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US Voting Rights | Voice of America

Host Carol Castiel and assistant producer at the Current Affairs Desk, Sydney Sherry, talk with Eliza Sweren-Becker, counsel in the Democracy Program at the Brennan Center for Justice, about the impact of the wave of restrictive voting laws emanating from mostly Republican state legislatures. Sweren-Becker also discusses the implications of the recent U.S. Supreme Court ruling upholding the state of Arizona’s new restrictive voting laws, the Department of Justice’s lawsuit against the state of Georgia, and the erosion of protections under the landmark Voting Rights Act of 1965.

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Pakistan’s Religious Minorities Say They Were Undercounted in Census | Voice of America

WASHINGTON – Religious minorities in Pakistan claim the country’s long-delayed census, released by the government in May, appears to have undercounted them.

Although the sixth Population and Housing Census was completed in 2017, the Pakistan Bureau of Statistics published the data on May 19. The previous census had been conducted in 1998.

The 2017 census began under former Prime Minister Nawaz Sharif, who hailed from Punjab, Pakistan’s most prosperous province. However, its results were delayed after the Khyber Pakhtunkhwa, Baluchistan, and Sindh provinces complained that that their populations were undercounted.

On April 12, the Council of Common Interests (CCI), a constitutional body that resolves power-sharing disputes between the federal government and the provinces, met under Prime Minister Imran Khan and approved release of the most recent data.

While the Khyber Pakhtunkhwa and Baluchistan governments, both allies of Khan’s Pakistan Tehreek-e-Insaf (PTI) government, dropped their objections, Sindh, under the Pakistan Peoples Party, insisted the CCI decision would lead to unfair distribution of federal resources.

Muslims girls display their hands painted with traditional henna to celebrate Eid al-Fitr holidays, marking on the end of the fasting month of Ramadan, in Peshawar, Pakistan.

Growing Muslim majority

Pakistan’s 1998 census recorded 132.3 million people, while its newly released 2017 data show the population has grown to 207.68 million — excluding Pakistan-administered Kashmir.

The data showed that Muslims grew to 96.47% of the population, while religious minorities shrank or grew only minimally. Hindus accounted for 1.73% of the population; Christians, 1.27%; Ahmadiyya, 0.09%; scheduled caste, 0.41%; and others, 0.02%.

Peter Jacob, director of the Center for Social Justice in Lahore, told VOA that the number of Christians decreased 0.32% from the last census and now total about 2.5 million.

“Even though Christians have migrated overseas and converted to Islam, our church records make us suspect that Christians may have been undercounted by at least half a million,” he said.

“We’re struggling to find accurate data, and somehow the government is not helping. It is not investigating,” he said.

Government response

Pakistan Central Secretary for Information Ahmad Jawad told VOA that the Sharif government began the 2017 census and the PTI government followed it up.

According to Jawad, the federal government’s ethnic-based political partner in Sindh, the Muttahida Qaumi Movement, had been the most vocal in its opposition to the census results. He said that any group objecting to the results should seek recourse in parliament.

“The parliament is the best forum to present these concerns. Let’s deliberate whether we need to hold a census again, when we need to hold it, so that next time we don’t have objections.”

Admitting that the system had flaws, Jawad said Pakistan needed to rely on its National Database and Registration Authority (NADRA) and improve data collection to address objections in the future.

“We are also willing to consider the objections raised by religious minorities for the next census,” he added.

The PTI government plans to begin the next census in October. However, the Sindh government and its Hindu religious minority support calling a joint session of Parliament to record their objections.

Members of a civil society group hold a demonstration demanding the government allow the construction of a Hindu temple, in…

Members of a civil society group hold a demonstration demanding the government allow the construction of a Hindu temple, in Islamabad, Pakistan, July 8, 2020

Undercounting

Religious minorities say that despite emigration and forced conversions to Islam, the recent census count of their populations was lower than expected.

Neel Keshav, a Supreme Court lawyer from Karachi, said the 1998 census data showed a Hindu population of nearly near 2 million. Yet the new census showed it had grown only to 3.5 million in 20 years.

Keshav estimates higher numbers, given that Hindus live in rural areas and have generally high fertility rates.

He suspects that migrations do not explain the low population growth and that undercounting may have occurred — as Jacob suspected concerning the Christian population.

He quoted an estimate by the Human Rights Commission of Pakistan: that only 8,000 people emigrated to India over the past six years.

According to media reports, hundreds of Pakistani Hindus took up a 2019 offer by India’s nationalist Bharatiya Janata Party government to grant them visas and a path to Indian citizenship. However, many of them have since returned to Sindh, where they have lived for generations.

In this photo released by the Press Information Department, Pakistani Prime Minister addresses the Parliament in Islamabad, Pakistan, June 25, 2020. Khan accused the United States on Thursday of having

In this photo released by the Press Information Department, the Pakistani Prime Minister addresses the Parliament in Islamabad, Pakistan, June 25, 2020.

Favored communities

Religious minorities claim that prior governments also tended to undercount them because it allowed Islamabad to draw smaller constituencies and apportion fewer seats in the assemblies and the Senate.

Currently, religious minorities may contest only 33 reserved seats in the assemblies and four seats in the Senate.

“We have created reserved seats for religious minorities to enable any minority legislator elected across the country to raise their rights in Parliament,” Jawad told VOA.

But Hindu community lawyer Keshav said, “Reserved seats give political parties the power to select candidates who are mere tokens and do not represent the grassroots community.”

Jacob noted that while Islamic fundamentalist parties gained visibility, “no Christians were inducted into the federal Cabinet.”

The minorities say the government’s award of seats to non-Muslims — such as to a member of the tiny polytheistic Kalash community and to a Sikh senator — are merely meant to boost Pakistan’s image as a diverse and tourism-friendly country.

Senior Pakistani and Indian officials signed a landmark border crossing deal to facilitate Indian Sikh pilgrims, Oct. 24, 2019.

Senior Pakistani and Indian officials signed a landmark border crossing deal to facilitate Indian Sikh pilgrims, Oct. 24, 2019.

Sikhs

Sikhs were also disappointed that despite their lobbying efforts, the government did not create a religious column for them in the 2017 census. Instead, it lumped them in among “others.”

Prior to the 2017 census, Pakistan Sikh Council leader Sardar Ramesh Singh said in a statement that the government’s failure to list the Sikhs showed “total disrespect to the community.”

Pakistan’s NADRA records show 6,146 registered Sikhs, down from an estimated 2 million at the time of partition in 1947.

Rights activists say that many Sikhs, who primarily live in Khyber Pakhtunkhwa and Punjab, have left Pakistan to escape Islamist militant attacks and institutional discrimination.

As a sign of goodwill to the Sikh community, Pakistan inaugurated in 2019 the Kartarpur Corridor, a visa-free pathway that allows India-based Sikhs access to pilgrimage sites in Pakistani Punjab.

FILE - Ahmadi refugees from Pakistan eat at the Ahmadiyya Muslim Community Center in Pasyala, Sri Lanka, April 26, 2019.

FILE – Ahmadi refugees from Pakistan eat at the Ahmadiyya Muslim Community Center in Pasyala, Sri Lanka, April 26, 2019.

Ahmadi community

Some Ahmadi community leaders say that the census may have undercounted them since many hide their religious identity.

The Ahmadis were declared non-Muslims by Pakistan in 1974 and forbidden from publicly practicing Islam.

“Ahmadis are banned from declaring or propagating their faith publicly, building mosques, or making the Muslim call for prayer,” says Human Rights Watch.

Qamar Suleman, a leader of the Ahmadi Jamaat in Punjab, told VOA: “We cannot keep a copy of the holy Quran. We cannot translate or print it. All the books written by our founder (Mirza Ghulam Ahmad) are banned as ‘hate material,’ and six members of our group are in prison for trying to teach the Quran.”

Suleman said that restricted freedoms and continued religious discrimination have driven Ahmadis to migrate to Germany, Canada and the United Kingdom.

Suleman called for “fundamental change” to address the minorities’ concerns, adding, “The citizens of Pakistan should not be judged on religion — and the ‘majority minority’ point of view must be ended.”

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Congressman John Curtis, R, Utah | Voice of America

Host Carol Castiel talks with Republican Congressman John Curtis from the western state of Utah about a range of issues with a focus on the Conservative Climate Caucus he recently founded. Curtis, a Mandarin speaker and member of the House Energy and Commerce Committee, tells VOA why he felt the need to create a separate Republican caucus on Climate and how its proposals would differ from the current bipartisan group. Curtis also expresses his views on US re-entry into the Paris Climate Agreement, US policy toward China, the bipartisan infrastructure framework, the Iran Nuclear Deal, voting rights, efforts to investigate the January 6 assault on the US Capitol and the US troop withdrawal from Afghanistan.

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Doctores sopesan pros y contras de recetar la nueva droga para el Alzheimer

Mientras médicos y expertos en políticas de salud debaten los méritos de Aduhelm, el primer fármaco para el Alzheimer aprobado en 18 años, los pacientes simplemente quieren saber: “¿me ayudará?”.

Los médicos no tienen una respuesta definitiva. “En cada persona, será absolutamente imposible de predecir”, dijo el doctor Allan Levey, director del Centro de Investigación de la Enfermedad de Alzheimer Goizueta, en la Universidad Emory.

El deterioro cognitivo varía ampliamente entre las personas que han comenzado a experimentar problemas de memoria y pensamientos, o que se encuentran en la etapa más temprana del Alzheimer, los pacientes en los que se evaluó Aduhelm, apuntó Levey.

“La naturaleza y la velocidad de progresión varían enormemente, y no sabremos cuando tratemos a alguien [con Aduhelm] si su progresión será rápida, lenta o promedio; simplemente no podremos decirlo”, explicó Levey.

Tampoco será posible especificar la diferencia que supondría este fármaco para un paciente determinado. “Tratar de decirle a una persona cuánto retraso en la progresión experimentará [si toman Aduhelm] es simplemente algo que no podemos hacer”, dijo el doctor Jason Karlawish, profesor de la Escuela de Medicina Perelman de la Universidad de Pennsylvania y co-director del Penn Memory Center.

La incertidumbre sobre los posibles beneficios de Aduhelm, que recibió la aprobación condicional de la Administración de Alimentos y Medicamentos (FDA) el 7 de junio, es considerable. Un ensayo farmacológico de fase 3 encontró que una dosis alta tomada a lo largo de 18 meses retrasaba el deterioro cognitivo en aproximadamente cuatro meses; un segundo ensayo clínico no demostró ningún efecto.

La FDA está exigiendo a los fabricantes de medicamentos Biogen y Eisai Inc. un ensayo posterior a la aprobación, para proporcionar más datos, pero es posible que los resultados finales no estén disponibles hasta febrero de 2030.

Con muchas preguntas sin respuesta sobre la aprobación de Aduhelm, el Comité de Supervisión y Reforma de la Cámara de Representantes ha abierto una investigación. Ante las críticas por una orientación insuficiente, la FDA modificó la etiqueta del medicamento para limitar su uso potencial.

Ahora dice: “El tratamiento con ADUHELM debe iniciarse en pacientes con deterioro cognitivo leve o en etapa de demencia leve de la enfermedad, la población en la que se probó el tratamiento en los ensayos clínicos”.

Estos cambios hacen que el trabajo de educar a los pacientes y sus familias sobre Aduhelm y recomendarlo a favor o en contra sea extraordinariamente difícil para los médicos.

Las conversaciones serán “muy desafiantes, dada la complejidad de la información que debe transmitirse”, dijo Karlawish.

Estos son los puntos clave que los expertos deberán explicar:

La eficacia no ha sido probada. Se ha demostrado que Aduhelm es muy eficaz para eliminar la proteína beta-amiloide, un sello distintivo del Alzheimer, del cerebro de los pacientes. Se cree que grupos de esta proteína, conocidos como placas amiloides, están relacionados con el desarrollo subyacente de la enfermedad. Pero los ensayos clínicos de otros medicamentos que eliminan las placas amiloides no han demostrado eficacia para detener la progresión del Alzheimer.

Aunque los datos de dos ensayos clínicos de Aduhelm fueron inconsistentes, la FDA otorgó una aprobación acelerada al medicamento y señaló que era “razonablemente probable que produjera un beneficio clínico”. Pero esto es especulativo, no un resultado comprobado.

Los beneficios potenciales son pequeños. El doctor G. Caleb Alexander, codirector del Centro Johns Hopkins para la Seguridad y Eficacia de los Medicamentos, fue parte del comité asesor de la FDA que revisó Aduhelm, un grupo que recomendó no aprobarlo.

Alexander caracterizó los resultados positivos de un ensayo clínico de Aduhelm como “un pequeño cambio clínico”. En una escala de 18 puntos utilizada para evaluar la cognición y el funcionamiento, los pacientes que respondieron al fármaco experimentaron una desaceleración de 0,39 en la tasa de disminución durante 18 meses.

Esto se traduce, aproximadamente, en un retraso de cuatro meses en los síntomas sutiles.

Las pruebas neuropsicológicas para evaluar la cognición suelen pedir a los pacientes que copien un diagrama, resten 7 de 100 y deletreen una palabra al revés, entre otras tareas. “Pero navegar en su vida diaria es mucho más complicado, y no está del todo claro si el supuesto beneficio de Aduhelm sería suficiente para afectar la vida diaria de una persona”, dijo el doctor Samuel Gandy, profesor de neurología y psiquiatría en la Escuela Icahn de Medicina de Mount Sinai, en la ciudad de Nueva York.

La progresión de la enfermedad continuará. “Supongamos que alguien tiene un deterioro cognitivo u otro deterioro funcional y decide tomar Aduhelm. ¿Volverán a la normalidad? No hay evidencia de que esto suceda”, dijo el doctor Henry Paulson, profesor de neurología y director del Centro de Enfermedad de Alzheimer de Michigan.

“La expectativa debe ser que la progresión de la enfermedad continúe”, coincidió Levey de Emory.

Los posibles efectos secundarios son comunes. El 41% de los pacientes tratados con la dosis más alta de Aduhlem (10 mg), el subgrupo que mostró alguna respuesta en un ensayo clínico, tuvieron hemorragias cerebrales e hinchazón, según un documento publicado por la FDA. Los escáneres cerebrales los identificaron como leves en el 30% de los casos, moderados en el 58% y graves en el 13%. La mayoría de los casos se resolvieron, sin incidentes graves, en un plazo de tres meses.

La FDA recomienda que los pacientes que toman Aduhelm se realicen al menos tres resonancias magnéticas del cerebro durante el primer año para detectar efectos secundarios.

Serán necesarias otras pruebas. Aduhelm se probó en pacientes con depósitos de beta-amiloide en el cerebro que habían sido confirmados por imágenes cerebrales por tomografía por emisión de positrones (PET).

En la práctica clínica, solo los pacientes que tienen esos depósitos deben tomar Aduhelm y obtener imágenes para confirmar que deberían ser necesarios, coincidieron los expertos. Pero eso presenta un problema para muchos pacientes. Debido a su edad, la mayoría están cubiertos por Medicare, que no paga las imágenes de PET fuera de los entornos de investigación. En cambio, la mayoría de los centros médicos se basarán en pruebas de líquido cefalorraquídeo amiloide, obtenidas mediante punciones lumbares.

Las pruebas genéticas para una forma del gen de la apolipoproteína E conocida como APOE4, cuya presencia aumenta el riesgo de Alzheimer, probablemente también se pedirán, sugirió Gandy.

Los pacientes tuvieron más probabilidades de responder a Aduhelm si portaban un gen APOE4; al mismo tiempo, fue más probable que sufrieran hemorragia cerebral e hinchazón, anotó. Pero Medicare no paga las pruebas APOE4 ni el asesoramiento relacionado, y una prueba positiva podría afectar significativamente a las familias de los pacientes.

“Una vez que encuentras el genotipo APOE4, todos los parientes de primer grado de esa persona están en riesgo”, señaló Gandy, “y cambias la psicología de una familia de inmediato”.

La terapia será cara. Medicare y las aseguradoras privadas aún no han decidido si imponen restricciones sobre quién puede obtener cobertura para Aduhelm, que se administrará mediante infusiones mensuales en los centros médicos. Considerando un precio de lista anual de $56,000 solo para el medicamento, los investigadores de KFF estiman que algunos beneficiarios de Medicare podrían pagar hasta $11,500 de su bolsillo para cubrir su coseguro.

Agregando a eso los costos de los escáneres cerebrales, las infusiones mensuales, los servicios médicos, las pruebas de amiloide y las pruebas genéticas APOE4, y los gastos podrían acercarse a los $100,000 al año, sugieren expertos.

“Lo más urgente que necesitamos es comprender el pago de este medicamento”, dijo el doctor Aaron Ritter, experto en demencia del Centro Lou Ruvo de la Clínica Cleveland para la Salud del Cerebro en Las Vegas. “Muchos pacientes tendrán ingresos fijos con capacidad limitada para pagar grandes cantidades”. Más de 1,000 pacientes en la clínica son buenos candidatos para Aduhelm, agregó.

Los especialistas no lo recetarán a todos los pacientes con Alzheimer. Aunque los médicos pueden recetar un medicamento aprobado a quien crean que ayudará, los expertos en demencia dicen que Aduhelm debe considerarse solo para pacientes similares a los de los ensayos clínicos: individuos con deterioro cognitivo leve (problemas de memoria y pensamiento que no interfieren con sus funcionamiento) y con la enfermedad de Alzheimer en etapa temprana (cuando los síntomas aún son leves pero el funcionamiento comienza a deteriorarse).

“Vamos a empezar poco a poco e ir despacio hasta que entendamos más” sobre la medicación y cómo responden los pacientes, dijo la doctora Maria Torroella Carney, jefa de geriatría y medicina paliativa de Northwell Health, el sistema de atención médica más grande de Nueva York.

Dado que Aduhelm no se probó en personas con Alzheimer moderado o grave, no debería administrarse a estos pacientes, dijeron varios expertos. “Si los pacientes en estas etapas posteriores solicitan el medicamento, diremos que no tenemos ninguna evidencia de que funcione en ellos y que no podemos dárselo de manera justificada”, dijo Paulson de la Universidad de Michigan.

Los médicos respetarán los deseos de los pacientes. Incluso los médicos a los que les preocupa que los posibles daños de Aduhelm puedan superar los posibles beneficios dijeron que recetarán el medicamento con precaución y una cuidadosa consideración. Karlawish de la Universidad de Pennsylvania se encuentra entre ellos.

“Ahora que este medicamento está disponible, tengo que seguir una ética fundamental de la práctica de la medicina, que es el respeto por la autonomía del paciente”, dijo. “Si los pacientes y los cuidadores familiares piden Aduhelm después de una discusión exhaustiva, seré un recetador reacio”.

Judith Graham:
khn.navigatingaging@gmail.com,
@judith_graham

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Effort to Decipher Hospital Prices Yields Key Finding: Don’t Try It at Home

A federal price transparency rule that took effect this year was supposed to give patients, employers and insurers a clearer picture of the true cost of hospital care. When the Trump administration unveiled the rule in 2019, Seema Verma, then chief of the Centers for Medicare & Medicaid Services, promised it would “upend the status quo to empower patients and put them first.”

I set out to test that statement by comparing prices in two major California hospital systems. I am sorry to report that, at least for now, that status quo — the tangled web that long has cloaked hospital pricing — is alive and well.

I have spent hours toggling among multiple spreadsheets, each containing thousands of numbers, in an effort to compare prices for 20 common outpatient procedures, such as colonoscopies, cataract surgeries, hernia repair and removal of breast lesions.

After three months of glazed eyes and headaches from banging my head against walls of numbers, I am throwing in the towel. It was a fool’s errand. My efforts ultimately yielded just one helpful piece of advice: Don’t try this at home.

I was most of the way to that realization when a conversation with Shawn Gremminger helped push me over the line.

“You are a health care reporter, I’m a health care lobbyist, and the fact that we can’t do this ourselves is an indictment of where things stand at this point,” said Gremminger, health policy director at the Purchaser Business Group on Health, which represents large employers who pay their employees’ medical bills directly and have a big stake in price transparency. “The subset of people who can do this is pretty small, and most of them work for hospitals.”

I heard similar comments from other veterans of the health care industry, even from the former managed-care executive who inspired the story.

He had come to me with a spreadsheet full of price info that appeared to show that a Kaiser Permanente hospital in the East Bay charged significantly higher prices for numerous procedures than a nearby hospital run by archcompetitor Sutter Health.

That was a compelling assertion, since Sutter is widely viewed in California as the poster child for excessive prices. Nearly two years ago, Sutter settled a high-profile antitrust case that accused the hospital system of using its market dominance in Northern California to illegally drive up prices.

I knew from the outset it would be tricky to compare Kaiser and Sutter because, operationally, they are apples and oranges.

Sutter negotiates separate deals with numerous health plans, and its prices can vary by thousands of dollars for the same service, depending on your insurance. Kaiser’s hospitals are integrated with its insurance arm, which collects premiums — so, in effect, it is playing with house money. There is just one Kaiser health plan price for each medical service.

Still, the story seemed worth looking into. Those Sutter and Kaiser prices matter, because they are used to calculate how much patients pay out of their own pockets. And helping patients know what they’ll owe in advance is one of the goals of the transparency rule.

The federal rule requires hospitals to report prices for all the medical services they provide in huge spreadsheets that can be processed by computers.

It also obliges them to provide prices in a more “consumer-friendly” format for 300 so-called shoppable services, which are procedures that can be scheduled in advance. And it requires that they report the cost of any “ancillary services,” such as anesthesia, typically rendered in concert with those procedures. Of the 300 “shoppables,” 70 are specified by the government and the rest are chosen by each hospital.

Most of the 20 common medical procedures I attempted to compare were among those 70. But a few, from lists of top outpatient procedures provided by the Health Care Cost Institute, were not. I decided to use the more comprehensive, less friendly spreadsheets for my comparisons, since they contained all 20 of the procedures I’d chosen.

Each carried a five-digit medical code known as a CPT, a term trademarked by the American Medical Association that stands for “current procedural terminology.” The transparency rule requires hospitals to include billing codes, because they supposedly provide a basis for price comparison, or in the rule’s jargony language, “an adequate cross-walk between hospitals for their items and services.”

Much to my chagrin, I soon discovered they don’t provide an adequate crosswalk even within one hospital.

My first inkling of the insuperable complexity came when I noticed that Sutter’s Alta Bates Summit Medical Center in Oakland listed the same outpatient procedure with the same CPT code three times, thousands of rows apart, with entirely different prices. CPT 64483 is the designated code for injection of anesthetics or steroids into a spinal nerve root with the use of imaging, which relieves pain in the lower back, legs and feet caused by sciatica or herniated discs. The spreadsheet showed a maximum negotiated price of $1,912 in row 12,718, $3,650.85 in row 19,014 and $5,475.80 in row 19,559 (let your eyes glaze over for just a few seconds, so you know what it feels like). The reason for the triple listing is tied to Medicare billing guidelines, Sutter later told me. I’ll spare you the details.

My head really began to hurt when I decided to double-check some of the prices I had pulled from the big spreadsheets against the same items on the shorter shoppables sheets. Kaiser’s prices were generally consistent across the two, but for Alta Bates, there were large discrepancies.

The highest negotiated price for removing a breast lesion, for example, was $6,156 on the big sheet and $23,069 on the shorter one. The difference seems largely attributable to the estimated cost of additional services, some rather nonspecific, that Sutter lists on the smaller sheet as accompaniments to the procedure: anesthesia, EKG/ECG, imaging, laboratory, perioperative, pharmacy and supplies.

But why not include them in both spreadsheets? And what do the two dramatically divergent prices actually encompass?

“How many bills they really represent and what they mean is difficult to interpret,” said Dr. Merrit Quarum, CEO of Portland, Oregon-based WellRithms, which helps employers negotiate fair prices with hospitals. “It depends on the timing, it depends on the context, which you don’t know.”

In some cases, Sutter said, its shoppables spreadsheets show charges not only for ancillary services typically rendered on the day of the procedure, but also for related procedures that may precede or follow it by days or weeks.

The listings for Kaiser’s ancillary services do not always match Sutter’s, which further clouds the comparison. The problematic fact of the matter is that hospitals performing the same procedures bundle their bills differently, use different medications, estimate varying amounts of time in the operating room, and utilize more or less advanced technology. And physician charges are not even included in the posted prices, at least in California.

All of which makes it almost impossible for mere mortals to anticipate the total cost of their medical procedures, let alone compare prices among hospitals. Even if they could, it might be of limited value, since independent imaging centers and surgery centers, which are increasingly common — and generally less expensive — aren’t required to report their prices.

The bottom line, I’m afraid, is that despite my efforts I don’t have anything particularly insightful to reveal about how Kaiser’s prices compare with Sutter’s. The prices I examined were as transparent to me as hieroglyphics, and I’m pretty sure that hospital executives — who unsuccessfully sued to stop implementation of the price transparency rule — are not losing any sleep over that fact.

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Federal Speech Rulings May Embolden Health Care Workers to Call Out Safety Issues

Karen Jo Young wrote a letter to her local newspaper criticizing executives at the hospital where she worked as an activities coordinator, arguing that their actions led to staffing shortages and other patient safety problems.

Hours after her letter was published in September 2017, officials at Maine Coast Memorial Hospital in Ellsworth, Maine, fired her, citing a policy that no employee may give information to the news media without the direct involvement of the media office.

But a federal appellate court recently said Young’s firing violated the law and ordered that she be reinstated. The court’s decision could mean that hospitals and other employers will need to revise their policies barring workers from talking to the news media and posting on social media.

Those media policies have been a bitter source of conflict at hospitals over the past year, as physicians, nurses and other health care workers around the country have been fired or disciplined for publicly speaking or posting about what they saw as dangerously inadequate covid-19 safety precautions. These fights also reflect growing tension between health care workers, including physicians, and the increasingly large, profit-oriented companies that employ them.

On May 26, the 1st U.S. Circuit Court of Appeals unanimously upheld a National Labor Relations Board decision issued last year that the hospital, now known as Northern Light Maine Coast Hospital, violated federal labor law by firing Young for engaging in protected “concerted activity.” The NLRB defines it as guaranteeing the right to act with co-workers to address work-related issues, such as circulating petitions for better hours or speaking up about safety issues. It also affirmed the board’s finding that the hospital’s media policy barring contact between employees and the media was illegal.

“It’s great news because I know all hospitals prefer we don’t speak with the media,” said Cokie Giles, president of the Maine State Nurses Association, a union. “We are careful about what we say and how we say it because we don’t want to bring the hammer down on us.”

The 1st Circuit opinion is noteworthy because it’s one of only a few such employee speech rulings under the National Labor Relations Act ever issued by a federal appellate court, and the first in nearly 20 years, said Frank LoMonte, a University of Florida law professor who heads the Brechner Center for Freedom of Information.

The 1st Circuit and NLRB rulings should force hospitals to “pull out their handbook and make sure it doesn’t gag employees from speaking,” he said. “If you are fired for violating a ‘don’t talk to the media’ policy, you should be able to get your job back.”

The American Hospital Association and the Federation of American Hospitals declined to comment for this article.

While the 1st Circuit’s opinion is binding only in four Northeastern states plus Puerto Rico, the NLRB decision carries the force of law nationwide. The case applies to both unionized and non-unionized employees, legal experts say.

In March, the NLRB similarly ordered automaker Tesla to revise its policy barring employees from speaking with the media without written permission.

Hospitals and health care organizations often have policies requiring employees to clear any public comments about the workplace with the organization’s media office. Many also have policies restricting what employees can say on Facebook and other social media.

Hospitals say requiring employees to go through their media office prevents the spread of inaccurate information that could damage the public’s confidence. In Young’s case, the hospital argued that her letter contained false and disparaging statements. But the 1st Circuit panel agreed with the NLRB that her letter was “not abusive” and that its only false statement was not her fault.

Health care organizations have undisputed legal authority to prohibit employees from disclosing confidential patient information or proprietary business information, legal experts say.

But the 1st Circuit panel made clear that an employer cannot bar an employee from engaging in “concerted actions” — such as outreach to the news media — “in furtherance of a group concern.” That’s true even if the employee acted on her own, as Young did in writing her letter. The key in her case was that she “acted in support of what had already been established as a group concern,” the court said.

The National Labor Relations Board issued a decision last year guaranteeing hospital workers the right to speak up about work-related issues and to contact the press. “It’s great news because I know all hospitals prefer we don’t speak with the media,” says Cokie Giles, president of the Maine State Nurses Association.(National Nurses United)

“I think employers with a blanket ban on talking to the media need to relook at their policies,” said Eric Meyer, a partner at FisherBroyles in Philadelphia who often represents companies on employment law matters. “If you go to the media and say, ‘There are unsafe working conditions impacting me and my colleagues,’ that’s protected concerted activity.”

Chad Hansen, Young’s attorney in a separate federal lawsuit alleging discrimination based on a disability against the hospital, said she has not yet been reinstated to her job. Young would not comment.

The hospital’s parent company, Northern Light Health, said only that its news media policy — which was amended after Young’s firing — meets the NLRB and 1st Circuit requirements and will not be further changed. The new policy created an exception allowing employees to speak to the news media related to concerted activities protected by federal law.

Speech rights under the National Labor Relations Act are particularly important for employees of private companies. Although the Constitution protects people who work for public hospitals and other government employers with its guarantee of unrestricted speech, employees at private companies do not have a First Amendment right to speak publicly about workplace issues.

“I hope this case keeps alive the right of health care workers to speak out about something that’s dangerous,” said Dr. Ming Lin, an emergency physician who lost his job last year at PeaceHealth St. Joseph Medical Center in Bellingham, Washington, after publicly criticizing the hospital’s pandemic preparedness.

Lin, who was employed by TeamHealth, which provides emergency physician services at the hospital, lost his assignment at PeaceHealth in March 2020 soon after saying on social media and in interviews with news reporters that PeaceHealth was not taking urgent enough steps to protect staff members from covid. He had worked at the hospital for 17 years.

In an April 2020 YouTube interview, PeaceHealth’s chief operating officer, Richard DeCarlo, said Lin was removed from the hospital’s ER schedule because he “continued to post misinformation, which was resulting in people being afraid and being scared to come to the hospital.” DeCarlo also alleged that Lin, who was out of town for part of the time he was posting, refused to communicate with his supervisors in Bellingham about the situation. PeaceHealth declined to comment for this article.

PeaceHealth’s social media policy at that time stated that the company does not prohibit employees from engaging in federally protected concerted activity and that they “are free to communicate their opinions.” TeamHealth’s social media policy, dated July 15, 2020, states the company reserves the right to take disciplinary action in response to behavior that adversely affects the company.

Lin, who’s now working for the Indian Health Service in South Dakota, has sued PeaceHealth, TeamHealth and DeCarlo in state court in Washington claiming wrongful termination in violation of public policy, breach of contract and defamation.

Dr. Jennifer Bryan, board chair of the Mississippi State Medical Association, who publicly defended two Mississippi physicians fired for posting about the inadequacy of their hospitals’ covid safety policies, said she faced pressure from her hospital for speaking to the news media without approval.

The medical association pushed its members to talk to the media about the science of covid, while employers insisted doctors’ messages had to be approved by the media office. That reflected a conflict, she said, between medical professionals primarily concerned about public health and executives of for-profit systems who were seeking to shield their corporate image.

Bryan predicted the court ruling and NLRB decision will be helpful. “Physicians have to be able to stand up and speak out for what they believe affects the safety and well-being of patients,” she said. “Otherwise, there are no checks and balances.”

Harris Meyer:

@Meyer_HM

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What is an organic mattress and why should I try one?

The afternoon’s note-worthy news report.

A few years ago, my daughter was having constant outbreaks of hives in the morning. We first removed the down comforter, and that helped some. But it wasn’t until we switched her mattress to an organic product that she had complete relief.

Oftentimes, people think organic mattresses are too costly or not worth the investment because organic materials are just too expensive. However, organic materials have a higher resale value and organic mattresses are still priced competitively to traditional mattresses on the market. The organic mattress provides many health benefits that traditional mattresses do not offer.

Organic Mattresses vs Traditional Mattresses

A key difference between organic and traditional mattresses is their construction. Organic materials for organic mattresses include organic cotton and wool while traditional mattress can contain polyurethane foam, polyester, and petroleum-based synthetic fibers. Organic mattresses are not only safer but they provide many health benefits such as lower levels of dust mites and bacteria, organic mattresses emit lower VOCs (volatile organic compounds), organic beds are naturally hypoallergenic and organic mattress have a biodegradable mattress cover.

Simply put, you’ll sleep better on organic

The Benefits of an Organic Mattress:

Organic mattresses provide comfort as well as health benefits.  Organic mattresses not only improve the quality of sleep but also decrease stress levels and pain. The organic materials used in organic mattresses help to support sound, restful sleep by providing better blood circulation and reducing night sweats.   Physically, organic mattresses do not cause any allergic reactions or adverse health problems.

Some organic mattresses such as organic latex mattress may offer relief from allergies. Non organic mattresses may emit VOCs that are harmful to one’s health which organic mattresses do not. Allergies can be caused by many things including shampoos, conditioners, detergents, carpets, and other household items. Some people have noticed improvements in their allergies through organic mattresses because organic mattresses are naturally hypoallergenic. Studies have showed that organic mattresses emit lower levels of VOCs (volatile organic compounds) which is also helpful for those with allergies.

Not sure if a green mattress is right for you? Sleep on a White Lotus Home mattress for 120 nights. If you don’t love it, return it, for a 30% re-stocking fee.

Organic Bed Bug Mattress Covers:

A mattress cover is a protective barrier that fits over your organic mattress. It helps to keep allergens, dust mites, and bacteria from penetrating into the organic mattress while offering protection against stains and spills.  Mattress covers are also washable which makes them easy to clean as well as recyclable depending on what material they are made of.

Traditional mattresses do not include organic bedding sets or organic mattress coverings but organic mattresses offer much more than traditional mattresses in terms of benefits for one’s health; therefore it may be wise to invest into an organic mattress rather than purchasing a non-organic product.

Organic mattresses are naturally hypoallergenic. Studies have shown a lower presence of dust mites and bacteria in an organic bed because they are less likely to grow due to the natural properties of organic materials. Dust mites tend to thrive in high humidity and warmth so using synthetic materials can cause problems for those with allergies as opposed to organic bedding. Encasing your mattress also prevents any environmental allergens from becoming trapped inside, which is another reason that people who suffer from seasonal allergies should consider buying an encasement for their mattress or bed set to ensure there is no buildup of pests due to night sweats.

Some organic mattresses are made of natural latex which can also offer relief from allergies. Organic latex is a material that comes from rubber tree sap and it is environmentally friendly, hypoallergenic, sustainable, biodegradable, and natural. Most latex used in traditional mattresses comes from Asia where children are sometimes used in harvesting the sap. This abusive practice was eliminated when people began buying organic latex mattress because organic latex is harvested without harming others or the environment.

Organic Mattress Life Expectancy vs Traditional Mattress Lifespan

Many organic mattresses can last 20 years while traditional mattresses only last around 10 years. a very think material which explains why organic mattresses are thinner than non-organic ones. The light weight allows for easier handling during delivery and assembling. Organics International says that by using organic cotton, organic wool and organic latex: “an organic mattress will last a lot longer than its counterparts because it is less vulnerable to mold and mildew”.  Organic mattresses are made of low density materials which mean they can hold their shape for years. Conventional organic beds have an 8-10 year lifespan while organic latex lasts around 20 years.

As more people begin purchasing organic mattresses the demand for organics increases which raises the prices of organic products such as latex or cotton. Organic foods also tend to be highly sought after especially during the holidays so many consumers expect organic goods to be sold at higher price points on average. There are various quality levels in different product types but all non-organic options are not equal.

Organic Mattress Weight vs Traditional Mattress Weight

An organic mattress has a much lighter weight of 18-30 lbs depending on the size of the mattress and is equivalent to a traditional 15 inch deep plush mattress with box spring at 30 lbs.

Other organic bedding topics:   organic cotton comforters organic quilts organic sheets organic duvet organic blankets organic pillows organic mattress pads organic comforter sets

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Delta Variant Surges in Colorado as the Bands Play On

GRAND JUNCTION, Colo. — Dr. Rachel LaCount grasped a metal hoop at a playground and spun in circles with her 7-year-old son, turning the distant mesas of the Colorado National Monument into a red-tinged blur.

LaCount has lived in this western Colorado city of 64,000 nearly her whole life. As a hospital pathologist, she knows better than most that her hometown has become one of the nation’s top breeding grounds for the delta variant of covid-19.

“The delta variant’s super scary,” LaCount said.

That highly transmissible variant, first detected in India, is now the dominant covid strain in the United States. Colorado is among the states with the highest proportion of the delta variant, according to the Centers for Disease Control and Prevention.

Mesa County has the most delta variant cases of any county in Colorado, state health officials report, making the area a hot spot within a hot spot. A CDC team and the state’s epidemiologist traveled to Grand Junction to investigate how and why cases of the variant were moving so quickly in Mesa County.

At her hospital, LaCount has put in orders for more rapid covid tests as the caseload has grown. She’s seen the intensive care unit start filling up with covid patients, so that hospital officials are placing two in a room against normal practices.

Despite these alarming signs, many in Mesa County have let down their guard. The rate of eligible residents fully vaccinated has stalled at about 42%. LaCount has noticed that few people wear masks anymore at the grocery store. Thousands of people recently flocked to Mack, 20 miles from Grand Junction, to attend the Country Jam music festival, which could accelerate the variant’s spread to the concertgoers’ hometowns.

As cases of the delta variant of the coronavirus spread in Mesa County, Colorado, officials considered banning alcohol at Country Jam or trying to get attendees a single-dose Johnson & Johnson vaccine in the weeks leading up to the music festival. They settled on signs warning people online and at the venue that the area was a covid hot spot.(Rae Ellen Bichell / KHN)

“We’re making national news for our covid variant and the CDC is here investigating, but we have a huge festival where people aren’t masking,” said LaCount. “Are we going to get herd immunity over here just because everyone’s going to get it? I mean, that’s probably going to happen at some point, but at what cost?”

LaCount’s worries aren’t necessarily for herself or her spouse — they are both vaccinated — but for their son, who can’t be vaccinated because he is under 12. She is uneasy about sending him to school in the fall for fear of exposure to the variant. She is reluctant to take him to birthday parties this summer knowing there’s a good likelihood he’ll be teased for wearing a mask.

A few yards away from LaCount and her son on the playground, a man fished in a still pond with his 10-month-old daughter in a backpack. Garrett Whiting, who works in construction, said he believes covid is still being “blown out of proportion,” especially by the news media.

“They got everybody scared really, really fast,” said Whiting, slowly reeling in a sparkly blue lure from the water. “There’s no reason to stop living your life just because you’re scared of something.”

Whiting tested positive for covid about three months earlier. He said he doesn’t plan to get vaccinated, nor does his wife. As for the baby on his back, he said he’s not sure whether they’ll have her vaccinated when regulators approve the shot for young children.

The delta variant is one of four “variants of concern” circulating in the U.S., according to the CDC, because the delta strain spreads more easily, might be more resistant to treatment and might be better at infecting vaccinated people than other variants.

The delta variant has raised alarms around the world. Parts of Australia have locked down again after the variant leapfrogged its way from an American aircrew to a birthday party where it infected all unvaccinated guests, health officials said, and after it also jumped between shoppers in a “scarily fleeting” moment in which two people walked past each other in a mall. Israel reissued an indoor mask requirement after a spate of new cases linked to schoolchildren. A leading health official there said about a third of the 125 people who were infected were vaccinated, and most of the new infections were delta variant.

A rise in delta variant cases delayed the United Kingdom’s planned reopening in June. But public health officials have concluded after studying about 14,000 cases of the delta variant in that country that full vaccination with the Pfizer-BioNTech vaccine is 96% effective against hospitalization. Studies around the world have made similar findings. There is also evidence the Moderna and Johnson & Johnson vaccines are effective against the variant.

Los Angeles County recently recommended that residents resume wearing masks indoors regardless of vaccination status, over concern about the delta variant. The World Health Organization is also urging vaccinated people to wear masks, though the CDC hasn’t changed its guidelines allowing vaccinated people to gather indoors without masks.

The variant arrived in Mesa County this spring, when it accounted for just 1% of all cases nationwide, said Jeff Kuhr, executive director of Mesa County Public Health.

“We were winding down just like everyone else. We were down to less than five cases a day. I think we had about two people hospitalized at one point,” Kuhr said. “We felt as if we were out of the woods.”

He even signed off on Country Jam, which bills itself as the state’s “biggest country music party.”

But in early May, the delta variant appeared in a burst, with five cases among adults working for the school district.

“It started to hit the children, those that were not of the age to be vaccinated,” Kuhr said. “That was telling me that, you know, wearing masks in school was not providing the protection with this new variant that it had previously.”

A sign urged Country Jam concertgoers to wear masks regardless of their vaccination status. Most did not. (Rae Ellen Bichell / KHN)

The county then started to see breakthrough cases in fully vaccinated elderly residents in long-term care facilities. The hospitals began to fill once more. Nine vaccinated people died, seven of them since the delta variant’s arrival, though it’s still unclear whether the variant is to blame. All were at least 75 years old, and seven lived in long-term care facilities. Now, Kuhr estimates, “above 90%” of cases in the county are delta variant.

The county is seeing the same trend as the state: The vast majority of people testing positive for covid, and people being hospitalized with it, are unvaccinated. “It’s a superspreader strain if there ever was one,” Eric Topol with the Scripps Research Institution told Scientific American. But he said people fully vaccinated with Pfizer or Moderna shots “should not worry at all.” There is less information about the protection offered by Johnson & Johnson’s vaccine.

Mesa County health officials considered canceling the music festival, but “it was really too late,” Kuhr said. After the announcement that the festival was on, about 23,000 people bought tickets.

Officials weighed banning alcohol or trying to get attendees a Johnson & Johnson single-dose vaccine in the weeks leading up to the festival. In the end, they settled on messaging: signs warning people online and at the venue that the area was a covid hot spot.

According to CDC guidance, outdoor events were low risk. A sporting event at the end of May in Grand Junction that filled a baseball stadium had resulted in only one known case, which made Kuhr optimistic.

“We put messaging on Country Jam’s website, and then in their social media pages, saying, you know, ‘Mesa County’s a hot spot. Be prepared,’” Kuhr said.

A stormy Friday dampened concert attendance at Country Jam. But on the last day of the festival, the sun was out and throngs of cowboy boot-clad concertgoers stepped around prairie dog burrows and kicked up gray-yellow dust on the path to the venue entrance.

Concertgoers head toward the entrance of Country Jam in Mack, Colorado, on June 26, 2021. The event, which this year featured Luke Combs, Toby Keith and Carrie Underwood, bills itself as the state’s “biggest country music party.”(Rae Ellen Bichell / KHN)

Many reveled in being able to attend a summertime event like an outdoor festival, taking it as another sign that the pandemic was waning.

“Covid is over in Colorado,” said Ryan Barkley, a college student from Durango who was playing beer pong in an inflatable pool at his campsite outside the gates.

That day, 39 people in the county were hospitalized with covid, and a CDC investigative team had arrived just four days earlier.

Inside the gates, an open field was filled with stages, concession stands, and vendors selling cowboy hats, coffee mugs and hunting clothes — and crowds of people. Chelsea Sondgeroth and her 5-year-old daughter took in the scene.

“It’s just nice to see people’s faces again,” said Sondgeroth, who lives in Grand Junction and previously had covid. She described it as one of the mildest illnesses she’s ever had, though her senses of taste and smell have not returned to normal. Watermelon tastes rotten to her, beer tasted like Windex for a while, and her daughter said Sondgeroth can’t smell certain flowers anymore.

Sondgeroth said she’s holding off on getting vaccinated until more research comes out.

Waiting in line at the daiquiri stand, Alicia Nix was one of the few people in sight wearing a mask. “I’ve gotten people that say, you know, ‘That stuff is over. Get over yourself and take that off,’” said Nix, who is vaccinated. “It isn’t over.”

Amid the music, beer and dancing, a bus turned into a mobile vaccine clinic was empty. A nurse on duty played Jenga with an Army National Guard soldier. Just six people of the thousands attending were vaccinated on the bus.

“You can lead a horse to water, but you can’t make them drink,” Nix said from behind her blue surgical mask.

The Colorado state health department sent a mobile covid vaccine clinic to Country Jam. In the three days of the music festival, only six people of the thousands attending were vaccinated on the bus.(Rae Ellen Bichell / KHN)

[Correction: This article was updated at 1:30 p.m. ET on July 8, 2021, to update the number of variants of concern, according to the CDC.]

Rae Ellen Bichell:
rbichell@kff.org,
@raelnb

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It’s not too late – but replacing Vidnami is going to get much more expensive

Today’s compelling article.

Vidnami has shut down.

Is losing this video marketing tool going to put your business on life support?

There is a Vidnami replacement with far more flexibility and utility. Vidnami was a video builder that allowed you to easily create attention-grabbing, bumper-style videos in just minutes. It was, in many ways, a best-in-class solution. Unfortunately, Vidnami has been shut down, victim of a corporate buyout by GoDaddy— an entirely unlikely suitor.

Vidnami Replacement is here

We have a replacement that provides even more power, at a lower price— at least for now. The opportunity is an evergreen deal, $77 for creating up to 3,000 videos a month, $147 for 10,000 videos monthly, or $297 for 30,000 videos monthly…and each pricepoint is a LifeTime Deal. For digital marketers, this is unbeatable pricing and it reflected the server power mustered by our choice to replace Vidnami

Don’t miss this very limited window. Act quickly.

https://nov.link/VideoBuilder

Yive Creator Marcus Cudd has sweetened the deal considerably. Yive Video Builder will be adding Vidnami features like multiple aspect ratios and platform-dependent sized videos. Users can upload their own voice overs, and they are also will be deploying a feature that has a workflow for single video creation(mimicking  Vidnami). However, Yive really shines in multiple video creation, simply blowing away any other platform on the market. This Vidnami replacement/upgrade offer will not last forever. Invest in your business and the profit train that is video marketing and get Yive’s VideoBuilder today.

Keep up with Vidnami news at dailycoloradonews.com/tag/vidnami/

Also making news: 
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vidnami crack
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Vidnami Apocalypse shocks Digital Marketers who rely on videos

The evenings’s good narrative.

Vidnami has shut down.

The tool was widely used by digital marketers to create larger volumes of videos, which were then uploaded to YouTube and other platforms. It allowed quick production of numerous videos, guided by an algorithm that approached artificial intelligence.

But there is a powerful replacement with far more flexibility and utility. Vidnami is a video builder that allowed you to easily create attention-grabbing, bumper-style videos in just minutes. Vidnami transformed many service businesses into online empires by helping them grow email lists and build connections with clients. Unfortunately Vidnami has been shut down.
Video marketers now have a replacement that provides even more power, at a lower price— at least for now. The Offer is Lifetime one, at $77 for up to 3,000 Videos a month, $147 for 10,000 Videos a month, or $297 for 30,000 videos a month…every offer is a LifeTime Deal – For digital marketers, that is a business preserving opportunity.

Don’t screw this up. Act quickly.

https://nov.link/VideoBuilder

That replacement tool is Yive VideoBuilder. Businesses can quickly get back up and running with the builder, replacing and improving on the Vidnami functionality

The Owner of Yive has stated they will be adding Vidnami features such as multiple aspect Ratio/size videos. You an upload your own Voice Overs, and they are also also be deploying a feature that has a workflow for single video creation(even closer to Vidnami). As Vidnami has been shut down and Vidmaker.net is really a subpar replacement. So get smart, get Yive’s VideoBuilder.

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