This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription. EHR Adoption By Doctors Reaches 55 Percent Medscape: EHR Adoption By Physicians Hit 55% In 2011, CDC SaysPhysician adoption of the electronic health record (EHR) may be at — or even past — the proverbial tipping point, or so suggests a government study released yesterday that is a litany of progress. In 2011, 55% of physicians reported having adopted an EHR, and of those, 85% said they were either somewhat or very satisfied with the technology, according to the report from the US Centers for Disease Control and Prevention (CDC). Roughly 3 in 4 physicians using EHRs said the software enhanced overall patient care. And 71% of digital physicians would buy their EHR program again (Lowes, 7/18).
This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription. CBO’s Updated Health Law Cost Estimates Could Be Released This Week Meanwhile, news outlets report on varying aspects of the implementation of state-based health exchanges — including the assistance provided to state officials by Michael O. Leavitt, an adviser to GOP presidential hopeful Mitt Romney and head of a health care consulting company.National Journal: CBO Health Estimate Expected This WeekFor the independent economists who score legislation for members of Congress, the hard work on President Obama’s landmark 2010 health care law began soon after the Supreme Court handed down its ruling on the law’s constitutionality. They’ve spent the past month rejiggering their estimates to arrive at a best guess for how much the law will cost now—a figure that Democrats and Republicans are eager to get (McCarthy, 7/23).The New York Times: Romney Aide Helps States Comply With Health Care LawIf Republicans in Congress agree on anything, it is their desire to eradicate President Obama’s health care law. But one of the top advisers to Mitt Romney, the party’s likely presidential nominee, has spent the last two years advising states and private insurers on how to comply with the law. The adviser, Michael O. Leavitt, gets high marks from state officials and policy experts, who describe him as a pragmatist with a voracious appetite for information. But his work has caused consternation among some conservatives, who want states to resist the health care law (Pear, 7/21). CQ Healthbeat: On Exchanges, Republicans Torn Over Moving AheadStates must notify the Department of Health and Human Services by Nov. 16 of whether they plan to create their own exchanges, but even so some Republican governors are waiting until the Nov. 6 election to make a decision — a risky strategy if they want to keep the federal government from running the show (Reichard, 7/20).The Washington Post: Va. Attorney General Argues For Do-Nothing Policy Against Federal Health-Care LawKen Cuccinelli II, the first state attorney general in the nation to sue over the federal health-care law, has hit upon a new anti-“Obamacare” strategy that is much easier than going to court: Do nothing. Virginia and other states can shield businesses from hefty fines for failing to provide adequate health insurance for employees, he contends, simply by refusing to set up their own state-based insurance exchanges (Vozzella, 7/21).The Associated Press/CBS News: Official: Progress Made On Neb. Health ExchangeState insurance officials assured lawmakers Thursday that Nebraska has made headway in its efforts to comply with the federal health care law, but one senator questioned whether Gov. Dave Heineman can fulfill the law’s requirements without calling a special session. Bruce Ramge, director of the Department of Insurance, told a legislative panel that Nebraska is “on par” with other states in its plans to create a state-based marketplace where users can comparison shop for health insurance (7/20).Politico Pro: Authors: Exchanges Can Provide SubsidiesThe “Obamacare” critics who are proposing a legal challenge to the exchange subsidies say it wasn’t just a drafting error in the law, but a deliberate decision by Congress that appears to allow subsidies in state exchanges but not federal ones. But people involved in drafting the Affordable Care Act don’t remember it that way — especially Senate Finance Committee Chairman Max Baucus, one of the main authors of the law (Millman and Dobias, 7/20).In other news related to the health law’s implementation – The Hill: Challenges To Obama Administration’s Birth-Control Mandate Piling Up In CourtChallenges to President Obama’s birth-control mandate are piling up in court. Twenty-four lawsuits have been filed against the federal birth-control mandate so far, mostly from religious groups that view the policy as a dangerous erosion of religious freedom. Foes of the mandate got a boost after Illinois-based Wheaton College — a prominent Protestant school — filed its own suit on Wednesday, joining mostly Catholic-affiliated institutions in arguing the mandate tramples on religious liberty (Viebeck, 7/22).
Campaign Issues And Answers: Health Coverage, Costs, Quality This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription. Policy positions related to the future of the nation’s health system have taken on significance for presidential candidates, as have issues related to women’s health, entitlement spending and deficit reduction.The Associated Press: Why It Matters: Issues At Stake In ElectionAmerica’s health care system is unsustainable. It’s not one problem, but three: cost, quality and coverage.The U.S. has world-class hospitals and doctors. But it spends far more than other advanced countries and people aren’t much healthier. And in an aging society, there’s no reliable system for long-term care (Alonso-Zaldivar, 9/29).The Associated Press/Washington Post: Why It Matters: Fight Over Birth Control And Abortion Rages On National And State LevelsThe issue: Whether women have access to abortion services and birth control is a longstanding and divisive issue in politics, and it has flared up from time to time in this campaign despite the candidates’ reticence to dwell on such hot-button topics (10/1).Politico: Big ‘Romneycare’ Secret: It Didn’t Rein In CostsIt’s one of the greatest stories never told. An ambitious Republican governor passes a revolutionary health reform plan that promises health insurance coverage for everyone but fails to reduce health costs or the growing reliance on the state’s overburdened hospitals — and depends heavily on the financial support of the federal government (Haberkorn and Cheney, 9/30).The Associated Press: Analysis: Candidates’ Deficit Plans Don’t Add UpHere’s the rap on the presidential candidates’ plans for cutting federal deficits: Mitt Romney’s is too bold and the numbers don’t add up, while President Barack Obama’s is too timid and his numbers don’t add up, either. … The Republican nominee promises to balance the budget in eight years to 10 years, but he also offers a mix of budgetary contradictions. … Obama claims more than $4 trillion in deficit savings over the coming decade. But it you peel away accounting tricks and debatable claims on spending cuts, it’s more like $1.1 trillion. Republicans say it’s even less because of creative bookkeeping used to mask spending on Medicare reimbursements to doctors (Taylor, 10/1).Meanwhile, The Washington Post offers some suggested questions for this week’s debate – The Washington Post: Some Debate Questions For Obama And Romney To Lob At Each OtherAll too often, neither (President Barack Obama nor GOP nominee Mitt Romney) has been directly challenged about his misleading statements. So here are some questions we would like to see. … Obama to Romney: You keep saying that health-insurance premiums have gone up by $2,500, as if “Obamacare” had anything to do with it. You know that most provisions of that law have not gone into effect yet, so experts say only a small portion of the increase is due to the law. … Romney to Obama: You keep claiming that health-care premiums will go down for people in the individual and small-group markets. But isn’t it correct that, because of a variety of provisions in the law, premiums are going to go up for young Americans and healthier individuals? (Kessler, 9/30).CNN: Romney Mail Piece Takes Aim At ‘Obamacare’A new mailer from the Romney campaign portrays “Obamacare” in a particularly harsh light, claiming that President Barack Obama’s health care law would send jobs overseas and force millions off Americans off their existing coverage. The mail piece, which landed in Virginia mailboxes late last week, says Republican nominee Mitt Romney would “take immediate steps to repeal and replace Obamacare” on the first day of his presidency (Hamby, 10/1).
Bloomberg: Malpractice Payouts To U.S. Veterans Reach 12-Year HighChristopher Ellison went to a veterans medical center in Philadelphia to get eight teeth extracted in 2007. What should have been a routine dentist visit left him permanently incapacitated. The $17.5 million Ellison and his family received in a malpractice judgment against the Department of Veterans Affairs was the largest against the agency in a dozen years — and one of more than 400 payments the U.S. government made last year to resolve VA malpractice claims, according to agency records obtained through a Freedom of Information Act request. The total cost came to $91.7 million, also the highest sum in at least 12 years (Miller, 9/9). For Veterans, Malpractice Payouts Reach 12-Year High This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
President Trump on Tuesday lashed out at Puerto Rico’s local lawmakers as “grossly incompetent” and singled out one of his favorite targets, Carmen Yulín Cruz, the mayor of San Juan, as “crazed and incompetent.” Mr. Trump’s latest invective toward the local leaders of an island devastated by a hurricane in September 2017 came in a torrent of tweets, which began on Monday night and spilled into Tuesday morning. Mr. Trump was reacting after the Senate on Monday blocked billions of dollars in disaster aid for Midwestern states, in part because Democrats said a proposed $600 million in nutritional assistance to Puerto Rico fell short of its needs. (Karni and Mazzei, 4/2) Politico: Progressive Leader Confronts Pelosi Aide Over ‘Medicare For All’ Two Democratic senators rolled out a proposal Tuesday that would allow anyone to buy Medicare plans, a proposal they say is a more realistic than proposals like Medicare for all that would eliminate private insurance companies and reshape the American health care system. The introduction of “Medicare X” comes as the Democratic Party debates its next steps on health care, with the left wing of the caucus pushing for a single-payer “Medicare for all” system and more moderate members supporting efforts to strengthen the Affordable Care Act (ACA). (Hellmann, 4/2) And in other news coming out of Capitol Hill — The Hill: Democratic Senators Unveil ‘Medicare X’ Bill To Expand Coverage Congressional Progressive Caucus co-chair Pramila Jayapal (D-Wash.) on Tuesday confronted a top aide to Speaker Nancy Pelosi, expressing frustration over his private dismissals of “Medicare for All” legislation. Jayapal, a lead author of the plan, H.R. 1384, told Wendell Primus, who serves as Pelosi’s senior health policy adviser, that she did not appreciate what she perceived as his efforts to undermine lawmakers’ bills. Jayapal pressed him to explain reports that he made disdainful remarks about the proposal in separate meetings with health policy researchers and insurance executives. (Cancryn, 4/2) The New York Times: Trump Lashes Out Again At Puerto Rico, Bewildering The Island CQ: House Vows Another Funding Increase For NIH Moderate Senators Roll Out Universal Coverage Plan They Tout As ‘More Practical’ Alternative To ‘Medicare For All’ Sens. Michael Bennet (D-Colo.) and Tim Kaine (D-Va.) are part of the moderate wing of the party, which is pushing for more incremental improvements to health coverage rather than overhauling the whole system. Their “Medicare X” plan would allow anyone to buy into Medicare, but leave the existing private insurance marketplace intact. Meanwhile, a progressive lawmaker questions House Speaker Nancy Pelosi’s aide over reports he undermined the “Medicare for All” movement. House Democrats on Tuesday suggested that the National Institutes of Health is poised for another funding increase in fiscal 2020, continuing an upward trend after the research agency’s budget climbed significantly in recent years. “I would like to increase this budget as much as we possibly can,” New York Democrat Nita M. Lowey, the full Appropriations Committee’s chairwoman, told NIH officials at a hearing of the House Appropriations Labor-HHS-Education Subcommittee. (Siddons, 4/2) This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
Tesla’s energy division is deploying a new Powerpack project in Weld County, Colorado, where it could save ratepayers and the local utility as much as $1 million per year. more…The post Tesla deploys new Powerpack project that could save Colorado ratepayers $1 million per year appeared first on Electrek. Source: Charge Forward
This week on the Electrek Podcast, we discuss the most popular news in the world of sustainable transport and energy, including Tesla Model 3 pricing shenanigans, new details about Autopilot features, GM unveils a Chevy Camaro electric, and more. more…The post Electrek Podcast: Tesla Model 3 pricing, new Autopilot features, Chevy Camaro electric, and more appeared first on Electrek. Source: Charge Forward
Source: Charge Forward As major motorcycle manufacturers around the world grapple with a new era of EVs, Ducati could be the next to roll out an electric motorcycle. That’s according to the company’s CEO who just confirmed Ducati’s commitment to developing a production electric motorcycle. more…The post Ducati CEO confirms ‘The future is electric’, says electric Ducati is coming appeared first on Electrek.
Another tipping point in energy seems to be on the horizon, as renewable energy in the US is expected to surpass coal in electricity generation for the first time this month. more…Subscribe to Electrek on YouTube for exclusive videos and subscribe to the podcast.https://www.youtube.com/watch?v=N8COKnXNH-EThe post Renewable energy to outpace coal for first time ever in US appeared first on Electrek. Source: Charge Forward
Lack of over-the-air updates forces Jaguar to conduct an ordinary recall of the I-PACE to solve a software issue related to a regenerative brake system failure.Source: Electric Vehicle News
In today’s EGEB:A newly introduced bill calls for at least 50% of electricity generation from renewables by 2035.As expected, US renewable electricity generation surpassed coal for the first time in April.The European solar market is rebounding. more…Subscribe to Electrek on YouTube for exclusive videos and subscribe to the podcast.https://www.youtube.com/watch?v=V1zk7Eb8r-s&list=PL_Qf0A10763mA7Byw9ncZqxjke6Gjz0MtThe post EGEB: Bill for 50% US renewables by 2035, renewables surpass coal in US, European solar rebound appeared first on Electrek. Source: Charge Forward
Transfer window Share on LinkedIn Milan offer Pennant deal but are told by Liverpool to forget move for Agger Topics Milan Mon 5 Jan 2009 21.24 EST FA Cup Jermaine Pennant is out of contract at Liverpool in the summer. Photograph: Paul Ellis/AFP/Getty Images Udinese Share on Twitter Premier League Share via Email Share on Facebook Milan have offered Jermaine Pennant the chance to move to San Siro on a free transfer next summer but have been warned by Liverpool that they will not succeed in any bid for Daniel Agger this month.Pennant is surplus to requirements at Anfield and has been offered a pre-contract by the Italian club which would see him join at the end of the season. However, Rafael Benítez is determined to hold on to Agger as he tries to keep the core of Liverpool’s title-chasing squad intact.Reports in Italy yesterday claimed that Milan would capitalise on Agger’s stalled contract negotiations by making an £8.5m offer for a player who will be available under a £7m release clause in the summer. Liverpool insist that no such clause exists, however, and have informed the Denmark defender and his agent, Per Steffensen, they will resist any approach for the 24-year-old as they concentrate on trying to win a first league title in 19 years. Share via Email The Fiver: the Guardian’s take on the world of football Andy Hunter This article is more than 10 years old news Read more Share on Messenger Share on Facebook Transfer window • Pennant offered chance to join Milan in the summer• Milan prepare to offer £.8.5m for Danish defender This article is more than 10 years old First published on Mon 5 Jan 2009 21.24 EST Share on Pinterest Share on WhatsApp Milan’s need to find replacements for their veteran defenders Paolo Maldini and Alessandro Nesta and Agger’s contract situation has alerted the Italians to a possible transfer. Agger is in the final 18 months of his contract and talks between the parties have proved problematic, although Liverpool deny they have offered the £75,000-a-week deal that he has reportedly rejected.Benítez is determined to avoid any disruption this month and insists that Andrea Dossena, the left-back signed for £7m from Udinese in the summer, still has a future. The 27-year-old has been unimpressive in his debut season and has not featured in Liverpool’s last four games, fuelling the belief that Benítez will seek to cash in. The Liverpool manager, however, said: “I have not considered selling Andrea Dossena. I think it is important to keep people together now.”Benítez’s stance follows news that Liverpool will be without Emiliano Insúa, the 19-year-old who has replaced Dossena in the side for their last four games, until 8 February. Insúa is expected to miss Liverpool’s league games with Stoke City, Everton, Wigan and Chelsea, plus the FA Cup fourth-round date with their Merseyside rivals, due to his involvement in the Under-20 South American championship with Argentina.The Liverpool manager has responded to Sunday’s FA Cup draw by warning his players they cannot be distracted from their championship challenge. Benítez’s team face Everton twice inside a week at Anfield this month after the fourth-round draw pitted the rivals together for the first time in 18 years. “We must remember that we have some big games coming up. Only when the Cup game comes around will it become our focus,” Benítez said.Jamie Carragher, however, thinks that the 20th anniversary of the Hillsborough disaster, when 96 Liverpool supporters were killed at the FA Cup semi-final against Nottingham Forest, has placed added significance on the competition this year for the Anfield club.The Liverpool defender said: “It is 20 years since Hillsborough and I think that anniversary makes this season’s competition more important for us,” he said. “It was a terrible time for the club, so I think it is important we try and do as well as we can. It is something we are all aware of. Going on to win it would be the perfect tribute to those who died.” Shares00 Rafael Benítez Share on Twitter Liverpool Reuse this content
In this recent testimony before the House Financial Services Committee, SEC Chair Mary Jo White stated: “as in other areas, the Commission is focused on holding individuals accountable in FCPA cases.” (emphasis added).The numbers do not support White’s statement.As highlighted in this recent post, since 2008 approximately 85% of SEC corporate FCPA enforcement actions have not (at least yet) resulted in any related SEC action against company employees.Indeed, prior to the SEC’s November 2014 FCPA enforcement action against Stephen Timms and Yasser Ramahi (individuals who worked in sales at FLIR System Inc.) there was a 2.5 year gap in any SEC individual enforcement actions. During that 2.5 years, the SEC brought 19 corporate enforcement actions and not one involved any related SEC action against company employees.As to the accountability portion of White’s statement, the two SEC individual FCPA enforcement during the last three years (the above Timms / Ramahi action and the January 2015 action against former PBSJ International employee Walid Hatoum) involved SEC administrative orders in which the individuals were allowed to settle without admitting or denying the SEC’s findings.It is debatable what is more concerning.A political actor making assertions without knowledge of and/or understanding of the underlying facts.Or a political actor making assertions with knowledge of and/or understanding of the underlying facts, but making the political statement anyway.Regardless of the cause or reason prompting Chair White’s recent statement, the numbers do not support her assertion that the SEC is “focused on holding individuals accountable in FCPA cases.”
Rosenstein continued:“Corporate enforcement and settlement demands must always have a sound basis in the evidence and the law.We should never use the threat of federal enforcement unfairly to extract settlements.We should reward prompt reporting of wrongdoing.And we should ensure that our policies and practices focus on deterrence, which is the primary goal of law enforcement.[…]Despite the Department’s investigatory tools and our efforts to build relationships with private enterprise, some companies are reluctant to report misconduct to law enforcement.We recognize that managers must consider many factors in deciding whether to voluntarily disclose a problem to law enforcement. There are legal, financial, and other concerns.[…]Compliance measures and cooperation might be steps that go beyond the minimum requirements of law. But like our Department, you should be thinking about the long-term.You need to protect your brand.The Department notices and evaluates carefully whether a corporate compliance program is applied faithfully.[…]It is important to make note of the progress of the business community in developing and augmenting corporate compliance programs. The sophistication of compliance measures and tools continues to improve.But no measures will be successful in deterring all criminals.[…] FCPA Institute – Boston (Oct. 3-4) A unique two-day learning experience ideal for a diverse group of professionals seeking to elevate their FCPA knowledge and practical skills through active learning. Learn more, spend less. CLE credit is available. We are establishing a Working Group on Corporate Enforcement and Accountability, which will offer recommendations on promoting individual accountability and corporate cooperation.[…]The Department is evaluating how to reward companies that demonstrate true commitment to upholding the rule of law.” Yet another speech by Deputy Attorney General Rod Rosenstein to pass along (see here and here for other recent speeches).Yesterday, Rosenstein deliver this morning keynote address at the U.S. Chamber Institute for Legal Reform. Among other things, Rosenstein stated: “Corporate enforcement and settlement demands must always have a sound basis in the evidence and the law. We should never use the threat of federal enforcement unfairly to extract settlements.”Was this merely an unobjectionable forward-looking statement or perhaps a subtle criticism of the Obama administration during which certain people felt that the DOJ often did just that? For instance, see here for a prior post highlighting former Deputy AG David Ogden’s speech criticizing the DOJ’s leverage-based enforcement approach as well as this FCPA Flash podcast episode during which Ogden further elaborates on the issues.Regardless of the best answer, talk to FCPA practitioners and in-house counsel and many will tell you in a candid private moment that FCPA enforcement is often viewed in this way.In the speech, Rosenstein also spoke about streamlining DOJ policy, voluntary disclosure, the challenges of compliance and how the DOJ “is evaluating how to reward companies that demonstrate true commitment to upholding the rule of law.”Relevant excerpts are highlighted below.“In the Department of Justice, our employees need to understand and abide by regulations, guidelines and policies. Clear policies promote consistency across the Department’s many offices and tens of thousands of decision-making employees. Consistency promotes fairness and enhances respect for the rule of law.But the Department’s own internal policies are spread among various sources. That diverts precious time and resources away from fighting crime. It also makes it more difficult to achieve consistency.We have manuals, memoranda, speeches, and articles restating and interpreting the policies. And every time a Department official speaks, it generates speculation and commentary about how the remarks affect the policies.Another challenge is that there are many outdated policy memos floating around. Their status as guiding policy is not always clear, particularly to people outside the Department.And too often, Department policy statements use three sentences to say what could be said in one[…]In order to promote efficiency and consistency in the Department of Justice, my office is working on a project to collect outstanding policy memoranda and incorporate them, where appropriate, into our operating manual. And we will keep it concise.” Learn More & Register
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A pair of upcoming trials will help determine whether two large makers of “smart” utility meters stole a small Carrollton company’s technology – and the stakes are huge . . .You must be a subscriber to The Texas Lawbook to access this content. Username Password Remember me Lost your password? Not a subscriber? Sign up for The Texas Lawbook.
The Moses Lake School District’s construction bond election has been upheld as a state appeals court denied a request to annul the election results. Our Grant County news partner iFiber One News reports the court dismissed the challenge that the Grant County Auditor engaged in misconduct by failing to call voters who had not returned their ballots after they failed to respond to notifications of signature issues sent by mail. The district’s $135 million bond passed in February of last year. The petitioners have hinted at seeking further legal proceedings to the state Supreme Court.The Division III Court of Appeals affirmed a Grant County Superior Court decision to dismiss the election challenge. The petitioners, six Moses Lake School District voters, appealed the superior court decision, claiming Grant County Auditor Michele Jaderlund engaged in misconduct by failing to call voters who had not returned their ballots after they were notified of signature issues by mail.Under state law, the auditor “shall notify the voter by first-class mail and advise the voter of the correct procedures for completing the unsigned declaration.” The law continues to state the auditor “shall attempt to notify the voter by telephone.”Both parties in the lawsuit agreed Jaderlund failed to make the phone calls despite having the phone numbers of the voters who failed to respond to the mailed notice of a challenged ballot. And like Grant County Superior Court, the appeals court ruled there was substantial compliance from Jaderlund with her duty to notify voters, and state law does not void an election if the auditor neglects one of her duties.The appeals court also noted the petitioners could not show that the election results would have changed if the challenged ballots had been returned and counted in the election.“An election is not to be set aside for a mere informality or irregularity that cannot be said in any manner to have affected the result of the election,” Chief Judge George B. Fearing wrote in the courts opinion. “The Moses Lake School District bond measure passed with a razor thin supermajority. Three votes could have changed the outcome. Nevertheless, we have no evidence that any of the uncalled voters would have corrected the signature if called, and, upon a correction, would have voted against the bond measure. Therefore, we cannot conclude that calling the voters would likely have altered the election result.”The petitioners also argued the auditor’s oversight in not calling disenfranchised the voters. The appeals court also ruled against that argument.“The vital and essential question in all election irregularity cases is whether want of statutory notice resulted in depriving sufficient of the electors of the opportunity to exercise their franchise to change the result of the election. We do not consider the uncalled voters as being deprived of the opportunity to exercise the franchise. They had ample opportunity and notice to vote,” Fearing wrote.Construction for the school district’s $135.3 million bond passed in the February 2017 special election is already delayed by at least a year.
by, Jenny SasserTweetShare47ShareEmail47 SharesI have a recurring memory of meeting for an interview with one of my spiritual teachers. How many years ago did this meeting take place? I think several, perhaps even a decade has passed. I was struggling with memories around personal and family wounds over-taking me during my contemplation and meditation practices. My teacher responded by asking me not about the memories that were intruding upon my practice – not about the content—but, rather, about the contours of my practice. I don’t remember what I described about my practice. But I do remember the dharma she offered to me; it was advice in the form of an aspiration. She said: I wish for you more opportunities to encounter the empty and groundless nature of reality, as you spend a lot of time in the realm of relative experience and self-cherishing.+++I’ve been pondering my ongoing misgivings regarding the anti-ageism activism I’ve been engaging in for the past quarter-century (at least). My misgivings feel fierce but hard to pin down. I often feel possessed by the conviction that much of the work on ageism isn’t quite getting it right, that there’s something problematic about the framing of the issue, there’s something problematic about the impulse to privilege ageism above all other forms of bias and discrimination. I’m sympathetic yet grumpy with the idea that because aging is a universal human experience, something that we are all doing across the life-course regardless of the many ways in which we are diverse, that this is the idea around which we can organize and engage in anti-ageism education and activism. The assertion that when we engage in ageism toward older persons we are discriminating against our future older selves is a potent idea, one that connects to the work I’ve been doing for at least twenty years around imagining and befriending our “future older selves” as a practice for more deeply engaging in one’s own life-long aging journey, as well for opening up space for curiosity about (and perhaps greater empathy for) others’ aging journeys.I’ve seen many people experience profound transformations in their consciousness about aging and old age as a result of engaging in an intentional relationship with their future older selves (as well as their previous younger selves). I’ve never tested whether this practice leads to a reduction in internalized or externalized ageism – this has never been an explicit purpose of the practice; rather, my fundamental aim in inviting others to engage in deep reflection (and sometimes discussion and writing, too) about their imagined future older selves is because it offers a creative way into experiencing ourselves as emerging, always-developing beings and aging as a dynamic, multi-faceted life-long process.The universality of aging is a potent truth – it is dharma. But I think in the context of anti-ageism education and activism we may hold some confusion about how best to harness this truth. (I myself share this confusion.) What is the texture of this truth and how might we embody and enact it? Touching the universality of aging feels to me to be connected to the “empty and groundless nature of reality” that my spiritual teacher entreated me to become more intimate with.Aging is also a deeply personal experience which is embedded in the context(s) – times, places and spaces – in which one is situated and shaped by (often over-determined by) one’s positionalities such as gender, class, race/ethnicity, ability, nationality, generation, and more. Contexts and positionalities contribute to the tremendous diversity of how aging unfolds and is experienced over the life-course. The diversity of aging experiences – the exquisite particularity of how we travel through the life-course — feels to me to be connected to the “realm of relative experience and self-cherishing.”We often get mired in the “realm of relative experience and self-cherishing,” possessed by and obsessed with the particularity of our experiences traveling through the life-course and confronting (and being confronted by) our aging. We feel betrayed by aging – how our bodies and minds change in ways that feel out of our control. We feel wounded by aging…or perhaps it would be more accurate to say wounded by ageism, those reductive and damaging messages which are projected and internalized. Our aging wounds can become totalizing forces, unconscious and under-theorized and thus potentially huge blind-spots. Aging wounds…. wounded by each other, by the culture, self-inflicted wounds. Oh, I’m barely scratching the surface, there’s so much more to be explored here!My strong and abiding take-away, which has been confirmed multiple times now in the context of the many informal and formal conversations I’ve facilitated about age, aging and ageism, is that our suffering around ageism has to do with the relative realm, not the universal realm. Our suffering has to do with feeling stuck, misunderstood, hemmed in, reduced, out-of- control, confused, disappointed, bereft of hope…. fundamentally aggrieved that the aging journey, which is the human journey, is a journey toward ultimate destruction of the self. The stronger our “self-cherishing,” the deeper and more intense our wound.Aging unfolds over the potentially long life-course and involves a balance between gains, losses and stability of abilities and functioning across multiple domains: body, mind, spirit, social roles and relationships. This is another important bit of dharma.When we foreground our aging wounds, when we focus on ageism, we tend to activate our fears of the many losses that inevitably visit us as we travel through the life-course (As Kunitz pleads in his poem “The Layers,” How shall our hearts be reconciled to its feast of losses?). Being human is to be vulnerable and at risk of losses no matter our age or life-course stage. But it is when we enter the land of later life – old age – that these losses and vulnerabilities become unavoidable and most intense.There are also many gifts – gains – that may come with traveling through the life-course. Every life-course stage and age is characterized by its special gifts. Part of the work of understanding and ending ageism and expanding aging awareness is to discover and celebrate the gifts of different ages and stages, to create the causes and conditions for these gifts to be appreciated and shared within and between generations. But what are the gifts of different ages and stages? Can we say that there are shared universal gifts, or are gifts made manifest in diverse ways at the individual and communal level and, thus, in the “eye of the beholder”? I’d suspect that there are gifts which are both shared and particular.One of the challenges in talking about “the gifts of aging,” which is often the antidote offered by anti-ageism workers addressing the “losses of aging,” is to do so without perpetuating a positive aging stereotype such as older people are wise in place of damaging negative aging stereotypes such as older people are senile. My friends, a stereotype is a stereotype, even if it is positive. How do we imagine the gifts of old age — or any age — without doing so in a totalizing, reductive way?+++This is all so complex, isn’t it? And we humans seem to not prefer to dwell with complexity. And yet, I suspect that dwelling in complexity is the secret to muddling through all of this. It surely feels like the answer to the question of how to reconcile my heart to its feast of losses.Dwelling in complexity – in this case the complexity of the aging journey – requires me to explore the ways in which aging is simultaneously an empty and groundless phenomenon, and a deeply personal experience of self-hood.Complexity is the dharma of aging.Originally published on geropunkproject.orgRelated PostsA Guiding StarWhen I was a toddler, I used to sit for hours on the floor under my maternal grandmother’s frame of stretched cloth and look up to watch her sew beads and spangles onto fabrics that became wedding gowns, banners, flags, altar cloths, and other decorative pieces.Review — This Chair Rocks: A Manifesto Against AgeismAshton Applewhite’s new book This Chair Rocks: A Manifesto Against Ageism is a wake-up call, especially for those who have the urge to make a difference while here, alive, and with the heart for change.Tales of Old Age MemoryOn Monday at The Elder Storytelling Place, our friend William Weatherstone entertained us with a 17-year-old column from newspaper editor, Colin McKim, about “losing it” as we get older. A sample line or two: ”These days I find I can’t…TweetShare47ShareEmail47 Shares
May 11 2018The Trump administration is considering a policy change that might discourage immigrants who are seeking permanent residency from using government-supported health care, a scenario that is alarming some doctors, hospitals and patient advocates.Under the proposed plan, a lawful immigrant holding a visa could be passed over for getting permanent residency — a green card — if they use Medicaid, a subsidized Obamacare plan, food stamps, tax credits or a list of other non-cash government benefits, according to a draft of the plan published by The Washington Post. Even the use of such benefits by a child who is a U.S. citizen could jeopardize a parent’s chances of attaining lawful residency, according to the document.Health advocates say such a policy could frighten a far broader group of immigrants who will avoid government-supported health coverage, creating public health problems that could prove dire. About 3 million people received green cards from 2014 through 2016, government records show. Immigrants with visas or those who may have no legal status but plan to seek citizenship based on a close family relationship would be affected.”We are very concerned that this rule, if finalized, would have a significant impact on health in this country,” said Erin O’Malley, senior director of policy for America’s Essential Hospitals, which discussed the plan with Trump administration officials in mid-April.O’Malley said she fears that some visa holders and their families would steer clear of getting routine treatment and resort to going to emergency rooms for medical care. Such a change would “undermine the stability of our hospitals by creating uncompensated care costs and creating sicker patients,” O’Malley said.The policy change could force a mother to weigh the need for hospital inpatient care for an ailing newborn against losing her legal immigration status, said Wendy Parmet, director of the Center for Health Policy and Law at Northeastern University.”The administration, in the draft, talks about self-sufficiency,” she said. “But we don’t expect that of [babies]” who are U.S. citizens because they were born in this country. “It’s extremely hardhearted.”Pushback has begun even though the proposal is in the earliest stages of the rulemaking process.Washington state Gov. Jay Inslee, a Democrat, is sending staff in mid-May to meet with the White House Office of Management and Budget, which is vetting the proposed rule. Inslee sent a letter on April 24 urging OMB Director Mick Mulvaney to consider the impact on tax-paying, lawful immigrants.”This will undoubtedly lead to people across the U.S. going hungry, not accessing needed medical care, losing economic self-sufficiency, and even becoming homeless,” Inslee wrote.The leaked draft said immigration officials would count the use of one or more non-cash benefits by the applicant within three years as a “heavily weighed negative factor” in deciding whether to grant permanent residency.On March 29, the Department of Homeland Security sent a version of the proposal to OMB, which reviews it for conflicts with existing law. Next, it will be published as a proposed rule that the public can comment on before it’s finalized.Marilu Cabrera, public affairs officer with the U.S. Citizenship and Immigration Services, declined to comment on whether the draft published by the Post mirrors what the OMB is reviewing.Fear in immigrant communities already weighs on physicians. Dr. Julie Linton, a spokeswoman for the American Academy of Pediatrics, treats many Latino immigrant families at an outpatient clinic in Winston-Salem, N.C. She said one woman from Mexico, who had a newborn baby and three other children, told Linton she was afraid to keep her family enrolled in the nutrition program for Women, Infants, and Children (WIC). “Is it safe to use WIC?” the woman asked her.Linton said questions like that put pediatricians in a tough position. She said evidence shows enrolling in WIC leads to better health outcomes for kids. But what if it also puts the family at risk of being split apart?”It feels very frightening to have a family in front of me, and have a child with so much potential … and be uncertain how to advise them” on whether to accept public benefits, Linton said.Maria Gomez, president of Mary’s Center, which runs health clinics in Washington, D.C., and Maryland, said she’s seeing three to four people a week who are not applying for WIC and are canceling their appointments to re-enroll in Medicaid.Related StoriesNew protein target for deadly ovarian cancerSugary drinks linked to cancer finds studyRepurposing a heart drug could increase survival rate of children with ependymomaThe leaked draft of the proposal zeroes in on who is considered a “public charge.” The concept emerged in immigration law in 1882, when Congress sought to bar immigrants who were “idiots, lunatics” or those likely to become a burden on the government.The notion of a “public charge” last surfaced in 1999, when the immigration service clarified the concept. Then and now, an immigrant considered a “public charge” is inadmissible to the U.S. if the person is likely to rely on the government for income, or lives in a government-funded long-term institution.Yet the guideline published in 1999 clarified that legal residents were free to access non-cash benefits like Medicaid, food stamps and assistance for heating bills. “These benefits are often provided to low-income working families to sustain and improve their ability to remain self-sufficient,” the guideline says.The proposal, as drafted, would upend that.Under such a policy, anyone who had recent or ongoing use of a non-cash government benefit in the previous 36 months would likely be deemed a “public charge,” and therefore inadmissible to the U.S. The use of such benefits by a spouse, dependent parent or child would also be taken into account.Applicants who have “expensive health conditions” such as cancer, heart disease or “mental disorders” and had used a subsidized program would also get a “heavily weighed” negative mark on their application, the draft says.Marnobia Juarez, 48, battled cancer successfully and is hoping her husband’s green card application is approved; she also dreams of one day getting her own. She said she never wanted to apply for public benefits until she was diagnosed with breast cancer in 2014. Since then, she has been treated at no cost under a program run by the state of Maryland.“I’m alive thanks to this program,” said Juarez, who is a health volunteer with an immigrant advocacy group. “You don’t play with life, and they are playing with life.”The draft says immigrants could post a minimum $10,000 bond to help overcome a determination that they are likely to be a “public charge.”Such changes would affect people sponsored by a U.S. citizen family member, most employment-based immigrants, diversity visa immigrants and “certain non-immigrants,” the draft says. In 2016, 1.2 million people got their lawful permanent residence status, or a green card. Of the total, 566,000 were immediate relatives or spouses of U.S. citizens and 238,000 more were family-sponsored, Department of Homeland Security data show.Some immigrants, such as refugees and asylees, would not be affected. Nor would the proposed changes apply to undocumented immigrants.”We’re talking about middle-class and working families,” said Madison Hardee, senior policy attorney with the Center for Law and Social Policy, which has organized a coalition to fight the proposal. “This could really put parents in an impossible situation between seeking health assistance for their children and obtaining a permanent legal status in the U.S.”The list of benefits includes the Children’s Health Insurance Program, known as CHIP; non-emergency Medicaid; the Supplemental Nutrition Assistance Program, or food stamps; WIC; and short-term institutionalization at government expense and others. The leaked draft notes that foreign-born and native-born Americans use such programs at similar rates.The draft says the proposal is meant to ensure that people seeking to “change their nonimmigrant status are self-sufficient.” It notes “relevant congressional policy statements,” including one that says “the availability of public benefits [should] not constitute an incentive for immigration to the United States.”KHN correspondent Emmarie Huetteman contributed to this report.KHN’s coverage of children’s health care issues is supported in part by the Heising-Simons Foundation. This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.
Is not eating at least 8 times within a 24-hour period Is jaundiced (yellowing of the eyes or skin) Often needs to be awakened for breastfeeding (newborns should have no more than one 4- to 5-hour break per day, including at night) Has not returned to birth weight in 10 to 14 days Has sudden stool pattern changes Visit LifeBridge Health’s community page for more information about upcoming breastfeeding support group meetings. You can also check Sinai Hospital’s breastfeeding and lactation page as well as Carroll Hospital’s website for additional information on breastfeeding resources.Source: http://www.lifebridgehealth.org/ Aug 15 2018Breastfeeding can have its challenges early on. There’s learning the appropriate feeding positions and techniques, knowing when and how often to feed the baby, and so many other intangibles.Getting off to a good start is key to successful long-term breastfeeding. Here are five things moms should do right from the time the baby is delivered:Have your baby placed skin-to-skin on your chest immediately following birth.Remember, the first feeding sets the tone for the next several feedings. Keeping your baby skin-to-skin until after the first feeding is important. Ask that your baby be placed on your tummy after delivery. Skin-to-skin contact, beyond feeding purposes, has other advantages. For one, it’s a way for both mom and dad to bond with the new baby. It also helps the baby stay warm and comfortable, latch on better and feed longer, and cry less, among other things.”Skin-to-skin has a lot of benefits, including stabilizing all of the baby’s vital signs, including their heart rate, their respiratory rate, their blood sugar, their blood pressure, their temperature, all of those things,” says Melissa L. Droddy, a Carroll Hospital lactation specialist. “Laying babies skin-to-skin after delivery is really just kind of letting them acclimate to this real world. And then once they get themselves together, usually they start kind of wiggling around and looking for the breast and trying to eat, usually after an hour or so. Sometimes, it’s quicker than that, sometimes it takes longer.”If you give birth by cesarean section, you can hold your baby on your chest or cheek-to-cheek, or your partner can hold the baby skin-to-skin until you are able to breastfeed.If possible, start the first feeding right after birth, as this is when newborns are alert and very eager to be fed. Ask the nurses if it’s possible to delay routine newborn treatment until after the initial feeding. “The baby is usually really alert for the first two to three hours,” Droddy says. “After that, the baby gets really sleepy.”After that first feeding, you can breastfeed your baby when he or she seems hungry or on demand. Just keep in mind that newborns need 8 to 12 feedings each day. Why so often? “Breast milk is a natural laxative, so basically what’s going in comes right out,” Droddy says.Room-in with your baby and keep your baby with you all night.If possible, keep the baby with you during your hospital stay so you can begin to learn his or her feeding cues (such as rooting and hand-to-mouth activity) and readily start feeding. This way, your baby won’t miss any important on-demand feedings.Related StoriesParenting book negates commonly held beliefsPre-pregnancy maternal obesity may affect growth of breastfeeding infantsNew study provides overview of potential risks of vaccinating breastfeeding womenAlso, research has shown that moms don’t sleep much better with the baby away in the nursery than they would with the baby in the room. At times during your hospital stay, the baby may have to be taken for required tests or procedures. But under normal circumstances, your baby should not be away from you more than two hours a day, if at all.Avoid supplementary feedings.Offer your breast often. Avoid formula unless medically indicated and prescribed by the doctor. If you have to use formula, nurses can show you alternative ways to feed your baby so you can avoid bottle nipples during the first few weeks (the fast flow and different feel of a bottle nipple can potentially confuse babies and make subsequent feedings difficult). In addition, if supplementation is indicated, mothers should start pumping to protect and increase their milk supply.Avoid the use of pacifiers and limit swaddling.Remember, any time your baby seems hungry, offer the breast and continue skin-to-skin holding. It’s ok to allow the baby to suck on his or her hands (any self-inflicted scratches on the baby’s face as a result should heal fast).Your doctor may recommend the use of a pacifier at some point, but likely not until breastfeeding is well established. As for swaddling, research has shown that babies who are regularly swaddled do not wake up as often for feedings. Babies should be swaddled loosely to allow them to get their hands to their mouth to show feeding cues.Frequent feedings over the first few weeks helps assure an abundant milk supply.Ask for help.Reach out to a lactation consultant if you feel the breastfeeding sessions aren’t going well or if you’re concerned about breast soreness. Droddy says you should also call your doctor if the baby: