National / International News

Kicking the Highway Trust Fund can

Marketplace - American Public Media - Wed, 2015-06-24 02:00

The House of Representatives will hold a hearing Wednesday on a proposed a corporate tax holiday on money kept overseas as a way of refilling the drained coffers of the Highway Trust Fund. The plan would temporarily reduce the tax rate to get the money back to the U.S., then stash it away to pay for roads and bridges. 

The idea has support on both sides of the aisle. But that won’t fix the fund’s solvency problem. The reason for that is the 18 cents you pay the fund for every gallon you put into your car is the exact same amount you paid back in 1993, the last year it was raised. And 18 cents buys a lot less today than it did back then.

“For some reason, the gas tax is politically toxic in Washington,” says Rob Puentes, senior fellow at the Brookings Metropolitan Policy Program. Puentes says that might be because states have their own gas taxes — and a bunch of those were hiked just in the past year.

“In some ways, perhaps this whole idea of repatriation is easier than trying to define what the transportation program should be for the future,” Puentes says.

James Burnley, transportation secretary under Ronald Reagan, says the repatriation idea is also “a temporary fix.”

Burnley says two federal commissions tasked with fixing the fund’s broken revenue stream have proposed the same permanent fix: a vehicle miles traveled tax.

“You tax based on how many miles a vehicle is driven each year. And you do that regardless the mode of power of the vehicle,” he says.

That, he says, is a good fix in a time of increasingly fuel efficient cars — if they use fuel at all. And it's also a fix, he says, that isn’t being entertained by Congress.

Supermarket giants agree merger

BBC - Wed, 2015-06-24 02:00
Dutch-based supermarket group Ahold agrees to merge with Belgium's Delhaize in a deal that could create one of the world's largest retailers.

Connecting inmates with their children through books

Marketplace - American Public Media - Wed, 2015-06-24 02:00

As part of our series about technology in prisons called "Jailbreak," we paid a visit to a new program that uses technology to fill an important role in the development of the children of those who are incarcerated.

Organizers say the TeleStory program the first of its kind in the country. At the main branch of the Brooklyn Public Library in New York, families of inmates bring their children to a special room filled with toys and books. Even more unique: the room is virtually connected to a prison on Rikers Island.

As part of the program, an inmate who has had training gets a rare opportunity: they get to read a book to their child. 

We paid a visit to the Brooklyn Public Library's main branch, where we got to chat with a family taking part in the program.

Click the media player above to hear more.

 

Personalizing medicine with tailored social services

Marketplace - American Public Media - Wed, 2015-06-24 02:00

Evelyn Powell is 68 years old and extraordinarily sick.

“I have emphysema. I’ve got arrhythmic heart failure; got asthma,” says Powell, who runs a rooming house in Portland, Oregon. “I was in and out of the hospital all the time — it would be a month, a whole month, I’d be in the hospital three or four times.”

She’s the kind of patient who gets labeled a “frequent flier” by healthcare providers. It’s a pejorative label, but it’s certainly easy to judge Powell.

She struggled to keep track of her medication. She ate lousy food. She kept smoking.

Physician assistant Cassie Ryan-Mapolski sees plenty of patients like Powell at her Portland clinic. Sooner or later, she says, you just get stuck.

“There can be those moments where you’re like, ‘I don’t know what else to do for you. Why are you here? What do you want? What do you want me to do? I have no way to help you, I have no way to help you help yourself,’” she says.

In virtually every city and town in America there are men and women who can’t keep up with chronic illnesses like diabetes and congestive heart failure. In virtually every city and town in America there are also doctors and nurses who believe poverty, mental illness and addiction are at the root of the problem.

These are among the most expensive patients in the healthcare system, and their ranks are growing. Under the Affordable Care Act, more people at the margins are getting insurance through Medicaid.

“If you were homeless and had a lot of healthcare needs, in the past you often couldn’t access healthcare, you would get sicker and you would often die,” says Harvard’s Dr. Ashish Jha. “Today we have a lot more people coming into the healthcare system, insurance expansion has meant a lot of these people thankfully can get healthcare.”

And that means the cost to taxpayers for prescriptions, ambulance rides and week-long hospital stays just keep climbing.

But unlike costs for people at the end of life, or even for those battling cancer, these costs – at least on paper – could be reduced or avoided if people get better care.

The consulting firm Oliver Wyman says delivering proper care to these patients nationwide could save $300 billion dollars a year.   

The question, of course, is what proper care looks like.

What’s happening on a recent afternoon at the Dishman Community Center in Portland may be part of the answer.

Social worker Lisa Pearlstein leads her patient-client Tony Horst toward the pool. He’s a little nervous. He hasn’t been swimming in 15 years.

“It might be hard on me, it might be not hard,” he says. “Hope I don’t have chest pains in the swimming pool.”

Horst has heart problem. He’s got to lug around an oxygen tank. He also has a lot of anxiety.

The fact that he showed up at all – after getting lost on his way here – is because of the relationship he’s built with Pearlstein.

Pretty soon the two are tossing around a striped beach ball.

Horst is part of the Health Resilience Program run by Care CareOregon, an insurance company covering Medicaid patients. Under the program people like Pearlstein seek out the whole picture of a person.

She asks about their priorities, their worries and their pain. As that relationship develops, it helps her more clearly see the medical and the social roadblocks.

That’s crucial to building the kind of trust she’s built with Horst.

“This population of people has been affected by so much hell,” she says. “It’s overwhelming sometimes.”

It may be overwhelming, and time consuming, but CareOregon believes getting to know patients so intimately lets them do a better job. The company also collects a lot of data, which has helped it realize that not all poor patients with chronic illnesses are the same.

Some are able to manage their disease and don’t cycle in and out of the hospital. Those who do find themselves at the hospital so frequently are often socially isolated. 

They’re patients like Joanie McVeigh. She’s married, but her husband is gone a lot, and she’s really sick. She has diabetes, OCD, PTSD, panic and anxiety attacks, asthma, sleep apnea, and plantar fasciitis.

McVeigh is asking for help from two people who are visiting her recently in her studio apartment at the Sandy Motel. This is her care team. CareOregon tackles social isolation by pairing patients with a social worker and a peer who has similar lived experiences.

McVeigh’s become fast friends with social worker Quinne Salemeh and with peer Sam Osborne, who also has bipolar disorder. McVeigh tells me about one day earlier this year when her feet and knee were driving her nuts.

“I was really frustrated,” she says, “and I was really in pain.” She couldn’t make headway with the doctor, and she felt her anxiety spooling up inside.

“I was emotionally feeling like I wanted to get to the hospital. I wanted to take pills. I was crying. It set my bipolar in. I wanted to throw things,” she says.

She was close to calling the ambulance, but instead she started scrolling through her phone, eventually texting Osborne.

“I remember she came and sat on my couch,” McVeigh says. “And we just had this amazing, connecting talk.”

Catastrophe averted. No 911 call, no ambulance, no ER admission.

CareOregon knows it still needs better data to prove the concept works, but this approach – with its focus on relationships and reaching the socially isolated – seems to be paying off.

Two-and-a-half years since the program launched, the company says it’s cut hospital and emergency room admissions by 35 percent

Part of that is because people like Joanie – and like Evelyn Powell, the “frequent flier” from earlier in our story, have never wanted to spend so much time in the hospital or ER. And now they don’t have to.

In Powell’s case, CareOregon has helped her avoid trips to the ER for the last year, and she’s only had one hospitalization of any kind in 2015.

Doctors love the program. They says it’s easier to work with these patients. Even the bean counters seem happy; CareOregon estimates that next year it will save at least double what it costs to run the program. 

Improving health and saving money is the only measure of success for many in the industry. Some like CareOregon’s Lisa Pearlstein wonder if that bar is too high.

“We could do everything and still people are going to struggle,” she says. “It’s just poverty is so profound. Trauma is so profound.”

Pearlstein tells me about Bop, a 50-something woman addicted to heroin for more than 30 years, in and out of an abusive relationship, in chronic pain.

“We had a standing appointment,” Pearlstein says. “She would show up on Monday morning at 9:30. I could see her get off the bus, and I could be able to tell if she was high or not.”

Pearlstein says while they worked together for a couple of years, Bop kept going to the hospital and the ER about the same as always.

She was on the street until Pearlstein got her into hospice.

“She died in her sister’s home, in a bed, with treatment,” she says. “She wasn’t in pain. She died with dignity."

“She didn’t just fall down, face down, in the street in the gutter and get picked up and taken to the emergency room where nobody knew her,” Pearlstein says.

No one ever saved any money on Bop, but she died the way she wanted, and for Pearlstein, maybe that was enough.

President Obama, the gun salesman

Marketplace - American Public Media - Wed, 2015-06-24 01:59
60 percent

That's how much demand for guns rose, year over year, immediately after Barack Obama was elected president in 2008, according to U.S. News and World Report. What's interesting is that the demand was tied specifically to Obama, surging as Hillary Clinton, who had similar policies on gun control, dropped out of the race.

40 percent

That's the percentage of people who say they don't know their partner's income. That's according to a new study from Fidelity investments, which also says about a third of couples had differing answers about their investable assets. Also worth noting: most couples in the study said they had great communication.

$41 million

That's how much candidates reported refunding in campaign contributions in the last election cycle, for public relations reasons, because the donor had been involved in criminal activity, or any number of other reasons. The New York Times' Upshot notes that campaigns don't give back money often — the refunds made up just 1.4 percent of contributions — but they don't often vet donors either.

20 percent

That's how much the luxury car market in Greece has jumped since the spring. Something like a $60,000 Porsche 911 is not an item you'd expect folks suffering a financial crisis to purchase. But in Greece, some citizens feel their money is safer in luxury cars than in the bank. 

$47,000

That's about how much an iPhone 6 costs in Venezuela as a result of a lack of supply, and skyrocketing inflation. Bloomberg takes a look at the causes behind the country's unreasonable smartphone market, which prices the latest iPhone at about 41 times the monthly minimum wage.

VIDEO: German marzipan for Queen on state visit

BBC - Wed, 2015-06-24 01:54
The Queen and Prince Philip are welcomed by the German president at his official residence, Bellevue Palace, where they exchange gifts, including German marzipan and books.

US search for 'stolen Nigeria money'

BBC - Wed, 2015-06-24 01:52
The US and other countries have promised to help find billions of dollars stolen from Nigeria, President Muhammadu Buhari says.

Murray seeded third for Wimbledon

BBC - Wed, 2015-06-24 01:12
Britain's Andy Murray is seeded third for Wimbledon as he bids to regain the title he won two years ago.

France 'will not tolerate' US spying

BBC - Wed, 2015-06-24 01:06
France "will not tolerate" acts threatening its security, President Francois Hollande says, after Wikileaks reveals that the US spied on French presidents.

Bulgaria Steps Up Efforts Against Drug Trafficking Across Its Borders

NPR News - Wed, 2015-06-24 01:05

Bulgaria has long been a drug trafficking hub. As recently as the the 1990s, the government looked the other way. Now an EU member, it's working to stop the flow of Afghan heroin into Europe.

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James Horner: Cameron pays tribute

BBC - Wed, 2015-06-24 01:01
Director James Cameron pays tribute to film composer James Horner, calling his death in a plane crash on Monday "sad and shocking" and "such a waste".

Netherlands ordered to cut emissions

BBC - Wed, 2015-06-24 00:58
A court in the Netherlands orders the government to cut greenhouse gas emissions by at least 25% by 2020, in a class action suit launched by activists.

EU climate chief slams UK wind policy

BBC - Wed, 2015-06-24 00:54
The EU's climate chief says the UK's scrapping of subsidies will make it harder to meet renewables targets and an official describes the move as "mind-boggling".

VIDEO: Zharnel Hughes runs Usain Bolt close

BBC - Wed, 2015-06-24 00:46
Team GB hopeful Zharnel Hughes runs the world's fastest man, Usain Bolt, close in the 200 metres at the Diamond League meeting in New York on 13 June.

A Thorn For Russia, Georgia's Ex-President Pops Up In Ukraine

NPR News - Tue, 2015-06-23 23:42

As president of Georgia, Mikheil Saakashvili boldly took on much larger Russia in a 2008. He promptly lost. Now he's a governor in another country, Ukraine, which is also doing battle with Russia.

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Fans pitch up as Glastonbury opens

BBC - Tue, 2015-06-23 23:19
Music fans begin setting up camp for the Glastonbury Festival after the gates opened for this year's festival.

Greek PM bids to seal debt deal

BBC - Tue, 2015-06-23 23:19
Greek Prime Minister Alexis Tsipras heads to Brussels to meet creditors ahead of a summit designed to seal a deal to avoid a Greek debt default.

VIDEO: Global and local inside Belfast's MAC

BBC - Tue, 2015-06-23 23:07
Who are they and what do they do?

Pakistan heatwave deaths cross 800

BBC - Tue, 2015-06-23 22:36
The death toll from a heatwave in Pakistan's southern Sindh province has passed 800, hospital officials say, with mortuaries reaching their capacity.

Escaped bird poses 'real threat'

BBC - Tue, 2015-06-23 22:28
A police warning is issued after a large ostrich-like bird goes missing in north Nottinghamshire.

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