#spent last 420 in the hospital and now this
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kwonhoshi0 · 4 years ago
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𝐢𝐜𝐢𝐜𝐥𝐞 𝐜𝐥𝐚𝐰𝐬 | chapter eight : you’re fucking strong
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pairing : todoroki x cat hybrid!reader
genre : fluff, crack, angst
warnings : blood, injuries, gore?, spoilers for end of season 1
disclaimer : for anyone who hasn’t seen the whole show, this attack in this chapter is made up so don’t worry about that
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you had been separated by yourself, another attack but you couldn’t rely on any but yourself right now, before you could think about going to find the others you heard a loud thud behind you and running towards you was shigaraki, quickly dodging his hand you let your claws out, clawing his waist as he turned to you again, you tried dodging his hand again but he wasn’t going for your face, he went for your hair, instead of turning your hair to dust he put his other hand on your elbow exactly like he did to aizawa at the USJ making you scream in pain as part of your elbow crumbled, yelping back he sniggered turning to kurogiri ‘this brat is from the USJ, stupid child should’ve dropped out when she had the chance’ you jumped up latching onto the mental bar above so he couldn’t reach you, even in your human form you could use some of your cat like skills.
running along the metal bar you felt the metal shaking beneath you looking behind quickly one of the nomus shigaraki brought was snapping it making you fall to the ground but you swiftly landed, before you were able to run again you were transported by a warp gate to where shigaraki was again, ‘what are you gaining from doing this!’ you yelled, he grinned ‘well if i kill a student from UA, the entire school will be shut down no? and if the schools shut down that means less annoying heroes and everything will collapse around me’, you tried to claw him again backing away but behind you was a nomu and kurogiri could easily warp you back to them, you were stuck. that was when it hit you, you had an idea, a risky one but it was an idea nonetheless.
swinging onto the half broken metal bar you aimed at shigaraki, swinging straight at him you quickly released and switched into your cat form, clawing deep into his shoulder making him yell out, before he could instruct nomu or kurogiri to do anything you switched back into your human form and kicked kurogiris metal body making him groan out and you ran as fast as you could for the entrance.
you ran thinking you could make it, you saw todoroki slowing down seeing him ‘SHOTO!’ he turned to you after freezing the last thug he was facing ‘y/n are you oka- Y/N MOVE OUT OF THE WAY’ you turned to see a nomu heading straight for you, it’s speed was incredible and way too fast for you to move, it grabbed you by the neck pushing you into the ground and breaking your leg with a swift stomp, you screamed a bloodcurdling scream, you couldn’t move, trying to move even a little bit to get out, you managed to to get out your claws sinking them deep into the nomus arm, it flinched in pain but didn’t make a noise, ‘smash her ribs in nomu’, your eyes widened seeing todoroki attempting to freeze the nomu, he froze it only for a second until it smashed out, after it got out of the ice it followed shigarakis instructions making everything go black.
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you woke up and looked around you, a peaceful todoroki, bakugou and denki were sleeping on some chairs next to you. not wanting to wake them up you attempted to sit up but groaning out in pain in the process, mina and kirishima walked in as you winced. ‘y/n!!’ they both squealed running over to you, mina put down the coffee they had got for the others and hugged you gently as kirishima waited for his turn. they woke up the boys in the process, ‘y/n i’m so glad you’re awake’ todoroki smiled sadly, ‘Y/N I SWEAR TO FUCK’ bakugou sat on the bed bringing his hands to your face cupping it, ‘DONT EVER FUCKING DO THAT AGAIN OR ILL KILL YOU MYSELF’ he said making you grin ‘not if i die before you can get to me loser’ he smirked at your response pretending to be angry ‘don’t say shit like that, fucking idiot’ todoroki watched bakugou like a hawk it was quite scary actually, you spent a couple hours in the hospital talking to your friends before getting discharged.
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taglist :
@blazedbakugou @theblueslytherin @reina-de-tay @cathwritestragediesnotsins @mybigredclifforddick @kyomihann @420-uwu @applekenm @xxoperatexx @h0tgluegun @chwlogy @todoroki-shoto-is-life @acenoor @awkwardangelthings @adorablepandasuniverse @g0niki
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A/N :
WHEWWWW we’re nearing the end 🥵
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Premier League Football - Chelsea XI, the highest goal scorer ever
Chelsea Football Club is one of the best clubs over the most recent twenty years. Many will rush to guide hands toward Russian extremely rich person Roman Abramovich as the purpose for these accomplishments, and they wouldn't be completely off-base.
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Since Abramovich welcomed his involved business way to deal with Stamford Bridge, the Blues have become stronger to strength. They have won 20 prizes since the Russian oligarch purchased the club in 2003. However, the Chelsea football club outfit before Abramovich came on board wasn't doing enormously by the same token. Indeed, there were monetary restrictions and credits, yet on the field, the Blues were sensibly solid.
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After fierce seasons during the 70s and 80s, the club's exhibitions on the contribute balanced out the 90s under past proprietor Ken Bates. In the decade before the turn of the thousand years, the Chelsea football club overwhelmed the world, winning six prizes locally and continentally. Indeed, even before the 70s, the Blues won the First Division title, the FA Cup, and the Community Shield.
A portion of the players highlighted on this rundown have gone under Abramovich's period. Be that as it may, there are not many whose goalscoring records in their positions have not been contacted in many years. Moving right along, we should check out the top unequaled goal scorers in each position in Chelsea's 4-3-3 development, beginning with Petr Cech.
Goalkeeper: Petr Cech - 0 goals
While numerous goalies have had the advantage of scoring a goal for their club, no Chelsea goalkeeper has ever so. Presently a specialized and execution guide for Chelsea, Petr Cech is a Blues legend. Joining the Blues in 2004, soon after Abramovich took the rules, the Czech would proceed to arrive at 100 clean sheets in only 180 appearances.
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Cech has won the Premier League Golden Glove multiple times with Chelsea. He likewise helped the club with consecutive Premier League football wins, in the long run finishing up his Chelsea playing vocation with more than 10 prizes.
Left-back: Tommy Law - 19 goals
He wasn't by and large known for the rankling pace or the swank speed increases that most full-backs have in plenitude nowadays. Tommy Law was very talented at punishments. Truth be told, the majority of his 19 goals scored for Chelsea in 318 appearances came from punishments.
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Protecting was Law's solid suit. He was an effective interceptor of the ball and had extraordinary positional mindfulness during guarded plays. His appropriation from the left-back position was heavenly and fundamental for Chelsea football club in the 14 years he spent at the club.
Center-back: John Terry - 67 goals
One of the most famous and productive captains of the Blues, John Terry's 19-year spell at Chelsea saw him score 67 goals. This is the most noteworthy for any Chelsea defender ever. Having begun his expert profession with the club in 1998, Terry drove Chelsea to 14 prizes. This incorporates a Champions League title and a Europa League title.
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Known for his physical and directing presence at the back, Terry's ability noticeable all around helped score from set-pieces. While he was less light-footed than others, his authority, handling abilities, and assurance made him a splendid protector in general.
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Center-back: David Webb - 33 goals
Joining Chelsea in 1968, the star defender proceeded to show up for the club, scoring 33 goals. He is generally remarkable for scoring the triumphant goal for the Blues in the FA Cup last of 1970, where he's heading abilities proved to be useful during an additional time corner. That was Chelsea's very first FA Cup win.
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All through his Blues vocation, Webb was a utility player who could play in virtually every position, and he for the most part gave cover somewhere else. Strangely, he once played as a goalkeeper against Ipswich in 1971, and Chelsea finished the game with a spotless sheet.
Right-back: Peter Sillett - 34 goals
Beginning his Chelsea profession, a couple of years after World War II, Sillett bloomed on the right flank. He in the long run held the record for most noteworthy scoring Chelsea football club defender until John Terry surpassed him numerous many years after the fact. Noted for his talented passing and cautious commitments, it was Sillett's incredible shot-taking that took the features.
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Sillett showed up during his nine-year spell with the club, and he strikingly won the First Division title and the FA Charity Shield.
Central midfielder: Frank Lampard - 211 goals
Beginning his vocation with the Blues in 2001, the previous Chelsea chief immediately turned into a fan top choice because of his strategic knowledge, passing reach, and goalscoring capacities. Seen as the main impetus of the Blues midfield for almost 13 years, Lampard turned into the most noteworthy scoring midfielder in Premier League football history.
The star showed up for Chelsea, scoring 211 goals and winning 13 prizes with the club. He was outstandingly the sprinter up to the Ballon d'Or and the FIFA World Player of the Year in 2005.
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Central midfielder: Tommy Baldwin - 92 goals
Going through 8 years of his profession at Stamford Bridge, Baldwin became one of Chelsea's most renowned players in the last part of the 60s and mid-70s. Even though he was regularly used to cover in assaulting positions, he played as a midfielder for the greater part of his vocation. In only 239 appearances for the club, he scored 92 goals, remarkably scoring on his introduction against Manchester City.
Central midfielder: Dennis Wise - 76 goals
Beginning his famous Chelsea vocation in 1990, Dennis Wise turned into a Chelsea legend in the wake of playing 445 games. He helped the side to six prizes, including a UEFA Cup Winners' Cup, a UEFA Super Cup, and two FA Cups. Cast a ballot Chelsea's player of the year twice, Wise was a cutthroat, splendid goal scorer with amazing passing reach.
He was generally entangled in contentions, which left him regularly suspended and shown red cards. In any case, Wise stayed a motivational player for the side. He drove the midfield through one of Chelsea's best a long time in football.
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Left-wing forward: Bobby Tambling - 202 goals
Before Lampard overwhelmed his record as the most noteworthy unequaled goal scorer for the Blues, Bobby Tambling held that record for more than forty years. His complete of 202 goals for Chelsea was an incredible accomplishment and it as of now puts the productive goal scorer in the second situation on the untouched rundown.
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Joining Stamford Bridge in his childhood, Tambling began his expert profession in 1957 and played 370 games in the 13 years before his retirement. He prominently helped Chelsea to a League Cup win in 1965.
Centre forward: Didier Drogba - 164 goals
Joining the club in 2004, the previous Ivorian global drove Chelsea through a splendid time of accomplishment for eight seasons. Drogba's actual qualities lay in the most significant games, similar to cup finals, where he would quite often score for Chelsea football club. Outstandingly, Drogba has scored in four separate FA Cup finals. Clinical, pacey ready, and solid noticeable all around, the Chelsea legend was the ideal goal man in the club's positions for almost 10 years.
Didier Drogba holds the record as the most elevated unfamiliar goal scorer in the club's set of experiences, and he once completed a season with 37 goals. Drogba got back to Chelsea in 2014, adding to a Premier League title and a League Cup win.
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Right-wing forward: Kerry Dixon - 193 goals
An expert goal scorer and a splendid aggressor, Dixon turned into a legend even before he left the club following nine years. He was the primary player to approach Bobby Tambling's unequaled goal scorer record before Lampard surpassed them both. Playing 420 games for the club since his introduction in 1983, Dixon scored 193 goals.
He helped his side to advancement from the Second Division, scoring support on his introduction against Derby County. Even though he didn't win any major prizes with the club, he in the end directed his side to a decent situation in the First Division.
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wildwonderer93 · 5 years ago
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9 things I implore you to consider before going to work at a lodge
In 2015 I was bright eyed, and bushy tailed at the prospect of working in the bushveld.  I was wooed by the stories I researched, the photos I saw and the thought of being close to nature. Little did I know what I was letting myself in for.
 Hospitality in the bush can be incredibly rewarding in its own ways, but it is a HARD life and not meant for everyone. I spend 5 years in the bush in lodges and “animal rehabilitation centers” – boy has this time changed my life as well as my opinion dramatically!
1.       Its never what it seems
My first job in the bush was a very well known “rehabilitation center”. I studied wildlife management and thought this would be my big break, the one I have been waiting for years. It looked incredible from the outside until I got into the working side of things. Animals were being bred for financial gain, moved between the center and the owner’s home at their will for their pleasure, meat being minced to feed them more economically. It was devastating. I spent two months in their butchery cutting up meat and wrapping animals they had allowed to die just to be stuffed and put on display in their museum. DO NOT be fooled by the social media, do your own research with the people who work there, or better yet worked there, to find out what really goes on.
I almost came back to my hometown and gave up on the whole adventure because of this place.
2.       Loneliness
Nothing can describe the black hole of loneliness you feel when moving to a new city and environment without people to support you. If you go alone, like I did, it can be almost impossible to push through and stay when everything in you is shouting to give up. It can be hard getting a new group of friends in the bush especially since you cannot really trust anyone, someone is always out to take your job or get you fired, leak your secrets etc. So you have to be incredibly cautious when choosing who to associate with at your workplace. It could cost you your job. This mentality might cause the worst loneliness you might feel but it will protect your reputation and job. After all you are going to work not to make friends. Being so far away from home and often working 3-6 weeks at once means you loose touch with friends and family – by the time you have leave (which could be cancelled at any minute without notice – regular hospitality thing) your friends have either grown apart from you or are busy, away, married, on vaycay you name it. You will lose the majority of your friend circle, be prepared.
3.       No pets
As mentioned above, it can be incredibly lonely. To make it worse you can never, ever have a household pet when working at a lodge or on a reserve. Most places have strict rules against pets as they can infect the wildlife with all sorts of horrible diseases. Some places allow you to foster a wild animal, if you find them helpless, but that wont last long. Not only is it cruel to keep a wild animal as a pet, this animal also has instincts that needs to develop with you cannot do for it and you also wont be able to move this animal to any other place, you are basically stuck at this place until you release it or it dies. So get use to the loneliness. We recently adopted our first puppy since we came back to the city, the joy this little guy brings us is indescribable, you will miss the unconditional love of an animal.
4.       Everyone is in everyone’s business – #DRAMA
If you do not know this yet, surprise! When you work at a lodge you live with the people you work with. This can be nice at times, but mostly is not. If you hook up with someone, everyone knows. There is no secrecy, everyone talks about everyone and they will all pretend to be nice to your face and speak about you behind your back. I thought the city was bitchy until I got to the bush…You cannot do or say anything without the whole lodge knowing, and information travels like wildfire. Get ready for your every move to be on the tips of every co-worker’s tongue.
5.       Long hard hours
You think you know what it means to work hard? You have not worked for a lodge yet then. Overtime is worked into most contracts and is deemed COMPULSORY. Working 10-16 hours a day for 6 weeks straight is normal. Working from 6am-4pm and coming back at 6pm till 12pm is normal. Also, you do not only do what you were appointed to do, you do what you are asked as the extra mile is EXPECTED not rewarded. Example – I was a administrative manager – I’ve made beds, washed dished, served food and drinks, cleaned rooms, cleaned pools, washed floors, did photoshoots, social media post, compaction writing and blog posts…none of that in my job scope, but if you want to be there you will do it. Also, you are very easily replaceable so do not think if you do not want to go the extra mile that they will not find a way to fire you (or make you leave on your own).
6.       Shitty accommodation
Okay so obviously you are not going to work in the bush to live in a 5-star villa, but it can be messy and sometimes a health risk. The first place I stayed in had a problem with bats in the roof, it was sinking in and breaking apart there was so much guano in the roof – its been 5 years, multiple people have gotten sick and still they haven’t fixed the roof. Another place I stayed at had literally no curtains or railings or even a toilet roll holder. It was basic. I am not moaning about the type of accommodation, usually a small room with a kitchenette and if you are lucky your own bathroom, I am moaning about the run down and unhygienic conditions of most staff accommodations. When you go for your interview ask to see the room you will be living it, trust me.  
7.       Do your own research, get your own facts
Every place can appear magical, beautiful, caring and just incredible through their social media pages and websites, but that is not really what you want to know when going to work at a lodge. What you want to know is the truth. Go onto Linkedin or Facebook and find people who work there or have worked there, yes maybe a little unconventional and stalkerish, but it is the best way to understand the workings and environment of the place. Talk to them and ask your questions. When you go for your interview pay attention to what is happening around you and feel the vibe. They will try and sway you with pretty words an promises but you wont know if it is right for you until you do your own research.
8.       Remoteness
Do you remember going to get an ice-cream when you were craving one? Decide to make pasta but you need some mince? Milk run out??? Well say goodbye to convenience. Cravings are so inconvenient that you most often change yourself just to get over them. Most lodges are in reserves about an hour away from the nearest shop. And trust me driving a two hour round trip is not worth your packet of sweeties. You will stop drinking milk for a week when you run out. You cannot go for a drink with anyone because you must drive an hour to get home or the reserve gates close. Say goodbye to most of your regular social activities – you will now unwillingly become the person who stays at home for a braai with your colleagues. Also, it is really difficult to find fro-yo in the bush!
9.       Human dignity
Of all the things I mentioned above, this must be the most important.
Never in my life did I think I would allow myself to be so disrespected and broken down for a job. Your human dignity goes down the gutter when you go into hospitality and it is best to expect it than to just blindly accept it. Prepare yourself.
I have been screamed at, sworn at, thrown with food and items, pushed around, my character attacked – and not once did any of my managers defend or protect me. Why? Because the customer is always right and if you work at a lodge you better be ready to accept that regardless of how the guest acts. You will be broken down, disrespected, and torn apart by the worst people while you just must stand there and take it. This is the main reason I will never go back to hospitality; my human dignity is much more important than a pay check.  Yes, people are rude and disrespectful all over the world, but I strongly believe people in hospitality, especially waiters, get treated like they are not humans beyond employees of the place they are staying at. You will not be thanked or rewarded for dedication and hard work; it is expected of you as an employee.
 Now, I have mentioned quite a lot of horrible factors of working in the bush. They are not all as bad as they seem. I for one enjoy being on my own and keeping to myself, and if it were not for the lodges, I would never have met my husband. But you need to be realistic about every factor when you make the decision to move to the bush, the good and the bad.
 I spent little over 5 years in the bush, I have seen some amazing things, experienced some amazing things that I never would have if I did not take this leap of faith. But now I am drained. 260 weeks of work for 60 weeks of leave. 1820 days of work for 420 days of leave. That is 80% work, 20% leave. Whereas in a normal 9-5 jobs its 65% work, 35% leave. ¾ of the last 5 years was devoured by work, which is unhealthy and unsustainable.
If you love wildlife and the bush I will no doubt encourage you to give this a go but remember you cannot go on like this forever. You and your body will get tired and if you are not careful you will go into autopilot and quickly realize you have been in the same place for the last 10 years, going nowhere.  
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dailykhaleej · 5 years ago
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Meet the students finally taking a flight home to the UAE on June 1
Alvira Khan together with her mother and father Picture Credit score: Provided
Dubai: Following the announcement by the UAE that as of June 1, stranded expats may return home, Indian expat Mohammed Azad is one excited father. His daughter Albira Khan will arrive home on the first flight carrying stranded UAE expats again to the emirates.
Albira is booked on the Emirates flight from London on June 1. A second yr scholar in College of Kent, UK, Albira was scheduled to fly to the UAE on March 19, the day the UAE suspended passenger flights.
“The last two and half months was very stressful since most of her friends and college mates had left the university,” mentioned her father. “But all’s well that ends well and we are just glad she is coming back.”
One other UAE expat and scholar, Gautam Agarwal, 19, a third yr under-graduate in physics from Imperial Faculty, London is scheduled to fly home on June 7. He too like Albira has obtained an approval from the ICA to return to UAE.
“After 70 days of despair, innumerable applications for his return, calls to authorities, we finally got ICA approval on May 31 morning,” his mom Monika mentioned.
“We are glad we are past the first hurdle now and overjoyed, quite literally. In fact, we wanted to scream from the rooftop! He was taking care of himself but at the end of day, he is just another 19-year old kid, living on his own, away from family and in the middle of a pandemic. The uncertainty about returning was the hardest to manage,” she mentioned.
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Dhanrudh Venkat Picture Credit score: Provided
Dhanrudh Venkat, a second yr scholar in the College of Washington Seattle, can be coming subsequent week. A former scholar of Cambridge Excessive College Abu Dhabi, Dhanrudh is due to return on June 4 on Emirates flight to Dubai. Talking to DailyKhaleej, his father Venkataraman Durairaja who has lived in Dubai since 2003 mentioned the household is elated their youngster is coming home.
“My wife spent many a sleepless nights worrying about the safety of our son. Now she is relaxed and happy. We have booked his flight from Chicago on June 4. He will fly from Seattle to Chicago in order to catch his flight to Dubai,” mentioned Venkataraman.
Whereas these mother and father are fortunate to get their kids again home some others aren’t so fortunate. In truth, over 420 mother and father, long-term residents of UAE, have come collectively to assist one another to assist carry their kids finding out overseas again home.
Sheethal Vaidya who began the group has compiled a record of students dwelling away from UAE and sharing the similar with authorities authorities to carry their kids home.
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Zahra Khosavi Picture Credit score: Provided
Dr. Abbas Khosravi, Iranian ICU specialist and workforce chief of COVID-19 remedy at a personal hospital in Dubai mentioned he and his spouse are anxious to get their daughter again home. His daughter Zahra is a first yr medical scholar in Eire. “My daughter’s residency visa was valid until 2021 but I cancelled it after I joined a new hospital. Unfortunately I could not get her new residence visa done owing to the pandemic situation in the country. Now like other students, she too is without a residency visa.”
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Ayesha Azhar with mum Snober Salim Picture Credit score: Provided
Pakistani mom Snober Salim can be pleading for her daughter Ayesha Azhar who’s finding out in London to return quickly. “I am a single mother, raised in the UAE. My daughter’s visa was cancelled due to technical reasons as there was a sponsorship change in my residency permit. My daughter has been in isolation and has been struggling with it.” “Her friends, room-mates have all left. I am afraid she is falling into depression and becoming very irritable.”
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simonsperalta · 8 years ago
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100 questions
100 Questions
1.    Are you young at heart, or an old soul? middle 
2.    What makes someone a best friend? Funny, caring, someone who makes you happy  and good taste in things 
3.    What Christmas (or Hanukkah) present do you remember the most? Xbox 360 
4.    Tell me about a movie/song/tv show/play/book that has changed your life. . Ghostbusters(2016) and Scream tv cause they have shown me how fuckin gay as fuck i am  
5.    Name one physical feature that you like about yourself, and one you dislike. Eyes and weight 
6.    Would you like to reconnect with any friends you’ve lost contact with? yes 
7.    What’s more important in a relationship: physical attraction or emotional connection? . emotional 
8.    Name a movie that you knew would be terrible just from reading the title. Justin Bieber : Never Say Never 
9.    What holiday do you most look forward to? . Halloween
10.  How is the relationship between you and your parents? My dad can be a dick and unsupportive but he tries 
11.  You’ve got the TV on, but you’re not really watching. What channel is the TV on? Sports
12.  Name a song that never fails to make you happy.  Debarge -Rhythm of the night (Im trash )
13.  You know at least one person named Michael. Tell me about him. Curly haired and knew him in year 8 
14.  Have you ever read the “missed connections” on Craigslist? Have you ever posted one, or wanted to?   ???
15.  If you could pick anywhere to live the rest of your life, where would it be? JAPAN 
16.  Can money buy happiness? Nope but it can buy food and does that count
17.  Do you drink? Smoke? Do drugsWhy, or why not? nope because 420 no blaze it 
18.  Is there anyone close to you that you know you can’t trust? You don’t have to give names. .   Yes 
19.  Where was your favorite place to go when you were a little kid?  BREWSTER FUCKIN BEARS 
20.  Have you ever spent a night in the hospital? . nearly 
21.  Do you enjoy being with only one or two friends, or with a large group of people?  one or two 
22.  Do you like the type of music your parents listen to? Do your parents like the type of music you listen to?    meh and nope
23.  Have you ever been bullied? Yes 
24.  If you could only eat one thing for the rest of your life, what would it be? chicken  
25.  If your partner wanted to wait until marriage before having sex, would you stay in that relationship? yes 
26.  Do you believe in a god? nope tbh 
27.  Of all the social networks in the world, why use Tumblr? because its fun as shit 
28.  What’s your favorite Tumblr tag to track? #HOLTZMANN
29.  Would you call yourself/your family “middle class?” Mehhh
30.  Name a TV series you didn’t enjoy until after it ended.    Telletubbies, that shit scared me  
31.  Have you ever bought a product from an infomercial? nope
32.  If you could give up your car and never have to drive again, would you? nah  
33.  If you go back to one point in time to give advice to yourself, when would you go and what would you say? back to the end of 2015 and tell myself to not run into that wall 
34.  What’s your “quirkiest” habit? a few 
35.  What is “normal?” Are you normal? nope lmao 
36.  Someone close to you is dying. You have the choice to let this person live for 10 more years, but if you do, you cause the death of 10 strangers. You don’t have to see them die. Do you take the offer? Yes because I cant afford to lose another family member, plus those 10 people could be evil and plus many people are dying in a second anyway 
37.  What is one thing you could never forgive? A person 
38.  Would you rather be in a relationship after the honeymoon period ends, or be single? relationship 
39.  Is it possible for guys and girls to be just friends? yes 
40.  Where do you and your friends go to hang out? i stay at home alone so lmao 
41.  Write the first paragraph of your obituary.  This person was in love with many things and the poor bastard could never get a date rip  
42.  What is the best TV theme song ever?  HERE I AM ONCE AGAIN FEELING LOST BUT NOW AND THEN I BREATHE IT IN TO LET IT GO AND YOU DONT KNOW WHERE YOU ARE NOW 
43.  When you were young, what would you dream you would be when you grew up? A juggler 
44.  When you’re alone in your own home, do you walk around naked? fuck no 
45.  What gets you out of bed in the morning? food 
46.  Do you want to have more friends than you have right now? no 
47.  What part of the past year sticks out in your mind? February 
48.  You win a scratch-off lottery game that gives you $2000 a week (after taxes) for the rest of your life. Do you keep your job? yes EXTRA MONEY BOIISS 
49.  Could you be in a long-distance relationship? If you’re in one, what makes yours work? I think so 
50.  What’s the best route to your heart? . kindness 
51.  Have you ever met someone through the internet, then met them in real life?. No unfortunately 
52.  What is your favorite sport? ping pong ;lol 
53.  What has been troubling you lately? . my problems ahahah 
54.  Did you enjoy your high school prom? not been yet 
55.   What do you use more often: your intuition or logical reasoning? logical 
56.   Do you know what makes you happy?  Ahemm..... kate mckinnon and bex taylor-klaus 
57.  Tell me about the last book you read. SERIAL KILLERS 
58.  What is the nicest compliment you’ve ever been given? hair looks nice 
59.  Who was your first crush? Either Misty from Pokemon or the blonde cheetah girl 
60.  Do you believe that there is life on other planets? probso 
61.   Predict what your life will look like a year from now. dissapointing 
62.  Often, people will ask how your last relationship ended. I want to know how it began. lmao ive never been in one 
63.  Where is your favorite place to go out and eat?  mcdonaaaaaaaaaaaaalds
64.  What is something you want to change about your current situation? Singleness lmao
65.  Early bird or night owl? night owl m8 
66.  Are there any childhood possessions you still hold on to? idk
67.   Give me an unpopular opinion you have. . i dont like naudrey 
68.  What was the last song that was stuck in your head? Blue Ocean Floor - Justin Timberlake 
69.   Where do you live? YORKSHIRE 
70.  Do you believe in giving kids medals and trophies for participation? Mhm 
71.  What was the longest car ride you’ve ever taken? to bognor reigis 
72.  Have you ever taken part in a protest? not yet  
73.  Would you ever use an online dating service? merh 
74.  What is your ethnic heritage? Atheist 
75.  Describe a person that inspires you. Many people 
76.  If you earn minimum wage doing what you love, would you? Sure 
77.  Do you believe in luck? meh 
78.  Describe the last time you were very angry at someone. When they said I dont resemble Pidge smh 
79.  Do you want to live until you’re 100? kinda 
80.  Do people change? If so, how do you keep a relationship together when both of you start to change? no idea
81.  Have you ever risked a friendship by telling someone you liked them? yes 
82.  Would you rather be alone doing something you enjoy, or doing something you don’t like with your best friends? enjoy 
83.  Do you practice what you preach? nope 
84.  If you take precautions to stay safe, do you ultimately act more recklessly? yes 
85.  What do you value more in a significant other: Attractiveness or intelligence? .intelligence 
86.  Are you hard-headed? idk 
87.  Have you ever laughed uncontrollably when it was socially inappropriate? yup 
88.  When have you felt most alive? when i was born 
89.  Would you prefer to live? A city? The suburbs? The countryside? The mountains? mountains
90.  Do you often skip breakfast? yes 
91.  How do you know what true love is? tbh no 
92.  Would you want to know the exact date and time you were going to die? no 
93.  Where is “home” for you? my room 
94.   What song best describes your life right now?  any depressing one lmao 
95.  Do you want to be perfect?  What have you never tried, but would really like to someday? nope 
96.  What’s holding you back? bed 
97.  How do you express your creativity? . no idea 
98.  Describe your neighborhood. smells of weed and cow shit 
99.  Name something you only liked because it was popular.  Call of duty 
100.   Give me the story of your life in six words. Single, obsessing, tubby, sad, boring, gay 
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blockheadbrands · 5 years ago
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COVID-19: How cannabis companies are helping in the crisis
David Downs of Leafly Reports:
During World War II, America crushed fascism by repurposing automobile factories into making fighters and bombers.
In today’s war on COVID-19, America’s $10.73 billion legal marijuana sector is rapidly redeploying assets to help fight SARS-CoV-2, with the goal of saving as many lives as possible. Legal cannabis makers have begun repurposing hash supply chains for hand sanitizer. Marijuana farmers are donating pest control gowns to desperate hospitals. And once-derided ‘pot shops’ are running food drives to keep America’s most vulnerable fed.
From hash to hand sanitizer
Healthcare workers nationwide have spent a month begging the public for more personal protective equipment—latex gloves, respirators, goggles, face shields, gowns, and disinfectants. Hundreds of thousands of lives are on the line if healthcare collapses under a wave of COVID cases.
Cannabis employs 243,700 Americans, many of them deemed “essential” and exempt from stay-at-home orders. They’re handling double the usual retail orders, and maintaining the weed supply chain, while also pitching into their communities.
In Santa Rosa, CA, about 5,000, 1-ounce tubes of hand sanitizer went out to Bay Area hospitals and police departments March 28, with another 20,000 on the way, courtesy of leading extract maker Care By Design.
Known statewide for the THC gel caps, tinctures, and vape pens, Care By Design converted a portion of their manufacturing space and production capacity to formulate and package up some COVID-killing gel. Hand sanitizer is back-ordered for weeks on Amazon.
Jim Hourigan, CEO of Care By Design’s parent company CannaCraft, said “when we started hearing reports of a shortage in hand sanitizer, we knew that we could be of assistance without negatively impacting our employees or our operations.”
CannaCraft founder Dennis Hunter told Leafly that ingredients and packaging once used to make cannabis extracts and skin creams are now keeping cops and nurses safe at work.
Earlier this month CannaCraft called upon three staff chemists to compound ethanol and other medical-grade alcohol with 55-gallon drums of aloe vera—both of which CannaCraft had at the plant. Their on-site lab verified the compound’s strength against SARS-CoV-2, according to FDA guidance documents. CannaCraft then repurposed unused topicals packaging, industrial bottle-filling machines, and label makers to mass-produce the needed supplies.
CannaCraft had planned to release the initial 40-gallon, 5,000-tube run of hand sanitizer to cannabis stores and delivery services. But a local newspaper story drew the attention of nearby nurses and cops. On March 26, CannaCraft loaded cases of Care By Design hand sanitizer into a Santa Rosa Police Department patrol vehicle.
That’s a far cry from four years ago, when public safety officials urged voters to reject Proposition 64.
“It’s just really amazing to be able to be in that position to help people and the community, and be part of the solution to the things we’re dealing with,” Hunter said.
Stepping up around the nation
CannaCraft isn’t the only company stepping up. Others around the industry are doing their part, including:
Bay Area retailer/grower SPARC also began producing hand sanitizer in-house and donated ten gallons of it to San Francisco and Sonoma hospitals.
California cannabis grower, packager, distributor and manufacturer Jahlibyrd (pronounced ‘jah lee bird’) has partnered with South Fork Vodka to make hand sanitizer.
In Las Vegas, cannabis megastore Planet 13 is partnering with Clark County Social Services to donate 100 meals per day, Monday through Friday to vulnerable stay-at-home seniors and disabled residents.
Cottage Hospital in Santa Barbara, CA, has 1,000 extra gowns this week thanks to Glass House Farms, a large-scale cultivator in Carpinteria. Industrial cannabis farming requires loads of disinfectant and protective gear for pest control. Glass House Farms president Graham Farrar knew he wanted to give back, and the plastic gowns were the first place to start.
In Massachusetts, a large number of dispensaries—working through the Commonwealth Dispensary Association—are making their own hand sanitizer. They include: Revolutionary Clinics, INSA, Central Ave. Compassionate Care, Inc., Sira Naturals, NETA, Theory Wellness, Garden Remedies, Triple M, Alternative Therapy Group Inc., Berkshire Roots, Cultivate, Northeast Alternatives, Patriot Care, and Mass Wellspring.
And CBD American Shaman is also making hand sanitizer in Kansas City.
“The industry is rallying,” said Hunter. “Not just to help each other, but others.”
Jahlibyrd: masks, hospital and food bank space
On March 30, Jahlibyrd, based in Nevada County, CA, near Lake Tahoe, received a huge order of masks destined for the entire front line—cops, nurses, and cannabis workers included. The company had anticipated the community need for masks weeks ago, and put in an order.
“We’ve been tracking this virus for a while and believe it’s a much bigger deal than most people do,” said Sky Rutherford, Jahlibyrd’s head of construction. “We are donating to multiple different first responders. We’re in touch with three different firehouses, the sheriffs department and two to three different medical clinics, as well the CEO of Dignity Health.”
Jahlibyrd has also donated the use of a 7,000 square-foot building to their local hospital for surge capacity, and 5,000 square-feet of space to the Nevada County food bank.
“We just want to show everyone that if everyone does a little we can accomplish a lot,” said Rutherford. “Just because we sell cannabis doesn’t mean we’re just in it for the money. It’s all about the community during these times.”
Food bank programs ramps up
Cannabis culture is rooted in compassion, from Brownie Mary Rathbun forward.
As sales surge at stores, cannabis retailers’ COVID-19 philanthropy efforts are just starting to ramp up. Many retail canna-businesses have existing food bank programs that they’re supporting as millions of Americans file for unemployment and face food scarcity.
For example, the Glass House group donates 5% of product sales from its Santa Barbara adult-use store to the Santa Barbara Foodbank. Farmacy employees also get paid sick leave and team lunches each day from local restaurants.
Santa Barbara’s local cannabis farming industry group has started the 93013 Fund (for the local ZIP code), and is donating $20,000 to local causes. Their fundraising target is $200,000.
Similarly:
Leading Bay Area, CA delivery service Sava donates 10% of sales to charity partners providing protective equipment for California medical workers.
ZoneIn CBD—a national brand from former NFL all-pro linebacker Lofa Tatupu—reports they will donate $5 of all purchases to Food Lifeline.
DefyCBD, co-founded by former NFL running back Terrell Davis, donated $400,000 in CBD drinks to Feeding America.
Compassion programs expand
Compassion programs earmark free or reduced-price cannabis for low-income medical cannabis patients and others. These programs have never been more important as folks on fixed incomes get squeezed hard.
Barbary Coast has two stores in San Francisco, and sold compassion eighth-ounces from Sherbinskis for $1, instead of the regular $75, to anyone in need on March 30. Dubbed Sherbinskis in Place, the eights sold out in a single morning. Similar sales will likely follow.
More marijuana business COVID-19 relief efforts
San Jose store and delivery service Caliva drops a truck’s-worth of shoe coverings, coverall suits, and sleeve covers at Valley Medical Center—donations from Caliva’s grow center in San Jose, CA. Caliva matches up to $10,000 in donations to Silicon Valley Strong.
Friends in Weed has donated over $35,000 in local restaurant gift cards, signed on more than 20 restaurant partners across Colorado and has welcomed 13 partners. In honor of 4/20, FIW is launching a four-day blitz called 420Help—a one-weekend giving push to galvanize the Colorado cannabis community to help fellow Coloradans in need during the COVID crisis. Every dollar raised during 4/20 weekend will go to the Governor’s Colorado COVID Relief Fund, which is providing millions of dollars in immediate aid to first responders, healthcare professionals, educators and other crucial community services throughout Colorado. 420Help challenges every cannabis consumer and fan to make a donation of $4.20 this 4/20 weekend and challenges cannabis businesses and coalitions to donate at least $420 or 4.2% of sales.
Multi-state operator 4Front Ventures in an effort to slow the spread of COVID-19 and protect vulnerable populations, will shift some of its manufacturing capabilities at its Washington production facility to begin producing liquid disinfectant. In partnership with the Last Prisoner Project, starting on April 20, the organizations will donate a portion of the subsequent hand sanitizer bottles to select prison populations in need of supplies.
The Galley of Santa Rosa, CA, repurposes their state-of-the-art manufacturing and production facility for a first run of “Stop & Sanitize” hand sanitizer bottles—25,000 units for distribution to hospitals, retail shops, grocery, and drug stores.
San Diego business owners of Torrey Holistics have been combatting the shortage of medical safety supplies by donating thousands of masks and hand sanitizers to local hospitals and senior centers across San Diego. Alongside these efforts, Torrey Holistics is donating a portion of its April sales to senior centers who are the most vulnerable.
Oregon’s Chalice Farms implements a customer contribution program at its dispensaries, located throughout the Portland metropolitan area. Chalice Farms matches total customer contributions up to $5,000 weekly. Each of the seven dispensary locations will select a local restaurant in its community to purchase at least $5,000 worth of meals from, to be donated to local hospitals, fire departments, paramedics and police departments.
Connecticut spirits distiller SoNo 1420, known for their hemp-infused spirits, is using its alcohol base to produce complimentary hand sanitizers for the community. The company’s hemp-infused gins and vodkas are distilled from 100% gluten-free corn to create a 95% pure ethanol base. That base is now being used to make hand sanitizer using a formulation recommended by the WHO. With a final concentration of 80% ethanol, it is more than 99.99% effective in killing illness-causing microbes. Complimentary bottles of the hand sanitizer are available at the distillery located at 19 Day Street, Norwalk, CT 06854.
See more cannabis industry efforts to fight COVID-19? Share them in the comments below.
We updated this March 31 story on April 17.
TO READ MORE OF THIS ARTICLE ON LEAFLY, CLICK HERE. 
https://www.leafly.com/news/lifestyle/cannabis-and-coconut-oil-uses-benefits-and-a-recipe-to-make-your
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gordonwilliamsweb · 5 years ago
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When Your Doctor Is Also A Lobbyist: Inside The War Over Surprise Medical Bills
When Carol Pak-Teng, an emergency room doctor in New Jersey, hosted a fundraiser in December for Democratic freshman Rep. Tom Malinowski, her guests, mostly doctors, were pleased when she steered the conversation to surprise medical bills.
This was a chance to send a message to Washington that any surprise billing legislation should protect doctors’ incomes in their battle over payments with insurers. Lawmakers are grappling over several approaches to curtail the practice, which can leave patients on the hook for huge medical bills, even if they have insurance.
As Congress begins its 2020 legislative session, there is evidence the doctors’ message has been received: The bills with the most momentum are making more and more concessions to physicians.
As surprise medical billing has emerged as a hot-button issue for voters, doctors, hospitals and insurers have been lobbying to protect their own money flows. All that lobbying meant nothing got passed last year.
Television and internet ads are the most visible manifestation of the battle. But in taking their cause to politicians, doctors like Pak-Teng have waged an extraordinary on-the-ground stealth campaign to win over members of Congress. Their professional credentials give them a kind of gravitas compared with other lobbyists, who are merely hired guns.
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Ending the practice of billing patients for the amount of their treatment not covered by insurance — sometimes triggered by unwittingly seeing a doctor out of network — is ultimately a fight between doctors and insurers over rate-setting and reimbursement. But as more patients balk at surprise bills — or suffer the enormous financial strain — lawmakers are under pressure to protect patients. In turn, powerful lobbying forces have activated to protect doctors and insurers who don’t want to pay the price for a fix.
The main message physicians are using to bring lawmakers into their corner? “We just want to be paid a fair amount for the services rendered,” Pak-Teng said.
Her congressman, Malinowski, has not endorsed any surprise billing legislation. In congressional testimony in July, he cited the “extra $420 million” in medical debt patients in New Jersey reckon with each year.
“There are many things that Republicans and Democrats sincerely disagree about in this body,” he said. “I don’t think that this is one of them. I don’t see any philosophical difference amongst us about whether people should be stuck with massive surprise medical bills.”
Doctors say they are taking the brunt of the criticism.
But little has been as powerful in shaping surprise billing legislation as the clout of hospitals and their doctors, many of whom are, in fact, employed by private equity-backed companies and armed with years of experience shaping surprise billing legislation at the state level.
They are throwing in a lot of money, too, funneling millions to lawmakers ahead of the 2020 elections. Four physician organizations that have heavily lobbied on surprise medical bills and have private equity ties — the American College of Emergency Physicians, Envision Healthcare, US Acute Care Solutions and U.S. Anesthesia Partners — gave roughly $1.1 million in 2019 to members of Congress, according to a Kaiser Health News analysis of Federal Election Commission records.
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The biggest recipients, from all four PACs combined, were Reps. Donna Shalala and Stephanie Murphy, Florida Democrats who got $26,000 each. Sen. Thom Tillis (R-N.C.) took in $25,500, Senate Majority Leader Mitch McConnell got $25,000, and Rep. Brett Guthrie (R-Ky.) received $22,500.
That was in tandem with a ground game led by local doctors. ER doctors, anesthesiologists, radiologists and other specialists who most often charge out-of-network prices — and also are among the highest-compensated practitioners — fanned out to shape legislation in a way that maintains their pay, and to voice their concern to lawmakers that insurance companies would have too much leverage to control their compensation.
“We by necessity place a tremendous amount of trust in our physicians,” said Zack Cooper, an assistant professor at Yale University who has extensively researched surprise medical bills. “Frankly, they have an easier time lobbying members [of Congress] than the folks who are affected by surprise billing.”
Arguing Over The Fix
Lawmakers in both parties appear unified on the need to resolve the problem of surprise billing. But as was clear when all the air blew out of legislative proposals on the table at year’s end, that is largely where the agreement ends.
Fixing the problem comes down to settling on a system for deciding how much to pay for a disputed bill. One approach is to set up an outside arbitration process, in which doctors and insurance companies would negotiate payment — this is the model preferred by doctors, who contend it puts them on better footing against insurance companies. Another option would be to resolve surprise billing disputes by having insurance companies pay doctors based on the median in-network rate for the service, an approach known as benchmarking. Large employers, labor unions and insurance companies prefer this.
The failure to get legislation through Congress set up a potentially explosive battle in an election year. Republicans and Democrats who have vowed to do something about health care costs must reckon with powerful industry groups whose influence transcends party lines.
Meanwhile, physicians and hospitals have made their case in Washington and back home through in-person meetings and phone calls with lawmakers and congressional staff. They’ve hosted dinners and fundraisers and organized fly-ins to swarm Capitol Hill with in-person meetings. They’ve even led tours of their emergency rooms.
Pak-Teng is among them, coming to Washington this month with other physicians to petition lawmakers. She is employed by Envision, a physician staffing company backed by private equity firm KKR. She’s also on the board of the American Academy of Emergency Medicine, a trade organization representing ER doctors.
“There is a lot of anti-physician rhetoric out there,” said Pak-Teng, who is pushing her physician colleagues to be more active in shaping public policy by sharing stories about the reality of caring for patients.
The lobbying by hospitals and physicians trying to protect their reimbursements has divided key lawmakers, compounding disagreements among senior House Democrats over the policy details of a bill and turf wars in Congress. Three House committees have now unveiled legislation to ban surprise medical bills, each with different details.
“We are not trying to stop legislation. We are trying to stop bad legislation,” said Anthony Cirillo, an emergency medicine physician who describes a “bad” bill as one that favors insurance companies over doctors.
Cirillo is also a lobbyist for US Acute Care Solutions, a physician staffing company backed by private equity firm Welsh, Carson, Anderson & Stowe. WCAS, which manages $27 billion in assets and is focused on health care and technology investments, is based in New York City and co-founded US Acute Care Solutions in 2015.
In an interview, Cirillo said he met with lawmakers and their aides about “10 to 12 times” in Washington last year. Financial disclosures show he spent $340,000 between July and September lobbying on surprise billing on behalf of US Acute Care Solutions. USACS’ political committee also contributed $134,500 to lawmakers in 2019, according to FEC records.
Tilt Toward Doctors
Before the private equity-fueled dark-money group Doctor Patient Unity started running ads warning of the dangers of government price controls as an argument against legislation, surprise billing legislation being drafted in one of Congress’ most powerful health care committees was already tilting to be more favorable to doctors.
“People on the Hill are very sympathetic to hospitals and physicians because they’re actually providing the care itself,” said one Democratic aide, speaking on the condition of anonymity to candidly describe sensitive political dynamics. “Nobody wants to defend the insurers.”
In May, a House Energy and Commerce Committee draft proposal included no mention of outside arbitration. The same was true for a bill the Senate Health, Education, Labor and Pensions Committee approved in June. Instead, under those proposals, surprise billing disputes would be resolved by insurance companies paying doctors based on similar rates in that area.
By mid-July, though — roughly a week before Doctor Patient Unity registered as a business in Virginia — the Energy and Commerce legislation was amended to allow doctors to appeal to an independent arbiter if their payments exceed $1,250. The revision was pushed by two physicians on the committee — Democrat Raul Ruiz of California and Republican Larry Bucshon of Indiana — and was a moment Sherif Zaafran, a Texas anesthesiologist, describes as a “turning point” in negotiations over the bill.
“It’s all about fairness,” said Zaafran, who works for private equity-backed U.S. Anesthesia Partners. He has been involved for a decade in surprise billing fights in Texas, which enacted a new law with an arbitration process last year. U.S. Anesthesia Partners gave $197,900 in campaign contributions to members of Congress last year.
Zaafran chaired another coalition of medical specialists, Physicians for Fair Coverage, in 2019, and pressured Congress to pursue a surprise billing approach modeled on a New York law under which insurers and providers rely on arbitration. Under that process, if there is a payment dispute between doctors and insurers, the two sides submit a proposed dollar amount to an independent mediator, who then selects one.
In New York, the mediators were told to base their decisions on the 80th percentile of the prices set by the hospital or physician. Research has suggested that the model is broadly making health care more expensive for state residents because of higher payments to doctors, according to findings from the USC-Brookings Schaeffer Initiative for Health Policy.
Still, on Capitol Hill, doctors complained that many procedures would fail to cost enough to qualify for arbitration as proposed in the Energy and Commerce bill, bolstered by data ER doctors presented to lawmakers showing that prices mainly fall below $1,250.
“It’s largely out of reach,” said Laura Wooster, a lobbyist with the American College of Emergency Physicians, whose political action committee contributed $708,000 to lawmakers in 2019. “The problem with a threshold is, you just have one threshold. It’s going to impact different specialties so differently.”
By December, House Energy and Commerce Committee leaders and Sen. Lamar Alexander, a Republican who chairs the Senate HELP Committee, agreed to lower the arbitration threshold to $750 as part of a bipartisan agreement on a bill. Notably, several hospital lobbying organizations, such as the American Hospital Association and the Greater New York Hospital Association — the latter a strong financial backer of Senate Minority Leader Chuck Schumer — refused to back the deal.
Pak-Teng and other physicians also say that arbitration threshold is still too high. The House Education and Labor Committee has unveiled surprise billing legislation with a similar framework.
“I’m open to listening to all sides on this,” Rep. Greg Walden of Oregon, the top Republican on the House Energy and Commerce Committee, said in an interview. “We want to make sure doctors are adequately compensated.”
Walden had harsh words for private equity firms that have attacked the Energy and Commerce legislation in a series of TV and internet ads, saying they were “misleading and scaring people” and just made lawmakers dig in deeper. The ads prompted a bipartisan probe from Walden and committee Chairman Frank Pallone (D-N.J.) into how the companies have influenced surprise billing practices.
“I’m not trying to hurtle a rock at them, but they’ve been throwing a few my way,” he said.
What’s Coming
Arvind Venkat, a Pittsburgh emergency physician employed by US Acute Care Solutions, traveled to Washington multiple times last year to meet with congressional offices representing Pennsylvania. But he also made sure to bring up surprise bills on his home turf, giving his congressman, freshman Democrat Conor Lamb, a tour of the emergency room at Allegheny General Hospital last summer.
“There are two issues here,” said Venkat, who leads the Pennsylvania chapter of the American College of Emergency Physicians and has practiced at Allegheny General for 12 years. “Patients need to be protected, [and] we need to avoid anything that disrupts in-network relationships between insurers and clinicians.”
The call seems to have been heard: Legislation is likely to change further this year as the House Ways and Means Committee pushes an approach that is friendlier to hospitals and doctors. It builds off a one-page document committee leaders issued Dec. 11 that blunted momentum for a bipartisan deal that was to be included in a December spending bill.
The latest proposal from the committee includes an arbitration process to resolve payment disputes, with no minimum dollar amount needed to trigger it, and doesn’t ban surprise billing from air ambulance companies — a win for yet another special-interest lobbying group. The patient protections would not take effect until 2022.
U.S. Rep. Richard Neal, a Massachusetts Democrat who chairs the House Ways and Means Committee, remains an ally of Massachusetts hospitals.(Hannah Norman/KHN Illustration; Getty Images)
Richard Neal, a Massachusetts Democrat who chairs the committee, remains an ally of Massachusetts hospitals. He released the brief December surprise billing document two days after the Massachusetts Medical Society and Massachusetts Hospital Association wrote a joint op-ed in The Boston Globe arguing that benchmarking physician payments — as the Senate HELP and Energy and Commerce deal would do — would wreck the state’s health care system.
“The heavy hand of government would create an unfair imbalance in the health care marketplace and insurers would have no incentive to engage physicians in building robust health care networks. The connected system of care we have all been working toward in Massachusetts would immediately become fragmented and disjointed,” the two groups wrote in The Boston Globe.
“They weren’t asking for favorable treatment. They were asking for fair treatment, and there’s a big difference,” Neal said in an interview. “I don’t want to rule anything out, but I think that the momentum right now is arbitration.”
“We need to get a little bit more balance,” added Shalala, who endorsed the Ways and Means legislation unveiled earlier this month.
Shalala has at least two hospitals in her Miami-area district that rely on private equity-supported physician staffing companies.
“I’m worried about the hospitals,” she said. “And the providers obviously include the docs.”
Victoria Knight contributed to this story.
When Your Doctor Is Also A Lobbyist: Inside The War Over Surprise Medical Bills published first on https://nootropicspowdersupplier.tumblr.com/
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stephenmccull · 5 years ago
Text
When Your Doctor Is Also A Lobbyist: Inside The War Over Surprise Medical Bills
When Carol Pak-Teng, an emergency room doctor in New Jersey, hosted a fundraiser in December for Democratic freshman Rep. Tom Malinowski, her guests, mostly doctors, were pleased when she steered the conversation to surprise medical bills.
This was a chance to send a message to Washington that any surprise billing legislation should protect doctors’ incomes in their battle over payments with insurers. Lawmakers are grappling over several approaches to curtail the practice, which can leave patients on the hook for huge medical bills, even if they have insurance.
As Congress begins its 2020 legislative session, there is evidence the doctors’ message has been received: The bills with the most momentum are making more and more concessions to physicians.
As surprise medical billing has emerged as a hot-button issue for voters, doctors, hospitals and insurers have been lobbying to protect their own money flows. All that lobbying meant nothing got passed last year.
Television and internet ads are the most visible manifestation of the battle. But in taking their cause to politicians, doctors like Pak-Teng have waged an extraordinary on-the-ground stealth campaign to win over members of Congress. Their professional credentials give them a kind of gravitas compared with other lobbyists, who are merely hired guns.
Email Sign-Up
Subscribe to KHN’s free Morning Briefing.
Sign Up
Please confirm your email address below:
Sign Up
Ending the practice of billing patients for the amount of their treatment not covered by insurance — sometimes triggered by unwittingly seeing a doctor out of network — is ultimately a fight between doctors and insurers over rate-setting and reimbursement. But as more patients balk at surprise bills — or suffer the enormous financial strain — lawmakers are under pressure to protect patients. In turn, powerful lobbying forces have activated to protect doctors and insurers who don’t want to pay the price for a fix.
The main message physicians are using to bring lawmakers into their corner? “We just want to be paid a fair amount for the services rendered,” Pak-Teng said.
Her congressman, Malinowski, has not endorsed any surprise billing legislation. In congressional testimony in July, he cited the “extra $420 million” in medical debt patients in New Jersey reckon with each year.
“There are many things that Republicans and Democrats sincerely disagree about in this body,” he said. “I don’t think that this is one of them. I don’t see any philosophical difference amongst us about whether people should be stuck with massive surprise medical bills.”
Doctors say they are taking the brunt of the criticism.
But little has been as powerful in shaping surprise billing legislation as the clout of hospitals and their doctors, many of whom are, in fact, employed by private equity-backed companies and armed with years of experience shaping surprise billing legislation at the state level.
They are throwing in a lot of money, too, funneling millions to lawmakers ahead of the 2020 elections. Four physician organizations that have heavily lobbied on surprise medical bills and have private equity ties — the American College of Emergency Physicians, Envision Healthcare, US Acute Care Solutions and U.S. Anesthesia Partners — gave roughly $1.1 million in 2019 to members of Congress, according to a Kaiser Health News analysis of Federal Election Commission records.
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The biggest recipients, from all four PACs combined, were Reps. Donna Shalala and Stephanie Murphy, Florida Democrats who got $26,000 each. Sen. Thom Tillis (R-N.C.) took in $25,500, Senate Majority Leader Mitch McConnell got $25,000, and Rep. Brett Guthrie (R-Ky.) received $22,500.
That was in tandem with a ground game led by local doctors. ER doctors, anesthesiologists, radiologists and other specialists who most often charge out-of-network prices — and also are among the highest-compensated practitioners — fanned out to shape legislation in a way that maintains their pay, and to voice their concern to lawmakers that insurance companies would have too much leverage to control their compensation.
“We by necessity place a tremendous amount of trust in our physicians,” said Zack Cooper, an assistant professor at Yale University who has extensively researched surprise medical bills. “Frankly, they have an easier time lobbying members [of Congress] than the folks who are affected by surprise billing.”
Arguing Over The Fix
Lawmakers in both parties appear unified on the need to resolve the problem of surprise billing. But as was clear when all the air blew out of legislative proposals on the table at year’s end, that is largely where the agreement ends.
Fixing the problem comes down to settling on a system for deciding how much to pay for a disputed bill. One approach is to set up an outside arbitration process, in which doctors and insurance companies would negotiate payment — this is the model preferred by doctors, who contend it puts them on better footing against insurance companies. Another option would be to resolve surprise billing disputes by having insurance companies pay doctors based on the median in-network rate for the service, an approach known as benchmarking. Large employers, labor unions and insurance companies prefer this.
The failure to get legislation through Congress set up a potentially explosive battle in an election year. Republicans and Democrats who have vowed to do something about health care costs must reckon with powerful industry groups whose influence transcends party lines.
Meanwhile, physicians and hospitals have made their case in Washington and back home through in-person meetings and phone calls with lawmakers and congressional staff. They’ve hosted dinners and fundraisers and organized fly-ins to swarm Capitol Hill with in-person meetings. They’ve even led tours of their emergency rooms.
Pak-Teng is among them, coming to Washington this month with other physicians to petition lawmakers. She is employed by Envision, a physician staffing company backed by private equity firm KKR. She’s also on the board of the American Academy of Emergency Medicine, a trade organization representing ER doctors.
“There is a lot of anti-physician rhetoric out there,” said Pak-Teng, who is pushing her physician colleagues to be more active in shaping public policy by sharing stories about the reality of caring for patients.
The lobbying by hospitals and physicians trying to protect their reimbursements has divided key lawmakers, compounding disagreements among senior House Democrats over the policy details of a bill and turf wars in Congress. Three House committees have now unveiled legislation to ban surprise medical bills, each with different details.
“We are not trying to stop legislation. We are trying to stop bad legislation,” said Anthony Cirillo, an emergency medicine physician who describes a “bad” bill as one that favors insurance companies over doctors.
Cirillo is also a lobbyist for US Acute Care Solutions, a physician staffing company backed by private equity firm Welsh, Carson, Anderson & Stowe. WCAS, which manages $27 billion in assets and is focused on health care and technology investments, is based in New York City and co-founded US Acute Care Solutions in 2015.
In an interview, Cirillo said he met with lawmakers and their aides about “10 to 12 times” in Washington last year. Financial disclosures show he spent $340,000 between July and September lobbying on surprise billing on behalf of US Acute Care Solutions. USACS’ political committee also contributed $134,500 to lawmakers in 2019, according to FEC records.
Tilt Toward Doctors
Before the private equity-fueled dark-money group Doctor Patient Unity started running ads warning of the dangers of government price controls as an argument against legislation, surprise billing legislation being drafted in one of Congress’ most powerful health care committees was already tilting to be more favorable to doctors.
“People on the Hill are very sympathetic to hospitals and physicians because they’re actually providing the care itself,” said one Democratic aide, speaking on the condition of anonymity to candidly describe sensitive political dynamics. “Nobody wants to defend the insurers.”
In May, a House Energy and Commerce Committee draft proposal included no mention of outside arbitration. The same was true for a bill the Senate Health, Education, Labor and Pensions Committee approved in June. Instead, under those proposals, surprise billing disputes would be resolved by insurance companies paying doctors based on similar rates in that area.
By mid-July, though — roughly a week before Doctor Patient Unity registered as a business in Virginia — the Energy and Commerce legislation was amended to allow doctors to appeal to an independent arbiter if their payments exceed $1,250. The revision was pushed by two physicians on the committee — Democrat Raul Ruiz of California and Republican Larry Bucshon of Indiana — and was a moment Sherif Zaafran, a Texas anesthesiologist, describes as a “turning point” in negotiations over the bill.
“It’s all about fairness,” said Zaafran, who works for private equity-backed U.S. Anesthesia Partners. He has been involved for a decade in surprise billing fights in Texas, which enacted a new law with an arbitration process last year. U.S. Anesthesia Partners gave $197,900 in campaign contributions to members of Congress last year.
Zaafran chaired another coalition of medical specialists, Physicians for Fair Coverage, in 2019, and pressured Congress to pursue a surprise billing approach modeled on a New York law under which insurers and providers rely on arbitration. Under that process, if there is a payment dispute between doctors and insurers, the two sides submit a proposed dollar amount to an independent mediator, who then selects one.
In New York, the mediators were told to base their decisions on the 80th percentile of the prices set by the hospital or physician. Research has suggested that the model is broadly making health care more expensive for state residents because of higher payments to doctors, according to findings from the USC-Brookings Schaeffer Initiative for Health Policy.
Still, on Capitol Hill, doctors complained that many procedures would fail to cost enough to qualify for arbitration as proposed in the Energy and Commerce bill, bolstered by data ER doctors presented to lawmakers showing that prices mainly fall below $1,250.
“It’s largely out of reach,” said Laura Wooster, a lobbyist with the American College of Emergency Physicians, whose political action committee contributed $708,000 to lawmakers in 2019. “The problem with a threshold is, you just have one threshold. It’s going to impact different specialties so differently.”
By December, House Energy and Commerce Committee leaders and Sen. Lamar Alexander, a Republican who chairs the Senate HELP Committee, agreed to lower the arbitration threshold to $750 as part of a bipartisan agreement on a bill. Notably, several hospital lobbying organizations, such as the American Hospital Association and the Greater New York Hospital Association — the latter a strong financial backer of Senate Minority Leader Chuck Schumer — refused to back the deal.
Pak-Teng and other physicians also say that arbitration threshold is still too high. The House Education and Labor Committee has unveiled surprise billing legislation with a similar framework.
“I’m open to listening to all sides on this,” Rep. Greg Walden of Oregon, the top Republican on the House Energy and Commerce Committee, said in an interview. “We want to make sure doctors are adequately compensated.”
Walden had harsh words for private equity firms that have attacked the Energy and Commerce legislation in a series of TV and internet ads, saying they were “misleading and scaring people” and just made lawmakers dig in deeper. The ads prompted a bipartisan probe from Walden and committee Chairman Frank Pallone (D-N.J.) into how the companies have influenced surprise billing practices.
“I’m not trying to hurtle a rock at them, but they’ve been throwing a few my way,” he said.
What’s Coming
Arvind Venkat, a Pittsburgh emergency physician employed by US Acute Care Solutions, traveled to Washington multiple times last year to meet with congressional offices representing Pennsylvania. But he also made sure to bring up surprise bills on his home turf, giving his congressman, freshman Democrat Conor Lamb, a tour of the emergency room at Allegheny General Hospital last summer.
“There are two issues here,” said Venkat, who leads the Pennsylvania chapter of the American College of Emergency Physicians and has practiced at Allegheny General for 12 years. “Patients need to be protected, [and] we need to avoid anything that disrupts in-network relationships between insurers and clinicians.”
The call seems to have been heard: Legislation is likely to change further this year as the House Ways and Means Committee pushes an approach that is friendlier to hospitals and doctors. It builds off a one-page document committee leaders issued Dec. 11 that blunted momentum for a bipartisan deal that was to be included in a December spending bill.
The latest proposal from the committee includes an arbitration process to resolve payment disputes, with no minimum dollar amount needed to trigger it, and doesn’t ban surprise billing from air ambulance companies — a win for yet another special-interest lobbying group. The patient protections would not take effect until 2022.
U.S. Rep. Richard Neal, a Massachusetts Democrat who chairs the House Ways and Means Committee, remains an ally of Massachusetts hospitals.(Hannah Norman/KHN Illustration; Getty Images)
Richard Neal, a Massachusetts Democrat who chairs the committee, remains an ally of Massachusetts hospitals. He released the brief December surprise billing document two days after the Massachusetts Medical Society and Massachusetts Hospital Association wrote a joint op-ed in The Boston Globe arguing that benchmarking physician payments — as the Senate HELP and Energy and Commerce deal would do — would wreck the state’s health care system.
“The heavy hand of government would create an unfair imbalance in the health care marketplace and insurers would have no incentive to engage physicians in building robust health care networks. The connected system of care we have all been working toward in Massachusetts would immediately become fragmented and disjointed,” the two groups wrote in The Boston Globe.
“They weren’t asking for favorable treatment. They were asking for fair treatment, and there’s a big difference,” Neal said in an interview. “I don’t want to rule anything out, but I think that the momentum right now is arbitration.”
“We need to get a little bit more balance,” added Shalala, who endorsed the Ways and Means legislation unveiled earlier this month.
Shalala has at least two hospitals in her Miami-area district that rely on private equity-supported physician staffing companies.
“I’m worried about the hospitals,” she said. “And the providers obviously include the docs.”
Victoria Knight contributed to this story.
When Your Doctor Is Also A Lobbyist: Inside The War Over Surprise Medical Bills published first on https://smartdrinkingweb.weebly.com/
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dinafbrownil · 5 years ago
Text
When Your Doctor Is Also A Lobbyist: Inside The War Over Surprise Medical Bills
When Carol Pak-Teng, an emergency room doctor in New Jersey, hosted a fundraiser in December for Democratic freshman Rep. Tom Malinowski, her guests, mostly doctors, were pleased when she steered the conversation to surprise medical bills.
This was a chance to send a message to Washington that any surprise billing legislation should protect doctors’ incomes in their battle over payments with insurers. Lawmakers are grappling over several approaches to curtail the practice, which can leave patients on the hook for huge medical bills, even if they have insurance.
As Congress begins its 2020 legislative session, there is evidence the doctors’ message has been received: The bills with the most momentum are making more and more concessions to physicians.
As surprise medical billing has emerged as a hot-button issue for voters, doctors, hospitals and insurers have been lobbying to protect their own money flows. All that lobbying meant nothing got passed last year.
Television and internet ads are the most visible manifestation of the battle. But in taking their cause to politicians, doctors like Pak-Teng have waged an extraordinary on-the-ground stealth campaign to win over members of Congress. Their professional credentials give them a kind of gravitas compared with other lobbyists, who are merely hired guns.
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Ending the practice of billing patients for the amount of their treatment not covered by insurance — sometimes triggered by unwittingly seeing a doctor out of network — is ultimately a fight between doctors and insurers over rate-setting and reimbursement. But as more patients balk at surprise bills — or suffer the enormous financial strain — lawmakers are under pressure to protect patients. In turn, powerful lobbying forces have activated to protect doctors and insurers who don’t want to pay the price for a fix.
The main message physicians are using to bring lawmakers into their corner? “We just want to be paid a fair amount for the services rendered,” Pak-Teng said.
Her congressman, Malinowski, has not endorsed any surprise billing legislation. In congressional testimony in July, he cited the “extra $420 million” in medical debt patients in New Jersey reckon with each year.
“There are many things that Republicans and Democrats sincerely disagree about in this body,” he said. “I don’t think that this is one of them. I don’t see any philosophical difference amongst us about whether people should be stuck with massive surprise medical bills.”
Doctors say they are taking the brunt of the criticism.
But little has been as powerful in shaping surprise billing legislation as the clout of hospitals and their doctors, many of whom are, in fact, employed by private equity-backed companies and armed with years of experience shaping surprise billing legislation at the state level.
They are throwing in a lot of money, too, funneling millions to lawmakers ahead of the 2020 elections. Four physician organizations that have heavily lobbied on surprise medical bills and have private equity ties — the American College of Emergency Physicians, Envision Healthcare, US Acute Care Solutions and U.S. Anesthesia Partners — gave roughly $1.1 million in 2019 to members of Congress, according to a Kaiser Health News analysis of Federal Election Commission records.
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The biggest recipients, from all four PACs combined, were Reps. Donna Shalala and Stephanie Murphy, Florida Democrats who got $26,000 each. Sen. Thom Tillis (R-N.C.) took in $25,500, Senate Majority Leader Mitch McConnell got $25,000, and Rep. Brett Guthrie (R-Ky.) received $22,500.
That was in tandem with a ground game led by local doctors. ER doctors, anesthesiologists, radiologists and other specialists who most often charge out-of-network prices — and also are among the highest-compensated practitioners — fanned out to shape legislation in a way that maintains their pay, and to voice their concern to lawmakers that insurance companies would have too much leverage to control their compensation.
“We by necessity place a tremendous amount of trust in our physicians,” said Zack Cooper, an assistant professor at Yale University who has extensively researched surprise medical bills. “Frankly, they have an easier time lobbying members [of Congress] than the folks who are affected by surprise billing.”
Arguing Over The Fix
Lawmakers in both parties appear unified on the need to resolve the problem of surprise billing. But as was clear when all the air blew out of legislative proposals on the table at year’s end, that is largely where the agreement ends.
Fixing the problem comes down to settling on a system for deciding how much to pay for a disputed bill. One approach is to set up an outside arbitration process, in which doctors and insurance companies would negotiate payment — this is the model preferred by doctors, who contend it puts them on better footing against insurance companies. Another option would be to resolve surprise billing disputes by having insurance companies pay doctors based on the median in-network rate for the service, an approach known as benchmarking. Large employers, labor unions and insurance companies prefer this.
The failure to get legislation through Congress set up a potentially explosive battle in an election year. Republicans and Democrats who have vowed to do something about health care costs must reckon with powerful industry groups whose influence transcends party lines.
Meanwhile, physicians and hospitals have made their case in Washington and back home through in-person meetings and phone calls with lawmakers and congressional staff. They’ve hosted dinners and fundraisers and organized fly-ins to swarm Capitol Hill with in-person meetings. They’ve even led tours of their emergency rooms.
Pak-Teng is among them, coming to Washington this month with other physicians to petition lawmakers. She is employed by Envision, a physician staffing company backed by private equity firm KKR. She’s also on the board of the American Academy of Emergency Medicine, a trade organization representing ER doctors.
“There is a lot of anti-physician rhetoric out there,” said Pak-Teng, who is pushing her physician colleagues to be more active in shaping public policy by sharing stories about the reality of caring for patients.
The lobbying by hospitals and physicians trying to protect their reimbursements has divided key lawmakers, compounding disagreements among senior House Democrats over the policy details of a bill and turf wars in Congress. Three House committees have now unveiled legislation to ban surprise medical bills, each with different details.
“We are not trying to stop legislation. We are trying to stop bad legislation,” said Anthony Cirillo, an emergency medicine physician who describes a “bad” bill as one that favors insurance companies over doctors.
Cirillo is also a lobbyist for US Acute Care Solutions, a physician staffing company backed by private equity firm Welsh, Carson, Anderson & Stowe. WCAS, which manages $27 billion in assets and is focused on health care and technology investments, is based in New York City and co-founded US Acute Care Solutions in 2015.
In an interview, Cirillo said he met with lawmakers and their aides about “10 to 12 times” in Washington last year. Financial disclosures show he spent $340,000 between July and September lobbying on surprise billing on behalf of US Acute Care Solutions. USACS’ political committee also contributed $134,500 to lawmakers in 2019, according to FEC records.
Tilt Toward Doctors
Before the private equity-fueled dark-money group Doctor Patient Unity started running ads warning of the dangers of government price controls as an argument against legislation, surprise billing legislation being drafted in one of Congress’ most powerful health care committees was already tilting to be more favorable to doctors.
“People on the Hill are very sympathetic to hospitals and physicians because they’re actually providing the care itself,” said one Democratic aide, speaking on the condition of anonymity to candidly describe sensitive political dynamics. “Nobody wants to defend the insurers.”
In May, a House Energy and Commerce Committee draft proposal included no mention of outside arbitration. The same was true for a bill the Senate Health, Education, Labor and Pensions Committee approved in June. Instead, under those proposals, surprise billing disputes would be resolved by insurance companies paying doctors based on similar rates in that area.
By mid-July, though — roughly a week before Doctor Patient Unity registered as a business in Virginia — the Energy and Commerce legislation was amended to allow doctors to appeal to an independent arbiter if their payments exceed $1,250. The revision was pushed by two physicians on the committee — Democrat Raul Ruiz of California and Republican Larry Bucshon of Indiana — and was a moment Sherif Zaafran, a Texas anesthesiologist, describes as a “turning point” in negotiations over the bill.
“It’s all about fairness,” said Zaafran, who works for private equity-backed U.S. Anesthesia Partners. He has been involved for a decade in surprise billing fights in Texas, which enacted a new law with an arbitration process last year. U.S. Anesthesia Partners gave $197,900 in campaign contributions to members of Congress last year.
Zaafran chaired another coalition of medical specialists, Physicians for Fair Coverage, in 2019, and pressured Congress to pursue a surprise billing approach modeled on a New York law under which insurers and providers rely on arbitration. Under that process, if there is a payment dispute between doctors and insurers, the two sides submit a proposed dollar amount to an independent mediator, who then selects one.
In New York, the mediators were told to base their decisions on the 80th percentile of the prices set by the hospital or physician. Research has suggested that the model is broadly making health care more expensive for state residents because of higher payments to doctors, according to findings from the USC-Brookings Schaeffer Initiative for Health Policy.
Still, on Capitol Hill, doctors complained that many procedures would fail to cost enough to qualify for arbitration as proposed in the Energy and Commerce bill, bolstered by data ER doctors presented to lawmakers showing that prices mainly fall below $1,250.
“It’s largely out of reach,” said Laura Wooster, a lobbyist with the American College of Emergency Physicians, whose political action committee contributed $708,000 to lawmakers in 2019. “The problem with a threshold is, you just have one threshold. It’s going to impact different specialties so differently.”
By December, House Energy and Commerce Committee leaders and Sen. Lamar Alexander, a Republican who chairs the Senate HELP Committee, agreed to lower the arbitration threshold to $750 as part of a bipartisan agreement on a bill. Notably, several hospital lobbying organizations, such as the American Hospital Association and the Greater New York Hospital Association — the latter a strong financial backer of Senate Minority Leader Chuck Schumer — refused to back the deal.
Pak-Teng and other physicians also say that arbitration threshold is still too high. The House Education and Labor Committee has unveiled surprise billing legislation with a similar framework.
“I’m open to listening to all sides on this,” Rep. Greg Walden of Oregon, the top Republican on the House Energy and Commerce Committee, said in an interview. “We want to make sure doctors are adequately compensated.”
Walden had harsh words for private equity firms that have attacked the Energy and Commerce legislation in a series of TV and internet ads, saying they were “misleading and scaring people” and just made lawmakers dig in deeper. The ads prompted a bipartisan probe from Walden and committee Chairman Frank Pallone (D-N.J.) into how the companies have influenced surprise billing practices.
“I’m not trying to hurtle a rock at them, but they’ve been throwing a few my way,” he said.
What’s Coming
Arvind Venkat, a Pittsburgh emergency physician employed by US Acute Care Solutions, traveled to Washington multiple times last year to meet with congressional offices representing Pennsylvania. But he also made sure to bring up surprise bills on his home turf, giving his congressman, freshman Democrat Conor Lamb, a tour of the emergency room at Allegheny General Hospital last summer.
“There are two issues here,” said Venkat, who leads the Pennsylvania chapter of the American College of Emergency Physicians and has practiced at Allegheny General for 12 years. “Patients need to be protected, [and] we need to avoid anything that disrupts in-network relationships between insurers and clinicians.”
The call seems to have been heard: Legislation is likely to change further this year as the House Ways and Means Committee pushes an approach that is friendlier to hospitals and doctors. It builds off a one-page document committee leaders issued Dec. 11 that blunted momentum for a bipartisan deal that was to be included in a December spending bill.
The latest proposal from the committee includes an arbitration process to resolve payment disputes, with no minimum dollar amount needed to trigger it, and doesn’t ban surprise billing from air ambulance companies — a win for yet another special-interest lobbying group. The patient protections would not take effect until 2022.
U.S. Rep. Richard Neal, a Massachusetts Democrat who chairs the House Ways and Means Committee, remains an ally of Massachusetts hospitals.(Hannah Norman/KHN Illustration; Getty Images)
Richard Neal, a Massachusetts Democrat who chairs the committee, remains an ally of Massachusetts hospitals. He released the brief December surprise billing document two days after the Massachusetts Medical Society and Massachusetts Hospital Association wrote a joint op-ed in The Boston Globe arguing that benchmarking physician payments — as the Senate HELP and Energy and Commerce deal would do — would wreck the state’s health care system.
“The heavy hand of government would create an unfair imbalance in the health care marketplace and insurers would have no incentive to engage physicians in building robust health care networks. The connected system of care we have all been working toward in Massachusetts would immediately become fragmented and disjointed,” the two groups wrote in The Boston Globe.
“They weren’t asking for favorable treatment. They were asking for fair treatment, and there’s a big difference,” Neal said in an interview. “I don’t want to rule anything out, but I think that the momentum right now is arbitration.”
“We need to get a little bit more balance,” added Shalala, who endorsed the Ways and Means legislation unveiled earlier this month.
Shalala has at least two hospitals in her Miami-area district that rely on private equity-supported physician staffing companies.
“I’m worried about the hospitals,” she said. “And the providers obviously include the docs.”
Victoria Knight contributed to this story.
from Updates By Dina https://khn.org/news/when-your-doctor-is-also-a-lobbyist-inside-the-war-over-surprise-medical-bills/
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torentialtribute · 6 years ago
Text
How Pep Guardiola made Manchester City go again and capture second straight Premier League title 
An hour after lifting his second Carabao Cup in February, Pep Guardiola stood inside a plush Wembley hospitality suite agitating to get away. Manchester City had laid on a winners' reception for family and sponsors to joyously toast another trophy, but their manager had already moved on.
Guardiola was pleasant, polite and graciously took the congratulations, yet his mind was elsewhere. He became an occupied look and all those present knew it.
Three more trophies were on the line at that stage. The biggest, and most significant, or those was the Premier League title – and retaining it. Liverpool still needed catching, two points the deficit. Guardiola longed to be back at the training ground studying videos, and back at his city center restaurant, Tast, drinking tomato juice and plotting his next move.
An hour after winning the Carabao Cup, Pep Guardiola's mind was clearly elsewhere
Guardiola longed to be training ground studying videos and plotting his next move
The Spaniard's incredible focus has been driven City to a second straight Premier League title
What has happened this season is Testiola to Guardiola, the first man since Sir Alex Ferguson in 2009 to retain the world's toughest league after Sunday's win at Brighton, where City equated their own record for most victories in a campaign, 32. He told his players back in August to expect a Liverpool onslaught and was proven correct, the level of Jurgen Klopp's wondrous team kicking City on achieving a staggering 98 points.
That's 198 points over the course of the last 76 games now – an average of 2.61 per match – and nobody is likely to rival the consistency of this set of players for a long, long tim
"I didn't expect to get the points so far after what we did last season," Guardiola said. "Normally the tendency for human beings is to relax a little bit."
He admitted he had expected his players to relax a little after winning the title last year
In July last year, in the wind of Chicago, Guardiola had somehow upscaled his efforts
Guardiola was unrelenting from the campaign as attempted to retain the crown
His drive can be traced back to last July, in the wind of Chicago, when those around the first team noticed this workaholic or a manager had somehow upscaled his efforts just further on City's pre-season tour. Even with the majority of his players on holiday recovering from the World Cup, Guardiola was unrelenting.
The Catalan puts this achievement down as one of his greatest in management. Retaining the Premier League title was his absolute focus and he made it plain the squad should pay similar amounts of attention.
Bernardo Silva flew out early to America after Portugal's campaign in Russia at the manager's request and has since flourished, arguably becoming the club's most reliable player. Leroy Sane was treated differently, cradled by his manager – afforded extra time off after his omission from the Germany squad – but appeared morose.
The winger soon fell out of favor, dropped from one squad completely after poor performances in training and general sullenness, and has struggled for starts all year. Despite his enviable goals and assists record, Sane is now firmly behind Bernardo in the pecking order. If you're not on board, City simply wants to place faith in others.
Bernardo Silva flew out early to America after the World Cup at the manager's request
The campaign has, in many respects, been a triumph for man management. The City dressing room has been described by first-team sources as 'extraordinary', and the best environment cultivated since Sheikh Mansour's money arrived in east Manchester. "I've never seen anything quite like it," one said.
The squad play card games on the way back from matches, rather than sit in isolation with headphones in. Bernardo's terrace chant – 'Ber-nar-do; Sil-VA; running down the wing, Sil-VA '- is a favorite singalong on the team coach. Players of different nationalities mix freely about compulsory breakfast and lunches at the training complex, with no real cliques.
The absent Benjamin Mendy Face Timed Vincent Kompany to congratulate his captain after that thunderbolt winner against Leicester. Birthdays or players or staff members are celebrated in unison after matches. Kompany spent an hour consoling a tearful Sergio Aguero in the dressing room after Champions League elimination, that night hitting the older players hard.
Not every club fosters this atmosphere and manage less to sustain it. Just look at the team across town. For that, Guardiola's large backroom team deserve credit. Mikel Arteta is well-liked by the players as well as Brian Kidd, whose arm around the shoulder brings comfort at opportune moments.
Vincent Kompany spent an hour consoling tearful Sergio Aguero after Champions League exit
This has been a season full of tribulations, not least that chastening night at St James' Park in late January. Beaten 2-1 by Newcastle, squandering an early lead and, according to the coaching staff at the time, squandering the title.
"It's over," one said solemnly that night after a defeat that gifted Liverpool the chance to go seven points clear. Guardiola was so angry at his side's passive performance that he just told some coaches not to bother entering the dressing room for what proved a 30-minute dressing down. He would deal with the players themselves.
Guardiola questioned his players' desire. Their emphatic answer was 14 straight wins, four short of the record they set in the previous season.
There are other difficulties to overcome along the way, particularly City's injury list. Kevin De Bruyne has played barely and Fernandinho has missed key games. Mendy's fitness problems persist and he is also attempting to clean up his act off the pitch.
Guardiola questioned his players' desire after losing to Newcastle – they won 14 straight after
A few players have moved homes. Mendy is out in Cheshire in an attempt to avoid city center distractions. So too Gabriel Jesus. John Stones, who has started two of the last 13 games, is now living in Guardiola's lavish apartment block after a very public breakdown or a relationship with his long-term girlfriend. Some switches have come on the advice of staff and manager.
Crucially, there is reverence for their boss. "You can feel Pep in the room," another source said. "He has an aura about him." Players are unsure or his methods are instinctive or planned, but they work. He is not mates with any of the squad and refuses to have favorites. One player has said that treating them all 'more or less the same' garner respect.
"We don't love each other too much, the players and the staff," Guardiola said. "We don't let them be creative, but it's the only way."
A Monday might bring a hug and a kiss from Guardiola. But he might not say a word to you on Tuesday. Team selections are rarely explained. Always remaining on your toes, and the healthy competition for places, stimulates this talented squad. Kyle Walker occasionally opted against bringing luggage with him when City stay overnight on the training ground the day before a game. Squads are only announced after all players have arrived and Walker did not wish to tempt fate on his spot, despite being an obvious regular.
Kyle Walker has sometimes opted against bringing luggage with him for trips to not tempt fate
Guardiola has tried to make them think more. Jesus has hired a personal trainer for fitness and diet from Brazil. Danilo has spoken or becoming more analytical when watching matches on television.
Training drills are generally kept for 10 minutes, with Arteta keeping them fresh to avoid boredom. City players barely had a genuine day off from November through to April. Afternoons post-training or the nights spent with families before matches are, therefore, cherished.
The night after the Newcastle defeat, Guardiola attended the musical Jersey Boys with his family at Oxford Road's Palace Theater in Manchester rather than watch Liverpool's draw with Leicester. He was at the Royal Exchange Theater to see West Side Story earlier this month too.
Guardiola and Mikel Arteta (second left) ensure training drills are short to avoid boredom
A large number of players have tried to keep away from Liverpool's games in the run-in. Ilkay Gundogan had Fenerbahce's 1-1 draw with Galatasaray on the trip back from Crystal Palace last month while Liverpool beat Chelsea. Others chose to watch the Masters. Raheem Sterling has joked he ignored Liverpool's games until it looked like they might drop points, only for them to score when they turned the TV on.
The scene inside City's dressing room at Old Trafford on April 24 has been described by one source as the tensest atmosphere they had ever witnessed before a match. Players were seen as pacing, heads bowed and conversation was minimal. Many wore that look Guardiola had two months earlier at Wembley.
City beat Manchester United 2-0. Turns out it was not nerves, it was steely determination.
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flauntpage · 6 years ago
Text
The 9 Most Important Things From Tom Verducci’s Excellent Piece on The Harper Negotiation
Similar to how Jayson Stark penned the definitive account on the Cliff Lee signing in 2010, it would appear Tom Verducci has provided us the inside look at the Harper signing.
Here are the highlights.
Bryce Harper valued length above all else
According to Verducci, Harper gave Scott Boras one mandate: length of contract. He wanted to remain in one place for the rest of his career, and wasn’t interested in opt-outs, despite prior reports.
“It was not only important not to have an opt out, he refused to allow me to do it,” Boras said. “He said, ‘I want to be with one team.’ I tried to talk him out of it. He gave me my marching orders.”
John Middleton is a Philly F-ing GOAT
John Middleton has emerged a dick-swinging owner. With “stupid money” and “I want my fucking trophy back” quotes attributed to his name, Middleton is the kind of win-at-all-costs owner every sports fan wants. And better yet, he’s a genuine ambassador for Philly.
He and his wife, Leigh, met with Harper and his better half, Kayla, twice last week in Las Vegas during the famed trip -once for dinner on Friday, and again for lunch on Saturday. Much of the time was spent talking about the ancillary benefits to calling this town home:
Middleton spent most of the time giving his best Chamber of Commerce speech. He talked up the Philadelphia area’s schools, hospitals, restaurants and general quality of life. When the Phillies began their courtship of Harper back in December, they kicked it off with a slickly-produced video in which the club found as many prominent Philadelphians as possible—athletes, politicians, restaurateurs, coaches, business owners, etc.—and had them speak directly to Harper to join them in the city. The video also included marquees of local arenas with his name in lights.
Odds on appearances in that video:
Doug Pederson -120
Mayor Kenney even
Jay Wright +180
Chase Utley +190
Carson Wentz +200
Joel Embiid +220
Ed Rendell +300
Claude Giroux +420
Michael Rubin +500
Jeffrey Lurie +600
Cole Hamels +20000
I was right
This is what I tweeted earlier this week… and last week:
My not-so-hot-take theory on Harper-Phillies: Boras is trying to extract every last drop and Phils are actually doing a decent job of not blinking. With no other sizable offer, Boras pulling out all the stops and “reports” to see if Phils panic. Middleton not as stupid as thought
— Kyle Scott (@CrossingBroad) February 20, 2019
After reading this, I go back to my Tweet from last week that Phils were actually doing a decent job of holding firm since they appeared to be only real interested. Now Dodgers report and this firm figure. I bet they get it done for something less than expected. https://t.co/S1OwhJ3UNm
— Kyle Scott (@CrossingBroad) February 25, 2019
I was mostly right– the Phillies were holding strong with the best offer. But money wasn’t the hold-up– it was years.
So Boras called in the Dodgers and Giants:
On Sunday, with the exhaust from Middleton’s jet barely dissipated, a contingent from the Dodgers flew into McCarran Airport in Las Vegas to offer Harper a record amount of money per year, but only on a deal covering four or five years. (The top average annual value bid to Harper was $43 million; Boras would not confirm it was from the Dodgers.) On Tuesday, right behind their divisional rival, the Giants jetted in with a 12-year offer worth around $310 million. All the stagecraft had the desired effect.
That’s what pushed the deal, and the Phillies, over the finish line– with Middleton calling Boras yesterday and making The Godfather offer of $330 million, with a manageable $25 million AAV, which is actually quite reasonable for a player of Harper’s stature. Consider Ryan Howard was making this much eight years ago, and it’s what Harper will be making a full 20 years later. The Phillies held firm – rigid, even – and only blinked after Boras brought in the heavy artillery. Both sides compromised, with Harper getting the years he wanted, and the Phillies not being totally stupid with their money.
I DON’T KNOW WHY YOU’D READ ANY OTHER SITE!
One particular winner, so far yet so near
Big market team, yo:
“Bryce took less AAV. He took more years,” Boras said, comparing the deal to the Machado contract. “And we’re playing on a winning team. Bryce Harper wanted to play on a winning team now and one that has the revenues to sustain it. He got all those things. When Manny Machado is 35, let’s see if he gets those millions over the remaining three years. You’d better be a real good defensive player, too. I did it for [Adrian] Beltre.”
Anyone still think Bryce didn’t want to play here?
The Nationals were never really serious
Ted Lerner, who once overpaid Jayson Werth, got outbid by the Phillies on his own superstar:
Before the process even began he lost a huge bargaining chip when Harper’s incumbent team, the Washington Nationals, sent an offer on the last weekend of the regular season. It was reported to be $300 million over 10 years, but included so much deferred money over such a long period—Harper would be 60 years old when the last payments were made—that the net present value was $184 million. The Harper camp saw the offer as little more than a publicity gesture to appease fans.
A source close to the Nationals described how Boras responded: “crickets.”
Surely, he wasn’t serious. And we’ll call him Shirley.
Other teams quick to take shots at their new Eastern overlords
Gimme. Gimme:
Frankly, some teams, such as the Braves, just didn’t see Harper as worth a record contract. “Harper is great friends with Freddie Freeman and would have loved Atlanta,” said one club source, “but [we] just didn’t value him that high.”
“Corner outfield is the easiest place to find a bat,” said one club president. “He doesn’t stand out as much as Machado, a righthanded-hitting third baseman who hits righthanded pitching.”
Said another club executive, “At best, he’s an average defensive player. At best.”
Some worried about how his violent swing would hold up.
“He’s Tiger Woods with that swing,” said one GM. “I’d take him for a few years, but it’s hard to see how that body is going to hold up when you swing like that. You saw how Tiger’s body broke down.”
Yeah, Tiger Woods won 8 majors after he was the age Harper is now. If Bryce wants to go down in sex-fueled flames after that sort of run, I’m here for it.
He’s our superstar
I like greatness so much:
“The reality is the greatest and most successful aspect of Hollywood are the stars,” Boras said. “George Clooney, Jennifer Lawrence, Bradley Cooper … whatever movie they are in is about them. People identify with the greatest of great people. In sports you think about Michael Jordan and Tom Brady. When you think about the people who are the billboards of teams it creates what we expect in sports. People want to watch greatness and they want to watch the greatness of individuals.
“What is best for baseball is what the fans tell us: when you have the greatest, most iconic players, the fans will come.”
Consider me coming.
Harper takes care of himself
Machine:
Boras’s next job was to convince the Phillies that Harper would hold up over more than 10 years. Harper, he told them, was a Mormon who didn’t drink or smoke, and who was both a baseball rat and a gym rat.
What it all came down to
This sounds familiar:
This is what Harper wanted: to chase records, chase titles, chase endorsements, and chase a legacy with one team rather than becoming a baseball nomad. And this, too: more money in one contract than has ever been handed over to a ballplayer. Ten years in the making, he got what he wanted.
Did someone say Chase?
Read the article here.
The post The 9 Most Important Things From Tom Verducci’s Excellent Piece on The Harper Negotiation appeared first on Crossing Broad.
The 9 Most Important Things From Tom Verducci’s Excellent Piece on The Harper Negotiation published first on https://footballhighlightseurope.tumblr.com/
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arisirie · 8 years ago
Text
*whispers* sorry to everyone who follows me; whenever i get a tad too antsy, i answer ask me memes by myself. the answers and questions are after the cut, so please don't feel obligated to read them
have a nice day! <3
source
65 Questions You Aren’t Used To
1. Do you ever doubt the existence of others than you?
nope. i'm more of a 'believe innocent until proven otherwise' person. or in this case, 'believe real'
2. On a scale of 1-5, how afraid of the dark are you?
when i'm with someone else: 2 on my own: 5
3. The person you would never want to meet?
oh? i don't know. i'm generally okay with everyone, even those that others consider 'bad'
4. What is your favorite word?
tintinnabulation: the sound of ringing bells. i love its definition and the way it rolls off my tongue
5. If you were a type of tree, what would you be?
some kind of conifer, i think. maybe pine or fir. i'm pretty sturdy and i love the cold weather
6. When you looked in the mirror this morning what was the first thing you thought?
'my bangs are assymetrical'
7. What shirt are you wearing?
right now, a dark blue shirt i've had since grade 5
8. What do you label yourself as?
let's see: girl, isfp, choice. that's as much as i'm willing to divulge at the moment
9. Bright room or dark room?
dark room, as long as the lights aren't completely off (i sleep with a nightlight)
10. What were you doing at midnight last night?
mm, i woke up a few minutes after twelve. after that, i spent a lot of time thinking
11. Favorite age you’ve been so far?
thirteen. grade 8 was my favourite grade
12. Who told you they loved you last?
my mother! <3
13. Your worst enemy?
i don't have one. but if we're not talking about people, i really hate spicy food
14. What is your current desktop picture?
a picture of megurine luka
15. Do you like someone?
at the moment, no! but i do like all my friends
16. The last song you listened to?
i'm currently listening to リサフランク420 / 現代のコンピュー by MACINTOSH PLUS (i'm a big fan of vaporwave) on repeat
17. You can press a button that will make any one person explode. Who would you blow up?
see #3 and #13
18. Who would you really like to just punch in the face?
see #3, #13, and #17
19. If anyone could be your slave for a day, who would it be and what would they have to do?
i'd get my brother as a helper, just so he can do a more equal share of his chores
20. What is your best physical attribute? (showing said attribute is optional)
i've been told it's my eyebrows
21. If you were the opposite sex for one day, what would you look like and what would you do?
i'd probably look like me, but with a very short haircut. i'd love to try talking to some guys though!
22. Do you have a secret talent? If yes, what is it?
well, i can type on an old school cellphone pretty quickly. though that comes with practice, since i've had one for about four years now
23. What is one unique thing you’re afraid of?
showing my feet in public. yikes
24. You can only have one kind of sandwich. Every sandwich ingredient known to humankind is at your disposal.
nutella + ice cream + sweet bread; i'm a sweet tooth
25. You just found $100! How are you going to spend it?
i had this exact same problem the other day (though the money was a gift, not a happenstance)! i spent about $40 on a few books i wanted, but i couldn't figure out what to spend the rest on
26. You just got a free plane ticket to anywhere in the world, but you have to leave immediately. Where are you going to go?
iceland, iceland, iceland. i've wanted to go there since i was a kid
27. An angel appears out of Heaven and offers you a lifetime supply of the alcoholic beverage of your choice. “Be brand-specific” it says. Man! What are you gonna say about that? Even if you don’t drink booze there’s something you can figure out... so what’s it gonna be?
i don't drink (i don't like how alcohol tastes), but i'd get an endless supply of red wine please. for brands, i searched them up and banrock station sounds good
28. You discover a beautiful island upon which you may build your own society. You make the rules. What is the first rule you put into place?
"no harming others"
29. What is your favorite expletive?
cheese on a breadstick
30. Your house is on fire, holy shit! You have just enough time to run in there and grab ONE inanimate object. Don’t worry, your loved ones and pets have already made it out safely. So what’s the one thing you’re going to save from that blazing inferno?
my bin of stuffed toys that i got from friends and family
31. You can erase any horrible experience from your past. What will it be?
my first panic attack, probably
32. You got kicked out of the country for being a time-traveling heathen who sleeps with celebrities and has super-powers. But check out this cool shit... you can move to anywhere else in the world!
probably england. it's close enough to iceland, and i'm not as good in any other language as i am in english
33. The Celestial Gates Of Beyond have opened, much to your surprise because you didn’t think such a thing existed. Death appears. As it turns out, Death is actually a pretty cool entity, and happens to be in a fantastic mood. Death offers to return the friend/family-member/person/etc. of your choice to the living world. Who will you bring back?
no one. don't mess with life and death
34. What was your last dream about?
ahhh, something about 'halftipedes.' sometimes i see this weird insect that looks like a mili/centipede in my house, and dream!brother told me that's what they're called
35. Are you a good...[insert anything you’d like here]?
...artist? i guess i'm okay. i'm not the worst, but i wouldn't get into art school
36. Have you ever been admitted to the hospital?
the most serious case was for stitches
37. Have you ever built a snowman?
yes! i live in a country that snows
38. What is the color of your socks?
grey. they're either grey or black, really
39. What type of music do you like?
i like all music! i'm a big fan of edm, but i also like bossanova, electro swing, baroque pop, rock, etc.
40. Do you prefer sunrises or sunsets?
sunsets. there's something calming about dark colours
41. What is your favorite milkshake flavor?
i'm generic: chocolate
42. What football team do you support? (I will answer in terms of American football as well as soccer)
i don't watch soccer often, but i have a soft spot for fc barcelona
43. Do you have any scars?
plenty. i fell a lot when i was younger
44. What do you want to be when you graduate?
clinical psychologist!
45. If you could change one thing about yourself, what would it be?
ermmm, probably my indecisiveness
46. Are you reliable?
i like to think i am, yes
47. If you could ask your future self one question, what would it be?
"are you happy?"
48. Do you hold grudges?
no, but i'm not someone who forgets
49. If you could breed two animals together to defy the laws of nature, what new animal would you create?
i'd breed a cat + dog. i'm curious what their kid would look like
50. What is the most unusual conversation you’ve ever had?
in recent memory, i had a conversation about how near the near future had to be for it to be considered the near future
51. Are you a good liar?
yep. pretty good. though i always feel guilty after a while
52. How long could you go without talking?
a long time, i think. not that i'd do it, but...
53. What has been you worst haircut/style?
when i cut my hair to shoulder length. that looked terrible
54. Have you ever baked your own cake?
not my own cake, but i'm baked cakes before
55. Can you do any accents other than your own?
the stereotypical asian accent, since i can speak tagalog
56. What do you like on your toast?
butter! i like it when it melts
57. What is the last thing you drew a picture of?
a tree on a field with a person underneath it
58. What would be your dream car?
a dark red bmw
59. Do you sing in the shower? Or do anything unusual in the shower? Explain.
no. the weirdest thing i do is think. a lot. i spend more than half of my time in the bathroom thinking instead of actually taking a shower
60. Do you believe in aliens?
yes. as well as ghosts and other supernatural/magical folk (because i really love mythology and folklore)
61. Do you often read your horoscope?
i read it whenever i get the newspaper, but i don't give it much weight. it's just for entertainment
62. What is your favorite letter of the alphabet?
'c' for cat. also because it’s the third letter of the alphabet (and my favourite number is 3)
63. Which is cooler: dinosaurs or dragons?
dinosaurs. i used to read about them all the time. my favourites are the stegosaurus and the plesiosaur
64. What do you think about babies?
they're cute! fussy, yeah, but i can live with that. i'm not thinking of having children though
65. Freebie! Ask anything interesting you can think of.
i'll share a fact about myself: i played the baritone horn in my school band. but if i could learn any instrument in the world, i'd like to learn the accordion
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gordonwilliamsweb · 5 years ago
Text
Women Shouldn’t Get A Bill For An IUD … But Sometimes They Do
After a few months on daily contraceptive pills, Erica M. wanted something more reliable. She wanted an intrauterine device, a form of long-acting reversible contraception that doctors call one of the most effective forms of birth control. (Erica’s last name has been withheld due to privacy concerns.)
It shouldn’t have been a problem. Erica, 23 at the time, had insurance through work. Under the Affordable Care Act, most health plans must cover all methods of birth control without any cost sharing. In fact, the birth control pills she was using were fully covered — she paid nothing out-of-pocket.
But a few weeks after her June 2018 appointment, she found herself on the receiving end of an IUD bill for about $1,900. On her $9-an-hour income, that expense simply wasn’t feasible.
“I never got any indication that it wouldn’t be covered,” she said. “I found out after the fact, obviously too late to do anything about it.”
Stories like hers are difficult to track. There is little research on how often women see surprise bills for IUDs, though an analysis of private insurance claims data suggests it’s not common. For those who are slapped with a fee, though, the prices are sky-high — and growing.
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Meanwhile, the Trump administration has issued rules to chip away at this contraceptive mandate, by expanding the cases in which employers can opt out of providing this coverage. Those efforts have been blocked by lower courts, and the Supreme Court has agreed to weigh in. If the administration succeeds, reproductive health experts say, that move will likely exacerbate the financial issues women like her face.
Theoretically, private health plans cover birth control with no out-of-pocket costs to patients. But there are exceptions, which are particularly relevant to the 60% of women who get insurance through an employer.
If your plan was “grandfathered” — meaning it was in place before the ACA took effect in 2010 and hasn’t changed since — it isn’t required to cover contraception. In 2019, about 13% of people getting insurance through work had a grandfathered plan.
Insurers aren’t required to cover every contraceptive product on the market. But they do have to account for one version of each birth control method, and cannot favor one method over others. (That means there has to be a hormonal IUD and a copper IUD available without cost sharing.)
If your employer is religious — such as a church — it is not required to provide contraceptive coverage.
If you work at a religiously affiliated institution, such as a university or hospital, your employer may not be required to buy contraceptive coverage, but the insurance company still has to pay for it. (This is the so-called religious accommodation.)
For almost everyone else who gets coverage through work or purchases an ACA-compliant plan, the policy should apply. However, there isn’t a clear or strong mechanism to make sure health plans that are required to cover birth control do so.
It is clear that, by and large, women now spend far less out-of-pocket on birth control than they did before the mandate. And the number of women opting for IUDs has gone up since the mandate took effect, though the number was already trending upward.
Still, the most recent research, conducted in 2014, found that insurance was inconsistent in guaranteeing full coverage of birth control options generally, and of IUDs specifically.
“This is an ongoing issue,” said Marian Jarlenski, an assistant professor of health policy at the University of Pittsburgh, who researches maternal and child health.
And the limited research means “no one knows how much of a problem this is,” said Dr. Nora Becker, a clinical fellow at Boston’s Brigham and Women’s Hospital, who has studied the contraceptive mandate’s impact.
In all likelihood, most women probably won’t get a bill for IUD insertion or a birth control prescription. Data compiled by the Health Care Cost Institute, an independent research group funded by insurers, suggested that in 2017 fewer than 5% of women had an out-of-pocket bill for the insertion.
Nevertheless, “there are definitely women out there who are still being billed inappropriately,” Becker said.
Erica worked at the time at a small religious college in Kentucky. So while the employer wasn’t required to cover birth control, her health plan still had to. She spent seven months going back and forth with her doctor, employer and insurance company before finally getting her plan to pay.
“It felt like a full-time job,” she recalled.
Patients often don’t have the time or resources to take on that kind of task.
“You may be hit by a surprise bill; you may just decide to pay out-of-pocket, not knowing there might be an appeals process; or you could go to a different clinic,” Jarlenski said.
And in those cases, the price is getting steeper.
The HCCI data didn’t indicate what patients with out-of-pocket costs ultimately paid. But it did showcase a sharp increase in what private insurance plans negotiated and then paid for IUDs over the past decade. Like much else in health care, there was wide variation in what different plans ended up paying.
From 2008 to 2017, the average payout for a Paragard copper IUD jumped from $420 to $818. In 2017, the top 90th percentile of private plans paid about $980 for the copper IUD; the bottom 10th paid $710.
“That’s a substantial difference,” said John Hargraves, a senior researcher at HCCI.
The impact may not be widely felt now, but reproductive health experts suggested it’s an issue that could grow more prevalent as the Trump administration pursues a federal rule change that would give more employers the ability to opt out of guaranteeing contraceptive coverage. Under the Trump proposal, religiously affiliated employers like Erica’s could drop coverage altogether, and the health plan she had wouldn’t still have to pay for contraception.
The change hasn’t taken effect — a federal appeals court issued a nationwide injunction last year, blocking the rule. This month, the Supreme Court agreed to hear the case. This decision marks the third time the high court has agreed to examine the contraceptive mandate, but the first case in which the deciding body will include the members nominated by President Donald Trump, Justices Neil Gorsuch and Brett Kavanaugh.
Women Shouldn’t Get A Bill For An IUD … But Sometimes They Do published first on https://nootropicspowdersupplier.tumblr.com/
0 notes
dinafbrownil · 5 years ago
Text
Women Shouldn’t Get A Bill For An IUD … But Sometimes They Do
After a few months on daily contraceptive pills, Erica M. wanted something more reliable. She wanted an intrauterine device, a form of long-acting reversible contraception that doctors call one of the most effective forms of birth control. (Erica’s last name has been withheld due to privacy concerns.)
It shouldn’t have been a problem. Erica, 23 at the time, had insurance through work. Under the Affordable Care Act, most health plans must cover all methods of birth control without any cost sharing. In fact, the birth control pills she was using were fully covered — she paid nothing out-of-pocket.
But a few weeks after her June 2018 appointment, she found herself on the receiving end of an IUD bill for about $1,900. On her $9-an-hour income, that expense simply wasn’t feasible.
“I never got any indication that it wouldn’t be covered,” she said. “I found out after the fact, obviously too late to do anything about it.”
Stories like hers are difficult to track. There is little research on how often women see surprise bills for IUDs, though an analysis of private insurance claims data suggests it’s not common. For those who are slapped with a fee, though, the prices are sky-high — and growing.
Email Sign-Up
Subscribe to KHN’s free Morning Briefing.
Sign Up
Please confirm your email address below:
Sign Up
Meanwhile, the Trump administration has issued rules to chip away at this contraceptive mandate, by expanding the cases in which employers can opt out of providing this coverage. Those efforts have been blocked by lower courts, and the Supreme Court has agreed to weigh in. If the administration succeeds, reproductive health experts say, that move will likely exacerbate the financial issues women like her face.
Theoretically, private health plans cover birth control with no out-of-pocket costs to patients. But there are exceptions, which are particularly relevant to the 60% of women who get insurance through an employer.
If your plan was “grandfathered” — meaning it was in place before the ACA took effect in 2010 and hasn’t changed since — it isn’t required to cover contraception. In 2019, about 13% of people getting insurance through work had a grandfathered plan.
Insurers aren’t required to cover every contraceptive product on the market. But they do have to account for one version of each birth control method, and cannot favor one method over others. (That means there has to be a hormonal IUD and a copper IUD available without cost sharing.)
If your employer is religious — such as a church — it is not required to provide contraceptive coverage.
If you work at a religiously affiliated institution, such as a university or hospital, your employer may not be required to buy contraceptive coverage, but the insurance company still has to pay for it. (This is the so-called religious accommodation.)
For almost everyone else who gets coverage through work or purchases an ACA-compliant plan, the policy should apply. However, there isn’t a clear or strong mechanism to make sure health plans that are required to cover birth control do so.
It is clear that, by and large, women now spend far less out-of-pocket on birth control than they did before the mandate. And the number of women opting for IUDs has gone up since the mandate took effect, though the number was already trending upward.
Still, the most recent research, conducted in 2014, found that insurance was inconsistent in guaranteeing full coverage of birth control options generally, and of IUDs specifically.
“This is an ongoing issue,” said Marian Jarlenski, an assistant professor of health policy at the University of Pittsburgh, who researches maternal and child health.
And the limited research means “no one knows how much of a problem this is,” said Dr. Nora Becker, a clinical fellow at Boston’s Brigham and Women’s Hospital, who has studied the contraceptive mandate’s impact.
In all likelihood, most women probably won’t get a bill for IUD insertion or a birth control prescription. Data compiled by the Health Care Cost Institute, an independent research group funded by insurers, suggested that in 2017 fewer than 5% of women had an out-of-pocket bill for the insertion.
Nevertheless, “there are definitely women out there who are still being billed inappropriately,” Becker said.
Erica worked at the time at a small religious college in Kentucky. So while the employer wasn’t required to cover birth control, her health plan still had to. She spent seven months going back and forth with her doctor, employer and insurance company before finally getting her plan to pay.
“It felt like a full-time job,” she recalled.
Patients often don’t have the time or resources to take on that kind of task.
“You may be hit by a surprise bill; you may just decide to pay out-of-pocket, not knowing there might be an appeals process; or you could go to a different clinic,” Jarlenski said.
And in those cases, the price is getting steeper.
The HCCI data didn’t indicate what patients with out-of-pocket costs ultimately paid. But it did showcase a sharp increase in what private insurance plans negotiated and then paid for IUDs over the past decade. Like much else in health care, there was wide variation in what different plans ended up paying.
From 2008 to 2017, the average payout for a Paragard copper IUD jumped from $420 to $818. In 2017, the top 90th percentile of private plans paid about $980 for the copper IUD; the bottom 10th paid $710.
“That’s a substantial difference,” said John Hargraves, a senior researcher at HCCI.
The impact may not be widely felt now, but reproductive health experts suggested it’s an issue that could grow more prevalent as the Trump administration pursues a federal rule change that would give more employers the ability to opt out of guaranteeing contraceptive coverage. Under the Trump proposal, religiously affiliated employers like Erica’s could drop coverage altogether, and the health plan she had wouldn’t still have to pay for contraception.
The change hasn’t taken effect — a federal appeals court issued a nationwide injunction last year, blocking the rule. This month, the Supreme Court agreed to hear the case. This decision marks the third time the high court has agreed to examine the contraceptive mandate, but the first case in which the deciding body will include the members nominated by President Donald Trump, Justices Neil Gorsuch and Brett Kavanaugh.
from Updates By Dina https://khn.org/news/contraceptives-birth-control-surprise-bills-women-shouldnt-get-a-bill-for-an-iud-but-sometimes-they-do/
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stephenmccull · 5 years ago
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Women Shouldn’t Get A Bill For An IUD … But Sometimes They Do
After a few months on daily contraceptive pills, Erica M. wanted something more reliable. She wanted an intrauterine device, a form of long-acting reversible contraception that doctors call one of the most effective forms of birth control. (Erica’s last name has been withheld due to privacy concerns.)
It shouldn’t have been a problem. Erica, 23 at the time, had insurance through work. Under the Affordable Care Act, most health plans must cover all methods of birth control without any cost sharing. In fact, the birth control pills she was using were fully covered — she paid nothing out-of-pocket.
But a few weeks after her June 2018 appointment, she found herself on the receiving end of an IUD bill for about $1,900. On her $9-an-hour income, that expense simply wasn’t feasible.
“I never got any indication that it wouldn’t be covered,” she said. “I found out after the fact, obviously too late to do anything about it.”
Stories like hers are difficult to track. There is little research on how often women see surprise bills for IUDs, though an analysis of private insurance claims data suggests it’s not common. For those who are slapped with a fee, though, the prices are sky-high — and growing.
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Meanwhile, the Trump administration has issued rules to chip away at this contraceptive mandate, by expanding the cases in which employers can opt out of providing this coverage. Those efforts have been blocked by lower courts, and the Supreme Court has agreed to weigh in. If the administration succeeds, reproductive health experts say, that move will likely exacerbate the financial issues women like her face.
Theoretically, private health plans cover birth control with no out-of-pocket costs to patients. But there are exceptions, which are particularly relevant to the 60% of women who get insurance through an employer.
If your plan was “grandfathered” — meaning it was in place before the ACA took effect in 2010 and hasn’t changed since — it isn’t required to cover contraception. In 2019, about 13% of people getting insurance through work had a grandfathered plan.
Insurers aren’t required to cover every contraceptive product on the market. But they do have to account for one version of each birth control method, and cannot favor one method over others. (That means there has to be a hormonal IUD and a copper IUD available without cost sharing.)
If your employer is religious — such as a church — it is not required to provide contraceptive coverage.
If you work at a religiously affiliated institution, such as a university or hospital, your employer may not be required to buy contraceptive coverage, but the insurance company still has to pay for it. (This is the so-called religious accommodation.)
For almost everyone else who gets coverage through work or purchases an ACA-compliant plan, the policy should apply. However, there isn’t a clear or strong mechanism to make sure health plans that are required to cover birth control do so.
It is clear that, by and large, women now spend far less out-of-pocket on birth control than they did before the mandate. And the number of women opting for IUDs has gone up since the mandate took effect, though the number was already trending upward.
Still, the most recent research, conducted in 2014, found that insurance was inconsistent in guaranteeing full coverage of birth control options generally, and of IUDs specifically.
“This is an ongoing issue,” said Marian Jarlenski, an assistant professor of health policy at the University of Pittsburgh, who researches maternal and child health.
And the limited research means “no one knows how much of a problem this is,” said Dr. Nora Becker, a clinical fellow at Boston’s Brigham and Women’s Hospital, who has studied the contraceptive mandate’s impact.
In all likelihood, most women probably won’t get a bill for IUD insertion or a birth control prescription. Data compiled by the Health Care Cost Institute, an independent research group funded by insurers, suggested that in 2017 fewer than 5% of women had an out-of-pocket bill for the insertion.
Nevertheless, “there are definitely women out there who are still being billed inappropriately,” Becker said.
Erica worked at the time at a small religious college in Kentucky. So while the employer wasn’t required to cover birth control, her health plan still had to. She spent seven months going back and forth with her doctor, employer and insurance company before finally getting her plan to pay.
“It felt like a full-time job,” she recalled.
Patients often don’t have the time or resources to take on that kind of task.
“You may be hit by a surprise bill; you may just decide to pay out-of-pocket, not knowing there might be an appeals process; or you could go to a different clinic,” Jarlenski said.
And in those cases, the price is getting steeper.
The HCCI data didn’t indicate what patients with out-of-pocket costs ultimately paid. But it did showcase a sharp increase in what private insurance plans negotiated and then paid for IUDs over the past decade. Like much else in health care, there was wide variation in what different plans ended up paying.
From 2008 to 2017, the average payout for a Paragard copper IUD jumped from $420 to $818. In 2017, the top 90th percentile of private plans paid about $980 for the copper IUD; the bottom 10th paid $710.
“That’s a substantial difference,” said John Hargraves, a senior researcher at HCCI.
The impact may not be widely felt now, but reproductive health experts suggested it’s an issue that could grow more prevalent as the Trump administration pursues a federal rule change that would give more employers the ability to opt out of guaranteeing contraceptive coverage. Under the Trump proposal, religiously affiliated employers like Erica’s could drop coverage altogether, and the health plan she had wouldn’t still have to pay for contraception.
The change hasn’t taken effect — a federal appeals court issued a nationwide injunction last year, blocking the rule. This month, the Supreme Court agreed to hear the case. This decision marks the third time the high court has agreed to examine the contraceptive mandate, but the first case in which the deciding body will include the members nominated by President Donald Trump, Justices Neil Gorsuch and Brett Kavanaugh.
Women Shouldn’t Get A Bill For An IUD … But Sometimes They Do published first on https://smartdrinkingweb.weebly.com/
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torentialtribute · 6 years ago
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Adriane Galisteu: I didn’t cheat on Ayrton Senna�� the day he died my world stopped 
It's 25 years since Ayrton Senna died after the San Marino Grand Prix crash on Imola.
On the occasion of the 20th anniversary of the 2014 tragedy, Sportsmail interviewed Jonathan McEvoy Senna & # 39; s girlfriend at the time, the model Adriane Galisteu.
We completely re-publish that interview here.
A blonde model with blue eyes will say a prayer for Ayrton Senna on Thursday. It is the same ritual that Adriane Galisteu has practiced on each of the 19 previous anniversaries of the driver's death.
A believer like Senna – & I believe in the Lord & # 39; – she spoke to Sportsmail that weekend 20 years ago, when the boyfriend in Tambola hit a concrete wall, he killed him.
She remembers the last hours spent at the Senna villa in the Algarve counting down to the San Marino Grand Prix
Formula 1 driver Ayrton Senna pictured with his girlfriend, the model Adriane Galisteu
<img id = "i-e7707672aa0c9258" src = "https://dailym.ai/2GOLLcL Formula_One_driver_Ayrton_Senna_pictured_with_his_girlfriend_the-a-18_1556700152019.jpg "height =" 472 "width =" 306 "alt =" <img id = "i-e7707672aa0c9258" src = "https://dailym.ai/2J2OwKp /01/09/12945746-6979943-Formula_One_driver_Ayrton_Senna_pictured_with_his_girlfriend_the-a-18_1556700152019.jpg "height =" 472 "width =" 306 "alt =" <img id = "i-e7707672aa0c9258" srci.dllmail: srci.dll. co.uk/1s/2019/05/01/09/12945746-6979943-Formula_One_driver_Ayrton_Senna_pictured_with_his_girlfriend_the-a-18_1556700152019.jpg "height =" 472 "width =" 306 "alt =" Formula 1 driver Ayrton Senna pictured with his girlfriend, the model Adriane Galisteu "
<img id =" i-3d4f759b11cba966 "src =" https://dailym.ai/2V7BOBe /12945744-6979943-Galisteu_cries_at_Senna_s_funeral_following_his_fatal_crash_in_t-a-19_1556700158216.jpg "height =" 472 "width =" 306 "alt =" Galisteu cries over Senna & # 39; s funeral 1994 after his deadly Marinoxxxxx2009 ]
<img id = "i-3d4f759b11cba966" src = "https://dailym.ai/2GKyZvU" height = "472" width = "306" alt = "Galisteu cries at Senna & burial after his fatal crash in 1994 San Marino Grand Prix at Imola" class = "blkBorder img-share Ayrton Senna with his girlfriend Adriane Galisteu ( left), which is depicted at his funeral (right)
<img id = "i-acd60e8b" src = "https://dailym.ai/2uS4u1n / i / pix / 2014/04/29 / article- 2616230-1D6FA69A00000578-772_634x384.jpg "height =" 384 "width =" 634 "alt =" Senna & # 39; s death in the seventh round of the San Marino Grand Prix, 25 years ago, the world rocked "
<img id = "i-acd60e8b" src = "https://dailym.ai/2V5qBRO .jpg "height =" 384 "width =" 634 "alt =" Senna & # 39; s death in the seventh round of the San Marino Grand Prix, 25 years ago, shook the world "of the San Marino Grand Prix , 25 years ago, shook the world
& He called me & she said. & # 39; He was not healthy. His head was wrong. & # 39; Rubens Barrichello, his good friend, was in the hospital (after an accident in Friday practice). He was very upset by the death of Roland Ratzenberger, a fellow driver who died on Saturday (during qualifying). He told me: & # 39; I am very sad & # 39 ;.
& # 39; I had cherished him before but never heard his voice like that day. I remember telling him: & # 39; Ayrton, don't enter that breed. & # 39;
The advice Galisteu gave to Senna, the triple world champion and perhaps the greatest driver of all time, echoed the words of Professor Sid Watkins, the Brazilian friend and medical representative of Formula One, as well as one of & # 39; the world's leading brain surgeons.
Although Senna was undoubtedly emotional when he visited the site of the Ratzenberger crash, there is a suggestion that his relationship with Galisteu was acesing him.
In Ayrton, the Revealed Hero (Ernesto Rodrigues), Ernesto Rodrigues claims that Galisteu had contacted his former lover and that Senna & brother, Leonardo, had ties with these secret conversations with him. had played. ]
<img id = "i-9d950675f514bcea" src = "https://dailym.ai/2GLwf1o a-21_1556700257736.jpg "height =" 420 "width =" 634 "alt =" <img id = "i-9d950675f514bcea" src = "https://dailym.ai/2Y2S2sx /09/12945742-6979943-image-a-21_1556700257736.jpg "height =" 420 "width =" 634 "alt =" Senna, seen here celebrating his famous victory in Monaco in 1992, won three world titles
Senna, seen here celebrating his famous victory in Monaco in 1992, won three world titles.
The author, former head of the London agency of the Globo TV channel in Brazil, visited seven countries and spoke to 213 people during two years of research on the book.
& # 39; My goal is not to talk about a book I didn't read & # 39 ;, Viviane once said, got upset when she pressed the allegations about Galisteu's behavior. I made the accusation myself to Galisteu.
& # 39; It never happened, no. I was 100 percent honest with Ayrton. I remember his skin and his scent. I only told him truths. I was a young girl and shortly after I first knew him I took him home to get to know my mother and my brother, the place where I lived and how I lived. & # 39;
She says she fell in love with him when they met during the Brazilian Grand Prix of 1993, where she was an umbrella girl. She had long admired him from afar, but never thought they would become lovers.
<img id = "i-ac440e7f" src = "https://dailym.ai/2V6Yy4t 1D6DFA7200000578-542_634x407.jpg "height =" 407 "width =" 634 "alt =" Senna, pictured the day before he died, was said it & # 39; was wrong & # 39; prior to the race "
<img id = "i-ac440e7f" src = "https://dailym.ai/2GOcC8Z" height = " 407 "width =" 634 "alt =" Senna, pictured the day before he died, was said to have been & # 39; not good & # 39; prior to the race "
Senna, pictured the day before he died
& # 39; When I tried to tell him not to race against Imola, I told him that I loved his job and he just couldn't get out of the race ", she remembers. & # 39; It's my life & # 39;
His strong tendency to race is confirmed by Senna & # 39; s manager, J ulian Jakobi, one of the most respected figures in the paddock.
He told me that although Senna was upset like everyone else at the weekend, he talked to Frank Williams, the team boss, and decided to compete. & # 39; Stories that say he did not want to race are simply not true & # 39 ;, said Jakobi.
Back in Portugal, Galisteu watched the race on TV. & # 39; I saw the accident and thought nothing of it, & # 39; she said. & # 39; In fact, I thought: & # 39; Well, he will be early, thank goodness & # 39 ;.
& # 39; But then I saw that it was more serious than I imagined. I stood in front of the TV and saw the repetition time and again. I could see that the car was damaged, but I never thought I was dead.
Nicola Larini, Michael Schumacher and Flavio Briatore respond to the news of the death of Senna "
[194590] <img id =" i-9cd140c315112f7c "src =" https: //i.dailymail. co.uk/1s/2019/05/01/09/12945740-6979943-image-a-23_1556700345176.jpg "height =" 373 "width =" 634 "alt =" Nicola Larini, Michael Schumacher and Flavio Briatore respond to it news of the death of Senna Flavio Briatore responds to the news of the death of Senna "
Nicola Larini, Michael Schumacher and Flavio Briatore respond to the news of the death of Senna
& # 39 I picked up the phone and it was his best friend's wife who told me to go to Imola. We left Lisbon on a private plane. I boarded the plane and thought he was alive;
Back at Imola, Senna was taken out of the car and flown to the hospital, and after a delay of 37 minutes the race restarted, winning Michael Schumacher, who was driving in Benetton, because Senna had violated the new rules of the season that prevented traction control. The champagne was sprayed on stage.
& # 39; When the plane was about to take off, the pilot said there was a phone call from the tower. I imagined Ayrton saying: & # 39; You don't have to come, everything is fine & # 39 ;.
& # 39; It was a friend: & # 39; Adriane, you don't have to come & # 39 ;. & # 39; Wow, that's good & # 39 ;, I said, thinking he should improve. & # 39; No, he is dead. & # 39; My world stopped at that moment.
& # 39; In my mind it was impossible: he could only die of old age. It was incredible that he died while doing what he knew best in life.
& # 39; It was very difficult for Brazil, for the whole world, but even more for me. It took me many years to get my life back, especially lovingly. "1945-9000
Galisteu, shown here in 2009, claimed that Senna wanted to end his career with the famous Italian Ferrari
Galisteu, who has just turned 41, married Alexandre Iodice in June 2010 n has a three year old son, Vitt
& # 39; My time with Ayrton was a great love story. He was more loved all over the world than he had ever known. His memory will never be erased. For me it was special, but now I am married and have a child. It means I can't say I was the love of my life. "
She remembers the remarkable funeral in Sao Paulo, when the entire vast city stopped to mourn over his icon: the sultry, brilliant, ruthless, smart, mystical, megalomaniac Senna.
& # 39; I spent as long as I could with his body. I didn't go home. I didn't wash. I stayed with him.
& # 39; Ayrton had three dreams & # 39; , she says lovingly. & # 39; The first was to end his career with Ferrari, the second was to get to know Disneyworld, the third was to become a father.
& # 39; more than a champion. He had a huge heart, a simple way of life and had simple dreams. He was entertaining. At home I was like a child. He was full of happiness. "
<img id = "i-1a72a426e7f7b548" src = "https://dailym.ai/2GNsnge" height = "459 "width =" 634 " alt = "Senna won 41 races and secured 65 poles during a career that promised so much more" class = "blkBorder img-
Senna won 41 races and secured 65 poles during a career that much more promised "class =" blkBorder img-share "
[19459] WORLD CHAMPION: 1988, 1990, 1991
RACES ENTERED [wijzigen] See also [bewerken] See also [bewerken] (19459005)
STAGE READINGS: 80
FIRST F1 RACE: Brazilian Grand Prix, 1984
Senna & # 39; s death shook Formula 1 deeper than anyone else's. For the Austrian rookie Ratzenberger, the driver had died for twelve years.
Niki Lauda, ​​the triple world champion, said: & God kept his hand on the formula for a long time.
Secondly, the entire dramatic scene was broadcast on TV all over the world, giving it a worldwide impact that had never been discovered before.
Murray Walker later described it as the most difficult commentary of his life, entering the fine line between empty optimism and morbid fatalism as he watched, unable to know exactly how Senna & # 39; s precarious.
In Imola, today and the next four days, there will be races in honor of the man who won 41 races and 65 poles.
Less favorable, his ruthlessness on the right track – especially when driving with Alain Prost finished in 1990 – has time for some of the less chivalrous driving that followed. (In all honesty, McLaren boss Ron Dennis commented, Senna & # 39; s superlative talent and mercy was matched by Prost in their glorious rivalry.)
<img id = "i-4a97685b497ed128" src = "https://dailym.ai/2V4hvER" height " "633" alt = "Senna led the San Marino 1994 Grand Prix at Imola for the sixth lap crash"
<img id = "i-4a97685b497ed128" src = "https: //i.dailymail. co.uk/1s/2019/05/01/09/12914874-6979943-Senna_had_led_the_1994_San_Marino_Grand_Prix_at_Imola_before_cra-a-36_1556700717134.jpg "height =" 395 "width =" 633 "alt =" Senna had the 1994 San Marino Grand Prix before he crashed in the sixth round "Senna led the 1994 San Marino Grand Prix in Imola before he crashed in the sixth round
Senna & wreck Wi
The most intriguing question is raised by Bernie Ecclestone's trial in Germany and the doubts it raises about the future of the 83-year-old at the head of the formula One: could Senna have taken over from Bernie? Senna was smart, calculating, sharp, suppressed by nobody and saw commercial opportunities for his time.
Just before he died, I made a deal with Audi to import their road cars.
He even ensured that Ecclestone changed the terms of the super license by concluding a deal with Sega before a pan-F1 contract with Nintendo was signed.
We had the loss of a driver of sublime brilliance. Maybe we will join Adriane by praying for him.
But we also have to think about the role he could play now in Formula 1, but that afternoon in Imola.
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