National News

Freakonomics and end-of-life health care

Marketplace - American Public Media - Tue, 2015-08-25 13:00

Stephen Dubner admits that he and the team behind Freakonomics Radio sometimes explore ideas most sane people would leave untouched. This time, Dubner decided to look at the economics of end-of-life health care.

It’s certainly a touchy subject, but also one that most families will have to face at some time in their lives.

Dubner poses the question: “What if someone was suffering from a terminal illness and they had the option of forgoing standard-end-of-life medical care, and instead they could get a cash medical rebate from their insurance companies?”

He’s calling the idea the Glorious Sunset Proposal, and the Freakonomics folks even made a fake commercial so you can hear how it might be pitched.

Dubner took the Glorious Sunsets Proposal and shopped it around to health care experts to see what they thought.

Health care economist Uwe Reinhardt wasn’t having it. Reinhardt says if he were an insurance company CEO, he wouldn’t offer a Glorious Sunsets option. As a health insurer, “your incentive is actually, in many ways, to increase health spending,” Reinhardt said.

When Dubner took the idea to doctor and bioethicist Zeke Emanuel, he wasn’t interested either.

“It’s so cold blooded, it’s so calculating, it’s so utilitarian that it’s not American,” Emanuel told Dubner.

Thomas Smith is an oncologist at Johns Hopkins. Dubner says Smith actually tried a Glorious Sunsets-like experiment years ago that gave cancer patients the option to forgo treatment and keep the money. But the experiment failed.

“Our patients were actually interested, but their doctor/providers weren’t,” Smith said. “It’s pretty hard to look at those two choices and decide what to do.”

It’s clear these three health care experts weren’t thrilled about the Glorious Sunsets Proposal. But Dubner says all three people — and more — that they spoke with did agree on one thing: “If anything in our health care system really needs to be revolutionized right now, it’s end-of-life treatment.”

But Dubner says, in the end, the economics are perhaps the least important factor. He points to what Zeke Emanuel had to say on the matter. “The health care system, instead of talking to a patient and getting it right, we sort of pound on their chest and try to resuscitate them, even when that may not be what they want,” Emanuel said. “And I think trying to get what patients want ought to be our primary focus." 

Dubner says doctors may soon pay more attention to what patients want. “The Centers for Medicare & Medicaid Services has just proposed a regulation that would actually finally pay doctors to do nothing more than have a conversation with patients about their impending death,” Dubner says.

Maybe it’s not Glorious Sunsets, but it’s “certainly a step in the right direction,” Dubner says. 

Click on the audio player above to hear the fake ad and the full interview.

Lebanon's Cabinet Rejects Bid That Might Have Eased Garbage Crisis

NPR News - Tue, 2015-08-25 13:00

Protesters from a group that's translated as either "You Stink" or "You Reek" criticized the bid for being too expensive and the government for being too corrupt.

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American Climber Confronts 'The Wall Of Death'

NPR News - Tue, 2015-08-25 12:56

Sasha DiGiulian is posting vertigo-inducing updates to social media as she tries to become the first woman to scale the north face of Eiger, an infamous Swiss peak.

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For Most Of Us, The "Real" Economy Matters More Than Markets

NPR News - Tue, 2015-08-25 12:52

Stock prices may be having a meltdown, but consumers and home buyers are still pushing the economy forward. In fact, a new round of data suggest the economy is gaining strength even as markets fall.

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Wildfire Smoke Becomes The Health Threat That Won't Go Away

NPR News - Tue, 2015-08-25 12:35

Cities and towns across the West are warning residents that high levels of smoke from forest fires threatens their health, with no sign of abating. That means indoor recess and no vacuuming.

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In Texas, a coal mine opens to power Mexico

Marketplace - American Public Media - Tue, 2015-08-25 12:29

The coal industry is struggling as cheaper and cleaner natural gas undercuts coal, and environmental regulations push utilities to shut down their older coal-burning plants.

Yet new coal mines open and others expand. In one Texas county on the Mexican border, local officials and residents seem nearly united in their opposition to a new coal strip mine, the Eagle Pass Mine. The company that owns it, Dos Republicas Coal Partnership, says it intends to ship out the first load of coal by train next month.

The Dos Republicas Coal Partnership owns the Eagle Pass Mine. 

Ingrid Lobet

Dos Republicas is backed, through layered ownership, by a major Mexican steel and coal firm, Altos Hornos de Mexico, S.A. All the coal from the Eagle Pass Mine is bound for Mexico. It will fire the Carbon I and II power plants half an hour south of the border in Nava, in the state of Coahuila.

“The excuse is that ‘we need energy,’” says Martha Bowles Baxter, a resident of Eagle Pass who opposes the mining plans. “Well, the energy is going to Mexico.”

It appears to be the first time a coal mine has been opened in the United States to serve a power plant in Latin America.

George Baxter, her husband and a civil engineer, says the smoke from the generating station in Mexico often drifts north to Eagle Pass.  

“You see the brown line, horizontal line of pollution," he says. "It extends as far as the eye can see.”

Now, he says, those results of burning coal will be added to the insults of mining it.

“Apparently the war on coal does not extend to Maverick County,” he says.

The Baxters’ chief preoccupations are widely shared. The local school district, city council and hospital officials oppose the mine. Many concerns focus on water. The Eagle Pass Mine intends to discharge into Elm Creek, which runs through the mine just before it joins the Rio Grande. Less than a mile downstream, the city of Eagle Pass takes its drinking water.

Elm Creek neighborhood residents fear that floods, like this one in 2013, will carry mine silt and waste from the Eagle Pass mine on either side of the creek. (Permission to reprint granted by Eagle Pass Business Journal)

Events in recent months have heightened a second water concern. The Eagle Pass area has had two 100-year floods in two years, according to David Saucedo, the Maverick County flood plain administrator.

“In 2013, we had 16 inches of rain in a 24-hour period," he says. "In 2014, we had 12 inches in a 24-hour period.”

One hundred and twenty houses were damaged or destroyed.

“You have seen these people go through these things," says Saucedo, who is also the Maverick County judge. "And on top of those floods, now you have to worry what is in the water? It weighs on you.”

The chance of two 100-year floods occurring back to back is one in 10,000. Texas mining regulations require that the ponds that collect heavy rains before they carry silt into the creek be dug deep enough to withstand just a 10-year flood.

Flood maps from the Federal Emergency Management Agency indicate an official flood zone along the creek where it runs through the mine, so Saucedo opposed the mine’s flood permit. The company sued him. A lower court judge agreed he acted within his authority and that case is at the state’s 13th Court of Appeals in Corpus Christi. 

In the course of those arguments, the mine has gone from paper to reality. Sixty million dollars worth of equipment has arrived at the site, hundreds of acres have been excavated and offices and parking lots for workers carved into the mesquite.  

Yet Martha Bowles Baxter believes another flood, this time carrying mud or mine waste, is inevitable, and that many homes will be in the path of the water. The local newspaper refers to the area directly adjoining the mine as “densely populated.”

 “When FEMA comes in, they are going to render all of that land completely contaminated," she says. "And those people are going to be losing all their homesteads, what they plan to give their children. And no one cares because this area is very, very poor and Hispanic."






Some residents of Eagle Pass, Texas, note that residents living near mines on the Mexican side of the border complain of soot and land settling, which causes cracks in dwellings. This banner, from Palaú, Coahuila, Mexico, accuses mine owners of assuring their own future at the expense of local children. Alonso Ancira (his last name is misspelled above) is a principal investor in the Mexican and the new Texas mines.      Rudy Rodriguez, who represents the mine owners, says not all of the mine area is in the flood plain, and engineered ponds at the mine will actually ameliorate flooding. The mine plan also complies with numerous agencies’ requirements and all state and federal law, he says.






Already, Rodriguez says, hard-hit Maverick County is benefiting from the tens of millions of dollars the mine has spent on equipment. At the mine, he points to a mechanic changing a tire on a truck so large it makes his Cadillac Escalade look like a Matchbox car. The tire alone cost $35,000, he says. Under the current footprint of the mine, which the owners seek to expand, it would inject more than $147 million into the local and regional economy.

By one measure, the project has been popular: It held a fair to connect with local vendors and would-be employees.

“We started at eight o’clock in the morning and went on in the evening,” Rodriguez says. “We had so many people want jobs — 680 applicants for 100 jobs.”

Saucedo says most of the town would rather see retail employment. Eight thousand people signed a petition against the coal mine, he says.

“To put that in perspective, you had 5,500 people come out to vote in the last election," he says. "Now, when you have more people signing a petition than going out to vote, that should send a message.” 

On Aug. 10, the U.S. Army Corps of Engineers held a hearing in Eagle Pass to gather public comment, following a request by Dos Republicas to add 25,000 acres of potential mine area to its existing 6,346 acres. According to the Eagle Pass Business Journal, all 28 people who testified, including Eagle Pass Mayor Ramsey English Cantú, spoke against the mine and its expansion.



The steel business is trying to stay strong

Marketplace - American Public Media - Tue, 2015-08-25 12:28

With the economy still recovering, and the chaos with the stock markets and China, business is tough in the U.S. Lisa Goldenberg, president of the Delaware Steel Company, says things “could always be better. We’re still in recovery period…. Recovery, good recovery, takes a long time, years, 10 years.”

In addition to that, Goldenberg has to keep her eye on the ups and downs happening in China.

“China is the largest steel producing market in the world, so you know I’m watching it every day,” she says. However, she says that the most recent upset with the yuan devaluation hasn’t directly hurt business.

What has hurt her business is the strong U.S. dollar. Goldenberg explains: “For my daily business, I’m a proponent of a much weaker dollar…. For my business, it rocks my world.” When the dollar is strong she has a tough time exporting anything. “I have zero business, not a little, zero when the dollar is strong.”

The strong dollar isn’t the only thing affecting business. There’s also the cost of shipping and freight.

“In the United States, there are so many other factors to shipping across this country than the cost of fuel," Goldenberg says. "We want our drivers to be insured, we want the roads to be safe, we want drivers to be certified and have proper resting times, and have weigh stations, and all the things we’re used to in a developed, sophisticated economy. And those things are very, very expensive.”

It’s hard to conduct business in this hectic economy when everyone is just trying to stay afloat. “It’s very, very stressful. It wears you down. And keeping your employees motivated, keeping their families safe and secure and confident is a full-time job. This economy is not for the faint of heart,” she says.

In The Search For The Perfect Sugar Substitute, Another Candidate Emerges

NPR News - Tue, 2015-08-25 12:22

There's a new contender in the century-old quest for perfect, guiltless sweetness: allulose. It's sugar — but in a form that our bodies don't convert into calories. Perfect? Not quite.

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Cattle Theft: An Old Crime On The Rise

NPR News - Tue, 2015-08-25 12:04

Cattle rustling is a growing problem in Oklahoma, Texas and other beef-producing states. High beef prices and drug addiction are fueling the resurgence.

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You have to give him a hand

Marketplace - American Public Media - Tue, 2015-08-25 11:45
2 days

That's the amount of time it takes to make parts for an award-winning robotic hand on a 3-D printer, the BBC reports. Joel Gibbard of Open Bionics says he can use a sensor on his tablet to size an amputee in minutes, print the parts in about 40 hours and fit them together in two hours. The prototype earned Gibbard the James Dyson engineering award, which carries a $3,500 prize and the chance to win the $45,000 international title.

10 percent

That's how much Netflix stock rebounded on Tuesday, the day after Black Monday — or should we call it Black Friday? Much like that busy holiday shopping day, buyers took advantage of sale-priced high-end tech stocks like Netflix, Apple, Google and Facebook, writes Molly Wood. But the bargains are fading as the global markets began the climb up again.


That's the number of years Carlos Valdez has spent in the same northeast Los Angeles neighborhood. "I'm Highland Park for life,” says Valdez, an entrepreneur who built a computer repair business there. But investors were buying the old brick buildings in the area, rehabbing them and raising the rent. Like so many of his neighbors, Valdez was nearly priced out of his home and business. His story is part of our York & Fig project on gentrification.


That's the number of times China's central bank has cut its interest rates since November. It's been the go-to strategy when the Shanghai Composite Index has dropped, as it did Tuesday by 7 percent. Rob Schmitz, Marketplace's China correspondent in Shanghai, says the central bank "would've saved everyone billions of dollars" if it had made that signature move three days ago. If lowering interest rates "had worked the first time, they wouldn't have had to keep doing it," he says. 

Trump Ires Ailes With New Tweets Attacking Megyn Kelly

NPR News - Tue, 2015-08-25 11:26

"I liked The Kelly File much better without" Megyn Kelly on it, Trump said in one tweet. "Perhaps she could take another eleven day unscheduled vacation!"

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PODCAST: Looking for a rebound

Marketplace - American Public Media - Tue, 2015-08-25 11:09

China tries to take control of its economy, looking for a rebound after Black Monday, and how Chicago's "zombie homes" got that way. 

Texas Set To Execute Nicaraguan National, Despite Legal Controversy

NPR News - Tue, 2015-08-25 10:55

Bernardo Tecero was convicted of killing a Texas school teacher. Supporters say he should not be executed because he wasn't informed of his right to contact a consular official.

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China's Financial Capital Tries To Become A Cultural Capital

NPR News - Tue, 2015-08-25 10:50

Private museums are sprouting up along Shanghai's river bank. The city that lures people seeking their fortune is also attempting to become a destination for art.

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Bicycling In India Has Its Risks (Cow Ahead!) And Its Rewards

NPR News - Tue, 2015-08-25 10:33

Especially when it comes to repairs. You don't have to make an appointment to see a mechanic. You don't have to wait a week for the work to be done. And the price is definitely right.

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Parisians On Hunt For Baguettes As Bakers Get Nod To Take Vacation

NPR News - Tue, 2015-08-25 10:19

An arcane law required bakers to tell city hall when they wanted to close up shop. Now that it's been scrapped, bakers can close any time, leaving Parisians hungry for good bread amid summer holidays.

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Stephen Hawking: Black Holes 'Are Not The Eternal Prisons' We Once Thought

NPR News - Tue, 2015-08-25 10:13

The world's most famous physicist unveiled a novel idea that he says solves the mystery of the information paradox. Essentially, he explained, information can escape a black hole.

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Biden's Path: Time Is Not Exactly On His Side

NPR News - Tue, 2015-08-25 09:54

History hasn't been kind to late presidential entrants. But with the vice president's name ID and position, his campaign could break the mold and challenge and sharpen Hillary Clinton.

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Not Over 'Til It's Over: Runner's Early Celebration Costs Her The Bronze

NPR News - Tue, 2015-08-25 08:43

American distance runner Molly Huddle is the latest athlete to learn the hard way about premature victory celebrations.

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Why Your Doctor Won't Friend You On Facebook

NPR News - Tue, 2015-08-25 08:35

Public professional Facebook pages focused on medicine are catching on. But doctors aren't ready to share vacation photos and other more intimate details with their patients.

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