26 Burst results for "Health Affairs"
"health affairs" Discussed on WTOP
"We've gotta follow up to a police chase and deadly shooting in Frederick County, Maryland. The suspects have now been identified. As we've reported to Then drove to Emmitsburg from Pennsylvania with police in pursuit. Yesterday, the suspects crashed their truck at an Exxon station and opened fire on police. The officers fired back killing Brian Selmer. The other suspect, A man named David Letterman was taken in without injury. Leatherman was wanted for attempted murder in Hanover, Pennsylvania. He's accused of stealing a family member's truck, which a police officer spotted in New Cumberland, Pennsylvania, and started the chase. 7 12. There are new questions about the quality of some generic drugs, which is supposed to work just a cz well as the brand name stuff. Kevin Schulman is a professor of medicine at Stanford. He and his family went through this Firsthand when his daughter's less expensive generic A D. H D medication wasn't working and was actually creating new side effects. When they stopped using the generic and switch to the original. Everything was fine again. Shulman writes about the experience in September's health affairs Journal and tells w GOP about what you should do if you're in the same situation as we were going through this process. I went back and talked to our pediatrician and I thought she was going to tell me we're overreacting. And she said, Oh, my goodness. Not you, too. I have this problem all day long with Children with a d h d or unstable doses of depression medicines. Every time the pharmacy switches, they have a reaction. Either. The dose isn't the right dose or they don't tolerate the medication or they're withdrawn from the market. She said. She literally is looking at it the FDA website week by week to see If any of the brand's being used for generic drugs are being withdrawn, you know so many people that rely on those generic medications it may be unaffordable. Otherwise, what air your lessons and advice for the rest of us navigating this clearly murky world of medications in our paper? You know, I said, really, clearly. Look, this isn't the FDA is fault. The FDA was in charge of drug manufacturing the US it was a really constrained environment now. Drug manufacturing is a global enterprise since 2005 more manufacturing's been done offshore. Been done in this country and and one agency just can't police the entire world. But what I take issue with is actually the pharmacy and the people behind the pharmacy. So when I went on the pharmacy website, they say that the generic drugs that they sell us are reviewed and tested by the FDA. And actually, that's not true. The FDA doesn't automatically test drugs unless there's a problem if you're faced with the choice of Generic form of the medication is important. Ask the doctor questions the pharmacist questions I guess all across the board you have to say is my child or am I getting the same benefit from the generic version as any other version? It is all across the board. You can ask the pharmacist who's making this Do you have experience with people Not tolerating this? You could ask the doctors again. You can try and have a preference. You know if I got in one brand of generic and in February and it was working, then we should get the same brand in March. But I think we also need to advocate with our Employers. You know, this is not tolerable. We should not be in this position as consumers. We don't have a lot of insight into this market there plenty of other people there in the supply chain that could make sure that the quality of the products is there for us again. That Stanford professor of medicine Kevin Schulman, he joined us on Skype and you can.
Bringing Health Policy to the Forefront with Susan Dentzer
"Great, Good Morning Susan Welcome to the woman. Thank you so much for making the time to speak with me today. It's great to be with you Daniel. Thanks so much for those of you who don't know, Susan Denser is while she was a health corespondent for P. B. S. for a decade correct that's right. What I'll lead you to that field I mean not I my old co-host. That's her ultimate goal is to be like a health corespondent and she's a nurse practitioner see she's her brain is amazing so. That's great. Well, it was all along time a print journalist. Came up through the ranks at A. Some some. Publications that used to be pretty big deals back in the day they kind of faded from glory. Magazine I ever Newsweek. I, was. Writer of business news for many years in Newsweek I was among other things the Wall Street correspondent. And I, a actually was covering economic policy. And one day my editor through me story that really was about for profit hospital companies. And I started reporting this story. It was not something I had previously and I stumbled into the fact that there were some major health policy changes of them. Watch that we're going to potentially affect the fortunes of this these companies. And One thing led to another and I said, you know there's this really interesting area of. Healthcare. That is a kind of a business. The first time I had ever thought of health care as having a business aspect to it, but obviously did it had for many years? and. As you know that was long ago So healthcare at the time I WANNA say probably about seven percent of the gross domestic product was pretty small. Of course, it's. Almost, eighteen percent of a much much larger economy. So this aspect of healthcare has if anything only boomed massively since then but as that was starting to happen back in the eighties I said, you know this is really interesting stuff. There's almost nobody eat reporting writing about it, which is hard to believe now, but it was true bad. Yeah and I said, I think I'm just GonNa Start Finding learning as much as I can about this. So a dead I spent several years. Still at Newsweek, writing more and more about healthcare and health policy I went up to Harvard on journalism, fellowship, and spent at year pretty much devoted to learning more about healthcare and health policy. Then I moved down to Washington. And became the chief economics. At US News and World Report. With the deal that I could devote a lot of my time to writing about health care help policy and like so I covered many of the major major health. Policy. Fights, really battles of that of that era and then. When I went to the PBS Newshour in Nineteen Ninety Eight, it was to create the First Health Policy Unit that the that the Newshour had ever had. Devoted specifically to help policy. And then when I got there, it turned out that That was not just going to be a job cover health policy was going to be essentially everything that had to do with health and healthcare. Ross our desk so I ended up. Really is the full fully functioning on Air Health Correspondence or the Newshour for ten years was then wooed away to become the editor in chief of the. Leading. Health Policy Journal the Era Health? Affairs. And So I did that for five years and got even deeper policy as a consequence of that.
FDA says outside pressure won't influence COVID-19 vaccine approval
"Race continues to make a vaccine in the fight against the Corona virus, FDA head Stephen Han Has made it clear now that his agency will handle outside pressure to approve a vaccine before it's ready. We will make that decision on Lee on the basis of science and data. We will not make that decision on the basis of politics. Asked by CBS News if he would resign if he's pressured to make a decision he doesn't agree with, he says. I think all options are on the table with respect. I hope we won't be in that position. But what I can tell you is we'll be making our decision with science and data. In an interview with the Financial Times, Han says he'd be open to fast tracking approval of a covert 19 vaccine before Phase three clinical trials are done by passing the normal approval process. FINANCIAL TIMES Washington Correspondent Karen Stacy spoke with hot Stephen Han is the man who is going to decide whether or not to approve a Corona virus vaccine in the next few months. Now he's under a lot of pressure from both sides. President Trump would obviously like an approval. His reelection chances. Others, however, worried such a short time scale would not be say Alan, while editor in chief of Health Affairs tells us Once there's a safe and effective vaccine. We have to make a lot of it distributed to the right people and make sure folks are willing to take it.
1 in 5 nursing homes experienced summer shortages in PPEs and staff
"Homes with new research out from health affairs, wanted five US nursing homes faced severe shortages of personal protective gear. That's according to a study released Thursday, which indicates there was no improvement from May to July and shortages of peopIe but also finds facilities in areas hard hit by covert 19 are struggling to keep staff the Centers for Medicare and Medicaid services says Sponsor, the Trump Administration has provided nursing homes with the tools they need to stop the spread. Hamburg ADI
Professor Ruqaiijah Yearby Discusses Structural Racism in Health Care
"Welcome to the healthcare policy podcast on the host David Cosso. During this podcast rookie year be professor and member of the Center for Health Law. Studies at Saint Louis. University School of law. Joins me to discuss the effects of structural racism in healthcare, Professor Year be welcome to the program. Thank you for having me on professor year. Because bio is of course posted on the podcast website briefly on background listeners are likely well aware of the US has had a long history of persistent and substantial disparities in healthcare, access, delivery and outcomes. For example, the black to white infant metality ratio has never dropped below two to one. Over the past two decades, the healthcare research and quality has publishes disparities report. In it, a third of disparity measures have shown no improvement in nearly one in six have worsened. Or largely explains healthcare disparities or health inequities is structural, institutional or systemic racism, though frequently less overt structural racism, the fair to provide equal benefit to racial and ethnic minorities is embedded in healthcare, education, employment, environmental housing, transportation, and numerous other governmental policies as a result, structural or endemic racism, 'cause minority population, suffering far greater disease burden, and has results significantly higher mortality rates. As I've noted recently in previous PODCASTS, due to higher rates of on and under insurance that have led to higher rates of comber biddies covid nineteen related deaths among African Americans and Hispanics are far greater than among Non Hispanic whites. George Floyd before he was killed had recovered from covid nineteen infection. This will recall structural racism was the theme of my January ninth discussion with Andrea Freeman, regarding her recently published book scam, breastfeeding race and injustice with me again and discuss structural racism in healthcare. His professor year be so professor with that. I opened with a brief and I'll admit somewhat blurred definition. Of Structural Racism I know you distinguish between structural. And Institutional. Can you explain this difference? Yes Oh structural racism is about the ways that our systems are structured particularly to advantage the dominant group in disadvantaged minorities. It also includes ways that organizations and institutions work together to create standards and policies that benefit them while harming minority and so we can see an example of this particularly in the healthcare sooner in the healthcare system when we look at access to healthcare, many predominantly African. American neighborhoods, predominantly immigrant neighborhoods do not have access to hospital care and that is so important doing Kobe nineteen, because that's where many people are receiving tests and treatment for covert nineteen and so the fact that we don't. Place hospitals based on need or need for health care rather we structure our system in a way that access to healthcare is based on ability to pay then benefits though who have jobs that have health insurance that can pay for health care, while it disadvantages racial and ethnic minorities who tend to work at low wage jobs, but do not have health insurance and cannot pay off for health care. Thank you I do have a question about hospital locations in. We'll get to that. Let me ask as a follow up question regarding critical race theory, somewhat similar fries actually possibly shocked that a week ago today the health affairs blog. BRIEFLY DISCUSS CRT in a post by Michelle Morrison and others. Can you give us a brief definition of what is critical race theory? for me. Critical race theory is about critiquing how. Has Been used as another means to harm minorities, particularly as I think about it anti-discrimination law when we look at historical articles about this we see they. antidiscrimination law has been set up to facilitate and support the existing social structures. When you look at anti-discrimination law in the area of employment you are looking to prove that an individual or that institution allowed policies that harmed individuals and. And so it never gets to the point where you're challenging the structures or the systems of employment, they can stay the same. We only look at individual perpetrators who have done some harm. So when we think about employment that is so relevant now in covert nineteen, because a lot of the wage, workers are being deemed as essential workers under covid nineteen, but they're not being provided with math. They don't have paid thickly. They do not Count under worker's COMP. They do not receive unemployment compensation because. Those are do not apply to them and so let me give you a specific example so the fair Labor. Standards, act. was passed back during the new deal time in nineteen thirty eight, but that was also the time of Jim Crow, and so it left out. Many workers domestic workers who include home care. Workers agricultural workers as well and so. What the? Standard acted was. Provide for a minimum wage overtime pay and limit the work week to forty hours, So. Most of these workers are not covered We're not covered by this actual act when in two thousand and fifteen. They did actually begin to be covered under fairly. Standard to act Then you see a shift again and the structure of employment, and so no longer are they considered employees companies shifting to independent contractors
"health affairs" Discussed on WTOP
"Pressure tonight on the Redskins to change their team name. Amazon is pulling all team merchandise from its website CNBC reports in a note to its cellars today, the retail giant says it's pulling a variety of Redskins products, including jerseys, T shirts and jewelry. This follows similar moves by WalMart, Nike and Target. Last week, the team said. It's reviewing its name and seems like everyone is talking about this. If the Washington Redskins change their team name, what should it be? One name is surfacing as the front runner. Red tails. Yet red tails. A reference to the Tuskegee Airmen is emerging as the leader. City paper says at least one major sports book as red tails as the odds on favorite to become the new name. It has some things going for it that would make the transition easier. For example, you could keep the H T T R hashtag. Red tails fits easily into the current fight song, and it makes it easy to keep the team's current colors. Kyle Cooper w T. O P NEWS ESPN is Adam Schefter is reporting that Washington is planning to have no Native American imagery when it does decide on a new name. Asked about the Redskins name issue. Maryland Governor Larry Hogan said today that the team's name quote probably should be changed, He was asked on NBC's Today show. Hogan grew up a fan of the team and expressed support for the name when he ran for governor in 2014. Now, he says, he thinks the time is right for a change Now to your health sponsored by my eye Doctor. Doctors of optometry, visit my eye doctor dot com. Black, indigenous and other people of color are testing positive for covert 19 a disproportionate rates and they're being hospitalized for Corona virus at high rates across the country. There is a group of people working to reverse this trend that you may not have heard off. They are community health workers. W T O PEACE. Dimitry Sota speaks with freelance health journalist Rob Waters, a contributing writer for health affairs. His new article in this month's Health Affairs Journal is about the people on the front lines of protecting vulnerable folks from Cove in 19 people of color people.
"health affairs" Discussed on AP News
"The border regions for the sprawling university of California system has named the new president will be taking over no later than mid August Dr Michael Drake has been named to replace Janet Uppala Tano he'll become the first black president at the university of California the seasoned administrator will be overseeing it 280000 students system that have life upended because of the corona virus pandemic and has been dealing with issues including accessibility for minorities and slashed budgets drink as a medical degree from UC San Francisco served as vice chancellor for health affairs for the UC system and ran the university of California Irvine for 9 years he retired last month as the head of the Ohio State University Drake told the UC board of regents he's excited and ready to address challenges including the pandemic the threat of climate change and social injustice I'm Jennifer king
University of California system names 1st Black president
"The border regions for the sprawling university of California system has named the new president will be taking over no later than mid August Dr Michael Drake has been named to replace Janet Uppala Tano he'll become the first black president at the university of California the seasoned administrator will be overseeing it two hundred eighty thousand students system that have life upended because of the corona virus pandemic and has been dealing with issues including accessibility for minorities and slashed budgets drink as a medical degree from UC San Francisco served as vice chancellor for health affairs for the UC system and ran the university of California Irvine for nine years he retired last month as the head of the Ohio State University Drake told the UC board of regents he's excited and ready to address challenges including the pandemic the threat of climate change and social injustice I'm Jennifer king
"health affairs" Discussed on News 96.5 WDBO
"Is no rain on wdbo interacted with the radar. It's 92 right down feels even warmer in some location. Florida's Corona virus cases have climbed by 8500. Today. That's a little under what has been the last couple of days. Governor De Santis is the whole deduce conference. Next hour. You'll hear it on Wdbo State Agriculture Commissioner Nicky Free Meantime, is calling on the governor to require everybody to wear masks. Everybody should be wearing masks. You know, we all know that the masts are not going to stop the spread, but it certainly will slow it down. We also need to reinforce that cove. It is not behind us, so everybody needs to stay vigilant. A study published in the journal Health Affairs found that wearing facemasks reduced the daily number of infections by his bunch of 2% in states of require mask to be worn in public questions Now about the death of a black man as police arrested him in Denver nearly a year ago, a lion Maclaine died. Going to police choke hold and being administered a sedative. Ketamine hears his family's attorney. He was wearing handcuffs and he was on the ground with an officer's weight on his body playing died a couple of days later in the hospital after being taken off life support. All three officers involved have been reassigned to non enforcement duties. It's a 1 32 Wdbo 1073 of them and 5 80 AM Hey, it's Tom Terry. This is where Orlando turns first for breaking news, Weather and traffic news 96 5 wdbo weather brought to you by us heating and air conditioning. Other extreme heat afternoon across the area that hazy sunshine as well. Look for the daytime high getting up to 97 the chance for storms today in just 20% for tonight Partly cloudy, really warm overnight. The morning low Tomorrow, just down to 76 more hazy sunshine and mainly dry weather for you Monday. Oh, by the way, it's gonna be hot again. 96 the daytime high just a 20% chance for a storm. I'm channel nine, but you're all just rusty McRaney. Now save such security, Triple team traffic Way Avenue slowdown along I for this will be heading west Bone looks like that all framed towards Kelly Evan, who is blocked off due to a crash. Just the right lane of that all France elsewhere,.
Racism and Medicine
"This is Dr Michael Wilks with a second opinion. It may seem that police brutality, racial discrimination, Kovic, nineteen and injustice have nothing to do with each other or with health care, but they are completely related and share. Root causes related to the social determinants of health. Earning a living wage having affordable housing with a safe environment paid leave an equitable and high quality, education system, or all mission, critical objectives for a healthy civilized society, but we are failing across the board. We have seen the disproportionate impact of covid nineteen on Latin X and black communities, but this disproportionate death among people of color is not new. We've known about it for decades and have done little to address the underlying systemic. Systemic problems that lead to premature death and disease in healthcare there are powerful and wealthy stakeholders that seek to maintain their power and wealth, and are unwilling to engage fairly resource. Poor communities, doctors, pharmaceutical companies, insurance companies, clinical laboratories, pharmacies and hospitals are all politically powerful, and you don't mess with them. They use this power to stay in power and increase profits working to fix poverty reduce racism improve how or reduce food insecurity. Insecurity are simply not in their self interest the journal Health Affairs points out that if we could consider the US healthcare a country, it would have the fifth highest GDP in the world. CEO's have healthcare organizations earn millions of dollars. Doctors earn hundreds of thousands of dollars and other healthcare providers are compensated way above the average American so they have little in common with those of lesser means one pervasive problem. Is that we? We have sub groups that are walled off and sees those outside of their group as others, this concept of the other and feeling, those groups as less than is what drives toward racism disrespect for genders and other divisions, those who get the best healthcare in America are the wealthy. When a wealthy person comes to the emergency department, they are taken aside away from the riffraff and get admitted quickly to a nice hospital room. Many parts of the University of California Healthcare System won't even provide chronic care or follow up care to poor patients those on medical, and certainly not to the uninsured. Why because they can't make a profit and that's important to them. Do we consider this acceptable behavior for our public hospitals? Over the years, medicine has contributed greatly to creating myths and justifications for racist behavior. It is time for healthcare to move from being part of the problem to being part of the solution, but power and wealth stand in the way of caring for those who are excluded from healthcare or suffer from the deadly condition of skin color, related to stop talking about disparities and create a healthcare system that is focused broadly. unhealth is caring and is truly an integrated system. This is Dr Michael Wilks with a second opinion.
Helping Underserved Patients Get the Quality Specialty Care They Need with Daren Anderson, Director at ConferMED
"I have the privilege of hosting Dr Darren Anderson. He's a director of confirm. Darren is a board certified general internist and has worked in safety net practices for his entire career. He's published articles in several peer reviewed medical journals including health affairs. The American Journal of Managed Care The Journal of Family Practice and the Journal of General Internal Medicine Doctor. Anderson obtained his undergraduate degree at Harvard College and his Medical Degree from Columbia University College of physician and surgeons. He's an outstanding contributor to the telehealth space. We've got a lot of things going on right now. Value-based cares one of those things. How do we deliver better on? Our healthcare dollar. Corona virus is something that's very live and and and a concern for many of our provider organizations and communities and so today we're going to touch on several of those things with Darren and also to learn more about what he and his company are doing to to add value to healthcare so Dr Anderson. Really appreciate you jumping on to join us today. Oh thank you. I really appreciate the chance to talk with you in the share. Some of the work we've been doing with your audience. Thanks a lot for the opportunity absolutely so tell us a little bit more about your journey and and what inspired your work in healthcare and in particular your focus on safety net practices yet will journey released her back in college. I was trying to figure out what I wanted to do with my lights. Give the short version. But I I became really inspired by more that I was reading By various authors talking about Underserved patients and their efforts to try to provide healthcare in safety practices. And I kind of decided early on that. I wanted to turn it for your that. Would allow me to to work in a medical in the safety net. So really went through my training with that. As a goal in after MED school did an internal medicine residency training and then went right into the National Health Service Corps where I was assigned to practice saw in a new Britain Connecticut Community Center. That's how he ended up in Connecticut which is to stay and you know. I started off working fulltime as a primary care doctor taken care of by an inner city population with a lot of a lot of complex problems. Most of my patients spoke Spanish in. I think early on even in my first year actes. I absolutely love taking care of patients but I was so struck even even having fun in knowing a little bit about What was going on in in Satanic Practices? I was struck by how inequitable the system was and healthcare. Quality is something that just greets you the minute you walk into an exam realized the opportunities that you may have right may have private insurance. The opportunities that are patients who have no insurance or perhaps Medicaid insurance don't have and so sort of starting charting career win. It took me more into the administrative research side of things looking to try to derive solutions to help reduce helping it make sure that patients regardless of where they were born what language they spoke or what insurance. They did or didn't have finding ways to make sure that they got the best health care that we provide in the US. I think that's That's wonderful baron. As we as we consider the topic of access and the challenges that surround that social determinants of health much of which were tackling. I think more seriously today in healthcare. I think this is a great opportunity for for us to to dive in a little bit. Deeper on on what you're doing at complimented Ellis. What it is that you guys are doing there to add value to the healthcare ecosystem. You know so one of the most striking and obvious disparities when you start practicing in in a federally house. Hendrick Community Health Center is when you need to send a patient. See a specialist so many may knowing your audience may know that there is a network of over twelve hundred community health centers across the country. They're called federally qualified health centers but they are independent nonprofit L. centers that are run by a board of directors that's majority controlled by patients in these clinics. Had been around for decades and really developing a strong effective primary care infrastructure. They were among the earliest without the. Hr's the SIM that I worked at. Has KIOSK CHECK INS integrated behavioral health? Many of the things that you would like in expect to see in the in the the best primary care clinic you could envision but it all comes to a screeching halt when you refer somebody or need to refer somebody actress in back in two thousand twelve when we first about the idea for what eventually became confirming. Mike Clinic was facing nine to twelve month. Wait minimum to get one of our Medicaid patients into be seen by the pitas dermatologists in pretty much. All of the specialties. Have at least some degree of a delay and this presents a real challenge for the primary care provider. You may have a pretty good idea of what you need to do. But you may not be sure you may need surgery. You may need a biopsy procedure but in any case off the only way to get answers to your questions or get a patient to have procedure disturb. Refer them into a specialty center and No unfortunately uninsured patients and and even those with Medicaid have great difficulty finding specialty care because the simple fact is reimbursement rates relatively low in many most specialists impact on limit or completely. Don't accept it. All patients without insurance or Medicaid and so forth that presented a really substantial challenge to us and that was that was the issue that we sought to address. Confirm it and that's a that's great so comes from a from a frustration that you had in your own practice and your patients not being able to get the care that they needed. I mean nine to twelve months. Wade is is really not acceptable. And so you dove in you. Roll up your sleeves. Tell us what confident does today? That's different than what's available today to solve on that specialist problem so I think we tested in the process that ultimately became for mid was designed and tested by me and my team of primary care providers nurses referral coordinators. And basically. What confirm it does is it allows the primary care provider to confer with a specialist virtually before they refer in a synchronous conferring dwell so died essentially it allows the primary care provider to send their question in some of the details about the case from the medical records to a special instant. They can get is on that console question rapidly and in no more than two days that most of our specialists on a within the same day. Seventy seven percent responded on the same day. The question was submitted. And they're able to put ice on that review the information that we submit and send back to that Primary Care Provider Advice Guidance. So basically what? We are as virtual network specialists around the country. That are on standby ready to answer. Questions in take a first look at all of the console requests that the primary care providers have in pretty much any specialty in his rebuilt out that network and developed really the understanding state by state of all the different types of Payments Environments. All the different types of practices. We continue to see that. A substantial percentage of the cases that get submitted to us in most specialties upwards of eighty percent. Don't need a face to face visit. It's not because it's inappropriate. Consult of the. Pcp made a mistake it simply because the nature of what the primary care provider is asking. The question that they have is one of the specialists answered by senior question reviewing the data and sending back in opinion and so what that does makes the system more efficient it allows those cases that can mean be maintained managed primary care same primary care. Unit allows those scarce resources that face to face visits to be allocated to patients who really need a procedure or hands on for some reason another and that's basically we met all that outdid series of studies in Connecticut. Utah in our health center to prove that it works that it was safe and what confirmed has done is take that scale and we're now providing that service to over one point three million patients across the country. That's fantastic congratulations on on the scaling of it To the point you've gotten it thus far Dr Anderson and and You know thinking through the the efficiency that this provides much of what we need in in healthcare is is the logistics and the efficiency. And and so you've created a nice fast lane to provide the care that's needed and eighty percent. Don't need that face to face visit and I think that's A great solution. So what's the cost than if somebody if it specialists is giving you a their idea or their analysis of the of the patient. What's the cost? The cost is way less than the cost of that specialised in their time in their overhead. Seeing the patient face to face meetings to think about it we batch leads. They're an inbox in the specialist and review them imaging patients evening in rattled off a significant number of them one after the other most e console responses. Take ten minutes out. There's arranged and we have. We have some units are averages tend to fifty minutes but if you think about it all they need is a laptop or whatever to do that office cost. There's no checking medical assistant. Any of the overhead costs the
CBPP's Dr. Joseph Llobrera Discusses the Administration's Proposed Cuts to the Supplemental Nutrition Assistance Program (SNAP)
"Can you. Provide a brief primer or background on the Supplemental Nutrition Assistance Program. Sure David Wanted to start off by saying that snap is proven highly effective program. It's vital to our nation's health and wellbeing and it's been shown to reduce poverty reduce food insecurity and improve health outcomes. And I WANNA come to those outcomes in just a minute but before that wanted to start off with some basics Snap as an entitlement which means it provides benefits to anyone who meets the programs eligibility requirements. this design means that it can respond quickly when needs increase We most saw this inaction during the last recession when it expanded to meet the needs of millions of Americans who are losing their jobs and losing their source of income It helps Close to forty million Americans each month and the vast majority of those are recipients in families with kids Older adults or those with disabilities At this point about eighty five percent of individuals that are eligible for the program participate. So it's Participant participation rates have improved over the past decade or so Participants received benefits through a debit card That can be used at over a quarter of a million retailers across the country Last year about fifty billion In benefits were distributed to Participating households I wanted to say that benefits are relatively modest They average about two hundred fifty dollars a month for the average household. I if you and if you do the math comes out to an average of about a dollar and forty cents per person per meal But despite those benefit levels those modest benefit levels snap has been shown to deliver strong outcomes reduces poverty so it it it's been shown to raise the income of millions of people and children out of poverty and and makes millions of Americans lest poor It's anti-poverty effect is larger than any other safety. Net program outside of The earned income tax credit child tax credit combination The other thing is the benefits are targeted fish. Lately to those with the greatest need Very poor households get the largest. Get larger and benefits kind of scaled. Down as household income. Goes up So the other area that's The literature shown snap having great if Impact is reducing food insecurity Participation in snap reduces food insecurity By up to thirty percent among Snap households that join That participated in the program and When if you were calling I referenced. The Recovery Act During the last recession snap benefits were increased across the board and we saw that With that boosting benefits Food Insecurity rates came down for participating households When when it came time to cut those benefits if years later the inverse happened Benefits of cut the benefits increasing food insecurity and then. The last area wanted or bucket. I wanted to address was Links BETWEEN SNAP AND IMPROVED. Health Outcomes Investing in snap is an investment in the health and wellbeing of Americans snouts been linked with a wide range of improved health outcomes Adults receiving snap miss fewer days of work. Because of illness make fewer physician office visits are more likely to adhere to their medications and have a more positive self assessment of their health status event. There have been studies that have shown that receiving snap early in life can lead to improved outcomes. Not just now but years down the road. is GonNa Studies that have found that access to snap during pregnancy and childhood was associated with fewer low birth weight babies and reduced risk of out Abi City and other conditions related to heart disease and diabetes and adulthood There's a study that came out on health affairs last fall that found that snap was really Was associated with a one to one to two percentage point reduction in population wide mortality So the last piece I wanted to touch on was Is that snap? Participation has been associated with reduced healthcare expenditures One study found that annual medical care costs of low income adults that are participating in the program was about a thousand four hundred dollars less than similar non-participants. So that's about twenty five percent less than Comparable non-participants okay. Thank you Joseph. I know your organization last November. Put out a snap chart book which includes a good number of research findings relative to the pros performance on healthcare. I did note somewhere in my reading that For every dollar spent on snap between three sixty seven eight thousand three or four cents is estimated to be saved in health care costs. So thank you for that overview. Let's go now to what the current administration has proposed the last few years and is proposing again in the twenty twenty one administration's budget as proposed This was out about a month ago. Your Organization wrote and overview What affects the proposal would have and that was in a February eighteenth memo which will provide a link When I post this but let's go. What did what did the trump administration propose This this past month for funding And the snap program in fiscal year. Twenty sure David thanks So too high level this administration's budget And other proposals With significantly cut public services that help struggling households for the basics and that includes snap As you mentioned this administration's Twenty Twenty one budget was very similar to the previous to And snap it calls for cuts of more than one hundred eighty billion over the next decade That represents nearly thirty percent reduction in program funding I did want to note that. That's on top of fifty billion dollars in cuts that administration is seeking to affect through regulatory action. And I'm hoping we have a tiny host best Unemployed workers elderly individuals low income working families and with kids all bear. The brunt of these cuts Just for some specifics For the first sorry for the third time in three budget proposals Administration is proposing to hold back about forty percent of benefits that comes out to twenty to thirty billion a year Half of those of that amount would go to what the administration is calling America's harvest boxes and the other half those benefits that are held back would simply be eliminated Some of your listeners may have heard of the harvest box But just briefly. It's A. It's a box of shelf. Stable food products peanut butter canned goods including canned meats pasta cereal shelf stable milk and other similar products Those that harvest box would not include Fresh fruits and vegetables and participants wouldn't have To our knowledge wouldn't have a say in what they what they receive The administration has justified this. Change these cuts by claiming that the government can purchase box and distribute food commodities at a substantial reduced cost but it hasn't really pro provided any evidence to back that up
Bias can have a large impact on health
"Twenty years ago official reports documented the many ways in which health is impacted did by our genes and our behaviors but also by external social determinants. Some of these like race economic factors and insurance coverage may seem obvious but other external social factors like transportation education housing and food security. Thirty also play an important role. This is Dr Michael Wilks. With a second opinion about twenty years ago official reports documented the many many ways in which health is impacted by our genes and our behaviors but also by external social determinants. Some of these. He's like race. Economic Factors and insurance coverage may seem obvious but other external social factors like transportation education education housing and food security also play an important role in how healthy we are. Bias is another factor that contributes to disparities in care but is often ignored particularly with regard to marginalized communities including racial minorities. LGBTQ he cute communities those who are beasts or disabled and many more since the report was written twenty years ago not much has changed with regarding differences in the health among marginalized groups obamacare certainly helped improve access and health equity for nearly fifteen and million people but disparities in life expectancy infant death rates. Malnutrition diabetes and many other markers just have not changed much. Some of these social issues are hard to change. But one factor that is not if given sufficient attention is implicit bias by healthcare workers. Implicit bias sees are those opinions and assumptions that we all have that affect our behaviors and beliefs toward others unconsciously and without our awareness. Even when you look at the highest highest income and highest education levels and you compare the health of blacks and whites blacks have worse outcomes in fact. Hi income educated. Black women have worse health outcomes than even poorly educated poor white women as I have mentioned in past reports. Blacks also get treated less aggressively for documented pain in our offer fewer treatment and options when they have a serious disease. Healthcare teams are composed of human beings who hold biases and prejudices. Joss lost like everybody else. In the general population but healthcare workers are unique in their positions of authority and control over our lives lives. Rudeness and mistreatment in the healthcare system is a common experience for blacks and Latino patients and are black and Latino medical students didn't and nursing students all have their own stories about staff and patients who regularly mistake them for people working in facilities food service or janitorial services. There is the distrust that grew out of historical racism such as the to Ski Gi experiments whereby by hundreds of black men were denied treatment for syphilis in order to observe what the CDC called the natural history of the disease so now a generation or two later how do people begin to trust the CDC and doctors who are the ones that enrolled enrolled them in ethically bankrupt studies so it turns out that some of these social determinants of health are nut so external but are actually usually internal to the healthcare system. Implicit bias is hidden subconscious and unintended to the offender but it is very real and very explicit to the offended. It is often easier to get food to a neighborhood or change our approach approach to say health insurance then it is to acknowledge and address our biases as an article in the Journal. Health Affairs recently pointed out. Attitudes can be changed but only when they are acknowledged an owned the process of making us all aware of our biases needs to be a part hard core education but there is no better place to start then in the healthcare system where people are vulnerable and dependent on
"health affairs" Discussed on POLITICO's Pulse Check
"I wanted to pick her brain, given the looming hearing over the Affordable Care ACT's constitutionality, the number of regulations at the Trump administration recently advanced Katie was also handpicked by health affairs to be the successor to Tim Jost, the prolific blogger. No heroes talk a bit about that gig to. Katie heath welcome to politico. Pulse. Check, thanks, Dan. Thank you for having me, your lawyer with healthcare background. Many listeners may know you from your blogging health affairs where you break down, legal challenges regulations related to the ACA. And that's where I wanted to start a Texas judge struck down the ACA the peels court hearing is coming up in a month at the fifth circuit is ObamaCare in legal jeopardy. Really great question. So I think the first point to make there is that the judge did not exactly strike the law down. He declared that it was invalid which matters for folks, because the characters still sort of fully in effect, people should be paying their premiums and have their coverage and protected and nothing has changed. So I think that's very, very important as we look at what the fifth circuit, does next you just mentioned, the arguments will be held July ninth, we will see what the court does there, a think conventional wisdom. Adam is that the circuits going to have a few issues with what judge read O'Connor in the northern district of Texas did in his decision because Joe Connor staked out such unusual legal territory. New is one word for it. That's right. There would be. No. I mean, I think that's right. It's sort of been panned by a scholar legal, scholars across ideologies, so conservative legal, scholars liberal legal, scholars, the Wall Street Journal, the national review, everyone has sort of come out and talked about how sort of extreme his decision was, in terms of taking zeroing out of the individual mandate penalty by congress in the tax reform Bill at the end of two thousand seventeen and using that as the reason or you know, really concluding that, that meant the entire ACA's. Now, invalid, the idea that, that one change would strike down. The entire law is quite extreme. So I want to underline this point because the fifth circuit it leans conservative. It has been populated, primarily by conservative judges, or at least judges. Appointed by Republican presidents. President Obama got three judges over eight years onto that court President Trump already has five in two years. Does that mean anything for when this decision comes before them in terms of the likelihood that Republican appointed judges will be ruling on a challenge? The I'm not sure yet, and I haven't actually looked at the panel that, you know, they'll be three judges from that group of, of judges on the circuit that you just highlighted, and we don't know which ones I we might I don't know if the top of my head, and so that will be something I think to watch, but the, the legal arguments should carry the day. Right. That's what we've as lawyer as someone who believes in the rule of law. We all think that, you know, some of the, the conclusions at judge O'Connor reached are quite wrong. And, you know, that is the consensus among most legal scholars out there, my experience reporting on the over the past ten years has been legal challenges come up. Get dismissed and yet they marched forward. Anyway, I remember when Tim Jones, your predecessor elva vers was saying that NFL beavers Sibelius the decision that made it all the way to the court and led to the Medicaid expansion, being changed..
"health affairs" Discussed on KYW Newsradio 1060
"A new health affairs study finds more than fourteen million American seniors are facing a housing crisis because of their finances for the next ten years, the number of middle income seniors seventy five and older will be priced out of the housing market. Founder, Robert Kramer of the national investment center for seniors housing ward than half of the middle income Americans in twenty twenty nine will not be able to afford the housing care options, they're likely to need at that point in their lives and primer says the public and private sectors, must unite to come up with solutions to the problem. Gary Nunn, CBS news. It happened again on the heels of Starbucks cups in one of the final episodes and game of thrones a couple of weeks back in Sunday's series finale. A water bottle was spotted during one of the biggest scenes in Sunday's farewell up Assode the bottle can be seen tucked behind sir Sam. Well Tarpley's foot underneath his chair, the coffee snafu was later edited out of. Future broadcasts, that type of CBS news. This is k y w News Radio. And I'm Jay Scott Smith. The owner of an electrical contracting company who admitted to his tax fraud and fax rod role in case include indicted labor leader, John Docherty, and seven others has been sentenced to prison tie, Haywood abused. The towel says that he's the first man to go down in the feds case against Johnny dot George Pell of the Berlin. New Jersey-based m j k electric apologized to friends and family, as well as the fed saying, how sorry I am for this lapse of judgement. Assistant, US attorney. Paul grace has pelts cheated the IRS and his own workers with impunity while pelts faced a maximum prison sentence of five years, the guidelines called for twenty four to thirty months and prosecutors sought thirty months defense lawyer berry, gross noted, they had to move the senate's to a larger courtroom because of all of those willing to speak up for and support, pelts saw downward variance because.
"health affairs" Discussed on AP News
"According to a new study in the analysis of fifteen states published in the journal, health affairs, chronic pain is followed by stiffness from multiple sclerosis and chemotherapy related nausea. The study didn't measure whether marijuana actually helped anyone with those problems. But the patients reasons match up with what's known about the science of marijuana and its chemical components. The study also found that Alaska Colorado, Nevada and Oregon saw declines so-called. Magic mushrooms could be decriminalised in Denver. When voters next hit the polls. The city says enough valid signatures were gathered to put the proposal on the. May seventh municipal election. Ballot. The mushrooms contain the who's an agenda drug saddle Sivan, the Denver's cyber mushroom decriminalization initiative said this will be the first time the drugs decriminalization has come before voters in the US. However, even if it passes like marijuana, which is legal in Colorado. Silence. Sivan will still be illegal under federal law. The US drug enforcement agency classifies silo Sivan in the same category as heroin and LSD. Afghan elders and Taliban representatives come together in Russia for talks aimed at ending years of fighting. But as AP's Charles de LA desma reports, they appear to have sidelined Afghan president Ashraf Ghani. He's government officials have criticized the Moscow gathering a the country's chief executive says the government should be at the center of peace initiatives. Adding the bull would prefer the Moscow meeting had a different shape. Abdullah says, the Taliban are the biggest obstacles piece, but if the Moscow meeting creates an opening for real peace talks, it would be a step forward. The Taliban have been staging near daily attacks in heavy casualties on the embattled Afghan army and security forces on Charleston this month. AP radio news. I'm Tim Maguire. The White House releases portions of the speech, President Trump is about to deliver to congress.
"health affairs" Discussed on AP News
"Run a story uncorroborated allegation off about fifteen years ago. Tells you exactly what this is all about the Washington Post says that it was approached by a woman back in twenty seventeen carefully investigated, but never published the accusation. I'm Matt small. Chronic pain is the most common reason people turn to medical marijuana. According to a new study in the analysis of fifteen states published in the journal, health affairs, chronic pain is followed by stiffness from multiple sclerosis and chemotherapy related nausea. The study didn't measure whether marijuana actually helped anyone with those problems. But the patients reasons match up with what's known about the science of marijuana and its chemical components. The study also found that Alaska Colorado, Nevada and Oregon saw decline in medical marijuana patients after those states legalized recreational marijuana more than eight hundred thousand patients were enrolled in medical marijuana programs in two thousand seventeen in nineteen states. So-called magic mushrooms could be decriminalised in Denver. When voters next hit the polls. The city says enough valid signatures were gathered to put the proposal on the may seventh municipal election. Ballot. The mushrooms contain the who's an agenda drug silos, Simon the Denver's mushroom decriminalization initiative said this will be the first time the drugs decriminalization has come before voters in the US. However, even if it passes like marijuana, which is legal in Colorado. Silence by been will still be illegal under federal law. The US drug enforcement agency classifies Sivan in the same category as heroin and LSD. AP radio news. I'm Ed Donahue, President Trump is getting ready for.
"health affairs" Discussed on Here & Now
"We'll see a big movement it's just a question of how long it will take thank you npr business reporter alina seljuk thanks a lot thank you a new study published this week in the journal health affairs lays out another benefit to eating well patients with chronic illnesses were delivered specially prepared healthy meals for an average of two years and researchers found those patients needed less healthcare over that time we're joined now by meghan fuel king she's a reporter at our partner staff health and medicine publication meghan tell us more about the study yes so the study was run in partnership with this boston based nonprofit called community servings that delivers medically tailored meals to patients with connick conditions so they might have high blood pressure or they might have liver disease or they might even be patients with cancer or some combination and so their diets can become pretty complicated and that can be hard to manage alone and becomes even more difficult if these patients have trouble getting out to the grocery store or standing at the encountered chop vegetables so the programs has dietitians who pick and choose pieces of different medical diets so that could be low potassium low sugar or low salt and then they freeze those meals and deliver them once a week and could they quantify how much less healthcare one of those patients was using because they got that food yes so participants who got the medically tailored meals they had fewer trips to the er fewer rides ambulances and actually fewer inpatient admissions to the hospital as well and of course that then translated to lower healthcare costs so if you take away the cost of actually providing the program the study found that those medically tailored meals were associated with about fifteen percent lower healthcare costs.
"health affairs" Discussed on 1A
"Perhaps this is one a i'm joshua johnson who is looking out for america's low income children a new study in the journal health affairs finds that a kid born in the us has a seventy percent higher chance of dying before adulthood then kids born in other wealthy democracies seventy percent higher at two that the viability of chip the children's health insurance program is in doubt according to kaiser health news some states may run out of money for chip as soon as january 21st of this year how are we ensuring that america's children especially from lowincome families can have a bright future too we asked you for your thoughts on the insecure future of chip in many states here is what some of you left in our inbox nancy st louis missouri i vote yes as all nurses and physicians no we have to act in accordance a something called the public good so yes for the chip i would pay more taxes to provide health care for low income and children of low income who cannot afford otherwise hi this is sabrina from illinois i think a lot of people don't understand shit than we need to figure out a way to make them understand chip is not just welfare for people not working or whatever their vendettas are it is children and it is shouldering like my daughter my husband and i both work fulltime my daughter has had to have multiple surgeries just in 2017 alone in a added it up and if it wasn't for chip we would have to come up with twenty thousand dollars out of pocket we are the gray area ninety million other kids are the gray area that has been abandoned by our government just ahead on one.
"health affairs" Discussed on Vox's The Weeds
"This is a cable news exists in his like limon allstate between like relaxing just like chilling out by like not doing your job and like actually focusing on the job with the president of the united states where like it's a bow politics largely but it hasn't it doesn't like help trump governed america constructively and it does make me wonder right if he was just like zoning out and you know watching baseball games it's like well fair enough but like i i don't understand what the upside is to watching cable news under basically any circumstance thank you just wants to see what people are saying about him on tv and tweeting i can't believe with john snow just did would probably not make any sense there was a follower s i would if donald trump live tweeted he should he should do game of thrones bingewatch and live tweet it would be amazing i bays approval rating with sore okay i think it's time for policy time now on the way yeah are we don't watch came okay so we started i'll tell us why why is that ruined such us every i mean they were gonna we talked about everyone dying on the last tuesday weeds today we'll talk about even more depressing topic of children dying so there was a pretty stunning research paper that came out yesterday in the academic journal health affairs that compared the united states against nineteen pure wealthy countries the cohort includes canada sweden the united kingdom france germany and what it finds is that the united states ranks last in childhood mortality in it isn't the worst not like we have the lowest number we of the most kids who are not surviving to adulthood uh one of the few of the stats from this that it is found really shocking is that in the united states children are seventy percent more likely not to survive to adulthood than in this group of twenty countries that since 1960 one has worked out two six hundred thousand excess child adults if these kids have been.
"health affairs" Discussed on Freedom 95 Radio
"Copays so healthy people don't run this system sick people do so uh you have to think being sick is where they make money regardless anyways so this is back to the actual articles that talks about the united states spent almost twice as much on health care as a percentage of its economy as other it advanced industrialized countries uh they spend twice as much on healthcare totalling three point three trillion dollars or about eighteen percent of gross domestic product and twenty th sixteen th but a few decades ago american healthcare spending was much closer to that of pierre nations well what happened a large part of the answer can be found in the title of a two thousand and three paper in the health affairs by the princeton university house at talks about it's the praises stupid uh that's an even the actual article it's the prices stupid the study that was written by um princeton university people found that people in the united states typical use the same amount of healthcare as people and other wealthy countries do but they pay a lot more for it we'll go through as prices in a minute so they started talking about a um a physician from harvard school of public health and the director of harvard global health initiative studied how health systems from various countries compare in terms of prices and healthcare use what was true in 2013 remains so today he said the us just isn't that different from other developed countries and how it uses healthcare it is very different on how much we pay for that healthcare so they go on to talk about how they broke down one hundred fifty five different health condition separately since their data included only personal health care spending.
"health affairs" Discussed on WCBM 680 AM
"Org because you put anything else in the in the search engine they they hijack it and they try to get you into some other kind of website is just really bizarre time for our outrage how great outrageous of the day today president trump's nominee to oversee the department of veterans affairs the pentagon yesterday said it's quote insane then american civilian can by an ar fifteen assault rifle during a nomination hearing before the senate committee armed services dr dean wins slow the nominee to be the assistant secretary of defense for health affairs the he said basically that it was quote i'd also like to and i may get in trouble with other members of the committee just say how insane that is that in the united states of america civilian could go out and buy semi automatic assault rifle like an they are fifteen which apparently was the weapon that was used said dr winslow i think it's insane that anybody like this would be nominated for a position in a trump administration and i also goods insane that he used that reference against than they are fifteen ignoring that another aar fifteen we was used to stop the man who may have been insane and that is our outrage of the day just incredible i would say about a good friends at rescue natural supplements they've got incredible deals going on right now and again i want to tell you about the folks at rescue and of course if you look for the little true energy this fallen all you have to do is a month breaking leaves make it a tough for you to get those leaves done that for your work because the joint pain the stiffness in your joints at cetera then what you need to do is order your rescue glycol plus are other take it a now four we'll several years used recalled glycol marine it's now been reformulated knowledge to deeds green looked muscle and collagen and glycol plus a.
"health affairs" Discussed on POLITICO's Pulse Check
"Somewhat rightfully so i think the chip advocate sometimes get viewed as raising a five alarm fire over everything but i think this might be a legitimate concern that you know if if republicans do try to push this off that there's gonna be real impact on policy that states are going to have to start notifying enroll ease that the funding might run out they might lose her coverage so i think this is something to watch i haven't seen this happened before on a chip plan and it's usually very bipartisan in they're able to get it done even despite the care antics so that's something that i'm looking out for that'll um and i'll point to there was an article in the last issue of health affairs that studied cyncially this phenomenon of hospitals of buying or acquiring small physician practices and how it's something that's been kind of happening all throughout the country and it's it's essentially entity in less choice of hospitals are less choice the providers for patients and it's not really something that antitrust regulators can do anything about it now that's all kind of complicated and walk you the implication is when we get to a broader discussion on how to control costs within healthcare system there was a lot of allusion to that last hope hearing on how do we kind of tackled the broader rising costs of health care one of the issues is going to be looked at is the increasing lack of choice among providers in also the increasing lack of choice among insurers and and those are two aspects that if we ever get passed this vital rob obamacare are going to be kind of central to the ah the healthcare landscape.
"health affairs" Discussed on Freakonomics
"And that's really what got us thinking and that's what led to this study because you know you end up putting cardiovascular arrest and then it turns out what we put on the death certificates populate our countries national health statistics so when the government puts out every year these are the most common causes of death in the united states and by the way that list is a big deal that list informs all of our research funding it informs all of our public health campaigns in america that list is a big deal so you know you realize were miss classifying medical mistakes as other causes and that medical mistakes don't even show up on the list so macarry and colleagues got hold of a mountain of data and started digging while we basically looked at the best available research on the topic from the new england journal of medicine and health affairs and big medicare analysis and something called the aliji report it was a government report that was independent and would they find before i tell you that let me tell you this there is a famous report put out by the institute of medicine in 1999 that set a benchmark for death by medical air that report estimated there were between forty four thousand and ninety eight thousand deaths annually in the us due to medical air those are obviously large and frightening numbers so large and frightening but i've heard many many medical professionals insist those numbers had to be way too high so what number did macarry come up with.
"health affairs" Discussed on Vox's The Weeds
"Get fleshed out enough to become actual plans but i think you know now feels like an appropriate moment for thinking about will what comes next we have this like three year period where trump is going to be president of unless something happens and who knows what can happen ends in that period there's a lot of thinking on what is the structure like what does the healthcare system that we want to build actually look like an i i do see evidence of that kind of thinking happening i mean maybe i'm just oldfashioned but you know i remember in the in the early days of the the 21st century that it was you know a new america foundation i think first laid out an idea for mandatory health insurance with some kind of subsidization raid and that was building on work fitted come from the heritage foundation is a counterproposal to bill clinton's idea a cut knocked around in massachusetts that was a big job than health affairs article that jump gene lambro and a third co author whose name i'm forgetting did um but that was saying this is an actually what obama care wound up doing but it was basically the federal employee health benefits program should be extended with their version of of the exchanges and you know many of these people were elected officials but the ark of elected officials thinking like eventually bent toward these kind of plans that that experts had been outlining four years you know kind of like doing the work for some way to subsidize people getting into a private health insurance was the big idea whereas now i feel like the process has become.
"health affairs" Discussed on KPCC
"Who is also on my as it turns out and i have to studies in the journal health affairs which is the leading up reviewed health policy journal and the world in in the first of only took a look at the impact of medical marijuana laws on prescription use in medicare and what we found there was significant reductions at prescription use most notably among pain medications and the largest plurality of those would be would be opiates we regard this study for medicaid just this past month in health affairs and and again found large reductions and the use of prescription pain medications when states turned on a medical cannibus walls and and i would say we've done some additional work with our colleagues here at the university of georgia manned abraham and grace atoms looking at deaths and at the county level and when states turn on dispensary based medical cannabis laws we see significant reductions in opium lady a death in fact we estimate that in two thousand fourteen of all state attorney those on we would have saved almost two thousand lives that year so are you saying that if you make medical marijuana legal you could turn the tide an opiate that's what the estimates that we have with the paper that we just presented at an international health policy conference the a couple of months ago i would suggest that we are looking at reductions that are in the two to three percent range so this is there is no one silver bullet to the opioid crisis this is a crisis with with many routes to it but unfortunately with the introduction of factional and to the the black market knew that states it seems that the crisis is accelerating again so we absolutely need to use.