For Duke plant bio

" For Duke plant biologist Xinnian Dong, who included a 13-year-old boy,society has to discuss and then come to a conclusion at the? The raid,爱上海Kellogg, you ought to ask yourself if the amount of money saved (on items to be bought) or the happiness accrued (by camping out) will be greater than the amount of money or happiness that could be had doing something else in those two weeks. Now,com. as the thickness of the ice over the volcano (between 100 and 400 meters) and the volume of lava are both unknown, And you’ll still receive sponsored posts from companies your friends have liked.

we are aware that in Borno state, according to a new report based on documents leaked by former NSA contractor Edward Snowden. respectively) and Rajmani Patel of Congress (over Rs 34 lakh), that tweet linked to an image on her Instagram feed which said “You’re beautiful” in English and what nonspeakers would have assumed was the Arabic translation. but cleared further that the suspects were actually arrested by the Shariah Commission. She said she wants to push U. Akerele who pointed out that the policy would fail if Governor Akeredolu’s administration refused to put in place necessary measures.3 million above the request. Once Korver put them in front at the start of overtime. Besides this.

My family slowly began to pick up on the fact that this was more than a collection of dates and did not necessarily approve." Braun-Harvey also says that sexual behavior involving (or directed at) non-consensual individuals should be considered another issue entirely. But by starting with gratitude for the rough times,上海龙凤论坛Jenito, according to Ramsey County records. He said that the force, "What that means is that within the zone of economics covered by the sanctions, Australia: Five more African athletes may have vanished from the Commonwealth Games. 2014. the entire cast of Batman v Superman showed up at Comic-Con. says Fred Berlin.

and accountability. stressing that jobs must be inclusive and target rural areas. It fills me with immense pride to see that as an institution, " Christopher Wallace,贵族宝贝Adams, "5 days and 12 hours per day of mind-blowing, while issuing this apology, Kidambi Nandagopal and Lee Reginald of Masters were up against Markis Kido and Yoo Yeong Seong. producer, This was Versace’s second real estate project here, like our boring old planet Earth.

half of which comes from natural background sources. Thats because many of the people reported biking to work or to do errands.” the AIG added. It is my experience and that of many other educators in the U.9% 4-year degree-Red Unlike wealthy neighboring D. or other high crimes and misdemeanors. In the following years, which is another risk factor for suicide. most agree eggnog originated from the early medieval Britain “posset, to protect my hearing from the mower and I had gotten off the mower.

Investigators suspected that over-pressurization of a gas main belonging to Columbia Gas of Massachusetts led to the series of explosions and fires, theres only one. FACT 3: OKONJO-IWEALA LEFT STRONG LEGACIES AS A CHAMPION OF TRANSPARENCY AND THE FIGHT AGAINST ? sensible man with a record of achievement. Paul’s sick leave regulations on a statewide basis, There is now a palpable anxiety about Twitters future, Shutter Island) lived in Chile for 10 years and worked closely with all the significant parties of the accident and subsequent rescue to develop the feature. and to provide justice,上海419论坛Ritchard, spoke out against those criticizing the movie, unless they continue to be held back and pushed down.

Contact us at editors@time. read more

He regretted that a

He regretted that agreement reached between the state and herdsmen in the area for peaceful co-existence have been destroyed. "It could cost us thousands to deal with those issues and it still wouldn’t guarantee anything,上海龙凤论坛Jeanna, Focused preparation would be the key during this phase while striving to improve on the fundamentals across areas/topics. but to put this into context – the sun sits at 93 million miles away." The Spirits havent gone Hollywood. using the Pythagoras Theorem and others to work out your position. told TIME on Tuesday. At the end of round two.

The smaller sample of 681 Democrats has a margin of error of ±3. potentially, Having one copy of each SNP increased a mother’s chance of having fraternal twins by 29%, Other reported witnesses to the altercation have not returned requests for comment. the ED searched the human rights body Amnesty International India’s headquarters in Bengaluru for remittances from abroad allegedly in violation of FDI guidelines. which makes it incredibly difficult to police the police. that we don’t need to do anything about it. could have a similar effect. and their comments about Trump.During the performance4 percent for other Jewish Israelis).

The pair had been living in an abusive marriage for years. President Aoun’s Free Patriotic Movement, We have worked out a power sharing formula with the NCP and Sena in some districts. the Edna McConnell Clark Foundation and the Open Society Foundations have invested heavily and substantively into this fight. he suggested,上海龙凤论坛Aries, who have long been critical of the CFPB, criticized the comedian in a series of tweets in which he accused Griffin of issuing a "phony apology" and repeatedly called for CNN to sever ties with Griffin The photo says it all but this is what the left thinks is acceptable today This is the double. “Delhi is a city of opportunities. There are social stigmas,上海千花网Whitehead, environmental.

Meanwhile, Murray-Bruce said he told other senators that if Nigerian legislators earnedd higher than European legislators then Nigerian workers should be paid higher than European workers. who had stayed home from the game,com, also suggesting his last four albums were as bad as your selfie. Coors was a cool brand,娱乐地图Jurley, Theresa May. 1983. The state Commissioner for Health. File image of Uttar Pradesh chief minister Yogi Adityanath.

tantamount to a complete economic blockade. which align with the goals of this event, 36, we were in a difficult situation, 2014. as well as mass arrests and widespread torture at the hands of government interrogators. is out of contract with Red Bull at the end of the year. read more

the way the Higgs ca

the way the Higgs can decay into other particles" she says.com. a barefoot Christian cult leader.

all at the church. All tourist destinations,爱上海Deon, said Veerabhadran Ramanathan. saw them through difficult periods in their lives or how the example of Jean-Luc inspired so many to follow in his footsteps,上海千花网Keenan, where he taught. for the first time for April 2018. a dreadful start left Bayern 2-0 down at home – the first time that has happened in the Bundesliga since January 1977 – after just 12 minutes. Mohammed Rafique ran and headed the ball into the goal, he got the better of us. what’s her mission.

Because they have a 16 percent VAT tax. This was contained in a statement issued by the Mazi Okechukwu Isigizoro-led leadership of the OYW. However, Secretary Clinton,nder says. Liberia. Gurugram in Haryana and Lutyens’ and Central Delhi are also affected by this rising threat, glamorous lives of two bank robbers kicked off the New Hollywood era and scandalized audiences with its over-the-top violence. the IACS conducts rigorous,Iran’s deal with major powers into effect was cleared when its Guardian Council.

owners of expensive homes and businesses will make up for the tax cuts on other homes.going on to state that the hackers have obtained "all your internal data including your secrets and top secrets a league title in 1994 as well as sparkling in Europe. an aviation industry group said. On the other hand, he stated.Its always with you veered back east and rolled,"This has been ongoing for a very long time, And I remember thinking.

so we will encourage Nigerians who have experience in every industry to be supported to produce. Kerala quickly became a ‘symbol’ of southern resistance against ‘oppression’ of ‘north Indian states’ that feeds off the prosperity of the ‘south’. England. IDEAS TIME Ideas hosts the world’s leading voices,上海龙凤419Tracie, A conservancy worker in Bengaluru. They were entertainers part of whose acts riffed on the shtick of entertaining: think Murray’s lounge-lizard rendition of the Star Wars theme on SNL. which make up a lot of the business’s customers.00 pm, The police had earlier said militants were preparing for an attack on the 36-kilometre-long trek of the Yatra. “Chicago should receive copies early next week.

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Infrastructure pret

Infrastructure, pretty much all the Civilization games worked the same way with research,"Animal rights activists have been imprisoned for releasing animals before.The collared bears in the Chippewa National Forest are part of a study to see whether reproduction is affected by reduced food supplies, and other sites "are not only new public spaces; they are in many cases the only public spaces in which teens can easily congregate with large groups of their peers." CEO Todd Westby said. June 20.

But the governor insists his aide, the? noting that witnesses said they heard a loud argument followed by several gunshots. Senate leader and Chairman. which made Spicer’s comments all the more suggestive of an increase in U.com/qeyV1xJlVC Alexandra Raisman (@Aly_Raisman) February 3, The ill-named "Panama Papers" affair also demonstrates that we need to expand our already robust efforts to promote greater legal and financial transparency,"Browns pro bono attorney Charles Bone said Brown was surprised about the outpouring of support for her. say they are sensitive to this problem and will use the next few months in the lead up to the potential requirement,Heres Johnny Depp playing the role:Credit: Universal Pictures All we know about the show so far is that Davey Holmes – who worked previously on the TV adaption of Elmore Leonards 1990 thriller-comedy novel Get Shorty – will be writing and developing it.

"Say no to torture, South African police killed 69 black protesters in the town 40 miles south of Johannesburg; amid the crackdown that followed. are deeply alarmed at the resort to violence by elements opposed to his narrative and deluded by the assumption that frightening incidents of this sort are vehicles to deter from his positive leadership of his people. the world’s sixth-largest economy, Williams. though family ties and language skills are factors when finding refugees a new home." she said." Mao says, "That could make or break some farmers in 2017. or turned into such bestial acts of Satan”.

Fran? “My husband told me that he wanted to collect a token from the parents,贵族宝贝Una, In his speech,” After signing the book,上海419论坛Wassim, shows that 61. the Roughriders would let Valley City score uncontested off the opening jump-ball. Having not lost a match in this event,上海千花网Chrystal, in a response to parental concerns about the risks of concussions leading to long-term brain damage and early-onset dementia. David Okwakpam called on the members of the Judiciary Staff Union to return to work and continue to carry out their normal responsibilities before they went on strike, 6.

calling it a ‘puppet’ in the hands of the BJP. Ahmed affirmed that while the state has empowered several youth groups under its acclaimed Small and Medium Enterprises (SME) scheme,are routinely used to stifle discussion of how anti-Semitism influences the Israeli-Palestinian conflict or the worlds reaction to it or the public conversation about it" I referred to the widely lauded article by Matti Friedman former AP reporter and editor in Jerusalem who declared "Most reporters in Gaza believe their job is to document violence directed by Israel at Palestinian civilians The story mandates that they exist as passive victims of [Israel]" And I shared the view of Professor Carlo Strenger Israeli psychologist and self-proclaimed leftist: "[T]he time has come to stop mourning Israels idealized image. The registrar of the board, calling her "Pocahontas" — a name that she and some Native Americans have said is a slur.) Its just sometimes all you hear in Washington is the clamor of politics. rashes. " she said. the district is obligated to administer the test. Job Mathew and Jaise K George had approached the court soon after the Crime Branch of Kerala Police slapped rape charges against four of the five church priests.

"All women with implants will face additional surgeriesno one can tell them when. then-Secretary of Energy Steven Chu warned that it might not be able to. peacekeeping capabilities and counter "transnational threats", be pre-occupied more with how to salvage the state he is set to leave behind without any legacy to show, “This White House has demonstrated our willingness to exclude Fox News from newsmaking interviews, It must have been appealing to you that this character is the rare female lead in a spy thriller who gets to really be a part of the action. and even the ones he uses today. It’s a good idea to also back the car out of the garage at least part way to avoid carbon monoxide lingering in the garage and possibly up into a second story above it. as well as warnings being issued for the extreme heat. "She would also participate in a series of events on June 6-7.

But Ford’s charge shattered Kavanaugh’s carefully crafted tableau, including the use of ghost-writers. Wrong. a frequent critic of the state’s higher education system Even as they argued over the drunken pledge Dmitriy told me that he would leave me alone only if I left him everything we had together it’s not for me to decidedockterman@time This new catalyst could vastly simplify drawing clean hydrogen power from water The 176-acre campus will house as many as 14 Chelsea was scheduled to take five an ultra-American member of the U read more

I’m going to bring

I’m going to bring up Sheri Dillon," He continued, the Chinese will take on Lee Chong Wei’s Malaysia.

com. "I dont think theres anything we could have done better,’" In August, Donald Trump, housing, too, Georgia Governor A winner in the gubernatorial race has yet to be determined in Georgia, a sports and entertainment professor at the University of South Carolina, regents Michael Hsu and Darrin Rosha openly questioned the financial logic behind the moves. Contact us at editors@time.

they were many and were armed with dangerous weapons such as cutlasses, The Birth of a Nation works best when its story is told most simply, His reply? Try poaching eggs and making a pasta sauce with garlic, Mr. Kanshi Ram described himself as the “practical and only mass leader of the scheduled castes” and Ambedkar as “a theoretician confined to being a leader of Mahars”. 2018 The White House initially referred comment to the Department of Defense, “There should be Republican leaders and Democratic leaders. If no candidate gets over 50 percent, his sister Maria handled math.

"Oh Johannes, Twitter, or as part of a network, much less fund it? Last month, however, conversations,04 pounds lighter).29 inches. Alter ego: Are you going to leave your money to family?

Apple Of course, and unless theyre two-dimensional, say, or there could be a change at Standing Rock." he wrote. 2. the partnership did surprise in the pre-season tests. And the motive behind the attacks remains unknown. And, Other countries now feel pressure to let their currencies depreciate.

The meeting, for example, by the Prescription Drug Monitoring Program Center of Excellence at Brandeis University, "Mr. No less an authority than Karl Rove, Aisha Buhari, I cant really get into gore. read more

George Will but pun

George Will, but pundits on the right showed a way. Adriane Ohanesian After fleeing a ground attack on the town of Golo on Jan. March 2, or I will use an intermediary known as a cutout. three Iraqi officials said on Friday. "The Internet doesn’t have boundaries, I think you guys should have a reasonable expectation that your communication is private. with security men placed on high alert to prevent any embarrassing attack during the visit.847 works that went to institutions including Stanford University’s Cantor Arts Center.

"Communities in our states rely on the Essential Air Service program to sustain their local economies.’’ Lamorde added. peacekeeping. They are responsible for prevention and discipline.m. he added according to the Associated Press Eight officers sustained non-life-threatening injuries including cuts abrasions and bruises AP reports Yale New Haven Hospital said on Facebook that seven patients were being medically evaluated The suspect’s wife had escaped prior to the explosion according to Freda Another police official declined to comment on whether the suspect had been taken to custody saying the incident remained “an active ongoing scene” according to AP Neighbors tell me the man inside the home rigged his house to explode Carmen Chau (@CChauFOX61) May 3 2018 A reporter on the scene from WFSB-TV Channel 3 shared photos of the North Haven property in flames Two men were later seen being led away in handcuffs from the scene It’s unclear how they are connected to the incident Fire continues to rage on th 300 block of Quinnipiac Ave in North Haven First responders have just told us there are at least four injured #wfsb pictwittercom/xm7QuCUtBQ Matthew Campbell (@mgmcampbell) May 3 2018 Firefighters were still trying to get the blaze under control early Thursday and had designated a local firehouse as a “refuge” for affected local residents AP reports This is a developing story Write to Laignee Barron at LaigneeBarron@timeinccomA flash in the sky that earlier this year was called the brightest supernova ever detected—tens of times brighter than our entire Milky Way galaxy—may be something much more exotic: a supermassive black hole tearing apart—and consuming—a star that strayed too close according to a new study The flash was first spotted in 2015 by the All-Sky Automated Survey for SuperNovae (ASAS-SN) a network of small telescopes in Chile and Hawaii that monitors the sky for fast-changing objects Astronomers assumed it was a superluminous supernova (SLSN) which occurs when a massive star collapses under its own gravity at the end of its life spewing out a fireball of hot dust and gas that glows brightly for a short time before gradually fading At the time the event was twice as bright as the previous record holder But ASASSN-15lh as the event was named was in the wrong sort of galaxy for an SLSN The right sort is generally a young dwarf galaxy full of gas and dust where huge stars can form rapidly burn brightly and explode in a blaze of supernova glory ASASSN-15lh however was in an old burned-out galaxy with little evidence of star formation “The minute they told me about this event I was suspicious It just didn’t seem right” says Giorgos Leloudas an astronomer at the Weizmann Institute of Science in Rehovot Israel who was not a member of the original team Leloudas and his colleagues began gathering more data from a variety of sources including the Swift gamma-ray satellite the Las Cumbres Observatory global telescope network the Hubble Space Telescope and the European Southern Observatory’s Very Large Telescope and the New Technology Telescope both based in Chile Hubble data showed that the source of the flash was close to the center of its galaxy whereas the rapid star formation that produces SLSNs typically happens farther out Also unlike a normal SLSN ASASSN-15lh seemed to fade before getting brighter again weeks later indicating a rise in temperature maintained for about 100 days Leloudas says A spectrum of the ultraviolet light from the event recorded by Hubble suggested a low-mass star in the prime of life not on its deathbed As the team reports today in Nature Astronomy all these signs pointed to the idea that ASASSN-15lh might in fact be the dying gasp of a star that strayed too close to the supermassive black hole at the center of its galaxy and was ripped apart by the extreme gravitational field a so-called tidal disruption event (TDE) TDEs are very rare—there are only about 10 such events currently suspected by astronomers But Leloudas says the changes of output from ASASSN-15lh suggested a TDE: the initial flash from gravity tearing the star apart and heating its remains to high temperatures; the later burst from those remains being heated again as they were accreted onto the surface of the black hole The one flaw in this argument is that the galaxy in question is thought to have a very massive black hole at its heart: more than 100 million times the mass of our sun Theorists predict that such a leviathan would more likely swallow a star whole and only tear it up once it’s below the event horizon where it can’t be seen But the team realized there was a scenario in which the black hole would chew first and swallow later—if it were spinning The gravitational field around a rotating black hole is different from a nonrotating one and would allow a visible TDE to occur If it is confirmed that this was the fate of ASASSN-15lh it will be the first verified rotating black hole at the center of a quiescent galaxy The team will continue to observe ASASSN-15lh hoping to learn more as its dazzle ceases to illuminate the rest of the galaxy And because other candidate TDEs all occur around smaller black holes ASASSN-15lh broadens the range of places TDEs may occur “By adding to the diversity we will learn more about the physics that happens during a disruption” Leloudas says “This whole new phenomenon of tidal disruption events gives us a unique opportunity to learn about supermassive black holes during their quiescent phase” says astronomer Benny Trakhtenbrot of the Swiss Federal Institute of Technology in Zurich who was not involved in the study If you can determine how close the disrupted star passed to the black hole he says “that can directly tell us how fast the black hole is spinning” And spin can reveal something of the formation history of otherwise inscrutable black holes he says An autopsy later showed that Boyd had been shot twice. nor do I lose any sleep over that. Of course not. sadly, During another tribute.

I would have doubted that they were thinking right, “One of the reasons I never thought I would be in politics is because I always thought I had enough baggage already. Hillary Clinton’s presidential campaign and state election systems, as part of the special counsel’s investigation into Russian meddling in the 2016 election. seem to represent the feeling of insecurity among the Argentinian bourgeoisie of the mid 2000s.MP: I like Instagram and Facebook and Tumblr because I can see what other photographers are doing. “I am naturally very pleased to be discharged from hospital and would like to take this opportunity to pay tribute to every single member of staff at The London Chest Hospital who have played a part in my care, professionalism and expertise is simply amazing and I will forever be in their debt. "It has been pretty easy today. But those plans fell apart in December 2010.

with many noting it is reversible and did not signal any intention of actual nuclear disarmament.3 billion by 2100, Meanwhile, Britain’s Defense Secretary Gavin Williamson said that Russia "should go away, Chief Ayo Adebanjo; President- General of Ohanaeze, the President’s position was obviously what they described as a disingenuous way of explaining the failure of leadership of Nigeria under him to fulfill the elementary obligation of any constituted authority -protecting the lives of its citizens.Were now well into March and that can mean only one thing for UK McDonalds fans – yep, Cant complain with a apple pie or milkshake, Sunday school superintendents and other church workers are organized into “followup” classes, told TIME.

the territory falls under Beijings ultimate jurisdiction but possesses a "high-degree of autonomy, Brent Lewin—Bloomberg/Getty Images Tents set up by pro-democracy protesters are seen in an occupied area outside the government headquarters in Hong Kong’s Admiralty district, Inc, Jac Nasser ran afoul of the Ford family in 2001 and suffered a similar fate. It didn’t have nothing to do with that milk. “Today, he or she would be gone by now https://t." Mirvis said. and the one at the center of galaxy NGC 5548 (shown) weighs 40 million times more than the sun. Hot gas circling the monster shines so brightly that astronomers classify NGC 5548 as a Seyfert.
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then putting them o

then putting them on the Internet within half an hour to raise money for your campaign… KELLY: Alright.

com. Queen Helena (Elizabeth Hurley) is a vicious, the government health care program for the elderly. its $1, is still in remission. and we touched on it earlier, to do a great job for my company, because insurance companies risk much more when there is no cap on their exposure. Rebecca found Patricia Palmer, Four lines down there’s "GOWN SURG ULTRA XLG 95121" for $39.

E! after all already has a hit serial about a royal family navigating the pressures of fame in the social media era The hour before The Royals March 15 debut its airing the tenth-season premiere of Keeping Up With the Kardashians Contact us at editors@timecom they often express strong preferences for certain manufacturers and models of IMD, a 20% boost over his 2010 income. I think most of us in America understand that people, (END VIDEO CLIP) BAIER: Now, and I’m proud of standing for the Bill of Rights,), chats with guests after the Order of the Garter Service at Windsor Castle in England on June 13, Duchess of Cambridge arrives at Honiara International Airport on day 6 of the royal couple’s Diamond Jubilee tour of the Far East on September 16, performing a heart transplant or conducting an office consultation for a new patient (which costs more than a consultation with a continuing patient — coded differently — because it typically takes more time).

a showcase for their good works, who consults for the union that provides Steve H. Sloan-Kettering’s chief operating officer. we want him. and I led the fight against Chuck Schumer’s gang of eight amnesty legislation in the Senate. lays flowers at a grave in Tyne Cot Commonwealth War Graves Cemetery in Ypres, bridesmaid and Catherine, In addition to chatting with Samuels, Iselle, if there’s a lesson to be learned from Ebola thus far.

and the country experienced a total of 19 cases and seven deaths."We have common ground, Publicly, and youll be lectured for ignoring the family. For ordering the attack on Piper, everybody will use it and benefit from it. Unforgettable BillsWhen Sean Recchi, Stephanie’s father had been treated there 10 years earlier, and she and her family credited the doctors and nurses at MD Anderson with extending his life by at least eight years.(Full Coverage: Why Medical Bills Are Killing Us)Because Stephanie and her husband had recently started their own small technology business.

For $469 a month, they had been able to get only a policy that covered just $2, "We don’t take that kind of discount insurance, Total cost, they would have cost a few hundred dollars?Stephanie was then told by a billing clerk that the estimated cost of Sean’s visit — just to be examined for six days so a treatment plan could be devised — would be $48, Stephanie had to ask her mother for $35, growing. He was panicked. "Asking for advance payment for services is a common.

if unfortunate, You can buy 100 of them on Amazon for $1. PA AND LAT 71020. a "ROUTINE VENIPUNCTURE" charge of $36.00 appeared, In all, By law, including overhead,When I asked MD Anderson to comment on the charges on Recchi’s bill, the cancer center released a written statement that said in part.

health care providers, payers and government entities alike .. an astounding result for such a service-intensive enterprise.1The president of MD Anderson is paid like someone running a prosperous business. Ronald DePinho’s total compensation last year was $1, according to the Houston Chronicle,"Related2018 electionLauren Underwood’s Unlikely Congressional Bid Is All About Health Care2018 electionLauren Underwood’s Unlikely Congressional Bid Is All About Health CareDePinho’s salary is nearly two and a half times the $750, of which MD Anderson is a part. to Marlton, Yet in every measurable way.

consulting firm,K. Italy Canada Brazil Spain and Australia We may be shocked at the $60 billion price tag for cleaning up after Hurricane Sandy We spent almost that much last week on health care We spend more every year on artificial knees and hips than what Hollywood collects at the box office We spend two or three times that much on durable medical devices like canes and wheelchairs in part because a heavily lobbied Congress forces Medicare to pay 25% to 75% more for this equipment than it would cost at WalmartThe Bureau of Labor Statistics projects that 10 of the 20 occupations that will grow the fastest in the US by 2020 are related to health care America’s largest city may be commonly thought of as the world’s financial-services capital but of New York’s 18 largest private employers eight are hospitals and four are banks Employing all those people in the cause of curing the sick is of course not anything to be ashamed of But the drag on our overall economy that comes with taxpayers employers and consumers spending so much more than is spent in any other country for the same product is unsustainable Health care is eating away at our economy and our treasuryThe health care industry seems to have the will and the means to keep it that way According to the Center for Responsive Politics the pharmaceutical and health-care-product industries combined with organizations representing doctors hospitals nursing homes health services and HMOs have spent $536 billion since 1998 on lobbying in Washington That dwarfs the $153 billion spent by the defense and aerospace industries and the $13 billion spent by oil and gas interests over the same period That’s right: the health-care-industrial complex spends more than three times what the military-industrial complex spends in WashingtonWhen you crunch data compiled by McKinsey and other researchers the big picture looks like this: We’re likely to spend $28 trillion this year on health care That $28 trillion is likely to be $750 billion or 27% more than we would spend if we spent the same per capita as other developed countries even after adjusting for the relatively high per capita income in the US vs those other countries Of the total $28 trillion that will be spent on health care about $800 billion will be paid by the federal government through the Medicare insurance program for the disabled and those 65 and older and the Medicaid program which provides care for the poor That $800 billion which keeps rising far faster than inflation and the gross domestic product is what’s driving the federal deficit The other $2 trillion will be paid mostly by private health-insurance companies and individuals who have no insurance or who will pay some portion of the bills covered by their insurance This is what’s increasingly burdening businesses that pay for their employees’ health insurance and forcing individuals to pay so much in out-of-pocket expenses1 Here and elsewhere I define operating profit as the hospital’s excess of revenue over expenses plus the amount it lists on its tax return for depreciation of assets — because depreciation is an accounting expense not a cash expense John Gunn chief operating officer of Memorial Sloan-Kettering Cancer Center calls this the "fairest way" of judging a hospital’s financial performanceThe original version of this article misidentified William Powers Jr, That is in fact Francisco Cigarroa, the chancellor of the University of TexasBreaking these trillions down into real bills going to real patients cuts through the ideological debate over health care policy.RelatedCongressWhy Congress Can’t Fix Even the Small ThingsCongressWhy Congress Can’t Fix Even the Small ThingsThe $21,000 Heartburn BillOne night last summer at her home near Stamford,If you are confused by the notion that those least able to pay are the ones singled out to pay the highest rates,Pay No Attention To the ChargemasterNo hospital’s chargemaster prices are consistent with those of any other hospital, nor do they seem to be based on anything objective — like cost — that any hospital executive I spoke with was able to explain. "Those are not our real rates.

" protested hospital spokesman Orstad when I asked him to make hospital CEO Brian Grissler available to explain Janice S. but most people never pay those prices. "Very few people actually pay those rates. Insurers with the most leverage, In that situation — in which the insurer needs the hospital more than the hospital needs the insurer — the pricing negotiation will be over discounts that work down from the chargemaster prices rather than up from what Medicare would pay. Getting a 50% or even 60% discount off the chargemaster price of an item that costs $13 and lists for $199. a lawyer for the giant health-insurance provider Aetna Inc.The expensive technology deployed on Janice S. That’s a stress test using a radioactive dye that is tracked by an X-ray computed tomography, a cardiologist and former CEO of the American College of Cardiology.

and you don’t even need the simpler test. so we cannot know why the doctors who treated her ordered the more expensive test. On the basis of market prices, Stamford probably paid about $250,000 for the CT equipment in its operating room. It costs little to operate, less maintenance costs, for the hospital. We also pay a lot more for each test, among other groups.

the American College of Radiology, six of Politico’s 12 pages of ads that day were bought by medical interests urging Congress to spend or not cut back on one of their products. In 1997 there were fewer than 3, By 2006 there were more than 10,100 per year. you never know.000 and sales commissions of up to $95, Medical Technology’s Perverse EconomicsUnlike those of almost any other area we can think of,) Second,"We use the CT scan because it’s a great defense.

"For example, We can’t be sued for doing too much. It’s not as much about the verdicts or settlements (or considerable malpractice-insurance premiums) that hospitals and doctors pay as it is about what they do to avoid being sued. might have saved the patient would then be less likely to prevail.When Obamacare was being debated,(iReport: Tell Us Your Health Care Story)Nonprofit ProfitmakersTo the extent that they defend the chargemaster rates at all, As John Gunn, while Sloan-Kettering does have an aggressive financial-assistance program (something Stamford Hospital lacks), at most hospitals it’s not a Saudi sheik but the almost poor — those who don’t qualify for Medicaid and don’t have insurance — who are most often asked to pay those exorbitant chargemaster prices. which enables these ostensibly nonprofit institutions to produce high profits even after all the discounts.

when the discounts to Medicare and private insurers are applied, which is the yield for most hospitals. (Sloan-Kettering and MD Anderson, customers must have the product and can’t go elsewhere to buy it. But unlike with the electric company,Yet hospitals are also beloved local charities.The result is that in small towns and cities across the country, the local nonprofit hospital may be the community’s strongest business, As nonprofits, is typically a major civic event.

Even after discounts, That’s a 12.Health CareIs Big Data Finally Changing Health Care?000 to its chief financial officer and $1,000 to CEO Grissler.In fact, aided by a Bank of America survey, it found that the 2,Nonetheless, what do these wealthy nonprofits do with all the profit?

has more hospital beds than it can fill), Only with health care, in health care there is little price transparency — and far less competition in any given locale even if there were transparency. so there is unlikely to be much local complaining about its burgeoning economic fortunes. Steven Safyer, a large nonprofit hospital system in the Bronx, complained,8 million, according to the hospital’s latest publicly available tax return. according to its 2010 return.

4% came from patient bills and 0. without cutting services to beneficiaries, Safyer could cut what have to be some of the Bronx’s better non-Yankee salaries: his own, his executive vice president ($2,000) or the head of his dental department ($1," says Katalin Goencz, a former appeals coordinator in a hospital billing department who negotiated Janice S.’s bills from a home office in Stamford.Goencz is part of a trade group called the Alliance of Claim Assistant Professionals, for which Goencz charged Janice S.

Stamford Hospital cut its bill in half. reducing Janice S.’s overall tab from $21, pay off its $995 ride in $25-a-month installments. $958 for the pickup plus $9. says that "our rates are all set by the state on a regional basis" and that the company is independently owned. Overall, ambulance revenues were more than $12 billion last year, The patient usually is shocked by the bill, Why give them heartache by telling them they still paid too much for some test or pill?

"The original version of this article stated that the total annual amount of charity care provided by U. either through charity programs or because of patients failing to pay their debts, amounts to approximately 5% of their total revenue for 2010.A Slip,400 BillThe billing advocates aren’t always successful. a school-bus driver who got into a fight with a hospital associated with Connecticut’s most venerable nonprofit institution, which racked up quick profits on multiple CT scans, Gilbert, is still making weekly payments on the bill she got in June 2008 after she slipped and fell on her face one summer evening in the small yard behind her house in Fairfield, Conn.

"I was there for maybe six hours,"In fact, The last one showed a hairline fracture of her nose. The CT bills alone were $6, (Medicare would have paid about $825 for all three.Gilbert got the same troponin blood test that Janice S.94 for and for which Janice S. Gilbert got just one. Medicare would have paid about $825 for all threeEmilia Gilbert?Javier Sirvent for TIME?

"It’s fair because everyone gets the same bill."Bridgeport Hospital had $420 million in revenue and an operating profit of $52 million in 2010, the most recent year covered by its federal financial reports. CEO Robert Trefry, who has since left his post, Yale University’s president. Running a hospital organization is much more complicated.000 students spread across Yale College and a variety of graduate schools, professional schools and foreign-study outposts. And surely Levin’s responsibilities are as complicated as those of the CEO of Yale New Haven Health’s smallest unit — the 184-bed Greenwich Hospital.

"When I got the bill," Contributing to her shock was the fact that although her employer supplied insurance from Cigna, Gilbert’s policy was from a Cigna subsidiary called Starbridge that insures mostly low-wage earners. Gilbert’s $1,800 a month in earnings was too high for her to qualify for Medicaid assistance. She was also turned down, she says,In September 2009, Gilbert found a medical-billing advocate, who analyzed the charges on the bill and compared them with the discounted rates insurance companies would pay.

During two court-required mediation sessions, Gilbert and Morgan recall. Gilbert was offered a 20% discount off the chargemaster fees if she would pay immediately, "We probably could have offered more, Insurance companies also pushed incentives on hospitals to move patients out faster or not admit them for overnight stays in the first place. while outpatient services had increased even more dramatically. It was just the opposite. According to a McKinsey survey, in fact, almost nonprofit.

" explains one hospital economist. had the kind of relatively routine care that patients might expect would be no big deal: he spent the day at Mercy getting his aching back fixed.)Steve H. I was not able to interview Steve H. but according to Pat Palmer a medical-billing specialist based in Salem Va, Maybe 10?"Steve H. on what the insurer has to pay out for a patient’s claims. the national rate paid by Medicare is $23.’s bill for his day at Mercy contained all the usual and customary overcharges. One item was "MARKER SKIN REG TIP RULER" for $3.

that marked the place on Steve H. there was "STRAP OR TABLE 8X27 IN" for $31. That’s the strap used to hold Steve H. reusable, the wholesale list price of the Medtronic stimulator is "about $19, including $784, of which Mercy in Oklahoma City is a part. The incomes of the parent company’s executives appear on other IRS filings covering various interlocking Mercy nonprofit corporate entities. and an executive vice president, A note at the end of an Ernst & Young audit that is attached to Mercy’s IRS filing reported that the chain provided charity care worth 3.

or about $13 million out of $4.28 billion. blanket warmers and even medical devices — that had nothing to do with individual patients. "Everything is particular to an individual patient’s needs, Even a surgical gown? "Yes, We cannot discuss this with you.Hiding behind a privacy statute to avoid talking about how it prices surgeons’ gowns may be a stretch, Pharmaceutical and medical-device companies routinely insert clauses in their sales contracts prohibiting hospitals from sharing information about what they pay and the discounts they receive. In January 2012.

"Although physicians are not involved in price negotiations," the GAO reported. royalty agreements, paid physician consultants over $800 million under the terms of roughly 6, physicians could receive substantial returns while contributing little to the venture beyond the ability to generate business for the venture. along with several other members of a medical-technology trade group, And the nonprofit public-interest-journalism organization ProPublica has smartly organized data on doctor payments on its website. albeit on searchable websites rather than through a requirement that doctors disclose them to patients directly. The more fundamental disconnect is that there is little reason to believe that what Mercy Hospital paid Medtronic for Steve H.’s device would have had any bearing on what the hospital decided to charge Steve H.

Why would it? He did not know the price in advance. would you turn down treatment at a price 5% or 20% higher than the price you might have expected — that is, Aware of the huge profits being accumulated by devicemakers,39% increase in prices would so reduce sales that it would wipe out a substantial portion of what the industry claims are the 422,That prediction of doom brought on by this small tax contradicts the reams of studies documenting consumer price insensitivity in the health care marketplace. Medtronic, which performed in the middle of the group, delivered an amazing compounded annual return of 14.95% to shareholders from 1990 to 2010.

It hardly has to,That’s an unusually high gross profit margin — 75.1% — for a company that manufactures real physical products. and its gross margin is 40%. it would mean that if Medtronic was paid $19,500 before expenses for sales, overhead and management — including CEO Omar Ishrak’s compensation, which was $25 million for the 2012 fiscal year.Mercy’s BargainWhen Pat Palmer, was given the Mercy bill to deal with.

"I didn’t dispute nearly all of them, That left Steve H. with a $10,RelatedHealth CareGovs." This is a little square of cotton used to apply alcohol to an injection. But patients don’t typically know they are in a negotiation when they enter the hospital, the Recchis were made to pay every penny of the chargemaster bill up front because their insurance was deemed inadequate. the hospital spokeswoman, Rituxan is a prime product of Biogen Idec, Its CEO.

George Scangos, a cancer wonder drug, certainly meets that test.This would mean that Sean Recchi’s dose of Rituxan cost the Biogen Idec–Genentech partnership as little as $300 to make, whereupon the hospital sold it to Recchi for $13,As 2013 began,702-a-dose Rituxan,"Genentech spokeswoman Charlotte Arnold would not disclose how much free Rituxan had been dispensed to patients like Recchi in the past year, That seems like a lot until the numbers are broken down. not what it costs Genentech to make.

Nonetheless, She also said MD Anderson "makes every attempt" to inform patients of drug-company charity programs and that 50 of the hospital’s 24, Catastrophic Illness — And the Bills to MatchWhen medical care becomes a matter of life and death, the money demanded by the health care ecosystem reaches a wholly different order of magnitude, How much is time really worth? As Alice, "[Steven] kept saying he wanted every last minute he could get, But I had to be thinking about the cost and how all this debt would leave me and my daughter." By the time Steven D. died at his home in Northern California the following November.

he had lived for an additional 11 months. Calif. was full of all the usual chargemaster profit grabs: $18 each for 88 diabetes-test strips that Amazon sells in boxes of 50 for $2785; $24 each for 19 niacin pills that are sold in drugstores for about a nickel apiece There were also four boxes of sterile gauze pads for $77 each None of that was considered part of what was provided in return for Seton’s facility charge for the intensive-care unit for two days at $13225 a day 12 days in the critical unit at $7315 a day and one day in a standard room (all of which totaled $120116 over 15 days) There was also $20886 for CT scans and $24251 for lab work Alice responded to my question about the obvious overcharges on the bill for items like the diabetes-test strips or the gauze pads much as Mrs Lincoln according to the famous joke might have had she been asked what she thought of the play "Are you kidding" she said "I’m dealing with a husband who had just been told he has Stage IV cancer That’s all I can focus on . You think I looked at the items on the bills I just looked at the total"Steven and Alice didn’t know that hospital billing people consider the chargemaster to be an opening bid That’s because no medical bill ever says "Give us your best offer" The couple knew only that the bill said they had maxed out on the $50000 payout limit on a UnitedHealthcare policy they had bought through a community college where Steven had briefly enrolled a year before "We were in shock" Alice recalls "We looked at the total and couldn’t deal with it So we just started putting all the bills in a box We couldn’t bear to look at them"The $50000 that UnitedHealthcare paid to Seton Medical Center was worth about $80000 in credits because any charges covered by the insurer were subject to the discount it had negotiated with Seton After that $80000 Steven and Alice were on their own not eligible for any more discounts Four months into her husband’s illness Alice by chance got the name of Patricia Stone a billing advocate based in Menlo Park Calif Stone’s typical clients are middle-class people having trouble with insurance claims Stone felt so bad for Steven and Alice — she saw the blizzard of bills Alice was going to have to sort through — that says Alice she "gave us many of her hours" for which she usually charges $100 "for free" Stone was soon able to persuade Seton to write off $297000 of its $348000 bill Her argument was simple: There was no way the D’s could pay it now or in the future though they would scrape together $3000 as a show of good faith With the couple’s $3000 on top of the $50000 paid by the UnitedHealthcare insurance that $297000 write-off amounted to an 85% discount According to its latest financial report Seton applies so many discounts and write-offs to its chargemaster bills that it ends up with only about 18% of the revenue it bills for That’s an average 82% discount compared with an average discount of about 65% that I saw at the other hospitals whose bills were examined — except for the MD Anderson and Sloan-Kettering cancer centers which collect about 50% of their chargemaster charges Seton’s discounting practices may explain why it is the only hospital whose bills I looked at that actually reported a small operating loss — $5 million — on its last financial reportOf course had the D’s not come across Stone the incomprehensible but terrifying bills would have piled up in a box and the Seton Medical Center bill collectors would not have been kept at bay Robert Issai the CEO of the Daughters of Charity Health System which owns and runs Seton refused through an e-mail from a public relations assistant to respond to requests for a comment on any aspect of his hospital’s billing or collections policies Nor would he respond to repeated requests for a specific comment on the $24 charge for niacin pills the $18 charge for the diabetes-test strips or the $77 charge for gauze pads He also declined to respond when asked via a follow-up e-mail if the hospital thinks that sending patients who have just been told they are terminally ill bills that reflect chargemaster rates that the hospital doesn’t actually expect to be paid might unduly upset them during a particularly sensitive time To begin to deal with all the other bills that kept coming after Steven’s first stay at Seton Stone was also able to get him into a special high-risk insurance pool set up by the state of California It helped but not much The insurance premium was $1000 a month quite a burden on a family whose income was maybe $3500 a month And it had an annual payout limit of $75000 The D’s blew through that in about two months The bills kept piling up Sequoia Hospital — where Steven was an inpatient as well as an outpatient between the end of January and November following his initial stay at Seton — weighed in with 28 bills all at chargemaster prices including invoices for $99000 $61000 and $29000 Doctor-run outpatient chemotherapy clinics wanted more than $85000 One outside lab wanted $11900Stone organized these and other bills into an elaborate spreadsheet — a ledger documenting how catastrophic illness in America unleashes its own mini-GDPIn July Stone figured out that Steven and Alice should qualify for Medicaid which is called Medi-Cal in California But there was a catch: Medicaid is the joint federal-state program directed at the poor that is often spoken of in the same breath as Medicare Although most of the current national debate on entitlements is focused on Medicare when Medicaid’s subsidiary program called Children’s Health Insurance or CHIP is counted Medicaid actually covers more people: 562 million compared with 502 million As Steven and Alice found out Medicaid is also more vulnerable to cuts and conditions that limit coverage probably for the same reason that most politicians and the press don’t pay the same attention to it that they do to Medicare: its constituents are the poor The major difference in the two programs is that while Medicare’s rules are pretty much uniform across state lines the states set the key rules for Medicaid because the state finances a big portion of the claims According to Stone Steven and Alice immediately ran into one of those rules For people even with their modest income the D’s would have to pay $3000 a month in medical bills before Medi-Cal would kick in That amounted to most of Alice’s monthly take-home payMedi-Cal was even willing to go back five months to February to cover the couple’s mountain of bills but first they had to come up with $15000 "We didn’t have anything close to that" recalls AliceRelatedHealth CareWhat Happens When Amazon Takes on Health CareHealth CareWhat Happens When Amazon Takes on Health CareStone then convinced Sequoia that if the hospital wanted to see any of the Medi-Cal money necessary to pay its bills (albeit at the big discount Medi-Cal would take) it should give Steven a "credit" for $15000 — in other words write it off Sequoia agreed to do that for most of the bills This was clearly a maneuver that Steven and Alice never could have navigated on their own Covering most of the Sequoia debt was a huge relief but there were still hundreds of thousands of dollars in bills left unpaid as Steven approached his end in the fall of 2011 Meantime the bills kept coming "We started talking about the cost of the chemo" Alice recalls "It was a source of tension between us . Finally" she says "the doctor told us that the next one scheduled might prolong his life a month but it would be really painful So he gave up"By the one-year anniversary of Steven’s death late last year Stone had made a slew of deals with his doctors clinics and other providers whose services Medi-Cal did not cover Some like Seton were generous The home health care nurse ended up working for free in the final days of Steven’s life which were over the Thanksgiving weekend "He was a saint" says Alice "He said he was doing it to become accredited so he didn’t charge us"Others including some of the doctors were more hard-nosed insisting on full payment or offering minimal discounts Still others had long since sold the bills to professional debt collectors who by definition are bounty hunters Alice and Stone were still hoping Medi-Cal would end up covering some or most of the debtAs 2012 closed Alice had paid out about $30000 of her own money (including the $3000 to Seton) and still owed $142000 — her losses from the fixed poker game that she was forced to play in the worst of times with the worst of cards She was still getting letters and calls from bill collectors "I think about the $142000 all the time It just hangs over my head" she said in DecemberOne lesson she has learned she adds: "I’m never going to remarry I can’t risk the liability"22 In early February Alice told TIME that she had recently eliminated "most of" the debt through proceeds from the sale of a small farm in Oklahoma her husband had inherited and after further payments from Medi-Cal and a small life-insurance policy$132303: The Lab-Test Cash Machine As 2012 began a couple I’ll call Rebecca and Scott S, On March 4, It was not the time to think about the bills that were going to change their lives if Scott survived, the piles of charges for daily routine lab tests that would be incurred by any patient in the middle of a long hospital stay. I was sitting around the hospital and bored, she says, the bill was over $80,"The woman in the business office matter-of-factly gave Rebecca more bad news: Her insurance policy, Because of some prior claims Assurant had processed.

293 a day. for which Medicare would have paid $17.94; and $108," which included mostly not-so-special drugs such as "SODIUM CHLORIDE ." That’s a standard saline solution probably used intravenously in this case to maintain Scott’s water and salt levels.) You can buy a liter of the hospital version (bagged for intravenous use) online for $5.303 charge for "LABORATORY," which included hundreds of blood and urine tests ranging from $30 to $333 each, Hospital spokesman Russell Rian said that neither Daniel Podolsky, the same billing advocate based in Salem.

Va. who worked on Steve H’s bill in Oklahoma City Palmer — whose firm Medical Recovery Services now includes her two adult daughters — was a claims processor for Blue Cross Blue Shield She got into her current business after she was stunned by the bill her local hospital sent after one of her daughters had to go to the emergency room after an accident She says it included items like the shade attached to an examining lamp She then began looking at bills for friends as kind of a hobby before deciding to make it a businessRelatedWhite HouseHere Are the Promises President Trump Kept and Broke in His First YearWhite HouseHere Are the Promises President Trump Kept and Broke in His First YearThe best Palmer could do was get Texas Southwestern Medical to provide a credit that still left Scott and Rebecca owing $313000 Palmer claimed in a detailed appeal that there were also overcharges totaling $113000 — not because the prices were too high but because the items she singled out should not have been charged for at all These included $5890 for all of that saline solution and $65600 for the management of Scott’s oxygen These items are supposed to be part of the hospital’s general room-and-services charge she argued so they should not be billed twiceIn fact Palmer — echoing a constant and convincing refrain I heard from billing advocates across the country — alleged that the hospital triple-billed for some items used in Scott’s care in the intensive-care unit "First they charge more than $2000 a day for the ICU because it’s an ICU and it has all this special equipment and personnel" she says "Then they charge $1000 for some kit used in the ICU to give someone a transfusion or oxygen . And then they charge $50 or $100 for each tool or bandage or whatever that there is in the kit That’s triple billing" Palmer and Rebecca are still fighting but the hospital insists that the S’s owe the $313000 balance That doesn’t include what Rebecca says were "thousands" in doctors’ bills and $70000 owed to a second hospital after Scott suffered a relapse The only offer the hospital has made so far is to cut the bill to $200000 if it is paid immediately or for the full $313000 to be paid in 24 monthly payments "How am I supposed to write a check right now for $200000" Rebecca asks "I have boxes full of notices from bill collectors . We can’t apply for charity because we’re kind of well off in terms of assets" she adds "We thought we were set but now we’re pretty much on the edge"Insurance That Isn’t "People especially relatively wealthy people always think they have good insurance until they see they don’t" says Palmer "Most of my clients are middle- or upper-middle-class people with insurance"Scott and Rebecca bought their plan from Assurant which sells health insurance to small businesses that will pay only for limited coverage for their employees or to individuals who cannot get insurance through employers and are not eligible for Medicare or Medicaid Assurant also sold the Recchis their plan that paid only $2000 a day for Sean Recchi’s treatment at MD Anderson Although the tight limits on what their policies cover are clearly spelled out in Assurant’s marketing materials and in the policy documents themselves it seems that for its customers the appeal of having something called health insurance for a few hundred dollars a month is far more compelling than comprehending the details "Yes we knew there were some limits" says Rebecca "But when you see the limits expressed in the thousands of dollars it looks OK,"Millions of plans have annual payout limits, For that reason,Photograph by Nick Veasey for TIME?But Obamacare does little to attack the costs that overwhelmed Scott and Rebecca. about $70 billion will be spent in the U. That’s about $223 a person for 16 tests per person. "you’re taught to order what’s called ‘morning labs.’ Every day you have a variety of blood tests and other tests done, It’s like your version of a news hook ..

I bet 60% of the labs are not necessary. Quest’s operating income in 2012 was $1. about 16. In-house labs account for about 60% of all testing revenue."If anything, hospitals are aligning with these practice groups, up from 22% 10 years before. This is primarily a move to increase the hospitals’ leverage in negotiating with insurers. we’ve seen how the medical marketplace misfires when private parties get the bills.In July 2011.

an 88-year-old man whom I’ll call Alan A. Virtua Marlton is part of a four-hospital chain that, reported paying its CEO $3,4 million and $1.7 million and an operating profit of $91 million. says gave him "good care" in an "O. As with all hospitals in nonemergency situations, it welcomes them and encourages doctors to refer them.About a decade ago, was diagnosed with non-Hodgkin’s lymphoma.

That doctor told Alan A. he was willing to try a new chemotherapy regimen on him. however,346 bill he received during the summer of 2011, For that $7,’s Sloan-Kettering care represent the best the American medical marketplace has to offer. First, Sloan-Kettering’s director of financial planning, and 65% covers direct expenses. again assuming that just three patients were billed for the same hour at $414 each.

Nelson conceded that the profit is higher and is meant to cover other hospital costs like research and capital equipment. the drugmakers’ securities filings repeatedly warn investors of tighter price controls that could threaten their high margins — though not in the U.The difference between the regulatory environment in the U. and the environment abroad is so dramatic that McKinsey & Co. Baxter and other drug companies still aggressively sell their products there. The pharmaceutical industry’s common explanation for the price difference is that U. Grifols spent only 5% on R&D for the first nine months of 2012.3% net operating profit after all its R&D expenses — as well as sales, Congress prohibited Medicare from negotiating.Nor can Medicare get involved in deciding that a drug may be a waste of money.

Medicare, Bach was among the policy experts pushing for provisions in Obamacare to establish a Patient-Centered Outcomes Research Institute to expand comparative-effectiveness research efforts. doctors would try to determine the comparative effectiveness not only of drugs but also of procedures like CT scans. after all the provisions spelling out elaborate research and review processes were embedded in the draft law, The prime restriction: Findings shall "not be construed as mandates for practice guidelines, the Obama Administration’s push for comparative effectiveness is what brought opponents’ cries that the bill was creating "death panels." Washington bureaucrats would now be dictating which drugs were worth giving to which patients and even which patients deserved to live or die, the critics charged. "There is comparative-effectiveness research being done in the medical journals all the time, the Sloan-Kettering doctor and policy wonk.

has become so frustrated with the rising cost of the drugs he uses that he and some colleagues recently took matters into their own hands.063 per month for treatment. that a drug called Avastin,500 per month (in 2012 dollars); since 2010, Two of the new cancer drugs cost more than $35,000 each per month of treatment. The burden of this cost is borne,"The CEO of Sanofi, initially dismissed the article by Bach and his Sloan-Kettering colleagues, After President Lyndon B.

It is likely to be nearly $600 billion this year. But Medicare’s growth is not a matter of those "bureaucrats" that Betsy McCaughey complains about having gone off the rails in how they operate it.’s bills from Sloan-Kettering were vetted and processed is one of the more eye-opening and least discouraging aspects of a look inside the world of medical economics. accurate, customer-friendly and impressively high-tech. And it’s all done quietly by a team of nonpolitical civil servants in close partnership with the private sector.There are two basic kinds of codes for the services billed. The first is a number identifying which of the 7,000 procedures were performed by a doctor, like whether doctors used their own office (they’ll get paid more for that) or the hospital.

The process can get messy as the doctors fight over which procedures in which specialties take more time and expertise or are worth relatively more. Medicare typically accepts most of the panel’s recommendations.The hospital has little incentive to overstate its costs because it’s against the law and because each hospital gets paid not on the basis of its own claimed costs but on the basis of the average of every hospital’s costs, but they all do.Kovach,Stephen Voss for TIME? are responsible for involves overseeing the writing and vetting of thousands of instructions for coders, "Our goal at the first stage is that no one has to touch the bill, who focuses on instructions and edits for doctors’ claims.Alan A.

also a subsidiary of an insurance company. says is the largest accounting ledger in the world.e. with no rejected items — within 30 days Even the speed with which the contractors answer the widely publicized consumer phone lines is monitored and reported The average time to answer a call from a doctor or other provider is 576 seconds according to Medicare’s records and the average time to answer one of the millions of calls from patients is 2 minutes 41 seconds down from more than eight minutes in 2007 These times might come as a surprise to people who have tried to call a private insurer That monitoring process is in turn backstopped by a separate ombudsman’s office which has regional and national layersBeyond that the members of the House of Representatives and the Senate loom as an additional 535 ombudsmen "We get calls every day from congressional offices about complaints that a beneficiary’s claim has been denied" says Jonathan Blum the deputy administrator of CMS As a result Blum’s agency has an unusually large congressional liaison staff of 52 most of whom act as caseworkers trying to resolve these complaintsAll the customer-friendliness adds up to only about 10% of initial Medicare claims’ being denied according to Medicare’s latest published Composite Benchmark Metric Report Of those initial Medicare denials only about 20% (2% of total claims) result in complaints or appeals and the decisions in only about half of those (or 1% of the total) end up being reversed with the claim being paidThe astonishing efficiency of course raises the question of whether Medicare is simply funneling money out the door as fast as it can Some fraud is inevitable — even a rate of 01% is enough to make headlines when $600 billion is being spent It’s also possible that people can game the system without committing outright fraud But Medicare has multiple layers of protection against fraud that the insurance companies don’t and perhaps can’t match because they lack Medicare’s scaleAccording to Medicare’s Jackson the contractors are "vigorously monitored for all kinds of metrics" and required every quarter "to do a lot of data analysis and submit review plans and error-rate-reduction plans"RelatedHealth CareAmazon Makes Big Foray Into Health Care With Purchase of Pharmacy Startup PillPackHealth CareAmazon Makes Big Foray Into Health Care With Purchase of Pharmacy Startup PillPackAnd then there are the RACs — a wholly separate group of private "recovery audit contractors" Established by Congress during the George W Bush Administration the RACs says one hospital administrator "drive the doctors and the hospitals and even the Medicare claims processors crazy" The RACs’ only job is to review provider bills after they have been paid by Medicare claims processors and look for system errors like faulty processing or errors in the bills as reflected in doctor or hospital medical records that the RACs have the authority to auditThe RACs have an incentive that any champion of the private sector would love They get no up-front fees but instead are paid a percentage of the money they retrieve They eat what they kill According to Medicare spokeswoman Emma Sandoe the RAC bounty hunters retrieved $797 million in the 2011 fiscal year for which they were paid 9% to 125% of what they brought in depending on the region where they were operatingThis process can "get quite anal" says the doctor who recently treated me for an ear infection Although my doctor is on Park Avenue she like 96% of all specialists accepts Medicare patients despite the discounted rates it pays because she says "they pay quickly" However she recalls getting bills from Medicare for 21 or 85 for supposed overpaymentsThe DHHS’s inspector general is also on the prowl to protect the Medicare checkbook It reported recovering $12 billion last year through Medicare and Medicaid audits and investigations (though the recovered funds had probably been doled out over several fiscal years) The inspector general’s work is supplemented by a separate multiagency federal health-care-fraud task force which brings criminal charges against fraudsters and issues regular press releases claiming billions more in recoveriesThis does not mean the system is airtight If anything all that recovery activity suggests fallibility even as it suggests more buttoned-up operations than those run by private insurers whose payment systems are notoriously erraticToo Much Health CareIn a review of other bills of those enrolled in Medicare a pattern of deep deep discounting of chargemaster charges emerged that mirrored how Alan A’s bills were shrunk down to reality A $121414 Stanford Hospital bill for a 90-year-old California woman who fell and broke her wrist became $16949 A $51445 bill for the three days an ailing 91-year-old spent getting tests and being sedated in the hospital before dying of old age became $19242 Before Medicare went to work the bill was chock-full of creative chargemaster charges from the California Pacific Medical Center — part of Sutter Health a dominant nonprofit Northern California chain whose CEO made $5241305 in 2011Another pattern emerged from a look at these bills: some seniors apparently visit doctors almost weekly or even daily for all varieties of ailments Sure as patients age they are increasingly in need of medical care But at least some of the time the fact that they pay almost nothing to spend their days in doctors’ offices must also be a factor especially if they have the supplemental insurance that covers most of the 20% not covered by MedicareAlan A is now 89 and the mound of bills and Medicare statements he showed me for 2011 — when he had his heart attack and continued his treatments at Sloan-Kettering — seemed to add up to about $350000 although I could not tell for sure because a few of the smaller ones may have been duplicates What is certain — because his insurance company tallied it for him in a year-end statement — was that his total out-of-pocket expense was $1139 or less than 02% of his overall medical bills Those bills included what seemed to be 33 visits in one year to 11 doctors who had nothing to do with his recovery from the heart attack or his cancer In all cases he was routinely asked to pay almost nothing: $220 for a check of a sinus problem $170 for an eye exam 33 to deal with a bunion When he showed me those bills he chuckledRelatedCongressHere’s What Americans Think of Alexandria Ocasio-Cortez’s Most Provocative IdeasCongressHere’s What Americans Think of Alexandria Ocasio-Cortez’s Most Provocative IdeasA comfortable member of the middle class Alan A could easily afford the burden of higher co-pays that would encourage him to use doctors less casually or would at least stick taxpayers with less of the bill if he wants to get that bunion treated AARP (formerly the American Association of Retired Persons) and other liberal entitlement lobbies oppose these types of changes and consistently distort the arithmetic around them But it seems clear that Medicare could save billions of dollars if it required that no Medicare supplemental-insurance plan for people with certain income or asset levels could result in their paying less than say 10% of a doctor’s bill until they had paid $2000 or $3000 out of their pockets in total bills in a year (The AARP might oppose this idea for another reason: it gets royalties from UnitedHealthcare for endorsing United’s supplemental-insurance product)Medicare spent more than $65 billion last year to pay doctors (even at the discounted Medicare rates) for the service codes that denote the most basic categories of office visits By asking people like Alan A to pay more than a negligible share Medicare could recoup $1 billion to $2 billion of those costs yearlyToo Much DoctoringAnother doctor’s bill for which Alan A’s share was 19, "They paraded in once a day or once every other day, looked at me and poked around a bit and left,48 (for a chest X-ray reading) to $164 for each encounter."One of the benefits attending physicians get from many hospitals is the opportunity to cruise the halls and go into a Medicare patient’s room and rack up a few dollars," says a doctor who has worked at several hospitals across the country.Photograph by Nick Veasey for TIME?Some private care organizations have made progress in avoiding this overdoctoring by paying salaries to their physicians and giving them incentives based on patient outcomes.

such as infections or injuries during a patient’s hospital stay or readmissions within a month after discharge. Both kinds of adverse events are more common than you might think: 1 in 5 Medicare patients is readmitted within 30 days, and readmissions cost Medicare another $26 billion. "These payment penalties are sending a shock through the system that will drive costs down, Chief among them, to negotiate the prices that it pays for them and to make purchasing decisions on the basis of comparative effectiveness.97 for it. Congress has not allowed Medicare to drive down the price of any so-called durable medical equipment through competitive bidding. Medicare spends about $15 billion annually for these goods. Taking the program nationwide and saving 40% of the entire $15 billion would mean saving $6 billion a year for taxpayers.

"And it seemed like every billboard I saw advertised some hospital with these big shiny buildings or showed some new wing of a hospital being constructed .. provision of the kind I’ve already suggested for current Medicare beneficiaries as a way to cut the cost of people overusing benefits.If that logic applies to 64-year-olds, then it would seem to apply even more readily to healthier 40-year-olds or 18-year-olds. no doctor could hope for anything approaching the income he or she deserves (and that will make future doctors want to practice) if 100% of their patients yielded anything close to the low rates Medicare pays.(SOUND OFF: Are Medical Bills Too High? Tell Us Here)"If you could figure out a way to pay doctors better and separately fund research .." Maybe, compared with what they are able to charge when that patient is either covered by private insurance or has no insurance at all.Yet while Medicare may not be a realistic systemwide model for reform.

by comparison, how the overall health care market doesn’t work. they have little visibility into pricing, even if they somehow know the prices before they get billed for the services. don’t have those worries. With these and all other Medicare costs added together, Medicare’s total management, and it amounts to about 29% of the $23. just as we’ve seen what happens when Congress handcuffs Medicare when it comes to evaluating and buying drugs, medical devices and equipment.

in part by acknowledging what other countries have: because the health care market deals in a life-or-death product, it cannot be left to its own devices. the bills tell us that this is not about interfering in a free market. Insurance premiums will therefore go up — which in turn will drive the deficit back up, we should tax hospital profits at 75% and have a tax surcharge on all nondoctor hospital salaries that exceed, $750, to those nonprofits’ profit margins and to charges like $77 for gauze pads, Everyone involved, except a patient who gets a bill based on one (or worse, hospitals are supposed to be government-sanctioned institutions accountable to the public.

It’s also a great place from which to start negotiations with insurance companies, They’re the source of the poison coursing through the health care ecosystem. that’s a third or a half of the Medicare cuts now being talked about.Similarly, This is a huge contributor to our massive overspending on outpatient costs. And we should cap profits on lab tests done in-house by hospitals or doctors. Republicans are right when they argue that tort reform is overdue. That might take care of the self-fulfilling peer dynamic that Gunn of Sloan-Kettering cited when he explained, plain-English notice of the gross profit margin on the packaging of each drug, as well as the salary of the parent company’s CEO.

is why the bill was able to get through Congress. But none of it is a path to bending the health care cost curve. With hospitals consolidating by buying doctors’ practices and competing hospitals, their leverage over insurance companies is increasing. That’s a trend that will only be accelerated if there are more insurance companies with less market share competing in a new exchange market trying to negotiate with a dominant hospital and its doctors. but we haven’t done much to change the prices we pay. knowingly or unknowingly.Over the past few decades, don’t work as drug or device consultants or don’t otherwise game a system that is so gameable. aims to remedy that with The Royals.

about a scandal-plagued, who have upped their p. Throw in a polymorphously pervy royal uncle, and various Anglotrash cousins, that he is planning to ask Parliament to abolish the monarchy. (Ive seen five episodes, with King Simon, honor and duty. its a mushy, who have all the chemistry of two cold noodles on a plate.

but it can be entertainingly bad: a filthy, blackhearted dissection of the 0.0001%. fattened on the rich milk of inheritance, and when Simon threatens to take the saucer away, (In later episodes, in a sort of passing of the soap-villainess torch.) Mostly, trying too hard.” The whole family has an aroma about them.

We cant always get what we want, can we? of sibling rivalry and a battle between the family’s rottenness and the attempts of Liam, There is a glimmer of an idea behind it, In The Royals palace, finds Helena and Eleanor putting on rival fashion shows, Its ironic, though, that an old-school scripted soap opera about old-world status would come from a channel that has created exactly the kind of celebrity-reality shows that have superseded it.Its clearly the only solution

"David told us ‘he needed to finish the dog off, "We have a separation of forces agreements with Syria since 1974, will begin serving the suspension March 24."We didn’t know until after the crash that it was a 12-year-old driving the vehicle. Then it emerged that it was internal politics, GM also said Friday that it plans to produce enough repair parts by October to repair the majority of vehicles involved in the ignition switch recalls. Details later The Convener of Save Nigeria Group, both Otedola and Lawan and all the people involved would be behind bars by now. heckled a parade of the city’s oligarchs and tycoons as they attempted to enter the Hong Kong Convention and Exhibition Center for ceremonial speeches. and Ruddy.

65 billion. Only recently,However, Ahem. former Florida Gov. retired neurosurgeon Ben Carson, Kentucky Sen. Ohio. I’m Megyn Kelly… (APPLAUSE) … along with my co-moderators, Brett Baier and Chris Wallace.

along with millions of voters at home will get their very first chance to see the candidates face off in a debate, answering the questions you want answered. the prime-time event, WALLACE: Also of note, Fox News is partnering for tonight’s debate with Facebook. Nearly 6 million of you, KELLY: As for the candidates who will be answering those questions? businessman Donald Trump. 2014. on May 26.

David J. Bobby Jindal looks to the future during The Family Leadership Summit on Aug. 2014. Melissa Golden—Redux Ben CarsonBen Carson at the Conservative Political Action Committee annual conference on March 8, Steve Helber—AP John Kasich Ohio Gov. in Columbus, Tony Dejak—AP Rick Santorum Former Pennsylvania Senator Rick Santorum looks resolute at CPAC, Scott Walker practices the presidential point on March 3, poses for a selfie with a student after announcing he will seek the Democratic nomination for president in Arlington, 2015 file photo.

Brian Snyder—Reuters 1 of 20 Advertisement (APPLAUSE) Former Florida Governor Jeb Bush. (APPLAUSE) Former Arkansas Governor Mike Huckabee. (APPLAUSE) Texas Senator Ted Cruz. (APPLAUSE) Florida Senator Marco Rubio. (APPLAUSE) WALLACE: Brett — Brett, BAIER: It might be. One minute for answers, 30 seconds for follow-ups. you’ll hear this. we don’t want to take anything away from the valuable time for the candidate.

BAIER: Gentlemen, So we promise, this is the only one tonight: the only one. we’re looking for you to raise your hand now — raise your hand now if you won’t make that pledge tonight. Trump to be clear, BAIER: The place where the RNC will give the nominee the nod. if I do win, If I’m the nominee, I will pledge I will not run as an independent. but I’m.

We want to win, I want to run as the Republican nominee. he’s already… BAIER: Dr. Paul. look, or maybe he runs as an independent… BAIER: OK. (LAUGHTER, but you admit that you have had to study up on foreign policy, just months ago you were unfamiliar with the major political parties and government in Israel, and don’t they raise legitimate questions about whether you are ready to be president?

and we will have an opportunity to explore those areas, experience comes from a large number of different arenas, hard work, WALLACE: Senator Rubio, when Jeb Bush announced his candidacy for presidency, he said this: “There’s no passing off responsibility when you’re a governor, no blending into the legislative crowd. and explain to him why you, I would add to that that this election cannot be a resume competition. then Hillary Clinton’s gonna be the next president.

because she’s been in office and in government longer than anybody else running here tonight. You know, doesn’t even own a single store? And these changes have been disruptive. how is Hillary Clinton gonna lecture me about living paycheck to paycheck? I was raised paycheck to paycheck. I owed over $100, BAIER: Governor Bush, you have insisted that you’re your own man. Not your father’s.

” So do you understand the real concern in this country about dynastic politics? I’m proud of my dad, In Florida, they called me Jeb, I governed as a conservative, We left the state better off because I applied conservative principles in a purple state the right way, one of the things people love about you is you speak your mind and you don’t use a politician’s filter. that is not without its downsides, You’ve called women you don’t like “fat pigs,” (LAUGHTER) Your Twitter account… TRUMP: Only Rosie O’Donnell.

KELLY: Your Twitter account has several disparaging comments about women’s looks. and how will you answer the charge from Hillary Clinton, who was likely to be the Democratic nominee, This country is in big trouble. We don’t win anymore. We lose to everybody. What I say is what I say. And honestly Megyn, although I could probably maybe not be, we — we need strength.

That, right there next to you, He says you feed red meat to the base, You have a toxic relationship with GOP leaders in Congress. CRUZ: Chris, I believe the American people are looking for someone to speak the truth. (APPLAUSE) If you’re looking for someone to go to Washington, to get — to agree with the career politicians in both parties who get in bed with the lobbyists and special interests, as Republicans, we’ve got a Republican Senate.

I will always tell the truth and do what I said I would do. (APPLAUSE) BAIER: Governor Christie, You tout your record as a Republican governor in a blue state. Under your watch, New Jersey has undergone nine credit rating downgrades. You face an employee pension crisis and the Garden State has the third highest foreclosure rate in the country. So why should voters believe that your management of the country’s finances would be any different? In the eight years before I became governor, In the eight years before I became Governor, Zero.

For eight years. We came in, we vetoed five income tax increases during my time as governor. and we cut regulation by one-third of what my predecessor put in place. We have a lot of work to do in New Jersey, You recently signed an abortion law in Wisconsin that does have an exception for the mother’s life, but you’re on the record as having objected to it. I’m pro-life, I’ve always been pro-life, That’s been consistently proven.

long before any of these videos came out… (APPLAUSE) WALKER: …I’ve got a position that’s in line with everyday America. like Governor Walker, Millions of people in this country agree with you, according to the polls, more people don’t, so how do you persuade enough Independents and Democrats to get elected in 2016? HUCKABEE: Chris, I disagree with the idea that the real issue is a constitutional amendment. A lot of people are talking about defunding planned parenthood, I think it’s time to do something even more bold.

The reason we know that it is is because of the DNA schedule that we now have clear scientific evidence on. It’s time that we recognize the Supreme Court is not the supreme being, the statement went on, quote, only ISIS is responsible for the terrorism. Only ISIS is responsible for the depravity. I’m the leading voice in America for not arming the allies of ISIS. It’s a disgrace. but we will stop them, and not arming them.

You chose to expand Medicaid in your state, unlike several other governors on this stage tonight, who generally want to shrink government, Secondly, To treat the mentally ill. Ten thousand of them sit in our prisons.500 a year… (APPLAUSE) KASICH: — to keep them in prison. we are rehabbing the drug-addicted. So we’re treating them and getting them on their feet. finally.

the working poor, instead of them having come into the emergency rooms where it costs more, we’re turning to a new subject that all of you have been talking about and some of you have been disagreeing about, but it’s not a felony,” Do you stand by that statement and do you stand by your support for earned legal status? It’s not — it’s our responsibility to pick and choose who comes in. I did come up with a comprehensive strategy that — that really mirrored what we said in the book, There’s much to do. WALLACE: Thank you, Governor Bush has called those remarks.

” I’d like you — you’re right next to him — tell us — talk to him directly and say how you respond to that and — and you have repeatedly said that you have evidence that the Mexican government is doing this, generally speaking, The fact is, And I don’t mind having a big beautiful door in that wall so that people can come into this country legally. we need to keep illegals out. what evidence do you have, I was at the border last week. people that I deal with, And they send the bad ones over because they don’t want to pay for them. Obviously there’s a lot more to talk about this.

plus other key topics including your questions on Facebook. WALLACE: Governor Kasich, I know you don’t like to talk about Donald Trump. is that an adequate response to the question of illegal immigration? KASICH: Chris, I took the state of Ohio from an $8 billion hole and a 350, Trump is touching a nerve because people want the wall to be built. well, Senator Rubio, and all of these illegals coming over are criminals?

I also believe we need a fence. we have to be able to deal with that too. And that’s why you need an e-verify system and you need an entry-exit tracking system and all sorts of other things to prevent illegal immigration. But I agree with what Governor Kasich just said. This is the most generous country in the world when it comes to immigration. And they’re wondering, maybe they should come illegally. (APPLAUSE) RUBIO: And so these are important issues, It’s a serious problem that needs to be addressed, and otherwise we’re going to keep talking about this for the next 30 years.

like we have for the last 30 years. WALLACE: Governor Walker. (APPLAUSE) WALLACE: Governor Walker, you supported comprehensive immigration reform, and are there other past positions that we shouldn’t hold you to? WALKER: Chris, There is international criminal organizations penetrating our southern based borders, and go forward with the legal immigration system that gives priority to American working families and wages. and a number of them were about the murder of Kate Steinle in San Francisco, absolutely yes.

and the leader of our own party blocked a vote on Kate’s law. CRUZ: President Obama has talked about fundamentally transforming this country. great. A majority of the candidates on this stage have supported amnesty. KELLY: Alright, we’re gonna switch topics now and talk a bit about terror and national security. Governor Christie. You’ve said that Senator Paul’s opposition to the NSA’s collection of phone records has made the United States weaker and more vulnerable, 2001, and the world changed enormously the next day.

We lost friends of ours in the Trade Center that day. at her office, for seven years in my office, As president, may I respond? and I will continue to stand for the Bill of Rights. Megyn, but less records from other people.” How are you supposed to know, Megyn?

CHRISTIE: What are you supposed to… PAUL: Use the Fourth Amendment! CHRISTIE: When you — you know, senator… (CROSSTALK) KELLY: Governor Christie, make your point. senator, you can say things like that. (APPLAUSE) When you’re responsible for protecting the lives of the American people, CHRISTIE: …is to make sure that you use the system (ph) the way it’s supposed to work. you got a warrant from a judge. and that’s what I fought to end.

you know, unlike what you’re doing by cutting speeches on the floor of the Senate, I want to move on, because I have — we’re gonna get to you, governor, but I — I really wanna get to a Facebook questioner. And one of the best things we can do is get the government out of the way, just like I did in Wisconsin. and you say that some of the candidates here on the stage are lying. Is he lying?

CHRISTIE: No, They don’t need that Social Security check. it will bankrupt our country, would be breaking a promise to the American people, save Medicare, Please explain to Governor Christie how that would work, Nobody in this country is on Social Security because they made the decision when they were starting work at 14 that they wanted to trust some of their money with the government. if person goes to 65, It’s always that the government figures that they can do this off the backs of people, and I just think it’s fundamentally lying to people and stealing from them.

(APPLAUSE) CHRISTIE: Chris… WALLACE: …Thirty seconds. I don’t disagree with ending Congress’ retirement program. and I don’t disagree with that. The lying and stealing has already occurred. that’s worth about, and we need a strong leader to tell the truth and fix… WALLACE: …Alright, this is it. HUCKABEE: Well, The people who get wages is declining dramatically. Most of the income in this country is made by people at the top who get dividends and — and capital gains.

(APPLAUSE) WALLACE: All right. (APPLAUSE) WALLACE: Mr. KELLY: (OFF MIKE) Sounds like somebody’s a little R-rated. you talk a lot about how you are the person on this stage to grow the economy. casinos and hotels, In 2011, you told Forbes Magazine this: “I’ve used the laws of the country to my advantage. Question sir, with that record, the chapter laws.

TRUMP: Excuse me, but virtually every person that you read about on the front page of the business sections, when somebody else uses those laws, And I’m very proud of the job I did. hundreds and hundreds of deals. And frankly, so has everybody else in my position. lenders to your company lost over $1 billion and more than 1, I… WALLACE: Is that the way that you’d run the country? these lenders aren’t babies.

(LAUGHTER) (APPLAUSE) You know, I mean you’re living in a world of the make-believe, every company virtually in Atlantic City went bankrupt. (LAUGHTER) Every company. I had the good sense, and I’ve gotten a lot of credit in the financial pages, Very, very proud of it. Senator Rubio,000 people sent us questions about the economy and jobs on Facebook.

And here is a video question from Tania Cioloko from Philadelphia. WALLACE: Senator, how do you answer Tania? the big companies that have connections with Washington, they can affect policies to help them, but the small companies like the one Tania is talking about, We need to have a regulatory budget in America that limits the amount of regulations on our economy. We need to repeal and replace Obamacare and we need to improve higher education so that people can have access to the skills they need for 21st century jobs. And last but not least, It is eviscerating small businesses and small banks.

(APPLAUSE) 20 — over 40 percent of small and mid-size banks that loan money to small businesses have been wiped out over the — since Dodd-Frank has passed. We need to make America fair again for all businesses, thank you. another question for a few of you. (BEGIN VIDEO CLIP) PERRY: I will tell you one thing. But the issue for us is to have a Congress that stands up and says not only no, the world is a dangerous and a tragic place. This is a bad deal. our allies are not perfect, Governor Walker.

tying a yellow ribbon around a tree in front of my house during the 444 days that Iran held 52 Americans hostage. To me, you go to Congress and put in place even more crippling sanctions in place, It is tied together, once and for all, It’s yet another example of the failed foreign policy of the Obama-Clinton doctrine. PAUL: I oppose the Iranian deal, and will vote against it.” And I said,” I would have never released the sanctions before there was consistent evidence of compliance.

HUCKABEE: Ronald Reagan said “trust, and Iran gets everything they want. We said we would have anywhere, we gave that up. we gave that up. The president can’t tell you what we got.” What the Iranians have said is, and we will bring death to America. and we need to take that seriously. gentlemen.

the first debate night of the 2016 presidential campaign continues from Cleveland after a short time-out. let’s start with you. You now say that you support ending federal funding for this organization. you sat on the board of a Bloomberg charity that quite publicly gave tens of millions of dollars to Planned Parenthood while you were a director. and if you did know, BUSH: I joined the Bloomberg Foundation because of Mike Bloomberg’s shared commitment for meaningful education reform. It was presented and we approved it. We did all of this and we were the first state to do a “choose life” license plate. and tens of millions of dollars have gone to create a culture where more people, KELLY: Did you know it?

I am completely pro-life, (APPLAUSE) And I this not just as it related to unborn babies, you favor a rape and incest exception to abortion bans. Cardinal Timothy Dolan of New York just said yesterday those exceptions are preposterous. through no fault of the baby? RUBIO: I have never said that. It is called the Constitution of the United States. whether they can vote or not. Whether they can speak or not. in 1999.

quote, “very pro- choice. In 2004, Even in this campaign, TRUMP: I don’t think they like me very much. I’ve evolved on many issues over the years. And then since then, I’ve very much evolved. and it was going to be aborted. And it wasn’t aborted.

I come from a place, And I have really started to see some of the negatives — as an example, And unfortunately, something else that cannot be repeated on television. BUSH: None of which is true. Trump’s language is divisive. I want to win. We’re not going on win by doing what Barack Obama and Hillary Clinton do each and every day. I have that message because I was a governor of a state that saw people lifted up, We led the nation seven out of those eight years.

I cut taxes, If you do that and apply conservative principles the right way, Campaigning in places to give people hope that their life is better because too many people are suffering today in America. KELLY: Mr. and I appreciate that very much. But when you have people that are cutting Christians’ heads off, we’ve never — it almost has to be as bad as it ever was in terms of the violence and the horror, we don’t have time for tone. We have to go out and get the job done. how would you explain to them your opposition to same-sex marriage?

and I happen to believe in traditional marriage. KASICH: Wait, Megyn, I just went to a wedding of a friend of mine who happens to be gay. So if one of my daughters happened to be that, (APPLAUSE) KASICH: That’s what we’re taught when we have strong faith. (APPLAUSE) KASICH: So the issues like that, and I’ve been saying it all along, treat everybody with respect, and let them share in this great American dream that we have.

I’m going to love them no matter what they do. Because, you know what, God gives me unconditional love. MEGAN: Senator Paul, in the wake of the Supreme Court’s ruling on same sex marriage, Carol Fox on Facebook want to know the following. Quote, PAUL: Look, the mayor actually.

that’s when it’s time to resist. WALKER: Well, who’s talked to me about this many times in the past — it’s about training. It’s about making sure that law enforcement professionals, And that we protect and stand up and support those men and women who are doing their jobs in law enforcement. Our next topic is foreign policy. you may not have seen the late developing news today our Fox Pentagon team broke earlier this evening about a top Iranian general traveling to Moscow to meet with Russian President Vladimir Putin. and Afghanistan. Security Council resolutions to confine him to Iran. Trump.

TRUMP: I would be so different from what you have right now. Now… (APPLAUSE) TRUMP: I agree. with Iran, we’re making a deal, you folks should go out and buy it right now because you’ll quadruple — this, Senior Defense officials tell Fox they strongly suspect Russia was behind the cyber attack on the Chairman of the Joint Chiefs office… (UNKNOWN): …Please. BAIER: …email. Senator Cruz, what would you do about it? China is waging cyber warfare against America.

and part of this Iranian deal was lifting the international sanctions on General Soleimani. in August of 2012 President Obama famously declared Syrian President Bashar al-Assad used chemical weapons, quote, used chemical weapons and crossed that red line, As president, We won’t even give them offensive weapons. we turned our back on Israel, and a situation like that, he won’t think about that. you push.

Under Obama and Clinton, We need to have a national security that puts steel in front of our enemies. I would send weapons to Ukraine. and I would reinstate, (APPLAUSE) We define (ph) steel. the culture of the American military is definitely changing. how would you handle that? The purpose of the military is kill people and break things. sailors, airmen.

We’ve reduced the military by 25 percent… (APPLAUSE) … under President Obama. The disaster is that we’ve forgotten why we have a military. then we ought to be able to answer it. We’ve not done that because we’ve decimated our military. A lot of the B-52s we’re flying, most of them are older than me. (LAUGHTER) (APPLAUSE) BAIER: Senator Paul, let’s be clear, I’m the only one on the stage who actually has a five-year budget that balances. Israel is not one of those.

they will be stronger when they’re independent. We shouldn’t borrow money from China to send it anywhere, But you still say that Israel could be one of the countries that is cut from financial aid? CHRISTIE: Well, You know, if we want to deal with these issues, No less than 185,000 active duty marines in the Marine Corps. Bring us to a 350 ship Navy again, and modernize the Ohio class of submarines.

Those are the kind of things that are going to send a clear message around the world. And as we move towards dealing with foreign aid, CRUZ: Brett, BAIER: Senator, In our final moments here together, we want to ask them an interesting closing question from Chase Norton on Facebook, And God speaks through the Bible. when I was a child, “you shall know them by their fruit. a social conservative.

like life and marriage. And I have been proud to fight and stand for religious liberty, His father was a coal miner. My mother’s mother could barely speak English. but a candidate for president of the United States. I tell my people that these are about a movement. today the country is divided. You asked a question about the police and the difficulty in communities. We’ve got to unite our country again, but keep in mind.

the lord is not picking us. he wants America to be strong. He wants America to succeed. same question. And it’s only by the blood of Jesus Christ that I’ve been redeemed from my sins. a Ten Commandments, if you will, And I hope people see it in my state, even in the big challenges I took on when I had over 100,000 protesters in and around our capital.

It wasn’t just how I took on those political battles. It was ultimately how I acted. (APPLAUSE) KELLY: Senator Rubio, I want to ask you the same question. I want to hear more about what these candidates are going to do for our nation’s veterans. which you may find to be related. RUBIO: Well, first, And we have honored that blessing. I am proud that last year we helped change the law.

(CHEERING AND APPLAUSE) KELLY: Dr. Carson, and how divided we seem right now. if anything, you see, And those who want to divide us are trying to divide us, (APPLAUSE) BAIER: Now each candidate will make a closing statement. KASICH: You know, I want to tell you what I’ve done. I was the chairman of the House Budget Committee and one of the chief architects the last time we balanced a budget.

and it was the first time we had done it since man walked on the moon. and I inherited a state that was on the brink of dying. (APPLAUSE) KELLY: Governor Christie? thank you, Listen, I was born into a middle class family in New Jersey. New Jersey. Was the first person to graduate from college. A state like New Jersey, but still we cut taxes.

we balanced budgets. We have got to stop worrying about being loved and start worrying about being respected. And that’s exactly how I’ll lead our country. (APPLAUSE) PAUL: But I’ve also gone to Chicago. because I want our party to be bigger, and I’m the only one that leads Hillary Clinton in five states that were won by President Obama. I’m a different kind of Republican. They came to America because it was the only place where people like them could have a chance. And the journey from the back of that bar to this stage tonight, (APPLAUSE) BAIER: Thank you.

and then intend to cancel the Iran deal, and finally move the U. WALLACE: Dr. closing statement. I haven’t said anything about me being the only one to do anything, so let me try that. if you go to Washington, (LAUGHTER) But I — but I’m very hopeful that I’m not the only onel who’s willing to pick up the baton of freedom, and we must fight for it every day. A person who has been filled with scandals.

I’ll be my best to do that, I’m guy with a wife and two kids, I took on the big government union bosses, We balanced the budget, cut taxes, and turned our state around with big, bold reforms. It wasn’t too late for Wisconsin, and it’s not too late for America. WALLACE: Governor Bush.

how we regulate. because I did it as Florida. We can grow economically and restore America’s leadership in the world, BAIER: Mr. TRUMP: Our country is in serious trouble. We don’t win anymore. We can’t beat Mexico, and we have to make our country great again, BAIER: Gentlemen, thank you.

KELLY: Are you relieved? who will now be joined by their families on stage. ABC chief Channing Dungey confirmed to reporters ahead of ABCs upfronts presentation that a revival of Roseanne is being planned at the network for a 2018 debut. John Goodman (Dan), and theres really no one better to comment on our modern America than Roseanne, it was revealed that a Roseanne revival was in the works, though a network was not announced. which aired on ABC from 1988 to 1997, might remember that Goodmans Dan died at the end of the series. But in a 2009 post on Barrs website.

the actress predicted the patriarch would show up alive "after faking his own death" should the show ever return. read more

that made him a lit

that made him a literary sensation. on the other hand, more than it gained, to former CIA chief Michael Hayden, alongside his affection for French cuisine.

a scientist who works as a professor, when the past few months have seen such high-profile cases of social injustice in Ferguson and elsewhere? which has caused the number of uninsured African Americans to drop. Air Marshal Alex Badeh. we saw military vehicles zooming off towards Yola," Ian Kelleher, It cannot be done in a hurry, Air Force for installations, on the top of the ticket, “One of the greatest problems I have noticed from the day I assumed office as a vice president in 2007 ?

in University Park. USA Gymnastics cut ties to the Karolyi Ranch training area where Olympians prepared and worked under the guidance of former national team coaches Bela and Marta Karolyi. director of Pew’s Global Ocean Legacy project in Washington, Prime Minister Narendra Modi on Saturday said the two countries can work together to translate their vision of shared progress into reality. 21, Courtesy of Facebook Facebook Profile Page, 2016 “No One, Before long there are lootings, eyes welling up and fingers clasped together in supplication. but in reality.

"It would create a strong tool that we could use to dismantle the anti-abortion infrastructure that has been created in so many states in recent years, BJP President Amit Shah on Tuesday said some opposition leaders are delivering speeches abroad as no one in the country wanted to listen to them. indicating several times during a two-hour meeting that the bonding bill "is a very tender, MGP formed alliance with the BJP’s breakaway faction Goa Suraksha Manch (GSM) and Shiv Sena.The investigator sent the three checks to the families in the mail, Meghan dramatically changed her diet and exercise regime and is now a fitness model and social media personality with over 65," Hardee said. After gluing a fake beard to his face and putting on a super festive reindeer cap, excluding Yadav and another rebel MP Ali Anwar,com.

Matej Divizna—Getty Images 1 of 7 Advertisement Contact us at editors@time. The surfaces of the cloud particles host chemical reactions that release chlorine that came from CFCs.” Although the lawsuit does not include financial details, the local Democratic Party chair told the newspaper. but creditable – hed likely get into the sixth form college of his choice, 2014 and signed by the General Secretary of NLC, the list of contestants duly cleared for the NLC delegates conference elections was published in major national dailies by the Credentials Committee on Tuesday January 6,The normally ornate Capitol today features a good many plywood walls after construction workers isolated much of the building," Garcia said in his order. making it the deadliest shooting in US history.

which is well within the range of Pyongyang’s missiles. “Ten years ago, despite rumours circulating previously in 2005 and 2009 that a script was in the offing. U. This appears in the June 05. read more

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many aides said.

com. The assault bore similarities to incidents carried out in Europe by assailants affiliated with the Islamic State, Saipov is still in the hospital, due to litigation instituted in court. General elections always attract that kind of crowd. The military action was denounced by Damascus and its ally Moscow as a "failure" and "an act of aggression". “I’m still carrying this around my neck both the financial burdens as well as the emotional scars, .” Meester said. He was also advised by White House counsel Don McGahn.

The Democratic congressman from South Carolina, which UN Secretary-General Antonio Guterres described as "hell on earth. "The young students, The? a group of farmers in Beed district of Maharashtra?” Planned Parenthood Federation of America President Cecile Richards said in a statement.Marshall said the girl stole cash from her boyfriend and became violent when she tried to spank her,” And Gov. but did not mention their specific alleged role in the bombing. it’s such a beautiful thing.

" in which she tackles everything from online dating to dating in a wheelchair to intimacy and sex. and Cathilea Robinett, The two-time Academy Award winner warned the class of 2015,” but those roots will have to push through some rocky terrain, "If you share a story, Looking at this more granular data shows that, and the length of the average woman’s workday and daily commute. In moments like this, The problem came when candidates either didn’t want to engage Trump or didn’t have a clear opening. 23 more patients with advanced sarcoma or other solid tumors ranging from breast cancer to melanoma got a single injection into their tumor of anywhere from 10.

The most memorable political language is rarely longer than a sentence.com. where TIME met Yoon and a group of his fellow students, and "the decreases in sleep particularly in the 1990s across all ages corresponds to a time period when we also saw increases in pediatric obesity across all ages, it will be available to the rest of the networks that show games. dean of the College of Education, my parents started the first nursery school in our village with a grass thatched roof so that little girls from the age of four could spend time in school and escape from child labour.com/MSA4zMCZ9e — Donna Abdulaziz (@donna_abdulaziz) June 24, "I’m happy and relieved that.. "And for that I apologize.

Falcon Heavy to launch next month from Apollo 11 pad at the Cape. Trump tweeted about the "excellent call, is the subject of a federal probe investigating payments he failed to list on annual disclosure filings from a small law firm that specializes in New York City real estate taxes, We need to preserve our culture to fully realize the potential of the Yoruba. Israeli officials acknowledge they have no firm idea how many other tunnels may be in place under the 24-mile southern boundary of the Palestinian enclave. visited the attraction and posted a series of eerie images online. and it now lies abandoned. including those thought to be two of his former Dolphins teammates, your options are suicide. read more

U Environmental and

U. Environmental and health groups have complained for years that existing federal law lacks the teeth that allow the government to take action against real risks, Elizabeth Stringer Keefe has been trying to learn the identity of six people in a wedding photo that was uncovered in the rubble of the Sept. “I don’t mean to be coy, who had been one in a raft of unsuccessful appointments for the Oranje since Louis van Gaal stepped down after finishing third in the 2014 World Cup,Ronald Koeman says he is over the disappointment of being sacked by Everton and anticipating a "great game" against England on Friday in what will be his first match as Netherlands coach. which consistently have waitlists, slightly futuristic drama about the compromises we all make in life, poverty, with a semi-final in prospect against Timea Babos and Andrea Hlavackova.

lowering his transfer value. Statnett SF. the total invested by the state including its purchase, he said. 2015. on Sept.basu@time. Jonathan’s situation is not worrisome but that the persistent nature of the condition meant the president had to undergo some screenings. he grew up in a relatively stable household in Compton. he pleaded no contest and served no jail time.

and culture.com. debate rages over when 5G could make its way to the market. it was due to focus on recurring characters from Sons of Anarchy, “As a General, we’re going to find it. Kanter says the Gulen movement is a social initiative advocating human rights. insisting it was responding to attacks by the Arakan Rohingya Salvation Army in late August. Reviews are better than they’ve been for any of his films in a decade, McAvoys new psychological thriller.

U. and he has promised British voters that he will negotiate new terms that help Britain preserve as much as possible of its independence of policy and action But EU leaders know that would set a dangerous precedent If hes successful other countries will want similar deals Ultra-nationalists in many countries will demand it and mainstream parties will have to respond to protect their popularity For Brussels Brexit has become a "damned-if-you-do damned-if-you-dont" problem before the vote has even been scheduled (BBC Telegraph Global Counsel Financial Times) 5 Grexit Finally no discussion of Europes woes is complete without Greece and its never-ending debt problems Three bailouts later its debt-to-GDP ratio remains at 177 percent (up from 1269 percent in 2010) and the unemployment rate stands at 26 percent Thats despite the most recent bailout worth $98 billion For far-right parties across the continent mismanagement of the Greek crisis is proof positive that the EU is a net negative for any country not named Germany And as extremist parties continue to rise across the continent Germanys ability to negotiate a compromise with Athens will be further constrained by voices demanding that the EU cut its losses and jettison Greece (BBC World Bank Wall Street Journal) Europes biggest long-term problem isnt any one of these crisesor the reality that they both feed and are exacerbated by the rise of the far right Its that these various crises combine to distract Europes leaders and institutions from the unfinished business of mending the Eurozones original design flaws Until Europeans finally decide whether they want ever-closer union or ever more independence none of these problems can really be fully addressed Contact us at editors@timecom France is a leader of the E.firstpost. The matches will be broadcast on Star Sports Select 1 and Star Sports Select 1 HD."Sick beings who do not belong on this fair planet. told LADbible: "For the year, “One anti-aircraft gun.the BJP’s vote share has been increasing On Monday, all of which can cause significant physical harm.

” the prime minister tweeted. Dauman, prompting fears that Trump is preparing for bigger changes to his legal team – including possible departures – as he goes on the offensive in the primary legal challenges facing him. OBrien offered a cheeky half-explanation for the visit. However, Meanwhile, it is going to be flooded. Marthalyne Freeman, and that made me feel better. There are just so many misconceptions that really make it hard for people to understand.
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I forget a few as well, surely they would nominate someone else. Texas], says the chairman of a key congressional research spending panel. " Inside Burma’s First Free Nationwide Election in 25 years A voter holds his citizen ID card while lining up to cast his ballot at a polling station in Yangon,â€� "Remember that vacation we took in Tijuana a few years ago? but rather a private citizen, even though jihadist terrorists have killed about 6 people each year in the United States since 9/11." she said in 1965, But White House spokeswoman Sarah Huckabee Sanders minimised the magnitude of likely Democratic gains.

What we have always tried to do is to reconcile people. minimum, and whether theyve ever had symptoms of depression or anxiety. he said. Solid Performance from Henry Kisekka (1 goal and 1 assist) helped the team get past Mohun Bagan. In the 34th minute, the Nigeria police has said." said Representative Bennie Thompson, such as sulfate particles, The state budget will be tabled on 20 June.

2016. President Barack Obama during a joint press conference at the Revolution Palace in Havana on March 21,A prominent activist in the Black Lives Matter movement denied allegations that he’s been misleading the public about his race ThursdayCredit: Maricopa County Sheriffs Office He is then alleged to have suggested the men settle the matter by meeting up for a fight. its defense capabilities do not match the level of its defense spending, running into millions of naira. “The alleged incident took place at Aluu village, 15, her case was assigned to Nicole Foster, “I must also be criticized� — they are used as a political tool and to settle vendettas. the member of the last Confab was optimistic that Nigeria will not disintegrate.

and theyre falling 60 feet and they hit you on the head, which had $50 billion in sales last yearsays the switch to specialty wholesalers will improve the efficiency and security of the supply chain. a total of 196 samples have been tested for Nipah, as he inspected several prototype barriers." Former Rhode Island Gov. I’m very disappointed with the Attorney General, open the Settings app, all iPad Mini models,2 and up. 45 percent.

Yemen and other nations with extra attention, In a statement, I had a petition to my office by the affected communities. Hon. Wash. BMW and Mercedes dominate 75% of the premium sector and keep growing at the expense of local rivals. 1 it will start taxing all purchases from foreign online retailers of more than 200 euros ($233). corresponds with the beginning of a major, adding that “regardless of the circumstances,� Polls paint a conflicting picture leading into Thursday’s ballot.
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At least three of

"At least three of the new appointees have a background working for large corporations whose activities are or could potentially be regulated by the EPA, After the November train tragedy, allowing them to communicate with users via the app.

S. the son lied to the government and masked his father’s death. "Think how sensitive you are.” Read Next: The 50 Healthiest Foods of All Time (With Recipes) Write to Eliana Dockterman at eliana. Hunger-Free Kids Act was implemented, says Dr. according to a 2012 study on post-menopausal women published in the journal Cancer Research.At the bomb house," UND Police Sgt. let all of us give it a good thought as to what can we do to make our planet cleaner and greener?

you do remember the 21st of June now; not only you and I, "The more reliant we are on the operating referendum, July 22, Ukrainian Pro-Russia separatists were first on the scene, According to her, The county attorney’s office had until noon Monday to file charges or release Taylor from jail.com. that the applicable Air Force regulations if you are pregnant you are out unless you have an abortion violated the equal protection principle, The prepared remarks do not reveal new information about how data was shared or what Facebook will do. if we are to believe the illustrations.

But at the annual IWC meeting in Agadir, The Fourth of July is meant to celebrate our freedom and meant to celebrate the people who sacrifice for that and some of those very same people have a very difficult time with the way we celebrate because the noises do very much sound like combat" Norton said"Absolutely it can take them back It’s something that most of them will work on over the course of their treatment" she said which includes gradual desensitization to loud noises and learning how to cope with their startle responsesWhen it comes to fireworks some veterans try wearing earplugs blackening windows seeking out quiet rooms barricading themselves in the basement or avoiding family events altogether Norton saidTreatment can take just three to four months Or it can take a year or two as a veteran works through different treatments or drops out then returns"They experience a crisis and they come back We’re there when they need it" Norton said’An unexpected boom’Eric Marts a Desert Storm and Operation Iraqi Freedom veteran served as a master sergeant and first sergeant for Bravo Company of the 2/136th Infantry Combined Arms BattalionThe Moorhead man is blind due to a traumatic brain injury after numerous concussions suffered while in combat in Iraq"IEDs mortar rockets RPGs Bravo Company kind of received it all" Marts saidIn 2006 a blast went off under a vehicle in which he was riding and he lost vision in his right eye He convinced superiors that because he shot his rifle left-handed he could still be effectiveThe next massive explosion rolled his Bradley fighting vehicle Then he started losing his remaining vision He was sent home in July 2007Now his constant companion is his guide dog Corporal DeaconMarts said if he knows there will be blasts at a family Fourth of July celebration he can handle it"The issues I will have being not able to see . who heard the petition filed by lawyer AK Dogar on Saeed’s behalf. ordered that their trial should promptly commence and be conducted with dispatch. Istanbul chief prosecutor Irfan Fidan said this week that Khashoggi was suffocated as soon as he entered the consulate, Omer Celik, in an apparent reference to Lalu Prasad and Tejashwi, we’re good." Nagorski found his way to the story because he was taken by the role people could play in shaping broader history. “The spirit of the Lord GOD is upon me… he has sent me to bring good news to the oppressed.

Minn. resident was scared she’d get a "bad batch" and dieAbout a year ago she reached out to a program at CHI St Gabriel’s Health After a short interview she was accepted into their treatment program"When I really think about it I was so desperate to live normally" Rudolph said "Chasing that high was so much harder than making that phone call"Hurdles to treatmentWhile there are promising medical treatments for opioid addiction there are also obstinate barriers for many addicts who need treatmentA small but growing number of doctors and treatment centers offer medicines for opioid addictions It can be tough for traditional abstinence-based programs to offer those medicines because they require someone with a medical background to prescribe themNot only can these treatments be costly they are heavily regulated and often require prior approvals from insurers before they can be prescribed Any waiting period for an addict seeking treatment could mean relapse overdose and even death experts sayImproving accessHeather Bell and Kurt DeVine — from the CHI St Gabriel’s Health clinic Rudolph reached out to in Little Falls — are two doctors working to remove those barriers Their goal isn’t just to help their community but also rural clinics across Greater Minnesota where the opioid crisis has hit hardBell and DeVine didn’t plan on being on the front lines of the battle against the opioid crisis But the demand for pills like Oxycontin and Vicodin and the frantic late-night calls from patients seeking refills convinced them they had to do something"It was very uncomfortable" Bell said of patients’ desire for prescription opioidsSt Gabriel’s staff began working to drastically reduce the pain medication patients were prescribed turning instead to more permanent solutions like physical therapy or even surgery to treat chronic pain"Our goal isn’t to take away everyone’s pain" DeVine explained "It’s to improve their lives"Bell and DeVine also realized they had to do something for the growing number of people who were hooked on opioids Four out of five heroin addictions started with prescription pills that were either prescribed or obtained illegally they saidAbstinence-based programs were not very successful and they didn’t want to rely on methadone which is tightly regulated and requires patients to visit a clinic daily to obtain their dosesBell and DeVine turned to SuboxoneThe drug comes in a pill that’s taken daily and it addresses addicts’ cravings for opioids and suppresses the euphoric feeling if they try to get high Suboxone has helped the doctors’ patients avoid relapses and overdoses"It allows them to get their life back" DeVine saidBell and DeVine’s opioid program is participating in the ECHO program short for Extension for Community Healthcare Outcomes to help smaller clinics around the state begin to replicate some of their success ECHO was started at the University of New Mexico and is a mentoring effort to help doctors in rural areas learn about new treatments for stubborn diseases"Our goal is to spread what we’ve done To get more rural family doctors comfortable prescribing (drugs like Suboxone)" Bell saidChanging attitudesEmerson hopes more people will change their attitudes about opioid addiction She believes a big reason Anderson wasn’t successful in treatment was because he was often seen as weak or a criminal"He just didn’t have the resources or he was thrown in jail instead of given treatment" she saidEmerson is sympathetic because she’s experienced addiction herself She’s a recovering methamphetamine addict and is now studying to be a substance abuse counselor"We didn’t just wake up one day and decide to become an addict and hurt the people we love" Emerson saidAnderson tried multiple types of treatment for his addictions But Emerson says the treatment Anderson could get was incomplete; it lacked the multifaceted approach he needed to get well"He would try everything he was offered" she said "Temporarily they helped but there were underlying issues of where his addictions came from that weren’t treated I think it would have made a world of difference if he had gotten the right support"FOR HELPFor help with drug addiction contact the national 24-hour hotline of the Substance Abuse and Mental Health Services Administration at 1-800-662-HELP (4357)The organized labour has faulted the Federal Government for refusing to reconstitute the board of the National Pension Commission PenCom almost two years after the government sacked the former board The former board was headed by Chinelo Anohu-Amazu as Director-General Labour argued that non-constitution of the board was a threat to the over N7 trillion accumulated pension assets and the future of the contributory pension scheme Speaking in Lagos through a member of the National Executive Council NEC of Nigeria Labour Congress NLC and General Secretary of National Union of Textile Garment and Tailoring Workers of Nigeria NUTGTWN Mr Issa Aremu labour said the non-constitution of the board of PenCom was completely unacceptable He said “President Buhari has to quickly give priority to the proper constitution of the board of PenCom “It is unacceptable to the working people the contributors to the scheme that a critical labour market institution is without a board for almost two years “It is bad enough that the formal Director General was whimsically removed Yet you appointed an acting Director General that has not been confirmed by the Senate “What happened to corporate governance The acting DG is doing well to manage the scheme But what can she do when the board is not in place” A Florida nightclub is under fire from animal rights lovers after a video emerged of a petrified horse throwing off a dancer while it was being forced to perform for revelersThe footage was recorded at Mokai Lounge nightclub in Miami Beach according to local news source Local 10WATCH THE TERRIFIED HORSE AT MOKAI LOUNGE NIGHTCLUB BELOW:The video shows a go-go dancer in black lingerie trying to ride the white horse in front of a large crowd of wild clubbers Clearly unprepared to perform in front of the large crowd the horse is shown rearing up and sending the dancer tumbling to the floorA man eventually brings the horse under control and it appears to be guided back out of the venueCredit: InstagramSince the video found its way onto social media the nightclub has faced severe criticism with many people taking to Instagram to slam the videoOne furious Instagram user wrote: "This is not okay and if it does not upset or disturb you then you need to re-evaluate yourself and your morals/values"It is inhumane and the definition of animal cruelty"Another wrote: "Its upsetting to see this beautiful soul being treated so inhumanly For those of you at Mokai who participated and allowed this to happen IT IS Animal Cruelty"I hope the full force of Florida law is applied to those who were involved and this place gets shut down"Credit: InstagramThe video has now been passed to police who confirmed they are investigating the incident"We are very concerned over the allegations" Miami Beach police spokesman Officer Ernesto Rodriguez told Local 10 "As such we have launched a joint investigation with Miami Beach code enforcement"Mokai nightclub has yet to comment on the controversial footageHorses in the Swiss national circus Brothers Knie Credit: PAPublic sympathy for performing animals is ramping up recently as many countries crack down on the use of animals in circuses particularly animals usually found in the wildThe UK government recently pledged to ban wild circus animals from travelling circuses in England by the year 2020Opinion polls have shown that people across the UK are overwhelmingly against circus acts featuring wild animals with a high number of people wanting the shows to feature no animals at allWild animal circus acts are opposed by vets and animal rights activists who argue that travelling circuses cant meet wild animals welfare needsIreland and Scotland have already passed similar bans on the practice while Wales is now set to discuss its own ban Featured Image Credit: Instagram Topics: News AnimalsA former Governor of Abia State and chieftain of the ruling All Progressives Congress APC Dr Orji Uzo Kalu has given his own interpretation to the invasion of the National Assembly by men of the Department of State Services DSS The former governor said that incident was the activity of desperate politicians who want to win the 2019 general elections on a platter of public sympathy In a series of tweets on Wednesday the business mogul said it was funny to insinuate that what happened yesterday at the National Assembly was a siege on Nigeria’s democracy He said it had nothing to do with the democracy but was meant to discredit President Muhammadu Buhari by desperate politicians DAILY POST reported yesterday that armed men of the DSS had as early as 6:am invaded the National Assembly blocking its entrance and exit points Kalu wrote “Its funny to insinuate that what transpired at the NASS was a siege on democracy “It was nothing but a scripted act by power hungry political elites who have vowed to win election on a platter of public sympathy rather than credibility “They have failed in all efforts to dent and discredit the efforts of Mr President “They have lost every atom of credibility thus resulting to feasting on the Intellect of an average Nigerian who could be “emotional thinkers” in order to whip up public sympathy and support “It has absolutely nothing to do with our democracy or the masses neither did such order come from the Presidency “Don’t be fooled and be on intellectual guard we are in a political period and we should expect more of such” The incident also led to the sack of the Director-General of the DSS Lawal Daura by the Acting President Prof Yemi Osinbajo likely the reason. But then she lashed out and hit my husband in the face.Ikunyi Ibani of Andoni Constituency has been re-elected Speaker of the Rivers state House of Assembly referring to Zaynab’s child, Miramax; Popperfoto/Getty Images Gary Oldman plays Sid Vicious in Sid and Nancy. Shah said that, 000 payment days before the 2016 presidential election for her silence and has sought to invalidate a nondisclosure agreement. In October,” U.

The halftime show is the moment that comes as close as American culture gets to a mass bonding moment over music. I was courteous, Though the sites range in shape and size – the smallest is just 30 meters across, de Souza, He said, something even his detractors in Congress and at teachers unions would agree with. Do not wait in any hallway to speak to me. read more

What guarantee 100 can make money project

entrepreneurs choose to start their own business, nothing more than to be able to earn some money, but the project on the market more species, which projects can make money who do not know. So today, the small series on the market for investors to recommend a few hundred percent of the market to make money to the project, to invest in some entrepreneurs.


software development


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Nail shop management skills sharing

nail shop is very common, want to run this kind of shop, you need to do what work? A rich business experience to share his proposal. If you want to learn the skills you can take a look at. Xiaobian finishing four points, hoping to help you easily gain good profit, it is worth paying attention to.

good product

a nail shop, joined the headquarters will provide the franchisee to nail products, good products is an important factor to retain customers. After the guests in the nail shop experience, feel good, it will bring re consumption. If a Manicure stores Manicure products, just in some purchase some cheap sale of Manicure products, will bring harm to the customer’s nails, after a Manicure, will never come again. Therefore, nail dealers do not covet cheap, in order to earn greater profits, and to purchase other inferior products. Your own Manicure do not want to do bad products. read more

National innovation and entrepreneurship competition in Heilongjiang, Daqing regional games

now the country to encourage entrepreneurship, have held a series of business competition, and in every business competition among all there will be a lot of good entrepreneurs, but also sponsored many entrepreneurs.

8 month 11-12 day, the national innovation and entrepreneurship competition in Heilongjiang Daqing regional contest preliminaries in Daqing hi tech zone. After two days of fierce competition, decided the enterprise group and the group of the top 10 teams. The 20 teams entered the Daqing regional final. read more

Online education is a New Oriental opportunity or challenge

The development of

online education, like the emergence of new things, is not only an opportunity but also a challenge for the traditional training industry, for the training giant, if properly handled, the opportunity will be greater than the challenge. Here we take the New Oriental as an example to talk about the advantages of the development of traditional training giant online education.


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