sentiments an
effective medium to spread their message. However, an analysis of a
viral Facebook campaign against a Pittsburgh pediatric practice reveals
that the movement isn’t “all about autism.” Instead, the research from
the University of Pittsburgh Center for Research on Media, Technology,
and Health finds that anti-vaccination arguments center on four distinct
themes that can appeal to diverse audiences.

The research, published in the journal Vaccine, suggests a framework that pediatricians can use to open a conversation with parents who are hesitant to immunize their children, while also “inoculating” those parents with skills to resist anti-vaccination messages on social media.

“If we dismiss anybody who has an opposing view, we’re giving up an
opportunity to understand them and come to a common ground,” said senior
author Brian Primack, M.D., Ph.D., director of Pitt’s Center for
Research on Media, Technology, and Health, and dean of the Pitt Honors
College. “That’s what our research is about. We want to understand
vaccine-hesitant parents in order to give clinicians the opportunity to
optimally and respectfully communicate with them about the importance of
immunization.”

Vaccines are hailed as one of the greatest public health
achievements of modern medicine and have prevented more than 100 million
cases of serious childhood contagious diseases. However, in the U.S.,
only 70 percent of children ages 19 to 35 months receive all recommended
immunizations, and, so far this year, hundreds of children in a dozen
states have contracted measles, a disease that was declared eliminated
in the U.S. nearly two decades ago due to high vaccination rates. In
Europe, tens of thousands of children have been diagnosed with the
vaccine-preventable disease, and dozens have died in the past year.

In 2017, Kids Plus Pediatrics, a Pittsburgh-based pediatric
practice, posted a video on its Facebook page featuring its
practitioners encouraging HPV vaccination to prevent cancer. Nearly a
month after the video posted, it caught the attention of multiple
anti-vaccination groups and, in an eight-day period, garnered thousands
of anti-vaccination comments.

Elizabeth Felter, Dr.P.H., assistant professor of community and
behavioral health sciences at Pitt’s Graduate School of Public Health,
connected Kids Plus Pediatrics with graduate student Beth Hoffman,
B.Sc., and scientists at the Center for Research on Media, Technology,
and Health. Hoffman led the team in partnering with the pediatrics
practice to perform a systematic analysis to better understand the
people behind the comments and how they cluster in the
digitally-connected world of social media.

Hoffman’s team analyzed the profiles of a randomly selected sample
of 197 commenters and determined that, although Kids Plus Pediatrics is
an independent practice caring for patients in the Pittsburgh region,
the commenters in the sample were spread across 36 states and eight
countries.

The team also found that the majority of commenters were mothers. In
those for which it could be determined, the top two political
affiliations of the commenters were divergent, with 56 percent
expressing support for Donald Trump, and 11 percent expressing support
for Bernie Sanders.

By delving into the messages that each commenter had publicly posted
in the previous two years, the team found that they clustered into four
distinct subgroups:

  • “trust,” which emphasized suspicion of the scientific community and concerns about personal liberty;
  • “alternatives,” which focused on chemicals in vaccines and the use of homeopathic remedies instead of vaccination;
  • “safety,” which focused on perceived risks and concerns about vaccination being immoral; and
  • “conspiracy,” which suggested that the government and other
    entities hide information that this subgroup believes to be facts,
    including that the polio virus does not exist.

“The presence of these distinct subgroups cautions against a blanket
approach to public health messages that encourage vaccination,” Hoffman
said. “For example, telling someone in the ‘trust’ subgroup that
vaccines don’t cause autism may alienate them because that isn’t their
concern to begin with. Instead, it may be more effective to find common
ground and deliver tailored messages related to trust and the perception
mandatory vaccination threatens their ability to make decisions for
their child.”

Todd Wolynn, M.D., chief executive officer of Kids Plus Pediatrics
and a co-author of the research paper, said that although the negative
comments in reaction to the practice’s video were disheartening, he’s
glad it turned into a learning experience that may benefit other
clinicians.

“We’re focused on keeping kids healthy and preventing disease
whenever possible. In this age of social media disinformation,
evidence-based recommendations from a trusted health care provider are
more important than ever,” he said. “We’re thrilled to play such a key
role in research that empowers pediatricians worldwide to meet parents
where they are, appreciate their concerns, and communicate the
incredible power and value of vaccination.”

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