npr--2020-01-29--In Battle For Europe's Phones, U.S. Suffers Setback, Huawei Notches A Win

In Battle For Europe 's Phones , U.S .
Suffers Setback , Huawei Notches A Win When it comes to U.S. national security , one foreign company sets off alarm bells like no other : Huawei , the Chinese telecom giant .
Huawei scored a key victory , and the U.S. suffered a significant setback , when the company received the green light to build up to 35 % of Britain 's 5G cellular phone network .
`` This is a major loss for American national security , foreign policy and technology policy , '' said Peter Singer of the @ @ @ @ @ @ @ The Trump administration has lobbied hard with U.S. allies , urging them not to buy from Chinese firms .
`` It 's critical that European countries not give control of their critical infrastructure to Chinese tech giants , '' Secretary of State Mike Pompeo wrote last month in an op-ed for Politico .
`` Just consider Huawei 's track record .
...
It is implicated in espionage in the Czech Republic , Poland and the Netherlands , [ and ] has allegedly stolen intellectual property from foreign competitors in Germany , Israel , @ @ @ @ @ @ @ .
David Edelman was on the National Security Council under President Obama and now runs MIT 's Internet Policy Research Initiative .
He puts it this way : `` The administration 's case goes like this .
They say first that Huawei equipment is generally less secure than its competitors .
Second , that Chinese security services might find it irresistible to try to steal secrets .
Third , and maybe most dramatically , if there were ever a major conflict , Beijing might use that access to remotely shut down critical systems @ @ @ @ @ @ @ based in part on working with Huawei for years on its existing cellular system .
Britain also believes it can manage the risk by limiting Huawei to the periphery of the new network — things like base stations and antennas that mostly pass on data — and keeping it away from the more sensitive network core .
This 5G network has n't yet been built , and the U.S. has n't yet given up making its case .
Pompeo was in Britain on Wednesday and said he would continue to stress U.S. security @ @ @ @ @ @ @ is whether we 've crossed a particular Rubicon , whether by having this Chinese content in the underlying 5G network , that effectively it 's a decision that ca n't be reversed , '' Edelman said .
Which brings us to the second big issue — the global technology competition .
For many in the West , China is viewed as a giant factory that puts together iPhones .
But the latest development means it 's now been cleared to help build a cutting-edge network in Western Europe .
5G is being billed @ @ @ @ @ @ @ lightning speed , driverless cars will communicate with each other , doctors will perform surgery remotely .
And China is now considered at the forefront .
`` China is today a major player in the technology market , '' said Beau Woods , who studies cyber issues at the Atlantic Council in Washington .
The British decision , he added , `` is a big win for China 's prestige and also kind of puts other nations , other companies , on notice that China 's not just the packaging and assembly hub @ @ @ @ @ @ @ 's stated goal is to be a world leader in the most important technologies of the 21st century .
To this end , the government supports Huawei and other tech companies in ways that Western countries do n't , said Dean Cheng with the Heritage Foundation .
When it comes to 5G , he said , Huawei offers the complete package , something Western firms ca n't match at this point .
`` They offer essentially soup to nuts , '' Cheng said .
`` That 's a huge advantage in terms of @ @ @ @ @ @ @ presumably works well with each other .
Also , it is significantly cheaper than any of the partial competitors out there . ''
All this makes it harder on the third big issue — U.S. foreign policy .
The Trump administration has pressed American allies to keep Chinese hardware out of their sensitive networks .
The results have been mixed at best .
`` If you 're not getting your closest intelligence partners on board , how can you expect to get the rest of Europe or Latin America , Africa ? ''
@ @ @ @ @ @ @ to watch for is the dominoes falling .
All the other states that have been holding back , may be saying , 'OK , the Brits are going this way now .
We can , too . '
'' Just a day after the British decision , the European Union on Wednesday recommended limiting , but not banning , `` high-risk '' companies .
Huawei said it welcomed the decision and hopes to be part of a fast , secure 5G network across Europe .
Greg Myre is an NPR national security correspondent @ @ @ @ @ @

In Battle For Europe's Phones, U.S. Suffers Setback, Huawei Notches A Win
Enlarge this image toggle caption Aris Oikonomou/AFP via Getty Images Aris Oikonomou/AFP via Getty Images
When it comes to U.S. national security, one foreign company sets off alarm bells like no other: Huawei, the Chinese telecom giant.
Huawei scored a key victory, and the U.S. suffered a significant setback, when the company received the green light to build up to 35% of Britain's 5G cellular phone network.
"This is a major loss for American national security, foreign policy and technology policy," said Peter Singer of the New America think tank in Washington.
Europe U.K. Allows Chinese Telecom Giant Huawei To Help Build 5G Network Over U.S. Objection U.K. Allows Chinese Telecom Giant Huawei To Help Build 5G Network Over U.S. Objection Listen · 3:45 3:45
The Trump administration has lobbied hard with U.S. allies, urging them not to buy from Chinese firms.
"It's critical that European countries not give control of their critical infrastructure to Chinese tech giants," Secretary of State Mike Pompeo wrote last month in an op-ed for Politico. "Just consider Huawei's track record. ... It is implicated in espionage in the Czech Republic, Poland and the Netherlands, [and] has allegedly stolen intellectual property from foreign competitors in Germany, Israel, the United Kingdom and the United States.
David Edelman was on the National Security Council under President Obama and now runs MIT's Internet Policy Research Initiative. He puts it this way: "The administration's case goes like this. They say first that Huawei equipment is generally less secure than its competitors. Second, that Chinese security services might find it irresistible to try to steal secrets. Third, and maybe most dramatically, if there were ever a major conflict, Beijing might use that access to remotely shut down critical systems."
Britain says it decision is based in part on working with Huawei for years on its existing cellular system. Britain also believes it can manage the risk by limiting Huawei to the periphery of the new network — things like base stations and antennas that mostly pass on data — and keeping it away from the more sensitive network core.
This 5G network hasn't yet been built, and the U.S. hasn't yet given up making its case. Pompeo was in Britain on Wednesday and said he would continue to stress U.S. security concerns.
Business Extradition Hearing Formally Begins For Huawei's Meng Wanzhou Extradition Hearing Formally Begins For Huawei's Meng Wanzhou Listen · 3:30 3:30
"The real question here is whether we've crossed a particular Rubicon, whether by having this Chinese content in the underlying 5G network, that effectively it's a decision that can't be reversed," Edelman said.
Which brings us to the second big issue — the global technology competition.
For many in the West, China is viewed as a giant factory that puts together iPhones. But the latest development means it's now been cleared to help build a cutting-edge network in Western Europe.
5G is being billed as revolutionary. Data will move a lightning speed, driverless cars will communicate with each other, doctors will perform surgery remotely. And China is now considered at the forefront.
"China is today a major player in the technology market," said Beau Woods, who studies cyber issues at the Atlantic Council in Washington. The British decision, he added, "is a big win for China's prestige and also kind of puts other nations, other companies, on notice that China's not just the packaging and assembly hub of the world anymore."
China's stated goal is to be a world leader in the most important technologies of the 21st century. To this end, the government supports Huawei and other tech companies in ways that Western countries don't, said Dean Cheng with the Heritage Foundation.
When it comes to 5G, he said, Huawei offers the complete package, something Western firms can't match at this point.
"They offer essentially soup to nuts," Cheng said. "That's a huge advantage in terms of the whole system being integrated. It presumably works well with each other. Also, it is significantly cheaper than any of the partial competitors out there."
All this makes it harder on the third big issue — U.S. foreign policy. The Trump administration has pressed American allies to keep Chinese hardware out of their sensitive networks. The results have been mixed at best.
"If you're not getting your closest intelligence partners on board, how can you expect to get the rest of Europe or Latin America, Africa?" Peter Singer asked. "The thing to watch for is the dominoes falling. All the other states that have been holding back, may be saying, 'OK, the Brits are going this way now. We can, too.'"
Just a day after the British decision, the European Union on Wednesday recommended limiting, but not banning, "high-risk" companies. Huawei said it welcomed the decision and hopes to be part of a fast, secure 5G network across Europe.
Greg Myre is an NPR national security correspondent. Follow him @gregmyre1.


npr--2020-01-29--Worried About Catching The New Coronavirus? In The U.S., Flu Is A Bigger Threat

Worried About Catching The New Coronavirus ?
In The U.S. , Flu Is A Bigger Threat If you live in the U.S , your risk of contracting the new strain of coronavirus identified in China is exceedingly low .
So far , the only people infected in the U.S. have traveled to the region in China where the virus first turned up in people .
And , though that could change , one thing is for certain : Another severe respiratory virus that threatens lives — the influenza or `` flu '' virus — is very active in the U.S. @ @ @ @ @ @ @ ( which generally begins in the U.S. in October and peaks during winter months ) , the Centers for Disease Control and Prevention estimates that more than 15 million people in the U.S. have gotten sick with flu .
More than 150,000 Americans have been hospitalized , and more than 8,000 people have died from their infection .
And , this is n't even a particularly bad flu year .
`` Last year we had 34,000 deaths from flu , '' says epidemiologist Brandon Brown of the University of California , Riverside .
@ @ @ @ @ @ @ for somewhere between 12,000 and 61,000 deaths each year .
`` And this is just in the United States , '' Brown says .
A flu shot is your best way to protect against getting the flu , and it 's still not too late to be vaccinated this season .
There 's another very effective strategy for fending off the flu virus — one that could also help protect against the novel coronavirus if it were to spread within the U.S , Brown says .
His top tip is remarkably simple , @ @ @ @ @ @ @ this ?
Wash your hands .
You need to lather up and wash for at least 20 seconds to make this work , according to the CDC 's tips for proper hand-washing .
The time it takes to hum the song `` Happy Birthday ' twice is about right duration .
`` Our hands are one of the main ways we can transmit a virus , '' Brown says .
As a reality check , begin to notice everything you touch in a day .
`` We shake other people 's hands , @ @ @ @ @ @ @ '' he notes .
In addition to inhaling airborne particles from a neighbor 's cough or sneeze , touching your hand to a contaminated surface and then to your eyes , nose or mouth is how the virus most often gets inside you .
There 's still a lot to learn about the new coronavirus , but respiratory illnesses in general — whether the flu , a cold , or a virus that humans have n't encountered before — can spread via little respiratory droplets when an infected person sneezes or coughs .
@ @ @ @ @ @ @ to cover their coughs , and to sneeze into an elbow .
Each of us can help prevent the spread of viruses , and good hygiene habits are key .
Another important reminder : The CDC recommends a pneumococcal vaccine for children under 2 , for adults who are 65 or older , and for people who smoke , as well as for those who have certain medical conditions .
It 's not that this vaccine will directly fight the pneumonia caused by influenza or the new coronavirus ; the pneumococcal vaccine actually @ @ @ @ @ @ @ different microbe — the common bacterium Streptococcus pneumonia – that also causes pneumonia .
However , one of the main reasons some people get very sick from flu is that , once infected and weakened by the influenza virus , they are extra vulnerable to getting a secondary infection from bacteria — and often , it 's the pneumococcal bacteria .
For an historical perspective : It was actually bacterial pneumonia that caused the most deaths during the 1918 influenza pandemic , according to the National Institutes of Health .
By fending off @ @ @ @ @ @ @ be an important part of a flu defense — and might also help in the defense against the new coronavirus strain .
`` We do n't know whether this new coronavirus tends to predispose people toward pneumococcal infection , but many respiratory viruses do , '' explains Marc Lipsitch , an infectious disease epidemiologist at the Harvard T.H .
Chan School of Public Health .
`` It [ would be ] better to be infected with only coronavirus , rather than the coronavirus and a bacterium at the same time , '' Lipsitch @ @ @ @ @ @ @ 's true is complicated , Lipsitch says , but in general , when we get a virus , `` the immune system is distracted . ''
It focuses on fighting the virus , and that makes it harder to fend off a bacterial infection .
`` It 's hard [ for the immune system ] to do both at once , '' Lipstich explains .

Worried About Catching The New Coronavirus? In The U.S., Flu Is A Bigger Threat
Enlarge this image toggle caption Mandel Ngan/AFP via Getty Images Mandel Ngan/AFP via Getty Images
If you live in the U.S., your risk of contracting the new strain of coronavirus identified in China is exceedingly low.
So far, the only people infected in the U.S. have been those who have traveled to the region in China where the virus first turned up in humans. And though that could change, one thing is for certain: Another severe respiratory virus that threatens lives — the influenza or flu virus — is very active in the U.S. right now.
Already this flu season (which generally begins in the U.S. in October and peaks during winter months), the Centers for Disease Control and Prevention estimates that more than 15 million people in the U.S. have gotten sick with flu. More than 150,000 Americans have been hospitalized, and more than 8,000 people have died from their infection. And, this isn't even a particularly bad flu year.
"Last year, we had 34,000 deaths from flu," says epidemiologist Brandon Brown of the University of California, Riverside. On average, the flu is responsible for somewhere between 12,000 and 61,000 deaths each year. "And this is just in the United States," Brown says.
A flu shot is your best way to protect yourself against getting the flu, and it's still not too late to be vaccinated this season.
There's another very effective strategy for fending off the flu virus — one that could also help protect against the novel coronavirus if it were to spread within the U.S, Brown says.
His top tip is remarkably simple, effective — and familiar. Ready for this? Wash your hands. You need to lather up and wash for at least 20 seconds to make this work, according to the CDC's tips for proper hand-washing. The time it takes to hum the song "Happy Birthday' twice is about right duration.
"Our hands are one of the main ways we can transmit a virus," Brown says. As a reality check, begin to notice everything you touch in a day. "We shake other people's hands, we touch surfaces, open doors," he says.
In addition to inhaling airborne particles from a neighbor's cough or sneeze, touching your hand to a contaminated surface and then to your eyes, nose or mouth is how the virus most often gets inside you.
There's still a lot to learn about the new coronavirus, but respiratory illnesses in general — whether the flu, a cold or a virus that humans haven't encountered before — can spread via little respiratory droplets when an infected person sneezes or coughs.
That's why we teach our kids to cover their coughs and to sneeze into an elbow. Each of us can help prevent the spread of viruses, and good hygiene habits are key.
Another important reminder: The CDC recommends a pneumococcal vaccine for children under 2, for adults who are 65 or older, for people who smoke and for those who have certain medical conditions.
It's not that this vaccine will directly fight the pneumonia caused by influenza or the new coronavirus; the pneumococcal vaccine actually revs the body's defenses against a different microbe — the common bacterium Streptococcus pneumonia – that also causes pneumonia.
However, one of the main reasons some people get very sick from flu is that, once infected and weakened by the influenza virus, they are extra vulnerable to getting a secondary infection from bacteria — and often, it's the pneumococcal bacteria.
For an historical perspective: It was actually bacterial pneumonia that caused the most deaths during the 1918 influenza pandemic, according to the National Institutes of Health.
By fending off those bacteria, the pneumococcal vaccine can be an important part of a flu defense — and might also help in fending off the new coronavirus strain.
"We don't know whether this new coronavirus tends to predispose people toward pneumococcal infection, but many respiratory viruses do," explains Marc Lipsitch, an infectious disease epidemiologist at the Harvard T.H. Chan School of Public Health.
"It [would be] better to be infected with only coronavirus, rather than the coronavirus and a bacterium at the same time," Lipsitch says.
The science of why that's true is complicated, Lipsitch says, but in general, when we get a virus, "the immune system is distracted." It focuses on fighting the virus, and that makes it harder to fend off a bacterial infection. "It's hard [for the immune system] to do both at once."


npr--2020-01-29--Scientists Find Imperfections In 'Minibrains' That Raise Questions For Research

Scientists Find Imperfections In 'Minibrains ' That Raise Questions For Research Brain organoids , often called `` minibrains , '' have changed the way scientists study human brain development and disorders like autism .
But the cells in these organoids differ from those in an actual brain in some important ways , scientists reported Wednesday in the journal Nature .
The finding suggests that scientists need to be cautious about extrapolating results found in organoids to people , says Dr. Arnold Kriegstein , a professor of neurology at the University of California , San Francisco .
`` It 's far @ @ @ @ @ @ @ examples of normal brain development because we just do n't know how well they really represent what 's going on in utero , '' Kriegstein says .
But Dr. Guo-Li Ming , a professor of neuroscience at the University of Pennsylvania who is not connected to the study , says she is `` not concerned too much '' by the finding .
`` If we are careful enough we can still learn from brain organoids , '' says Ming , who used the approach to help understand how Zika virus could affect the @ @ @ @ @ @ @ Brain organoids are clusters of lab-grown brain cells that assemble themselves into structures that look a lot like human brain tissue .
The process by which these cells become specialized and begin to communicate resembles the development of a human brain in the months before birth .
But Kriegstein 's lab wondered just how accurate the model was .
`` We wanted to see whether the organoids that we and others have been using to model normal brain development as well as disease actually represented the cell types faithfully , '' he says @ @ @ @ @ @ @ look at 200,000 cells from organoids that mimic the brain 's outer layer , the cortex .
They used genetic tests to classify the cell types and then compared them with a database of cell types found in actual brain tissue .
`` We were surprised to see that there were some dramatic differences that had n't been reported before , '' Kriegstein says .
The organoids included the major cell types found in cortex .
But the organoid cells were just a little off , says Aparna Bhaduri , a postdoctoral scholar @ @ @ @ @ @ @ the normal brain you have very clear and precise different types of cells , '' she says .
`` What we 're seeing in the organoid is more of a confused identity . ''
The cells looked immature .
It was as if they had n't quite decided what kind of cells to be when they grew up .
The organoid cells also showed signs of metabolic stress , Bhaduri says , meaning they looked like cells that had been undernourished .
`` Something about the artificial nature of the media or the @ @ @ @ @ @ @ actually resulting in this stress , '' says Madeline Andrews , another postdoc in Kriegstein 's lab .
When the team transplanted normal brain cells into a growing organoid , those cells became stressed and `` this confused identity begins to arise , '' Andrews says .
And when the team took cells from an organoid and transplanted them into a mouse brain , the stress and identity problems went away .
`` It tells us that you can take away the stress from these cells , that they 're not permanently stressed @ @ @ @ @ @ @ lab has also detected stress in organoid cells .
But she 's not convinced that stress is the reason organoid cells remain immature and fail to acquire clear identities .
`` That has n't been established , '' she says .
Even so , Ming 's lab is looking for ways to protect organoid cells from stress , and make them more like actual brain tissue .
Using `` brain organoids is the best approach for allowing us to at least understand what 's happening '' to a human brain before birth , @ @ @ @ @ @ @ n't invalidate current research using brain organoids , Kriegstein says .
Instead it offers a roadmap to improve the model so that researchers can learn more about diseases and disorders including Parkinson 's , Alzheimer 's , autism , and schizophrenia .
`` If you 're going to model those diseases in a dish , you really want to make sure you 're reproducing the same cells with the same cell type identities that they would normally have , '' Kriegstein says .

Scientists Find Imperfections In 'Minibrains' That Raise Questions For Research
Enlarge this image toggle caption Muotri Lab/UCSD Muotri Lab/UCSD
Brain organoids, often called "minibrains," have changed the way scientists study human brain development and disorders like autism.
But the cells in these organoids differ from those in an actual brain in some important ways, scientists reported Wednesday in the journal Nature.
The finding suggests that scientists need to be cautious about extrapolating results found in organoids to people, says Dr. Arnold Kriegstein, a professor of neurology at the University of California, San Francisco.
"It's far too early to start using organoids as examples of normal brain development because we just don't know how well they really represent what's going on in utero," Kriegstein says.
But Dr. Guo-Li Ming, a professor of neuroscience at the University of Pennsylvania who is not connected to the study, says she is "not concerned too much" by the finding.
"If we are careful enough we can still learn from brain organoids," says Ming, who used the approach to help understand how Zika virus could affect the brains of babies in the womb.
Brain organoids are clusters of lab-grown brain cells that assemble themselves into structures that look a lot like human brain tissue. The process by which these cells become specialized and begin to communicate resembles the development of a human brain in the months before birth.
But Kriegstein's lab wondered just how accurate the model was.
Shots - Health News After Months In A Dish, Lab-Grown Minibrains Start Making 'Brain Waves' After Months In A Dish, Lab-Grown Minibrains Start Making 'Brain Waves' Listen · 3:41 3:41
"We wanted to see whether the organoids that we and others have been using to model normal brain development as well as disease actually represented the cell types faithfully," he says
So Kriegstein's team took a close look at 200,000 cells from organoids that mimic the brain's outer layer, the cortex. They used genetic tests to classify the cell types and then compared them with a database of cell types found in actual brain tissue.
"We were surprised to see that there were some dramatic differences that hadn't been reported before," Kriegstein says.
The organoids included the major cell types found in cortex. But the organoid cells were just a little off, says Aparna Bhaduri, a postdoctoral scholar in Kriegstein's lab.
"In the normal brain you have very clear and precise different types of cells," she says. "What we're seeing in the organoid is more of a confused identity."
The cells looked immature. It was as if they hadn't quite decided what kind of cells to be when they grew up.
The organoid cells also showed signs of metabolic stress, Bhaduri says, meaning they looked like cells that had been undernourished.
"Something about the artificial nature of the media or the conditions they're being grown in is actually resulting in this stress," says Madeline Andrews, another postdoc in Kriegstein's lab.
Two experiments backed that idea.
When the team transplanted normal brain cells into a growing organoid, those cells became stressed and "this confused identity begins to arise," Andrews says.
And when the team took cells from an organoid and transplanted them into a mouse brain, the stress and identity problems went away.
"It tells us that you can take away the stress from these cells, that they're not permanently stressed," Bhaduri says.
Ming's lab has also detected stress in organoid cells. But she's not convinced that stress is the reason organoid cells remain immature and fail to acquire clear identities. "That hasn't been established," she says.
Even so, Ming's lab is looking for ways to protect organoid cells from stress, and make them more like actual brain tissue.
Using "brain organoids is the best approach for allowing us to at least understand what's happening" to a human brain before birth, she says.
The new study doesn't invalidate current research using brain organoids, Kriegstein says. Instead it offers a roadmap to improve the model so that researchers can learn more about diseases and disorders including Parkinson's, Alzheimer's, autism, and schizophrenia.
"If you're going to model those diseases in a dish, you really want to make sure you're reproducing the same cells with the same cell type identities that they would normally have," Kriegstein says.


npr--2020-01-29--A $41,212 Surgery Bill Compounded A Patient's Appendicitis Pain

Joshua Bates knew something was seriously wrong .
He had a high fever , could barely move and felt a sharp pain in his stomach every time he coughed .
The 28-year-old called his roommate , who rushed home that day in July 2018 .
The pair drove to the nearest emergency room , the Carolinas Medical Center in Charlotte , N.C. After several tests , including a CT scan of his abdomen , the emergency team determined that Bates had acute appendicitis .
`` They said my appendix was minutes away from rupturing , '' Bates said .
Not @ @ @ @ @ @ @ the hospital was out of network with the insurance plan provided through his job .
Even so , he could n't have jumped up and gone elsewhere .
His appendix was about to burst .
He had surgery that night , which went smoothly , and went home the next day .
`` Everything seemed according to plan , '' said Bates .
Then the bill came .
Patient : Joshua Bates , a technical recruiter for a staffing firm , who lives in Charlotte , N.C .
The Continental Benefits insurance plan @ @ @ @ @ @ @ and an annual out-of-pocket maximum of $ 6,350 .
Total bill : $ 41,212 covering the surgery , one night at the hospital and the emergency room charges .
After payments by both Bates and his insurer , the hospital sent Bates a bill for the balance , just over $ 28,000 .
What gives : Bates was `` balance billed '' because he went to an out-of-network hospital — and even though it was an emergency , he fell through the limited protections in existing law .
`` Terrifying , '' is @ @ @ @ @ @ @ when he first saw the bill for $ 28,000 .
Do n't worry , his insurer told him — it would negotiate with the hospital .
`` If you pay your complete deductible , this will all go away , '' Bates recalled the insurer saying .
`` I pay .
It does n't get resolved . ''
More than a year later , negotiations between the hospital and his insurer were at a standstill .
With his credit score falling because the $ 28,000 debt had gone to collections , a frustrated @ @ @ @ @ @ @ team .
`` From what my insurance is telling me , the hospital is just nonresponsive to them trying to negotiate this price , '' he said .
His situation is not unusual .
A recent study found that about 18 % of emergency room visits have at least one such charge for out-of-network care .
A balance bill is the difference between what insurers pay toward a bill and a provider 's `` list charges , '' which facilities set themselves and which often bear little or no relationship to actual costs @ @ @ @ @ @ @ insurer paid $ 8,944 toward the $ 41,212 in charges , according to his explanation of benefits from his insurer .
On top of that , Bates paid the hospital about $ 4,000 , a combination of his annual deductible and his coinsurance for emergency care .
That left $ 28,295 of the hospital 's charges unpaid .
The online site Healthcare Bluebook , which calculates costs based on health insurers ' claims data , estimates that a laparoscopic appendectomy ( the type that Bates had ) ranges from $ 9,678 to more @ @ @ @ @ @ @ code .
The `` fair price '' it suggests for the surgery is a little over $ 12,000 — completely in the ballpark of the $ 12,944 that Bates and his insurer already paid the hospital .
Fair Health , another site that collects claims data , estimates total costs for an out-of-network appendectomy at $ 19,292 — about $ 11,000 less than the hospital says Bates still owes .
`` It 's ridiculous .
He 's a young kid who goes to the emergency room and he has insurance , '' said @ @ @ @ @ @ @ Bates ' employer .
Sunby added that Continental 's payment to the hospital was nearly 2 1/2 times more than Medicare would have paid for similar services , but the facility is going after Bates for more than seven times what the federal government would pay .
A growing outcry about such balance bills has attracted attention from statehouses and Congress , but current protections for patients often fall short .
Congress last year debated several bills that would have provided federal protection nationwide , especially for emergency room patients .
But bipartisan @ @ @ @ @ @ @ intense lobbying by providers , including private equity-backed physician groups , over how to calculate what insurers should pay providers .
Bates is the kind of person who would be helped by a federal law , because his employer `` self-funds '' his insurance plan — all such plans are regulated by the federal government .
In the absence of federal rules , about 21 states have taken action , although a study from policy experts at Georgetown University 's Health Policy Institute cites only nine as having comprehensive protections .
North Carolina @ @ @ @ @ @ @ protections for people in state-regulated plans , according to the study .
It limits , for example , the amount patients owe in out-of-network emergency cases .
But the state law does n't cover Bates ' type of job-based insurance .
`` We really need a federal solution , '' said Maanasa Kona , an assistant research professor at the Center on Health Insurance Reforms at Georgetown .
Bates ' insurer brought in a third-party firm called Advanced Medical Pricing Solutions , which examined his bill and called the $ 28,000 `` excessive @ @ @ @ @ @ @ September an adjustment or an explanation of the charges .
That move came not long after Bates received a `` final '' payment notice from a collections group connected with the hospital .
A credit reporting agency `` told me it would continue to impact my credit score , '' said Bates .
He said that his score had dropped almost 200 points and that this change meant he 'd had to put his plans to buy a house on hold .
Resolution : After Kaiser Health News inquired about his bill with @ @ @ @ @ @ @ Medical Pricing Solutions , Bates received a call from a top executive at the Carolinas Medical Center .
`` He seemed really eager to help me out , '' said Bates , `` which is crazy after two years of reaching out and trying to communicate with them .
They call shortly after they catch wind of the story . ''
However , in an email to KHN , a spokesperson for Atrium Health , the hospital 's parent company , essentially pointed to the insurer for a solution .
`` We believe @ @ @ @ @ @ @ the costs for patients who are unable to choose where they are treated due to a medical emergency , '' wrote Dan Fogleman .
`` We continue to be willing to work with this patient to pursue any additional payments that may be due to them from the insurer . ''
Continental Benefits CEO Betsy Knorr declined to comment : `` It is a legal issue at this point , and we do not want to prejudice the process . ''
`` The hospital is trying to put all the burden on the @ @ @ @ @ @ @ to put the burden on them .
I 'm back to square one , essentially , '' he said .
Insurance plans ' yearly out-of-pocket maximums apply only if you stay in network .
So , if possible , check ahead of time to see if your hospital is in your plan 's network — and the network status of anyone who might be involved with your care .
Sometimes that is n't possible , as in Bates ' case .
What then ?
If you get a balance bill after your insurer @ @ @ @ @ @ @ laws and check with your state 's insurance regulators to see what protections you may have , said Kona , particularly if your bill resulted from an emergency room visit .
Ask your insurer or employer to pay the bill or to negotiate a discount with the provider , said Mark Hall , a law professor at Wake Forest University who studies contract law and medical billing issues .
Check online claims-data websites , such as Healthcare Bluebook and Fair Health , to research what insurers pay for similar care in your area @ @ @ @ @ @ @ about what you may owe .
Even if your employer plan is exempt from state laws limiting patient responsibility for out-of-network emergency care , ask the provider to honor that benefit .
They do n't have to agree , but it can be worth a shot .
Hall also said patients may be able to hire a lawyer and go to court challenging whether the amount being charged is reasonable , although that could be costly and success is not guaranteed .
NPR produced and edited the audio report by NPR 's Selena @ @ @ @ @ @ @ a crowdsourced investigation by Kaiser Health News and NPR that dissects and explains medical bills .
Do you have an interesting medical bill you want to share with us ?
Tell us about it !

A $41,212 Surgery Bill Compounded A Patient's Appendicitis Pain
Enlarge this image toggle caption Logan Cyrus for KHN Logan Cyrus for KHN
Joshua Bates knew something was seriously wrong. He had a high fever, could barely move and felt a sharp pain in his stomach every time he coughed.
The 28-year-old called his roommate, who rushed home that day in July 2018. The pair drove to the nearest emergency room, the Carolinas Medical Center in Charlotte, N.C.
After several tests, including a CT scan of his abdomen, the emergency team determined that Bates had acute appendicitis.
"They said my appendix was minutes away from rupturing," Bates said.
Not mentioned, he said, was that the hospital was out of network with the insurance plan provided through his job. Even so, he couldn't have jumped up and gone elsewhere. His appendix was about to burst.
Share your medical billing story Do you have a medical bill you'd like us to investigate? You can tell us about it and submit it here.
He had surgery that night, which went smoothly, and went home the next day.
"Everything seemed according to plan," said Bates.
Then the bill came.
Patient: Joshua Bates, a technical recruiter for a staffing firm, who lives in Charlotte, N.C. The Continental Benefits insurance plan comes with a deductible of $2,000 and an annual out-of-pocket maximum of $6,350.
Total bill: $41,212 covering the surgery, one night at the hospital and the emergency room charges. After payments by both Bates and his insurer, the hospital sent Bates a bill for the balance, just over $28,000.
Service provider: Carolinas Medical Center, owned by Atrium Health, a nonprofit health system based in Charlotte.
What gives: Bates was "balance billed" because he went to an out-of-network hospital — and even though it was an emergency, he fell through the limited protections in existing law.
"Terrifying," is how Bates describes the feeling he had when he first saw the bill for $28,000. Don't worry, his insurer told him — it would negotiate with the hospital.
"If you pay your complete deductible, this will all go away," Bates recalled the insurer saying. "I pay. It doesn't get resolved."
More than a year later, negotiations between the hospital and his insurer were at a standstill. With his credit score falling because the $28,000 debt had gone to collections, a frustrated Bates contacted the Bill of the Month team.
"From what my insurance is telling me, the hospital is just nonresponsive to them trying to negotiate this price," he said.
His situation is not unusual. A recent study found that about 18% of emergency room visits have at least one such charge for out-of-network care.
A balance bill is the difference between what insurers pay toward a bill and a provider's "list charges," which facilities set themselves and which often bear little or no relationship to actual costs.
In Bates' case, the insurer paid $8,944 toward the $41,212 in charges, according to his explanation of benefits from his insurer. On top of that, Bates paid the hospital about $4,000, a combination of his annual deductible and his coinsurance for emergency care. That left $28,295 of the hospital's charges unpaid.
The online site Healthcare Bluebook, which calculates costs based on health insurers' claims data, estimates that a laparoscopic appendectomy (the type that Bates had) ranges from $9,678 to more than $30,000 in Bates' ZIP code. The "fair price" it suggests for the surgery is a little over $12,000 — completely in the ballpark of the $12,944 that Bates and his insurer already paid the hospital. Fair Health, another site that collects claims data, estimates total costs for an out-of-network appendectomy at $19,292 — about $11,000 less than the hospital says Bates still owes.
Enlarge this image toggle caption Logan Cyrus for KHN Logan Cyrus for KHN
"It's ridiculous. He's a young kid who goes to the emergency room and he has insurance," said Duane Sunby, the insurance broker for Bates' employer.
Sunby added that Continental's payment to the hospital was nearly 2 1/2 times more than Medicare would have paid for similar services, but the facility is going after Bates for more than seven times what the federal government would pay. A growing outcry about such balance bills has attracted attention from statehouses and Congress, but current protections for patients often fall short.
Congress last year debated several bills that would have provided federal protection nationwide, especially for emergency room patients. But bipartisan efforts stalled late in the year following intense lobbying by providers, including private equity-backed physician groups, over how to calculate what insurers should pay providers.
Bates is the kind of person who would be helped by a federal law, because his employer "self-funds" his insurance plan — all such plans are regulated by the federal government.
In the absence of federal rules, about 21 states have taken action, although a study from policy experts at Georgetown University's Health Policy Institute cites only nine as having comprehensive protections.
North Carolina, where Bates lives, has partial protections for people in state-regulated plans, according to the study. It limits, for example, the amount patients owe in out-of-network emergency cases. But the state law doesn't cover Bates' type of job-based insurance.
"We really need a federal solution," said Maanasa Kona, an assistant research professor at the Center on Health Insurance Reforms at Georgetown.
Bates' insurer brought in a third-party firm called Advanced Medical Pricing Solutions, which examined his bill and called the $28,000 "excessive charges." The company sought in September an adjustment or an explanation of the charges.
That move came not long after Bates received a "final" payment notice from a collections group connected with the hospital. A credit reporting agency "told me it would continue to impact my credit score," said Bates. He said that his score had dropped almost 200 points and that this change meant he'd had to put his plans to buy a house on hold.
Resolution: After Kaiser Health News inquired about his bill with the hospital, the insurer and Advanced Medical Pricing Solutions, Bates received a call from a top executive at the Carolinas Medical Center.
"He seemed really eager to help me out," said Bates, "which is crazy after two years of reaching out and trying to communicate with them. They call shortly after they catch wind of the story."
However, in an email to KHN, a spokesperson for Atrium Health, the hospital's parent company, essentially pointed to the insurer for a solution.
"We believe it is imperative that insurance companies cover the costs for patients who are unable to choose where they are treated due to a medical emergency," wrote Dan Fogleman. "We continue to be willing to work with this patient to pursue any additional payments that may be due to them from the insurer."
Continental Benefits CEO Betsy Knorr declined to comment: "It is a legal issue at this point, and we do not want to prejudice the process."
Bates is deflated.
"The hospital is trying to put all the burden on the insurance, and the insurance is trying to put the burden on them. I'm back to square one, essentially," he said.
The takeaway:
Insurance plans' yearly out-of-pocket maximums apply only if you stay in network.
So, if possible, check ahead of time to see if your hospital is in your plan's network — and the network status of anyone who might be involved with your care.
Sometimes that isn't possible, as in Bates' case. What then?
If you get a balance bill after your insurer has paid the provider, check state laws and check with your state's insurance regulators to see what protections you may have, said Kona, particularly if your bill resulted from an emergency room visit.
Ask your insurer or employer to pay the bill or to negotiate a discount with the provider, said Mark Hall, a law professor at Wake Forest University who studies contract law and medical billing issues.
Check online claims-data websites, such as Healthcare Bluebook and Fair Health, to research what insurers pay for similar care in your area. Use that price range in negotiations about what you may owe.
Even if your employer plan is exempt from state laws limiting patient responsibility for out-of-network emergency care, ask the provider to honor that benefit. They don't have to agree, but it can be worth a shot.
Hall also said patients may be able to hire a lawyer and go to court challenging whether the amount being charged is reasonable, although that could be costly and success is not guaranteed.
NPR produced and edited the audio report by NPR's Selena Simmons-Duffin.
Bill of the Month is a crowdsourced investigation by Kaiser Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!


npr--2020-01-29--Migrants In Mexico Face Crackdown, But Officials Say They're Being 'Rescued'

Migrants In Mexico Face Crackdown , But Officials Say They 're Being 'Rescued' The last two weeks have been busy for Mexico 's immigration authorities .
Since Jan. 18 , the Mexican government says it has `` assisted returns '' of 2,303 Central American migrants back to their home countries .
`` Assisted returns '' means deported — but much of the official language referring to migration in Mexico remains euphemistic , critics say , even as the government 's migration policies have grown harsher .
Mexico has been under pressure from the Trump administration , with threats of tariffs @ @ @ @ @ @ @ stop U.S.-bound migrants .
Last week , Acting Deputy Secretary of Homeland Security Ken Cuccinelli praised Mexico for its most recent efforts .
Nearly all those deported were Honduran , and most were part of a large caravan that had entered Mexico illegally , with hopes of reaching the U.S. Mexican officials say all the deportations were done according to law and with full respect for human rights .
Advocates for migrants dispute this and say they are worried about Mexico 's new , increasingly draconian policies toward those fleeing chronic poverty and @ @ @ @ @ @ @ these policies is n't immediately obvious when listening to the language used by Mexican officials , including President Andrés Manuel López Obrador .
In his daily morning press conferences , the president describes the mass deportations of Central Americans as `` assisted returns . ''
Foreign Secretary Marcelo Ebrard , the administration 's point person on immigration matters , uses the same term and corrects reporters who do n't .
Last week , the day after Mexican troops rounded up a group of 800 migrants who had crossed the shallow Suchiate River from @ @ @ @ @ @ @ reporter who asked how many migrants Mexico had detained .
`` They are not detained , '' Ebrard insisted .
`` They are in migration stations . ''
That 's the euphemism the government uses to refer to migrant detention centers .
Such wording has been common for years , but critics say it is more jarring now , given Mexico 's hardening of migration policy .
According to Ebrard and the National Migration Institute , migrants are not arrested or detained — they are `` rescued . ''
Deportations are `` assisted @ @ @ @ @ @ @ time — officials say — are voluntary .
`` Their language often does n't match reality , '' says Eric Olson , a global fellow at the Wilson Center in Washington , D.C. `` There are times when migrants are given no option but to sign 'voluntary ' departures or are essentially forced to accept 'assisted returns , ' '' he says .
Olson , who has been visiting Mexican detention centers for the past eight years , says it is clear that migrants in Mexico can not move around freely and have @ @ @ @ @ @ @ essentially detention facilities , although Mexican authorities do not like to use that language , '' he says .
Mexico is sensitive to the way it is perceived in treating migrants .
For decades , the government publicly criticized the U.S. for its handling of Mexican migrants , many of whom crossed illegally into the country .
López Obrador campaigned on creating a more humane policy for migrants in Mexico .
But critics say the government 's euphemisms are masking human rights abuses — especially in recent days , when reports of National @ @ @ @ @ @ @ them in pepper spray have been splashed across newspapers and on prime-time news shows .
Migrant advocates say it 's cruel for authorities to continue to refer to those incidents as `` rescuing '' migrants .
Some critics of the government 's crackdown say they are being silenced .
Porfirio Muñoz Ledo , a veteran lawmaker from the president 's own party , was blocked by other party members from speaking in Mexico 's Congress last week about what he later described as `` savage aggression '' against the migrants by National Guard @ @ @ @ @ @ @ of the border clashes , but was stopped .
Activists at the Fray Matías de Córdova Human Rights Center in Tapachula , Chiapas , say they have been barred from entering a large detention facility in the southern border city .
They have provided free legal assistance to migrants in the facility for two decades .
Based on past visits , `` Conditions inside are bad , it lacks good hygiene , there is physical mistreatment of migrants and lack of medical care , '' says Salva La Cruz , an activist with @ @ @ @ @ @ @ authorities notified the human rights center that it would no longer have access to the detention facility because it had not acted professionally or respected operating hours .
La Cruz denies the accusation and says his group is appealing the ruling .
`` The government is using this doublespeak to control their image , '' he says .
`` They are obsessed with providing results to the U.S. irrespective of people 's human rights . ''
The National Migration Institute and Ebrard 's office did not respond to NPR 's requests for comment @ @ @ @ @ @ @ over treatment of migrants has hurt López Obrador 's popularity .
Polls show he maintains high approval ratings and surveys show a hardening of Mexican attitudes toward migrants .
In a poll earlier this month , a majority said Mexico should pressure migrants to return to their respective countries .
About a third said migrants should be protected and given humanitarian aid .
Alethia Fernández de la Reguera , who researches immigration at the National Autonomous University of Mexico 's Legal Studies Institute , worries the language used by the Mexican government is @ @ @ @ @ @ @ detention centers in the country are housing migrants longer and under harsher conditions than even in Mexico 's prisons .
`` They are lying and confusing everyone , '' she says .
`` This new government is still saying they are promoters of human rights ... but there is a big contradiction about what they say and what is happening . ''

Migrants In Mexico Face Crackdown, But Officials Say They're Being 'Rescued'
Enlarge this image toggle caption Alfredo Estrella/AFP via Getty Images Alfredo Estrella/AFP via Getty Images
The last two weeks have been busy for Mexico's immigration authorities. Since Jan. 18, the Mexican government says it has "assisted returns" of 2,303 Central American migrants back to their home countries.
"Assisted returns" means deported — but much of the official language referring to migration in Mexico remains euphemistic, critics say, even as the government's migration policies have grown harsher.
Mexico has been under pressure from the Trump administration, with threats of tariffs and sanctions, to do more to stop U.S.-bound migrants. Last week, Acting Deputy Secretary of Homeland Security Ken Cuccinelli praised Mexico for its most recent efforts.
Nearly all those deported were Honduran, and most were part of a large caravan that had entered Mexico illegally, with hopes of reaching the U.S. Mexican officials say all the deportations were done according to law and with full respect for human rights.
Advocates for migrants dispute this and say they are worried about Mexico's new, increasingly draconian policies toward those fleeing chronic poverty and violent gangs. But the toughness of these policies isn't immediately obvious when listening to the language used by Mexican officials, including President Andrés Manuel López Obrador.
Enlarge this image toggle caption Alfredo Estrella/AFP via Getty Images Alfredo Estrella/AFP via Getty Images
In his daily morning press conferences, the president describes the mass deportations of Central Americans as "assisted returns." Foreign Secretary Marcelo Ebrard, the administration's point person on immigration matters, uses the same term and corrects reporters who don't.
Last week, the day after Mexican troops rounded up a group of 800 migrants who had crossed the shallow Suchiate River from Guatemala into Mexico, Ebrard interrupted a reporter who asked how many migrants Mexico had detained.
"They are not detained," Ebrard insisted. "They are in migration stations."
That's the euphemism the government uses to refer to migrant detention centers. Such wording has been common for years, but critics say it is more jarring now, given Mexico's hardening of migration policy.
According to Ebrard and the National Migration Institute, migrants are not arrested or detained — they are "rescued." Deportations are "assisted returns," which most of the time — officials say — are voluntary.
"Their language often doesn't match reality," says Eric Olson, a global fellow at the Wilson Center in Washington, D.C. "There are times when migrants are given no option but to sign 'voluntary' departures or are essentially forced to accept 'assisted returns,'" he says.
Enlarge this image toggle caption Marco Ugarte/AP Marco Ugarte/AP
Olson, who has been visiting Mexican detention centers for the past eight years, says it is clear that migrants in Mexico cannot move around freely and have limited communication. The centers "are essentially detention facilities, although Mexican authorities do not like to use that language," he says.
Mexico is sensitive to the way it is perceived in treating migrants. For decades, the government publicly criticized the U.S. for its handling of Mexican migrants, many of whom crossed illegally into the country. López Obrador campaigned on creating a more humane policy for migrants in Mexico.
But critics say the government's euphemisms are masking human rights abuses — especially in recent days, when reports of National Guard troops chasing down migrants and dousing them in pepper spray have been splashed across newspapers and on prime-time news shows.
Migrant advocates say it's cruel for authorities to continue to refer to those incidents as "rescuing" migrants.
Some critics of the government's crackdown say they are being silenced. Porfirio Muñoz Ledo, a veteran lawmaker from the president's own party, was blocked by other party members from speaking in Mexico's Congress last week about what he later described as "savage aggression" against the migrants by National Guard troops. He tried to show video of the border clashes, but was stopped.
Activists at the Fray Matías de Córdova Human Rights Center in Tapachula, Chiapas, say they have been barred from entering a large detention facility in the southern border city. They have provided free legal assistance to migrants in the facility for two decades.
Based on past visits, "Conditions inside are bad, it lacks good hygiene, there is physical mistreatment of migrants and lack of medical care," says Salva La Cruz, an activist with the center.
La Cruz says immigration authorities notified the human rights center that it would no longer have access to the detention facility because it had not acted professionally or respected operating hours. La Cruz denies the accusation and says his group is appealing the ruling.
"The government is using this doublespeak to control their image," he says. "They are obsessed with providing results to the U.S. irrespective of people's human rights."
The National Migration Institute and Ebrard's office did not respond to NPR's requests for comment.
It doesn't appear that criticism over treatment of migrants has hurt López Obrador's popularity. Polls show he maintains high approval ratings and surveys show a hardening of Mexican attitudes toward migrants.
In a poll earlier this month, a majority said Mexico should pressure migrants to return to their respective countries. About a third said migrants should be protected and given humanitarian aid.
Alethia Fernández de la Reguera, who researches immigration at the National Autonomous University of Mexico's Legal Studies Institute, worries the language used by the Mexican government is manipulating public opinion. She says that detention centers in the country are housing migrants longer and under harsher conditions than even in Mexico's prisons.
"They are lying and confusing everyone," she says. "This new government is still saying they are promoters of human rights ... but there is a big contradiction about what they say and what is happening."


npr--2020-01-29--Georgia Rep. Doug Collins Announces U.S. Senate Run

Rep. Doug Collins , R-Ga. , has formally announced he 's running against U.S. Sen. Kelly Loeffler , a fellow Republican , setting up a Republican battle over the seat left vacant by former Sen. Johnny Isakson .
`` We just need to have a process that lets people decide .
Lets them choose for themselves how they want to see this vision , '' Collins , a staunch defender of President Trump , said Wednesday on Fox News .
`` I look forward to a good exchange of ideas and am looking forward to this election . ''
Collins @ @ @ @ @ @ @ space for a Democrat to win the seat .
He responded : `` No we 're not concerned about that at all .
I 'm concerned about going to the people of Georgia .
I 've always run with three reasons in mind , that 's Jordan , Copelan and Cameron ; those are my three kids . ''
The National Republican Senatorial Committee , which backs Loeffler , released a scathing statement saying , `` The shortsightedness in this decision is stunning .
Doug Collins ' selfishness will hurt [ U.S .
@ @ @ @ @ @ @ Loeffler , and President Trump . ''
`` All he has done is put two Senate seats , multiple House seats , and Georgia 's 16 electoral votes in play . ''
Last year many Republicans , including Trump , tried to convince Gov .
Brian Kemp to appoint Collins , not Loeffler , to the Senate , but Kemp ignored that advice .
Still , Trump gave Loeffler a shout-out Wednesday before signing the USMCA trade agreement : `` Congratulations , Kelly , '' he said to the senator who was in @ @ @ @ @ @ @ They already like you a lot .
That 's what the word is . ''
Meanwhile , a bipartisan group of state House lawmakers has moved to change the rules of this Senate race so it adds a party primary .
As it stands now , multiple Republicans and Democrats could all be together on one November ballot , without party primaries .
Critics argue the move would undercut Loeffler 's chances and favor Collins , whom House Speaker David Ralston calls a friend .
But Ralston said it 's not about politics @ @ @ @ @ @ @ about personalities .
This is about making the elections more orderly ... and anybody that 's running is going to have an equal shot at winning , '' he said .
Gov .
Kemp has threatened to veto this new primary idea , and a spokeswoman called it `` attempts to undermine the rule of law for perceived political gain . ''
Still , any such move would require approval from the state Senate , which is run by Lt. Gov .
Geoff Duncan , who stood behind Kemp at the press conference @ @ @ @ @ @ @ the state 's second female U.S. senator .

Georgia Rep. Doug Collins Announces U.S. Senate Run
Enlarge this image toggle caption J. Scott Applewhite/AP J. Scott Applewhite/AP
Rep. Doug Collins, R-Ga., has formally announced he's running against U.S. Sen. Kelly Loeffler, a fellow Republican, setting up a Republican battle over the seat left vacant by former Sen. Johnny Isakson.
"We just need to have a process that lets people decide. Lets them choose for themselves how they want to see this vision," Collins, a staunch defender of President Trump, said Wednesday on Fox News. "I look forward to a good exchange of ideas and am looking forward to this election."
Collins was asked if his decision would create space for a Democrat to win the seat. He responded: "No we're not concerned about that at all. I'm concerned about going to the people of Georgia. I've always run with three reasons in mind, that's Jordan, Copelan and Cameron; those are my three kids."
The National Republican Senatorial Committee, which backs Loeffler, released a scathing statement saying, "The shortsightedness in this decision is stunning. Doug Collins' selfishness will hurt [U.S. Sens.] David Perdue, Kelly Loeffler, and President Trump."
"All he has done is put two Senate seats, multiple House seats, and Georgia's 16 electoral votes in play."
Last year many Republicans, including Trump, tried to convince Gov. Brian Kemp to appoint Collins, not Loeffler, to the Senate, but Kemp ignored that advice. Still, Trump gave Loeffler a shout-out Wednesday before signing the USMCA trade agreement: "Congratulations, Kelly," he said to the senator who was in the audience for the ceremony. "They already like you a lot. That's what the word is."
Meanwhile, a bipartisan group of state House lawmakers has moved to change the rules of this Senate race so it adds a party primary. As it stands now, multiple Republicans and Democrats could all be together on one November ballot, without party primaries.
Critics argue the move would undercut Loeffler's chances and favor Collins, whom House Speaker David Ralston calls a friend. But Ralston said it's not about politics.
"Look, this is not about personalities. This is about making the elections more orderly ... and anybody that's running is going to have an equal shot at winning," he said.
Gov. Kemp has threatened to veto this new primary idea, and a spokeswoman called it "attempts to undermine the rule of law for perceived political gain."
Still, any such move would require approval from the state Senate, which is run by Lt. Gov. Geoff Duncan, who stood behind Kemp at the press conference when he introduced Loeffler last December as the state's second female U.S. senator.


npr--2020-01-29--Face Masks: What Doctors Say About Their Role In Containing Coronavirus

Face Masks : What Doctors Say About Their Role In Containing Coronavirus As the Wuhan coronavirus continues to spread , officials in China are urging citizens to wear masks in public to stop the spread of the virus — and cities in China as well as other parts of Asia are reportedly running out of face masks .
But can a mask really keep you from catching the virus ?
To answer that , it helps to clarify which kinds of masks we 're talking about .
Because experts do n't yet know exactly how the virus is transmitted , @ @ @ @ @ @ @ is recommending that health care workers treat it like an airborne pathogen — germs that can travel in particles or droplets in the air .
That means health care workers interacting with a coronavirus patient should wear a heavy-duty mask called an N95 respirator .
These respirators are designed to fit tightly around the nose and mouth , and , when worn correctly , block out at least 95 % of small airborne particles , according to the CDC .
But wearing an N95 respirator is serious business , says Dr. William Schaffner @ @ @ @ @ @ @ care workers who use these respirators are required by law to undergo an annual fit test — a check to make sure the mask forms a tight seal on the wearer 's face so that contaminated air ca n't leak in .
Although N95s are disposable , workers must also demonstrate that they know how to put on and wear the model that they are using .
This type of mask is `` difficult to wear '' because it 's uncomfortable , Schaffner says .
Some people find it harder to breathe when @ @ @ @ @ @ @ 's the kind of protection that really works . ''
While N95 respirators are available for the public to purchase , there 's no recommendation from health agencies for the general public to wear them .
By contrast , surgical masks — those cheap , disposable , gauzy masks that often come in blue or green — are less uncomfortable .
But Schaffner says the scientific evidence that `` there might be a benefit for people in the community wearing [ surgical ] face masks is very , very meager .
The general @ @ @ @ @ @ @ certainly not an absolute protection . ''
In other words , they do provide some benefit but they 're far from foolproof .
Surgical masks are just a physical barrier that will protect you against `` a visible splash or spray of fluid or large droplets , '' explains Raina MacIntyre , an infectious disease researcher and professor of global biosecurity at the University of New South Wales in Sydney who has studied the efficacy of face masks .
These masks fit loosely on the face around the edges , so they do @ @ @ @ @ @ @ small airborne particles can still get through .
MacIntyre 's research has shown that N95 respirators offer far superior protection .
But in one study , she did find that family members who wore surgical masks when caring for a sick child at home had a lower risk of getting infected .
But the benefit only occurred if people wore the masks `` all the time when you are in the same room as the infected person , '' MacIntyre says — something many families in the study found difficult to do .
@ @ @ @ @ @ @ , yes , they got protection . ''
MacIntyre notes that cloth masks — which people wash and reuse — are also common in Asian countries .
She says there 's no evidence to show they have any benefit , and her research suggests they `` may actually be harmful , '' because infrequent washing and moisture retention can make cloth masks a breeding ground for pathogens .
Experts note that how you remove a mask — be it a surgical mask or an N95 respirator — is also important .
If you @ @ @ @ @ @ @ , you could end up contaminating yourself .
As for wearing a mask outdoors in public ?
Marybeth Sexton , an assistant professor of medicine in the division of infectious diseases at Emory University , says there 's no need if you 're in the U.S. or another country where the risk of catching the Wuhan coronavirus is considered low .
Sexton says wearing a surgical mask is a good idea if you have a respiratory illness and need to see the doctor .
But that 's really so you wo n't infect @ @ @ @ @ @ @ , do n't rush out and buy a mask .
Leave them for the people who need them — like health care workers and ill people — so as not to contribute to mask shortages , she says .
Some infectious disease experts have also suggested that wearing a face mask may have some value if it keeps you from touching your face and nose .
That 's a common way germs get into our bodies — say , touching a doorknob someone sneezed on , then perhaps inadvertently bringing your fingers to @ @ @ @ @ @ @ But Clarence Tam , a public health researcher at the National University of Singapore , notes that because wearing masks can be uncomfortable , `` the discomfort might make you actually touch your face more . ''
This could contaminate your fingers with any germs that might have attached themselves to the outside of the mask .
Another potential downside ?
`` If you see everyone around you wearing a mask , that also can be fairly alarming , '' Tam notes .
MacIntyre agrees there 's no need to run out and @ @ @ @ @ @ @ a low-risk country like the U.S .
But she says the calculation may be different for people in a place like Wuhan , China , the epicenter of the coronavirus outbreak .
`` If it 's someone in Wuhan , where most of the cases have been , then there might be some value to it , '' MacIntyre says .
`` There 's a lot of unknowns about this infection .
That 's the problem . ''
Observational studies found that wearing a surgical mask did provide health care workers some protection @ @ @ @ @ @ @ notes that those studies were not randomized controlled trials , considered the gold standard in research .
Tam adds that the health care workers who were responding to SARS were also using other protective measures .
And regardless of where you are , there is something that all the infectious disease experts I spoke with recommended everyone do to keep from getting sick : Wash your hands — frequently .
`` Hand-washing for sure , '' Schaffner says .
`` Constantly .
Frequently .
All the time — summer , winter , whatever @ @ @ @ @ @ @ .
It is flu season , after all .
It does n't offer protection against Wuhan coronavirus , but here in the U.S. , Sexton says , the flu remains the bigger risk to health .

Face Masks: What Doctors Say About Their Role In Containing Coronavirus
Enlarge this image toggle caption Science Photo Library/ Getty Images; South China Morning Post/Getty Images Science Photo Library/ Getty Images; South China Morning Post/Getty Images
As the coronavirus continues to spread, officials in China are urging citizens to wear masks in public to stop the spread of the virus — and cities in China as well as other parts of Asia are reportedly running out of face masks.
But can a mask really keep you from catching the virus?
To answer that, it helps to clarify which kinds of masks we're talking about.
Because experts don't yet know exactly how the virus is transmitted, the Centers for Disease Control and Prevention is recommending that health care workers treat it like an airborne pathogen — germs that can travel in particles or droplets in the air. That means health care workers interacting with a coronavirus patient should wear a heavy-duty mask called an N95 respirator. These respirators are designed to fit tightly around the nose and mouth, and, when worn correctly, block out at least 95% of small airborne particles, according to the CDC.
But wearing an N95 respirator is serious business, says Dr. William Schaffner of Vanderbilt University Medical Center. Health care workers who use these respirators are required by law to undergo an annual fit test — a check to make sure the mask forms a tight seal on the wearer's face so that contaminated air can't leak in. Although N95s are disposable, workers must also demonstrate that they know how to put on and wear the model that they are using.
This type of mask is "difficult to wear" because it's uncomfortable, Schaffner says. Some people find it harder to breathe when wearing the N95. But "that's the kind of protection that really works."
While N95 respirators are available for the public to purchase, there's no recommendation from health agencies for the general public to wear them.
By contrast, surgical masks — those cheap, disposable, gauzy masks that often come in blue or green — are less uncomfortable. But Schaffner says the scientific evidence that "there might be a benefit for people in the community wearing [surgical] face masks is very, very meager. The general sense is perhaps, but they're certainly not an absolute protection." In other words, they do provide some benefit but they're far from foolproof.
Surgical masks are just a physical barrier that will protect you against "a visible splash or spray of fluid or large droplets," explains Raina MacIntyre, an infectious disease researcher and professor of global biosecurity at the University of New South Wales in Sydney who has studied the efficacy of face masks. These masks fit loosely on the face around the edges, so they don't completely keep out germs, and small airborne particles can still get through.
MacIntyre's research has shown that N95 respirators offer far superior protection. But in one study, she did find that family members who wore surgical masks when caring for a sick child at home had a lower risk of getting infected. But the benefit only occurred if people wore the masks "all the time when you are in the same room as the infected person," MacIntyre says — something many families in the study found difficult to do. "But if they did wear it, yes, they got protection."
MacIntyre notes that cloth masks — which people wash and reuse — are also common in Asian countries. She says there's no evidence to show they have any benefit, and her research suggests they "may actually be harmful," because infrequent washing and moisture retention can make cloth masks a breeding ground for pathogens.
Experts note that how you remove a mask — be it a surgical mask or an N95 respirator — is also important. If you touch the front when taking it off, you could end up contaminating yourself.
As for wearing a mask outdoors in public? Marybeth Sexton, an assistant professor of medicine in the division of infectious diseases at Emory University, says there's no need if you're in the U.S. or another country where the risk of catching the coronavirus is considered low.
Sexton says wearing a surgical mask is a good idea if you have a respiratory illness and need to see the doctor. But that's really so you won't infect other people. Otherwise, she says, don't rush out and buy a mask. Leave them for the people who need them — like health care workers and ill people — so as not to contribute to mask shortages, she says.
Some infectious disease experts have also suggested that wearing a face mask may have some value if it keeps you from touching your face and nose. That's a common way germs get into our bodies — say, touching a doorknob someone sneezed on, then perhaps inadvertently bringing your fingers to your eyes, nose or mouth. But Clarence Tam, a public health researcher at the National University of Singapore, notes that because wearing masks can be uncomfortable, "the discomfort might make you actually touch your face more." This could contaminate your fingers with any germs that might have attached themselves to the outside of the mask.
Another potential downside? "If you see everyone around you wearing a mask, that also can be fairly alarming," Tam notes.
MacIntyre agrees there's no need to run out and buy face masks if you're in a low-risk country like the U.S. But she says the calculation may be different for people in a place like Wuhan, China, the epicenter of the coronavirus outbreak.
"If it's someone in Wuhan, where most of the cases have been, then there might be some value to it," MacIntyre says. "There's a lot of unknowns about this infection. That's the problem."
Observational studies found that wearing a surgical mask did provide health care workers some protection during the SARS epidemic. But MacIntyre notes that those studies were not randomized controlled trials, considered the gold standard in research. Tam adds that the health care workers who were responding to SARS were also using other protective measures.
And regardless of where you are, there is something that all the infectious disease experts I spoke with recommended everyone do to keep from getting sick: Wash your hands — frequently.
"Hand-washing for sure," Schaffner says. "Constantly. Frequently. All the time — summer, winter, whatever."
And get your flu shot. It is flu season, after all. It doesn't offer protection against the coronavirus, but here in the U.S., Sexton says, the flu remains the bigger risk to health.


npr--2020-01-29--Pentagon Now Says 50 Troops — Not 34 — Suffered Brain Injuries In Iran Strike

Pentagon Now Says 50 Troops — Not 34 — Suffered Brain Injuries In Iran Strike The number of U.S. service members diagnosed with traumatic brain injury after Iranian missile attacks earlier this month has risen to 50 — up from the 34 reported last week .
The Pentagon announced the increase Tuesday evening and said 32 of those 50 service members have already received treatment and returned to duty in Iraq .
The remaining 18 were sent to Germany for further evaluation .
`` The department is committed to delivering programs and services intended to lead to the best possible @ @ @ @ @ @ @ any injury , '' Lt. Col. Thomas Campbell , a Pentagon spokesperson , said in a statement .
`` As stated previously , this is a snapshot in time and numbers can change . ''
The uptick in reported injuries comes about three weeks after the Iranian attack , which targeted at least two Iraqi military bases housing U.S. personnel .
The attack , itself a reprisal for the U.S. killing of a prominent Iranian commander , destroyed swaths of at least one of those bases — Ain al-Asad air base , northwest @ @ @ @ @ @ @ service members were killed .
In fact , hours after the attack , President Trump announced that `` no Americans were harmed . ''
`` All of our soldiers are safe , '' he said during an address at the White House , `` and only minimal damage was sustained at our military bases . ''
That declaration turned out to be inaccurate .
The next week , a military spokesman noted that `` several '' people were treated for concussions .
The number of injured service members later jumped to 11 in @ @ @ @ @ @ @ 34 in another statement issued last week .
`` A lot of these symptoms are late-developing .
They manifest over time , '' Defense Department spokesperson Jonathan Hoffman said at a news conference .
He added that some service members `` saw their conditions improve rapidly .
And then others , we saw , their conditions did n't improve .
Some got worse .
And some had severe enough symptoms that they were transported on for further treatment . ''
Trump has made additional comments that are contradicted by defense officials and numbers @ @ @ @ @ @ @ a news conference at the World Economic Forum in Davos , Switzerland , the president downplayed the service members ' injuries as `` headaches . ''
`` No , I do n't consider them very serious injuries , relative to other injuries that I 've seen , '' the president told reporters , comparing them to what he considers to be `` really bad injuries '' — the effects of roadside bombs .
`` I 've seen people with no legs and with no arms .
I 've seen people that were horribly @ @ @ @ @ @ @ '' That assessment belies a shift in recent years in the way military doctors and scientists , as well as in Trump 's own administration , view traumatic brain injury and its effects .
Researchers at the Department of Veterans Affairs have linked TBI with long-term changes to brain function that might result in faster aging , difficulties communicating and problems with coordination .
The VA says more than 408,000 TBIs have been reported among U.S. service members between 2000 and early 2019 .
In the wake of the Pentagon 's initial announcement @ @ @ @ @ @ @ Wars requested an apology from the president .
`` TBI is a serious injury and one that can not be taken lightly , '' William `` Doc '' Schmitz , national commander of the nonprofit veterans service organization , said in a statement last Friday .
`` TBI is known to cause depression , memory loss , severe headaches , dizziness and fatigue — all injuries that come with both short- and long-term effects . ''
The White House has not commented publicly on the latest Pentagon numbers .

Pentagon Now Says 50 Troops — Not 34 — Suffered Brain Injuries In Iran Strike
Enlarge this image toggle caption Ayman Henna/AFP via Getty Images Ayman Henna/AFP via Getty Images
Updated at 1:15 p.m. ET
The number of U.S. service members diagnosed with traumatic brain injury after Iranian missile attacks earlier this month has risen to 50 — up from the 34 reported last week. The Pentagon announced the increase Tuesday evening and said 32 of those 50 service members have already received treatment and returned to duty in Iraq.
The remaining 18 were sent to Germany for further evaluation.
"The department is committed to delivering programs and services intended to lead to the best possible outcomes for our service members who suffer any injury," Lt. Col. Thomas Campbell, a Pentagon spokesperson, said in a statement. "As stated previously, this is a snapshot in time and numbers can change."
The uptick in reported injuries comes about three weeks after the Iranian attack, which targeted at least two Iraqi military bases housing U.S. personnel. The attack, itself a reprisal for the U.S. killing of a prominent Iranian commander, destroyed swaths of at least one of those bases — Ain al-Asad air base, northwest of Baghdad. No U.S. or Iraqi service members were killed.
In fact, hours after the attack, President Trump announced that "no Americans were harmed."
"All of our soldiers are safe," he said during an address at the White House, "and only minimal damage was sustained at our military bases."
That declaration turned out to be inaccurate.
The next week, a military spokesman noted that "several" people were treated for concussions. The number of injured service members later jumped to 11 in a Pentagon statement, and then to 34 in another statement issued last week.
"A lot of these symptoms are late-developing. They manifest over time," Defense Department spokesperson Jonathan Hoffman said at a news conference.
He added that some service members "saw their conditions improve rapidly. And then others, we saw, their conditions didn't improve. Some got worse. And some had severe enough symptoms that they were transported on for further treatment."
Trump has made additional comments that are contradicted by defense officials and numbers. In remarks last week, during a news conference at the World Economic Forum in Davos, Switzerland, the president downplayed the service members' injuries as "headaches."
"No, I don't consider them very serious injuries, relative to other injuries that I've seen," the president told reporters, comparing them to what he considers to be "really bad injuries" — the effects of roadside bombs. "I've seen people with no legs and with no arms. I've seen people that were horribly, horribly injured in that area."
That assessment belies a shift in recent years in the way military doctors and scientists, as well as in Trump's own administration, view traumatic brain injury and its effects. Researchers at the Department of Veterans Affairs have linked TBI with long-term changes to brain function that might result in faster aging, difficulties communicating and problems with coordination.
The VA says more than 408,000 TBIs have been reported among U.S. service members between 2000 and early 2019. In the wake of the Pentagon's initial announcement last week, the Veterans of Foreign Wars requested an apology from the president.
"TBI is a serious injury and one that cannot be taken lightly," William "Doc" Schmitz, national commander of the nonprofit veterans service organization, said in a statement last Friday. "TBI is known to cause depression, memory loss, severe headaches, dizziness and fatigue — all injuries that come with both short- and long-term effects."
The White House has not commented publicly on the latest Pentagon numbers.


npr--2020-01-29--U.S. Elections 2020: Understanding What's At Stake For Health Care

U.S .
Elections 2020 : Understanding What 's At Stake For Health Care Health care has been a leading issue in the presidential campaign over the past year , as Democratic candidates have clashed with each other , and especially with President Trump .
But voters , who tell pollsters that health is among their top concerns , also complain that the health debate has been confusing and hard to follow .
With voting about to begin in many states , here 's a guide to some key health care terms , issues and policy differences at play .
Universal @ @ @ @ @ @ @ and single-payer are not the same thing Universal coverage is any method of ensuring that all of a nation 's residents have health insurance .
Other countries do it in various ways : through public programs , private programs or a combination .
A single-payer system is one in which a single entity , usually but not always a government , pays for needed health care services .
Single-payer is not the same as socialized medicine .
The latter generally refers to a system in which the government pays all the bills , @ @ @ @ @ @ @ health professionals who work there .
In a single-payer system , such as Medicare in the U.S. , the bills are paid by the government but the delivery system remains mostly private .
Medicare for All is a proposal that was originally developed in the late 1980s .
Building on the popularity of the Medicare program for senior citizens , the idea was to extend that program to the entire population .
However , since Medicare 's benefits have fallen behind those of many private insurance plans , the later iterations of Medicare @ @ @ @ @ @ @ , and very generous , program for all Americans .
Voters are even more concerned about health care costs than about losing health care coverage While Democrats fight over how best to cover more people with insurance , the majority of Americans already have coverage and are much more worried about the cost , according to polls .
A recent survey of voters in three states with early contests — Iowa , South Carolina and New Hampshire — found voters in all three ranked concerns about high out-of-pocket costs far ahead of concerns @ @ @ @ @ @ @ a good reason voters are so concerned about what they are being asked to pay for medical services .
U.S. health spending is dramatically higher than that of other industrialized nations .
In 2016 the U.S. spent 25 % more per person than the next highest-spending country , Switzerland .
Overall , U.S. health spending is more than twice the average of other Western nations .
But that 's not because Americans use more health services than citizens of other developed nations .
We just pay more for the services we use .
@ @ @ @ @ @ @ health economist Uwe Reinhardt and colleagues quipped in 2003 : `` It 's the Prices , Stupid . ''
A subsequent study published by the team last year confirmed that is still the case .
`` Because the differential between what the public and private sectors pay for medical services has grown significantly in the past fifteen years , U.S. policy makers should focus on prices in the private sector , '' the researchers say .
Drug companies and insurers are n't the only ones responsible for high prices To listen to many @ @ @ @ @ @ @ may seem drug companies and health insurers are together responsible for most — if not all — of the high health spending in the U.S. '' The giant pharmaceutical and health insurance lobbies have spent billions of dollars over the past decades to ensure that their profits come before the health of the American people , '' Sen. Bernie Sanders says on his presidential campaign website .
`` We must defeat them , together . ''
Most insurance spending , though , actually goes for care delivered by doctors and hospitals .
And @ @ @ @ @ @ @ gouging to patients than high prices charged by drugmakers or administrative costs added by insurance companies .
Wall Street firms that have bought physician groups are helping block a legislative solution to `` surprise bills '' — the often huge charges faced by patients who inadvertently get care outside their insurance network .
And hospitals around the country are being called out by the news media for suing their patients over bills almost no patient can afford .
Democrats and Republicans have very different views on how to fix health care To the @ @ @ @ @ @ @ presidential race , stories have mostly been about disagreements among Democrats : Some want Medicare for All , while others are pushing for less sweeping change — often described as a `` public option '' that would allow but not require people to purchase a government health plan .
However , there are much bigger divides between Democrats and Republicans .
Democrats nearly all support a larger role for government in health care ; they just disagree on how much larger it should be .
Meanwhile , Republicans generally want to see less @ @ @ @ @ @ @ bear .
The Trump administration has already either implemented or proposed a variety of ways to decrease regulation of private insurance and is weighing whether to allow states to effectively cap the amount of money they spend on Medicaid patients .
And in the biggest difference of all for the coming election , the Trump administration and a group of GOP-led states are , again , challenging the entire Affordable Care Act in court , arguing that it is unconstitutional .
The Supreme Court has opted not to decide the case ahead of @ @ @ @ @ @ @ likely to continue to be a major issue in the campaign .
There are important health issues beyond insurance coverage and costs While Medicare for All and drug prices have dominated the political debate recently , other critical health issues have received far less attention .
Some candidates have talked about how to best provide and pay for long-term care , which will become a growing need as baby boomers swell the ranks of the `` oldest old . ''
Several have addressed mental health and addiction issues , a continuing public health @ @ @ @ @ @ @ out plans for the special needs of Americans in rural areas and those with disabilities .
Kaiser Health News is a nonprofit , editorially independent program of the Kaiser Family Foundation .
KHN is not affiliated with Kaiser Permanente .

U.S. Elections 2020: Understanding What's At Stake For Health Care
Enlarge this image toggle caption YinYang/Getty Images YinYang/Getty Images
Health care has been a leading issue in the presidential campaign over the past year, as Democratic candidates have clashed with each other, and especially with President Trump. But voters, who tell pollsters that health is among their top concerns, also complain that the health debate has been confusing and hard to follow.
With voting about to begin in many states, here's a guide to some key health care terms, issues and policy differences at play.
Universal coverage, "Medicare for All" and single-payer are not the same thing
Universal coverage is any method of ensuring that all of a nation's residents have health insurance. Other countries do it in various ways: through public programs, private programs or a combination.
A single-payer system is one in which a single entity, usually but not always a government, pays for needed health care services. Single-payer is not the same as socialized medicine. The latter generally refers to a system in which the government pays all the bills, owns the health facilities and employs the health professionals who work there. In a single-payer system, such as Medicare in the U.S., the bills are paid by the government but the delivery system remains mostly private.
Medicare for All is a proposal that was originally developed in the late 1980s. Building on the popularity of the Medicare program for senior citizens, the idea was to extend that program to the entire population. However, since Medicare's benefits have fallen behind those of many private insurance plans, the later iterations of Medicare for All would create an entirely new, and very generous, program for all Americans.
Voters are even more concerned about health care costs than about losing health care coverage
While Democrats fight over how best to cover more people with insurance, the majority of Americans already have coverage and are much more worried about the cost, according to polls. A recent survey of voters in three states with early contests — Iowa, South Carolina and New Hampshire — found voters in all three ranked concerns about high out-of-pocket costs far ahead of concerns about insurance coverage itself.
'It's the prices, stupid'
There's a good reason voters are so concerned about what they are being asked to pay for medical services. U.S. health spending is dramatically higher than that of other industrialized nations. In 2016 the U.S. spent 25% more per person than the next highest-spending country, Switzerland. Overall, U.S. health spending is more than twice the average of other Western nations.
But that's not because Americans use more health services than citizens of other developed nations. We just pay more for the services we use.
In other words, as the late health economist Uwe Reinhardt and colleagues quipped in 2003: "It's the Prices, Stupid." A subsequent study published by the team last year confirmed that is still the case. "Because the differential between what the public and private sectors pay for medical services has grown significantly in the past fifteen years, U.S. policy makers should focus on prices in the private sector," the researchers say.
Drug companies and insurers aren't the only ones responsible for high prices
To listen to many of the candidates' messages, it may seem drug companies and health insurers are together responsible for most — if not all — of the high health spending in the U.S.
"The giant pharmaceutical and health insurance lobbies have spent billions of dollars over the past decades to ensure that their profits come before the health of the American people," Sen. Bernie Sanders says on his presidential campaign website. "We must defeat them, together."
Most insurance spending, though, actually goes for care delivered by doctors and hospitals. And some of their practices are far more gouging to patients than high prices charged by drugmakers or administrative costs added by insurance companies.
Wall Street firms that have bought physician groups are helping block a legislative solution to "surprise bills" — the often huge charges faced by patients who inadvertently get care outside their insurance network. And hospitals around the country are being called out by the news media for suing their patients over bills almost no patient can afford.
Democrats and Republicans have very different views on how to fix health care
To the extent health has been addressed in the presidential race, stories have mostly been about disagreements among Democrats: Some want Medicare for All, while others are pushing for less sweeping change — often described as a "public option" that would allow but not require people to purchase a government health plan.
However, there are much bigger divides between Democrats and Republicans. Democrats nearly all support a larger role for government in health care; they just disagree on how much larger it should be.
Meanwhile, Republicans generally want to see less government and more market forces brought to bear. The Trump administration has already either implemented or proposed a variety of ways to decrease regulation of private insurance and is weighing whether to allow states to effectively cap the amount of money they spend on Medicaid patients.
And in the biggest difference of all for the coming election, the Trump administration and a group of GOP-led states are, again, challenging the entire Affordable Care Act in court, arguing that it is unconstitutional.
The Supreme Court has opted not to decide the case ahead of the 2020 election, but it is likely to continue to be a major issue in the campaign.
There are important health issues beyond insurance coverage and costs
While Medicare for All and drug prices have dominated the political debate recently, other critical health issues have received far less attention.
Some candidates have talked about how to best provide and pay for long-term care, which will become a growing need as baby boomers swell the ranks of the "oldest old." Several have addressed mental health and addiction issues, a continuing public health crisis. And a few have laid out plans for the special needs of Americans in rural areas and those with disabilities.
Kaiser Health News is a nonprofit, editorially independent program of the Kaiser Family Foundation. KHN is not affiliated with Kaiser Permanente.